On the first of January 2019, abortion care became more widely available in the Republic of Ireland. Prior to this abortion was only available when there was a “significant risk to the life of the mother” due to either physical or mental health conditions.
Following a public referendum in 2018, abortion is now available under 12 weeks for any reason, and later if there is significant risk to the life or health of the mother or in the case of a “fatal fetal abnormality” where the fetus had a condition likely to lead to their death within pregnancy or the first 28 days of life. Under nine weeks gestation, care is largely provided within general practice or family planning clinics, unless there is a requirement for hospital care (such as maternal bleeding disorder). At over nine weeks all abortion care takes place within maternity hospitals. Of the nineteen maternity units within the Republic of Ireland, ten provide abortion care, including all the units within Dublin, Cork, Galway, and Limerick.
While a two thirds majority of voters supported the 2018 referendum, not everyone agreed with expansion in abortion care. Protests have occurred at clinics and hospitals. They have been largely small and haven’t affected patient care, so clinicians have usually stayed silent, not willing to increase visibility to a small group of people.
On 1 January 2020—the one year anniversary of the legislation coming into effect—the largest protest yet was held in front of a maternity hospital in Dublin, a video of which quickly went viral. A group outside the hospital carried placards and crosses, said prayers and had small white coffins. This has raised again the issue of safe access zones, or exclusion zones, for clinics and hospitals, similar to those implemented by Ealing Council.
Abortion is only a small portion of maternity care. The majority of people coming in and out of the doors of Ireland’s maternity hospitals come to avail of routine pregnancy care, high risk care, gynaecology advice and treatment, or are attending following a pregnancy loss.
There are women who are attending with suspected or confirmed miscarriage, couples attending with stillbirths, and families coming who have had a previous pregnancy loss. For people with these histories and experiences, small white coffins are incredibly traumatising and triggering of loss, pain, bereavement, and grief. A small coffin represents the finality of a pregnancy loss, the sadness of never knowing the personality and potential contained within. For staff members, the coffins represent some of the most difficult days of their professional career, where their support and care of bereaved families has been what helped people move through heartbreak and loss.
Within the hospital there are visitors including older siblings of newborn babies. I saw one child asking her grandmother why there were people outside the hospital holding pictures of babies. The grandmother was silenced by the thought of a conversation that could follow.
The women, couples, and families who attend for abortion care also deserve respect and dignity. The decision to have an abortion, whatever the reason, is difficult. It can be heart wrenching, and made during long nights of the soul. To then have to access a clinical site, whether a general practice surgery, a family planning clinic or a maternity hospital, and walk past other people who visibly disagree with your choice must be incredibly emotionally difficult (and in some sites in the United States, also physically difficult).
Women report harassment by the very presence of activists at a clinic, rather than their actual activity. For many activists, techniques such as “pavement counselling” and “prayerful witnessing” promote an (often religious) ideal where motherhood is sacred and natural, and that the decision not to proceed is therefore damaging.
There is no other area in medicine that I am aware of that the issues of privacy, respect, and confidentiality, are thrown away by having people outside protesting your decision to access clinical care. I have no issue with people expressing their right to free speech by peacefully protesting. I can appreciate that it must be difficult to live in a country that overwhelmingly voted to extend abortion care, if this is abhorrent to your personal views of morality and ethics. My issue is having protests that stigmatise the legal right to choose different versions of healthcare in front of those clinical areas and in plain sight of the few who are accessing this care, as well as the many who are not, but could be traumatised by this exposure.
In this I, and many others, believe that we have to advocate for those who cannot advocate for themselves—whether they are too upset, or angry, or their decision is too recent, or they wish to avail of their legal right to confidentiality and respect. In this way I am one of many physicians who serve as “faithful witnesses to the real world effect of legislative change”. Therefore we welcome the announcement by the Irish Minister for Health that legislation will be brought forward for safe access zones around clinical areas providing care. This is what the people of Ireland deserve.
Mary Higgins is an obstetrician working in Dublin.
Competing interests: None declared.