On May 26, 2018, Irish women spilled onto the streets to celebrate a historic win for reproductive rights and bodily autonomy. The staunchly Catholic country had overwhelmingly voted to scrap the Eighth Amendment of the Irish Constitution, under which abortion was essentially illegal—one of the most restrictive abortion laws in the world.
Five years on, the mood has sobered. Under the new laws, those seeking an abortion have to undergo a mandatory waiting period, adhere to strict time limits, and contend with a lack of providers. From 2019 to 2021, 775 people made use of their right to travel freely between the United Kingdom and Ireland to head to Britain to access abortion services. In 2020, despite the pandemic, nearly 200 people still traveled across the Irish Sea to get abortion care in the UK. The Abortion Support Network (ASN), a charity that helps people in Europe access abortion through telemedicine or by supporting travel, says every three days they hear from someone in Ireland looking for help.
In the aftermath of the US Supreme Court overturning Roe v. Wade, Ireland’s success was held up as a beacon of progressiveness that made America’s regression all the more stark. If a deeply religious country could usher in expansive abortion access, what had gone wrong in the United States? Perhaps the Irish story could even offer lessons on how to move beyond severe restrictions. But in reality Ireland’s new abortion landscape is patchy and restricted. The progress made has been huge, but Ireland’s current situation shows that securing the right to an abortion is not where the battle ends.
Equal Rights, Unequal Access
Abortion access in Ireland is closely tied to where you live. Swaths of the country, particularly rural areas, are effectively abortion care deserts. Only 11 of Ireland’s 19 maternity hospitals offer abortion services, and only 10 percent of general practitioners, or GPs, are signed up to offer them. Nine out of Ireland’s 26 counties have fewer than five doctors who offer abortions. “The government has completely dragged their heels on the provision of services,” says Camilla Fitzsimons, an activist and author of Repealed: Ireland’s Unfinished Fight for Reproductive Rights.
The point in a pregnancy at which a person can still obtain an abortion—called gestational age limit—also complicates access. Under Irish law, abortion is permissible as long as the person is less than 12 weeks pregnant, but at this point many are not yet aware that they are. Setting aside the US states that have banned abortions post-Roe, this is actually a tighter limit than tends to be in place in most US states that still allow abortion.
In Ireland, patients are also required to attend two appointments three days apart between requesting and receiving abortion care, which is called the mandatory waiting period. An abortion is allowed after 12 weeks only in the case of a fatal fetal anomaly, and this requires the sign-off of two doctors who say the baby will die within 28 days; if they are wrong, they could face imprisonment of up to 12 years. “Abortion is still illegal in Ireland,” says Fitzsimons. “It’s still a criminal offense—outside of very strict parameters.”
Niamh, who is 37 and lives in Dublin, found out she was pregnant last year. She decided against continuing with the pregnancy, and thought the law change would mean that getting an abortion in Ireland would be barrier-free. Her name has been changed to protect her privacy. Niamh called her local clinic, but they were booked up for the next two weeks. So she went online and found another GP. When she visited, she was told she had to complete the mandatory waiting period before she could be prescribed the medication. “I found it quite distressing,” she says.
This waiting period, sometimes called a “cooling-off period,” is a practice the World Health Organization (WHO) recommends against, because of the extra barriers—financial and logistical—it places on abortion seekers. It also “completely undermines people’s capacity to choose,” says Fitzsimons—and perpetuates the stereotype that abortions are carried out on impetuous whims, rather than being thought-out health care decisions.
The medication abortion ended up failing, and Niamh was referred to a maternity hospital to try the process again, which took nine hours. At this point she was about 10.5 weeks pregnant; if the abortion had happened much over a week later, she would have needed to travel to finish the process that had begun in Ireland. Her doctors told her she was “lucky”; Niamh did not feel lucky. “I want people to know that this is what the reality is like,” she says. “It’s not what I thought [it would be] when I was marching five years ago for this.”
Forced to Travel
Ireland represents a paradox of abortion access—and it’s not alone. With a few exemptions, such as Poland, Malta, and Hungary, the majority of European countries have the most liberal abortion laws in the world—but only on paper. In reality, many Europeans are blocked from exercising their full right to abortion.
The idea that Europe is an abortion utopia is misguided, says Mara Clarke, the founder of ASN and cofounder of Supporting Abortions for Everyone (SAFE), a charity she started in February 2023 to combat the attack on abortion rights across the continent. Her group is helping build infrastructure so activists around Europe can organize activities in their own countries. In 2020, ASN helped almost 800 people in Europe with abortion services—the majority from Poland, where a near-total ban is one of the most severe in all of Europe. Total bans are in place in Andorra and Malta.
