AUSTIN, Texas, Oct. 19, 2018 -- Despite a policy change to provide free abortion services for women traveling from Northern Ireland to clinics in Great Britain, Northern Irish women still experience multiple barriers to accessing care, according to new research from the LBJ School of Public Affairs at The University of Texas at Austin. The study also found that some women preferred to use medication from online telemedicine services to self-manage their abortions at home, but that the experience is dominated by fear and isolation due to the risk of prosecution.
Northern Ireland's abortion laws permit the procedure only to preserve a woman's life or prevent permanent long-term physical or mental injury. Any abortion taking place outside the law is punishable by up to life in prison.
Abigail Aiken, an assistant professor of public affairs and a fellow of the Richter Chair in Global Health Policy at the LBJ School, conducted anonymous in-depth interviews with 30 women living in Northern Ireland who either traveled to England to obtain an abortion in a clinic or who self-managed a medication abortion at home using online telemedicine. Results, which were peer-reviewed and published in BMJ Sexual and Reproductive Health, show barriers to traveling for abortion services, including the cost of travel, the inability to receive care confidentially and the challenges of arranging child care or taking time away from work.
"The recent policy change to provide free abortions for women traveling from Northern Ireland to clinics in Great Britain has not been sufficient to create a reliable and accessible pathway to care," Aiken said. "In addition to the physical toll and emotional stress of traveling overseas, many women do not have the required travel documents or need to keep their abortions secret from their families or communities."
Women in the study often said they found self-managing their abortions at home with medication more acceptable than travel. But those in the study who chose this option said they experienced severe anxiety about when or even whether they would receive the medications if Northern Irish Customs seized or delayed their packages. Some tried less effective or even unsafe methods while they waited.
Finally, the lack of clarity surrounding the duties of health care providers to report self-managed abortion led women in the study to mistrust the health care system. Although the Northern Ireland Department of Health, Social Services and Public Safety declared in 2016 that medical personnel who treat women experiencing miscarriage symptoms aren't required to ask about or report an attempted abortion, women still feel compelled to either lie to their doctors or avoid seeing a health care professional altogether.
Earlier this year, an overwhelming majority in the Republic of Ireland voted to repeal the Eighth Amendment outlawing abortion, and legislators in the Isle of Man also voted to legalize the procedure -- moves that put pressure on lawmakers in Northern Ireland and the U.K. Parliament to re-examine the country's abortion laws. In a 2017 survey, nearly 80 percent of Northern Ireland's population supported changing current regulations.
The research was supported by funding from a Junior Investigator grant from the Society of Family Planning, a grant from the European Society of Contraception and Reproductive Health, and a grant from the HRA Pharma Foundation. The study was also supported in part by an infrastructure grant awarded to the Population Research Center at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.