Joanna Mishtal

Until 2018, abortion in the Republic of Ireland was banned in almost all circumstances under one of the most restrictive legal regimes in Europe. The main solution for Irish women and pregnant people seeking abortion services had been to pursue care abroad, typically in clinics in England. In this paper we focus on the hardships of waiting for abortion care experienced by Irish residents leading up to their travel for appointments in England in 2017 and 2018. Based on in-depth interviews with 53 Irish women collected at three British Pregnancy Advisory Services (BPAS) clinics in England we analyse women’s experiences as they navigated an ‘environment of secrecy’ in Ireland. This included making specific secrecy efforts when navigating travel arrangements, conversations, movement, health records, and the travel itself. Despite the expansion of abortion access in Ireland in 2018, the need to travel abroad continues for many women. We argue that the continued need for secrecy when women have to travel abroad for care perpetuates this important phenomenon’s invisibility. This argument also applies to other countries where abortion access is restricted, and women are forced to travel for care. We also caution against the presumption that all Irish residents are able to travel internationally for healthcare.

Background: In 2018, the right to lawful abortion in the Republic of Ireland significantly expanded, and service provision commenced on 1 January, 2019. Community provision of early medical abortion to 9 weeks plus 6 days gestation delivered by General Practitioners constitutes the backbone of the Irish abortion policy implementation. We conducted a study in 2020–2021 to examine the barriers and facilitators of the Irish abortion policy implementation. Methods: We collected data using qualitative in-depth interviews (IDIs) which were conducted in-person or remotely. We coded and analysed interview transcripts following the grounded theory approach. Results: We collected 108 IDIs in Ireland from May 2020 to March 2021. This article draws on 79 IDIs with three participant samples directly relevant to the community model of care: (a) 27 key informants involved in the abortion policy development and implementation representing government healthcare administration, medical professionals, and advocacy organisations, (b) 22 healthcare providers involved in abortion provision in community settings, and (c) 30 service users who sought abortion services in 2020. Facilitators of community-based abortion provision have been: a collaborative approach between the Irish government and the medical community to develop the model of care, and strong support systems for providers. The MyOptions helpline for service users is a successful national referral model. The main barriers to provision are the mandatory 3-day wait, unclear or slow referral pathways from primary to hospital care, barriers for migrants, and a shortage and incomplete geographic distribution of providers, especially in rural areas. Conclusions: We conclude that access to abortion care in Ireland has been greatly expanded since the policy implementation in 2019. The community delivery of care and the national helpline constitute key features of the Irish abortion policy implementation that could be duplicated in other contexts and countries. Several challenges to full abortion policy implementation remain.

Background: The laws governing abortion access vary across Europe. Even in countries with relatively liberal laws, numerous barriers to abortion access exist. In response to these barriers, evidence suggests that people living in countries with both restrictive and liberal laws travel outside of their home country for abortion care. England and Wales are common destinations for those who travel to seek abortions, but little is known about the motivations and experiences of those who undertake cross-country travel to England or Wales to obtain care. This paper aims to describe the abortion seeking and travel experiences of women and pregnant people who traveled to England and Wales for an abortion between 2017 and 2019. Methods: We recruited 97 participants who had traveled cross-country from both liberal and restrictive contexts to seek abortion care at three participating BPAS clinics in England and Wales. Participants completed an electronic survey about their reproductive histories, abortion decision-making, experiences seeking abortion care, and traveling. We conducted a descriptive analysis, and include comparisons between participants who traveled from liberal and restrictive contexts. Results: Over a third of participants considered abortion four weeks or more before presenting for care at BPAS, and around two-thirds sought abortion services in their home country before traveling. The majority of participants indicated that they would have preferred to have obtained an abortion earlier and cited reasons including scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. About seventy percent of participants reported travel costs between €101–1000 and 75% of participants reported that the cost of the abortion procedure exceeded €500. About half of participants indicated that, overall, their travel was very or somewhat difficult. Conclusions: This analysis documents the burdens associated with cross-country travel for abortion and provides insight into the factors that compel people to travel. Our findings highlight the need for expanded access to abortion care throughout Europe via the removal of legal impediments and other social or procedural barriers. Removing barriers would eliminate the need for cumbersome abortion travel, and ensure that all people can obtain necessary, high-quality healthcare in their own communities.

