A State of Isolation: Access to Abortion for Women in Ireland

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The main reason for this is not that women have fewer abortions or that the Irish government provides adequate care, but rather the proximity of Ireland to the United Kingdom UK and continental Europe, where abortion is legal and available though expensive for women from Ireland—a situation that has allowed the Irish government to abdicate its responsibility to protect the human rights of women who require access to abortion by exporting the problem abroad.

Since , hundreds of thousands of women have traveled to the UK from Ireland to terminate their pregnancies. Many women have traveled to other European countries for the same reason. The potential imposition of life-time prison sentences for procuring an abortion in Ireland in and of itself threatens the right to liberty and security as women may risk prison for seeking to exercise their right to health.

Further, the Irish government limits access to information about safe and legal abortion services through restrictive legislation. It has sought to prevent individual women from traveling abroad for abortion through injunctions and it refuses to regulate access to legal abortion within Ireland. The Irish government declined to be interviewed for this report and indicated that it had no plans to review the current situation.

The women interviewed by Human Rights Watch described a climate of fear and shame, at least in part attributable to the criminalization of abortion. They explained their concerns about disclosing that they had had an abortion and the burden of secrecy that they are forced to carry. They also described their confusion about whether they could legally leave Ireland to access an abortion in the UK or other parts of Europe, and their concerns about whether to access post-abortion care, legally available in Ireland.

They also described financial constraints. Every woman interviewed for this report told Human Rights Watch how difficult it was to raise the money needed to pay for travel and the costs of the abortion. Even those who were employed indicated that the costs related to traveling created a significant barrier and delayed their access.

The current economic climate will inevitably create new financial barriers that will further limit access, especially for women who are poor or unemployed.

Access to Abortion for Women in Ireland | HRW

These circumstances will conspire to reduce the numbers of women who can afford to travel to access safe and legal abortions and may force them to resort to less safe options or continue with unwanted pregnancies. There are no reliable statistics about the numbers of women who continue with a crisis pregnancy or who have illegal abortions because they cannot travel to the UK or Europe. Service providers interviewed by Human Rights Watch suggest that significant numbers of women are not able to travel, and therefore are forced to carry on their pregnancies.

It is the hope of Human Rights Watch that this report will give a voice to some of these women. Ireland is a party to several international human rights treaties, and has been repeatedly criticized by international treaty bodies for implementing abortion restrictions that are in violation of the human rights obligations the government has voluntarily undertaken. In , the United Nations Human Rights Committee called on the Irish government to ensure that women were not forced to continue with unwanted pregnancies and expressed concern about the limited circumstances in which legal abortions were permissible in Ireland.

In the interim, the government should immediately ensure that those abortion services that are currently legal under Irish law be provided to all who need them without discrimination, and that full and accurate information on how to obtain safe abortions both within Ireland and outside its borders be available to all women, without discrimination. One interview was conducted in Washington D. In total, Human Rights Watch conducted 46 interviews with 55 people for this report. All interviews were conducted in English, and no incentives or compensation were offered or provided to persons interviewed.

Human Rights Watch conducted individual interviews with 13 women about their experiences accessing abortions outside of Ireland. The names of all the women have been disguised to protect their privacy. Human Rights Watch also conducted interviews, individually or in small groups, with 38 key individuals about reproductive health services available to women in Ireland and barriers to accessing abortion services available in the UK and continental Europe. The interviews were conducted at the offices of a reproductive health service provider in Dublin or at places convenient to the interviewees.

A small number of these interviews were conducted telephonically. Human Rights Watch also directed several requests for interviews to senior civil servants from these departments, but was unable to secure interviews with them. These are both statutory advisory bodies that assist the Department of Health and Children to respond to the health needs of women. Although they have policy mandates, they have no specific legislative mandate and the Minister of Health and Children is under no legal obligation to follow their advice. Abortion is criminalized in Ireland in almost all circumstances.

Access is only permitted where it is necessary to save the life of the pregnant woman, including as a result of a risk of suicide. Ireland is one of only three countries in the European Union EU that places such severe restrictions on access to abortion. The ban on abortion has not stopped women from having abortions. It has, however, turned what should be a profoundly personal decision into a situation where women routinely experience unnecessary risk, stigma, shame and anguish.