Abortion laws and administration vary across the continent, with the effect that many people are traveling across borders to access services. In 2021, the Netherlands provided abortion care to almost 3,000 non-Dutch residents. England and Wales were also once popular destinations, but Brexit has meant that the number of non-residents visiting for abortions has shrunk from around 4,700 in 2018 to just 613 in 2021, most of whom were people from Ireland. (Even within Britain, access differs; people from Scotland often have to travel to England or Wales, as a lot of Scottish health boards set the gestational age limit earlier than the 24-week legal limit.)
The majority of Europeans who need abortion care can and do get it in the country in which they live, says Leah Hoctor, the senior regional director for Europe at the Center for Reproductive Rights. “But then we do, of course, have some countries in the region where, although abortion is legal, access—in practice—is very difficult,” she says.
Even in countries where abortions are legal and there are plenty of doctors to carry them out, access can be a minefield. Consciousness objection, a process by which medical professionals can refuse to carry out an abortion on ethical or religious grounds, is legal in 26 European countries. Italy is one place where this greatly restricts access, even though abortion is technically legal. As of 2019, 69 percent of Italian gynecologists conscientiously object, meaning they refuse to have any involvement with the process due to their moral or religious beliefs. Italy also has a lengthy waiting period for abortions, at seven days.
According to WHO guidelines, if a doctor conscientiously objects to providing an abortion, then that country’s health system must refer a patient to an alternative health care provider. But mandatory referrals are a poor fix and conscientiously objecting health care professionals are also often reluctant to reliably refer patients to someone who will provide necessary care. Hoctor says this systemic failure to ensure backup providers is one of the main reasons behind poor access in certain European countries, including Italy.
Conscientious objection is on the rise in some countries, especially in Croatia, Romania, and Slovakia. Others, including Sweden, Finland, and Bulgaria, have outlawed it, ensuring that abortion access is seen as part of the duty of a health care provider.
But research has found that the most common reason behind traveling for abortion care—as seen in Ireland—is a country’s gestational age limit. While the WHO recommends against prohibiting abortion on the basis of gestational age, in more than 20 European countries, abortion access is capped at 12 weeks. In some places, the limit is even tighter; Croatia and Portugal, for example, have a 10-week limit.
Many people often need an abortion past their country’s limit due to a failed medication abortion, cost, or other barriers—or not realizing they were pregnant. Research has found that when people are refused an abortion due to gestational age limits, it can result in the unwanted continuation of pregnancy, particularly for people with cognitive impairments.
In many countries with a 12-week limit there are also convoluted exceptions that allow for an abortion to happen at a later point. Take Greece. Its 12-week limit shifts to 19 weeks in cases of rape or incest, to 24 weeks if the fetus has an abnormality, and is removed completely if there is a risk to the mother’s life or a chance of serious permanent damage to the mother’s physical or mental health. But on request, there are only a handful of countries in Europe where you can get a second trimester abortion—such as the Netherlands, England and Wales, and Spain—which means some countries are flooded with requests from people looking for care after the 12-week limit.
In some countries that have tight limits, abortion access can depend on how strictly the law is interpreted. In Germany abortion is illegal, but pregnant people can still obtain an abortion at up to 12 weeks if they agree to counseling, or later than this if the pregnancy poses a danger to the health of the mother. In England, the opposite is true; it has a liberal law, but it is enforced. In June 2023, the English public were served a harsh reminder that abortion beyond 24 weeks is still a criminal offense, when a woman was given a 28-month prison sentence for lying to procure abortion pills after the legal limit had passed.
And then there’s the issue of expense. If you have the funds to travel, the costs won’t stop there: Non-residents must pay over €1,000 to receive an abortion in the Netherlands, for example. Even for people not traveling abroad for an abortion, in 31 countries in Europe abortion isn’t included in national health care coverage, meaning that costs pose a significant barrier and disproportionately affect marginalized people. Refugees and people with disabilities, as well as those unable to afford travel, are already more hindered by a country’s restrictions.
Hoctor warns against disregarding the waves of progress for reproductive rights in the past year, partly due to what’s happening in America right now. Europe might not be the utopia some see it as, but progress continues to be made. Waiting periods have been trashed in Spain, gestational age limits expanded in France, the need for a two-doctor sign-off scrapped in Finland. “It’s really important that we document the progress that is happening,” Hoctor says. But the fight for reproductive rights continues, not just in the US—but in every country around the world. “Across the board, there’s room for improvement, in every country in the region.”