Abortion Policy Implementation in Ireland: Lessons From the Community Model of Care

Authors

Joanna Mishtal, Department of Anthropology, University of Central Florida, Orlando, Florida, United States of America.
Karli Reeves, Department of Population Health Sciences, University of Central Florida, Orlando, Florida, United States of America.
Dyuti Chakravarty, School of Sociology, University College Dublin, Dublin, Republic of Ireland.
Lorraine Grimes, Department of History, National University of Ireland Galway, and Social Sciences Institute, Maynooth University, Kildare, Republic of Ireland.Follow
Bianca Stifani, Department of Obstetrics and Gynecology, New York Medical College/Westchester Medical Center, New York, New York, United States of America.
Wendy Chavkin, Global Doctors for Choice, New York, New York, United States of America.
Deirdre Duffy, Department of Social Work and Social Care, Manchester Metropolitan University, Manchester, United Kingdom.
Mary Favier, Parklands Surgery, Cork, Republic of Ireland.
Patricia Horgan, Broad Lane Family Practice, Cork, Republic of Ireland.
Mark Murphy, Eldon Family Practice, Dublin, Republic of Ireland.
Antonella F. Lavelanet, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.

Author Type(s)

Faculty

DOI

10.1371/journal.pone.0264494

Journal Title

PLOS One

First Page

e0264494

Document Type

Article

Publication Date

1-1-2022

Department

Obstetrics and Gynecology

Abstract

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.

Recommended Citation

Mishtal, J., Reeves, K., Chakravarty, D., Grimes, L., Stifani, B., Chavkin, W., Duffy, D., Favier, M., Horgan, P., Murphy, M., & Lavelanet, A. F. (2022). Abortion Policy Implementation in Ireland: Lessons From the Community Model of Care. PLOS One, 17 (5), e0264494. https://doi.org/10.1371/journal.pone.0264494