As a result of the severe legal restrictions, every year thousands of women are forced travel to the UK [3] , and more recently to the Netherlands [4] and other EU countries, [5] to obtain safe and legal abortions. The need to travel to have a medical procedure raises many concerns for women: Women fear judgmental and negative attitudes from healthcare workers when they return to Ireland and may be reluctant to seek post-abortion medical care or counseling.

The Irish ban on abortion unequivocally denies women protection for this range of their human rights. At the most fundamental level, women are prevented from fully enjoying their right to health by being denied access to information about a medical procedure and being forced to travel to obtain a medical procedure they clearly need. At its most extreme, this denial of basic rights may lead to death and serious injury. The mental anguish and distress caused by substantial and burdensome barriers to care may, in some circumstances, amount to cruel, inhuman, and degrading treatment.

Abortion has been illegal in Ireland since at least Irish law penalizes women who have or attempt to have abortions, [8] and anyone who assists them [9] and imposes strict constraints on the provision of abortion-related information. The Irish Constitution has been amended twice on issues related to abortion during the past two decades.

In , an amendment to guarantee freedom to travel for abortion services and the right to information about such services lawfully available in another state was passed. The Regulation of Information Services Outside the State for the Termination of Pregnancies Act was passed in , ostensibly to give effect to the constitutional amendment that gave women a legally protected right to seek, receive and impart abortion-related information, and to bring Irish law into line with the Open Door v. Ireland ruling of the European Court on Human Rights, [15] but in effect it placed very strict conditions on the manner in which such information may be provided and the type of information that can be made available.

Despite the amendment which also guaranteed the right to travel, the Irish government has continued to try to prevent women from leaving the country. As recently as , for example, a year-old minor in the custody of the Health Services Executive [18] had to go to court to get permission to travel to the UK for an abortion.

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Ireland is a party to a number of human rights treaties guaranteeing rights to women which are undermined or violated by the current law and practice in Ireland. She argued that the lack of clear guidelines about when abortion may be legally performed, and the lack of availability of lifesaving health services such as therapeutic abortion services, violated her right to physical integrity under the ECHR.

The Court also heard arguments on discrimination on the grounds of sex and poverty, as this relates to access to abortion services for women in Ireland. The Irish government has repeatedly made it clear that it does not plan to amend the laws on abortion in Ireland at this time. As in most countries where abortion is illegal or severely restricted, accurate information about the prevalence of and need for abortion among women in Ireland is hard to obtain, and statistics and estimates vary widely.

The Irish government does not appear to systematically collect data on either the number of legal and illegal abortions carried out within Ireland, or the number of women who access medical attention abroad, thereby failing the most basic due diligence standards with regard to monitoring the consequences of its restrictive policies. The Crisis Pregnancy Agency CPA has conducted a cross-section national survey to establish current attitudes, knowledge and experience of contraception, crisis pregnancy and related services in Ireland.

The most accurate current estimates on the need for abortions in Ireland are based on information provided by the UK Department of Health, and apply to abortions provided in England, Wales, and Scotland. British clinics collect information regarding the number of women accessing abortion who give a non-UK address as their home contact information and then publish this information annually. These numbers are however likely to be an under-estimate of the need for abortion, as some women may give false addresses and many others now travel to countries other than the UK for care.

There are no statistics available about the numbers of women who cannot travel because they cannot afford to, do not have the necessary travel permissions, or who lack information about services available outside Ireland.

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These women are mostly invisible, ignored by their government and failed by a health system that does not respond to their health needs. The unwillingness of the government to monitor and evaluate the prevalence of abortion, inside and out of Ireland, is yet another expression of the extent to which it continues to ignore the issue, at the expense of the human rights of women. The lack of reliable statistics severely hampers the ability of the Irish government to provide women in Ireland with the medical services to which they are entitled, including necessary post-abortion care.

Moreover, it perpetuates the prevailing inaccurate and destructive myth that women in Ireland do not want or need abortions. Women living in Ireland face substantive obstacles to accessing safe abortion services. The vast majority must by law travel from their homes to a foreign country to access these services.