Objectives: Little is known about the experiences of women who travel within Europe for abortion care from countries with relatively liberal laws. This paper aims to assess the primary reasons for travel among a sample of women who travelled from European countries with relatively liberal abortion laws to obtain abortion care mainly in the UK and the Netherlands.Design: Multi‐country, 5‐year mixed methods study on barriers to legal abortion and travel for abortion.Setting: UK, the Netherlands and Spain.Population or Sample: We present quantitative data from 204 surveys, and qualitative data from 30 in‐depth interviews with pregnant people who travelled to the UK, the Netherlands and Spain from countries where abortion is legal on broad grounds within specific gestational age (GA) limits.Methods: Mixed‐methods.Main outcome measures: GA when presenting at abortion clinic, primary reason for abortion‐related travel.Results: Study participants overwhelmingly reported travelling for abortion because they had exceeded GA limits in their country of residence. Participants also reported numerous delays and barriers to receiving care.Conclusions: Our findings highlight the need for policies that support access to abortion throughout pregnancy and illustrate that early access to it is necessary but not sufficient to meet people’s reproductive health needs.Funding: This study is funded by the European Research Council (ERC).Tweetable This study shows that GA limits drive women from EU countries where abortion is legal to seek abortions abroad.

In 2018, the Irish public voted to repeal the Eighth Amendment to the Irish Constitution, which since 1983 banned abortion in the country. While this was a watershed moment in Irish history, it was not unconnected to wider discussions now taking place around the world concerning gender, reproductive rights, the future of religion, Church–State relationships, democracy and social movements. With this Forum, we want to prompt some anthropological interpretations of Ireland's repeal of the Eighth Amendment as a matter concerning not only reproductive rights, but also questions of life and death, faith and shame, women and men, state power and individual liberty, and more. We also ask what this event might mean (if anything) for other societies dealing with similar issues?

As the global COVID-19 pandemic unfolds, risks to sexual and reproductive health rights have rightly been at the forefront. Abortion access, in particular, should remain essential, with the reducti...

Reproductive rights struggles have continued to dominate public debates in Poland since the political resurgence of the Catholic church in 1989. In 2015, the state passed a landmark “In Vitro Policy” to regulate assisted reproductive technologies. Its religiously based compromises may jeopardize other reproductive rights. I argue that the new policy negotiations demonstrate how versions of competing human rights claims are central to reproductive governance and struggles in the new Polish “ethical order.” These negotiations reveal a reciprocal and temporal effect between infertility and abortion laws, in which previously enacted abortion restrictions are used to limit and define “In Vitro” rights.

A bstract: Scholarship and advocacy work regarding reproductive health have often focused on women’s experiences. Concerns about men’s sexual and reproductive healthcare (SRH) have historically been on the margins in this context. In the United States, young men are at the greatest risk for sexually transmitted infections (STIs), yet are the least likely to seek SRH. Based on research with 18 healthcare providers in a large public Florida university clinic, we examined providers’ perspectives about expanding men’s SRH provision and utilisation. Research findings demonstrate inconsistent provider strategies in treating men’s SRH needs and a clinical environment that has low expectations of men receiving preventive care, further perpetuating the placement of SRH responsibility upon women. This article contributes to applied and medical anthropology scholarship on health inequalities through its discussion of the challenges and barriers that contribute to poor SRH for young men and the critical role of providers in this context.

Implementing effective health interventions in recent epidemics has been difficult due to the potentially global nature of their spread and sociocultural dynamics, raising questions concerning how to develop culturally-appropriate preventive measures, and how these health threats are understood locally. In Belize, health policy makers have only been marginally effective in managing infections and mosquito vectors, and Zika has been declared endemic in certain regions, particularly on the island of Caye Caulker. Based on ethnographic research conducted primarily in 2017, we examine how perspectives of Zika-related health consequences are shaped, and how state interventions to manage Zika are understood. We argue that despite its declared endemic status, Zika is not perceived as a true health concern for community members due to numerous neoliberal structural challenges. Moreover, the state’s restrictive form of reproductive governance which limits family planning services is forcing individuals to weigh conflicting conceptions of health consequences. This also contributes to an ambiguous healthcare environment for health practitioners, giving them an unclear picture of the scope of Zika as a public health concern. We also consider how critical medical anthropology and feminist analytical approaches are useful in exploring these questions and contributing to understandings of the health impacts of Zika.