Even the women who, by law, are entitled to have an abortion in Ireland because their pregnancy threatens their life often cannot get one due to lack of information and willing providers, and a general climate of fear and uncertainty. These general obstacles to access are further compounded for women who do not live close to sources of information and available services, adolescents, disabled women and those without financial resources, all of whom face additional challenges in planning for an expensive medical procedure abroad at a time when they are already in a state of some emotional distress.

Those who cannot travel because of their immigration status, lack of money, because they are in state custody, or for any reason whatsoever are forced to choose between continuing a crisis pregnancy and accessing illegal, often risky services. The availability of safe abortion services in other EU countries, particularly in the UK, has played a significant role in allowing the Irish government to abdicate its responsibility to protect the human rights of women who require access to abortion.

A physician who has worked with pregnant women for a significant length of time told Human Rights Watch that she has never heard of any legal abortions being performed in Ireland. She recounted the case of a woman whose life was endangered by her pregnancy and who had to leave the country to access care, despite the fact that Irish law entitles her to an abortion at home.

The International Conference on Population and Development ICPD Programme of Action was the first international consensus document to recognize that where abortion is legal, services must be provided and must meet certain standards. The Irish government has failed utterly to ensure that health services are available to those women who are legally entitled to an abortion. In the UN Human Rights Committee, which oversees the implementation of the International Covenant on Civil and Political Rights ICCPR to which Ireland is a party, examined the situation of a young girl in Peru, who was not able to access a legal abortion in a legislative context which is similar to that of Ireland.

In the specific case examined by the Committee, a pregnant adolescent had been forced to continue with an anencephalic pregnancy. The United Nations Committee against Torture CAT , which oversees the Convention Against Torture to which Ireland is also a party, has also described the in ability to access abortion in a situation of a life threatening pregnancy as a violation of human rights.

In April , the Commissioner for Human Rights for the Council of Europe, following a visit to Ireland, highlighted the failure of the Irish government to ensure access to legal abortion and called on the government to ensure that adequate services were in place to carry out legal abortions in Ireland. The Committee has explicitly noted that no woman should be forced to go through with a pregnancy which would mean her suffering inhuman or degrading treatment. In Ireland, the very divisive public debate on abortion in the context of a small country with a limited number of practicing obstetrics and gynecology specialists, all of whom know of each other, has also limited the availability of legal abortion services.

Research from other countries where abortion is only legal in limited circumstances suggests that women will continue to face obstacles in accessing services to which they are legally entitled until the government regulates access and actively addresses the stigmatization of service provision among medical practitioners, including by enforcing strict confidentiality measures for both patients and providers. Several international human rights treaties to which Ireland is a party include the obligation to respect and ensure the right to information also as it relates to the right to health.

The World Health Organization guidelines on safe abortion set out in detail the information and confidentiality requirements for crisis pregnancy counseling that would allow women to make decisions in an informed and autonomous manner, in accordance with their human rights. Firstly, it fails to ensure access to information about abortion services in Ireland in those circumstances permitted by law, and it does not adequately inform women and providers about their rights to confidentiality and health information.

It further fails to ensure that women are able to access accurate information about abortion and services legally available outside of Ireland. Human Rights Watch found that many medical practitioners do not know what services they may lawfully provide to women and what the standard of medical care should be when an abortion is performed in Ireland.

Service providers also do not know when they can advise their clients to request an abortion. The Medical Council, a statutory body established in to regulate the medical profession and protect the interest of the public in Ireland, is supposed to provide guidance on ethics and is responsible for disciplining those doctors who breach the required standards of conduct and behavior. The relevant portion of the submission is reprinted in the guide.

The submission fails to refer to the risk of suicide as a ground to legally terminate a pregnancy. The failure of the Irish government to ensure that women have access to information about when legal abortions may be obtained in Ireland clearly violates their right to health.

The UN Committee on Economic, Cultural and Social Rights has articulated the positive obligation on the part of the state to disseminate information about sexual and reproductive health, including through information and education campaigns. The failure of the Irish government to ensure that women have access to abortion-related information means that many women struggle to access timely, accurate, and complete information about legal abortion services abroad. As a result, they experience delays in accessing care, which heightens the possibility of health complications from the intervention.

Aoife C was living in a rural part of Ireland when she got pregnant. As a result of the delay, she was almost 28 weeks pregnant when she finally had an abortion. The Irish government has failed to take steps to inform women of their right to travel. The European Court of Human Rights at the time found Ireland to be in violation of its human rights obligations regarding access to information. The European Court of Human Rights noted that limiting access to information created a health risk to those women who, due to inadequate counseling, sought abortions at a later stage in their pregnancy, or who were not seeking post-abortion care.

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The legislation, ostensibly enacted to give effect to the constitutional amendments guaranteeing the right to travel and information and to bring the law more in line with the Open Door ruling, in fact places far-reaching curbs on the manner in which information can be given and almost inevitably delays access to services. For example, information may only be given during a face to face meeting.

Service providers are required to prioritize the prescripts of the law over caring for their patients. A researcher and activist described how legal constraints on the provision of information, as provided for in the Information Act, negatively impact the provision of care:. Although the internet now means that many women can access information about abortion services abroad without having to meet with a service provider, and in some ways the Act has become obsolete, it continues to discriminate against marginalized, resource-poor, or rural women who do not have ready access to the resources provided by the internet.

Since information may not be provided telephonically, access for those women and for anyone else without access to transport, is further limited. For some women, these forms of information may be the only way in which they are able to find out about available services. Barriers to information are higher in non-Irish and in resource-poor communities. A service provider who assists African immigrant women indicated that her clients encountered particular problems in securing information about abortion services. I give them information in a way that they can give it to others.

The law requires that information about abortion be provided without any advocacy or promotion of abortion. We have to send them away with a list of clinics to call. A community organizer who has spoken to many women in need of services added: The difficulty in accessing full and accurate information about abortion, and the strict regulation imposed on bodies that provide what limited information on legal abortion services they can, is further exacerbated by the existence of unregulated agencies that actively provide misleading or inaccurate information about abortion and related services in their efforts to delay or prevent abortions.

These agencies misrepresent their services as neutral sources of information about crisis pregnancies and all available options, luring in women seeking information about a full set of options. The act regulating the provision of abortion-related information does not apply to service providers who do not give abortion-related information.

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  5. As a result, women who seek accurate information about all their options are at risk of receiving inaccurate, untruthful and misleading information, or in many cases, are denied information about abortion services altogether. Claire C was under the impression that the agency she sought advice from would give her information and counseling about all her options. Instead, she was given misleading information, similar to that given to Sinead Ahern. I stopped answering [calls with] withheld numbers.

    Have you killed it yet? Jane H and her boyfriend were also misled by an advertisement. Interpretations of international law unequivocally support the conclusion that decisions about abortion should be made by pregnant women, and them alone. The UN Committee on Economic, Cultural and Social Rights has explicitly recognized the obligation of the state to ensure that third parties do not limit access to information. Women who find out that they are carrying a fetus with severe genetic abnormalities face additional challenges, including the stress of unexpected emotional, physical, financial, and other consequences of dealing with a special needs pregnancy.

    In Ireland, they do so without any support from the state. Not only does Irish law prevent women with severe fetal abnormality pregnancies from accessing legal abortion services at home should they so choose, it also does not facilitate screening for fetal abnormalities for pregnant women in the first place. The lack of consistent access to screening is of particular concern as fetal abnormality pregnancies can have a detrimental effect on the physical health of the pregnant woman, especially as the pregnancy progresses, in addition to the emotional stress that comes with dealing with a difficult pregnancy without support.

    These medical facts, while uncontested in Ireland, have not translated into policies and practices that ensure that all pregnant women have routine access to antenatal care that includes screening for fetal abnormalities, or that they may choose to terminate a pregnancy that can severely endanger their health. The general stigmatization of abortion exacerbates a situation that is already painful. A clinical midwife specialist at the largest maternity hospital in Dublin who has dealt with fetal abnormality pregnancies for more than a decade, recalled the distress of the family members of a year-old daughter carrying an anencephalic pregnancy: But now I am in a society that expects my daughter to have this pregnancy!

    There is no national protocol that regulates antenatal screening, although the Royal College of Gynaecologists recommended in that ultrasound screening for abnormalities be offered to all pregnant women.

    A survey of maternity units in Ireland found wide variations in practice, and recommended that a standard national protocol be developed. It also indicated that a national debate on ultrasound screening for fetal abnormality was urgently needed. If a woman wishes to terminate a pregnancy with fetal abnormalities, early detection is preferable, both for the safety of the procedure itself, and to minimize the physical and emotional health consequences for the pregnant woman.

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    Moreover, an early termination allows those women who wish to do so, to attempt having a healthy pregnancy sooner, with potentially mitigating effects on their emotional health. In the UK, the terminations are earlier. Aisling J encountered several obstacles in accessing diagnostic tests throughout the early part of her pregnancy, and therefore discovered relatively late that the fetus she was carrying had spina bifida [81] and hydrocephalus [82] and could not survive.

    She explained the problems she had met with:. I was not referred to anyone else either. She elected to terminate the pregnancy. She told Human Rights Watch: I felt let down, maltreated. A medical practitioner interviewed by Human Rights Watch, who did not want to be identified, inadvertently illustrated the cruelty of a system that, because abortion is illegal, fails to provide sensitive support and care:. There is little, if any, support and assistance provided to women who are grappling with complex and traumatic decisions.

    For pregnant women and their partners, the discovery that the fetus may not survive, may only live a short time after birth, or may be severely disabled, is devastating. All the women interviewed for this report identified the costs associated with traveling as their most immediate and urgent concern once they had decided to have an abortion. Sarah B was 24 years old when she traveled to the UK for an abortion.

    She was a student and working part-time as a waitress. I was just, how am I going to do this? Claire A was also a student when she had an abortion. He had to involve his brother, who was appalled and even now These costs do not include other direct costs, such as travel and accommodation, or indirect costs, including childcare, loss of income and the costs of a traveling companion. Service providers interviewed by Human Rights Watch confirmed how difficult it is for many women to raise the money to travel and the lengths that some must go to to ensure their access to safe and legal abortions.

    A community activist described the situation of the women she works with: There are circumstances where they have been violently beaten because they cannot afford to repay. For women who are in the asylum seeking process in Ireland, money is even more difficult to borrow, earn or find. The costs of traveling to obtain an abortion are plainly out of reach for them, unless they are willing to take drastic action. Asylum seekers are in a particularly vulnerable position. Often isolated, without family and other social support, they fear the consequences of seeking permission to leave the country to have an abortion.

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    They also face additional costs as they have no travel documents, and must therefore apply and pay for emergency temporary travel documents, which are issued by the Department of Justice, Equality and Law Reform. A service provider, who spoke to Human Rights Watch on condition of anonymity, described the situation of a young female asylum seeker she had worked with:. Mary E, a young woman from an African country, had already applied for asylum when she became pregnant and decided to terminate her pregnancy.

    Another service provider confirmed that their clients had experienced particular difficulties on getting entry visas to the UK due to a lack of information about how to apply for the visa and what documents are required. However, she concluded that the Department of Justice was unwilling to come up with a policy to cover all women and persisted in treating each application as a new and separate case.

    The position of Traveller women is equally difficult. One service provider Human Rights Watch spoke to had assisted eight women with unwanted pregnancies over a period of four years: The Covenant on Economic, Social, and Cultural Rights prohibits discrimination in the enjoyment of the rights protected by the covenant, including specifically on the ground of property.

    Women interviewed for this report described a profound and pervasive sense of shame and guilt caused by the stigma attached to abortion in Ireland. Being forced to leave their homes to have an abortion reinforced these feelings. The distress the women we interviewed felt was profound and in many cases linked to the reluctance on the part of the Irish government to address the issue of abortion. Having to travel abroad for a procedure at a time when many women are already in distress because of an unwanted or unhealthy pregnancy was a major source of anxiety.

    It is still so traumatic even if you can afford it. I felt completely abandoned. Siobhan G described an equally harrowing experience. Siobhan was pregnant with twins when she discovered that both had fatal birth defects:.