“I was very struck by if I didn’t become a provider, what had it all been about?” says one GP who is providing abortion services in Ireland.
Approximately 10% of GPs in Ireland have chosen to provide early medical abortion and, in a UCC study, doctors who have their anonymity protected explain their moral reasoning and personal experiences in providing the care.
“You owe this service to your patients. It’s the right thing to do. If I didn’t actually live that myself, I just would be a big fraud,” Dr C said, explaining the link between their political campaigning role and the decision to provide abortion care.
In the study, GPs recount personal experiences of women they had known — professionally and in some cases personally — who had had to go abroad for abortions.
They also tell of situations where women were unable to travel for financial reasons or because of their legal status in cases of asylum seekers or undocumented women.
“I’ve been working for a long time in practice before the repeal of the Eighth Amendment and just saw the appalling situations that women were in and the cruelty of it, the absolute unfairness of it, the discrimination against women who didn’t have the means to travel,” said Dr M in the study.
The doctors also tell of feeling nervous before the service roll-out for several reasons — partly because of their lack of clinical experience in delivering abortion care, but also in anticipation of possible reactions of other people working in their practice and patients.
There was also trepidation about protests, while some GPs had anxiety about the risk of violence.
“I think everybody had that fear that they were literally going to have people throwing stones at their windows, nearly … That was, I suppose, one of the things that was a big fear”, said Dr B.
Dr A spoke of calling the “guards” in relation to protests outside the practice. “When they put the crosses up first, I went around and told the guards and showed them the photographs. They said if they give you any trouble, we’re there for you. So that was a very positive experience.”
In general, the researchers said: “Violent or extremely intimidating protests did not materialise.”
However, the study said a small number encountered “serious difficulties with practice colleagues, leading one provider to leave that practice and set up on their own”.
The study revealed some had also been subjected to attempted ‘stings’, receiving suspicious phone-calls, including requests by male callers for the provision of abortion care to minors.
The authors of the study, Prof Mary Donnelly and Claire Murray from UCC’s School of Law, say the study shows the increased normalisation of early medical abortion in primary care.
“This is apparent in the slow but steady increase in the numbers of GPs providing the service. This study highlights the ongoing link between a moral commitment to women’s autonomy and health and the decision to provide early medical abortion in primary care settings following the repeal of the Eighth Amendment.”
Overall, the researchers said the “strong finding” was the experience of provision had been extremely positive.
“I think that … the reward of it is that … you feel you are supporting that autonomy, that people are making the decision that is best for them. The more times you hear it, the more you realise that people really have thought about what is best in this situation. Quite often, there’s no win for them — they’re not happy about it, but they know that it’s the best thing for them,” Dr B said.
A small number of the GPs spoke of caring for women who had several abortions.
“I think it’s important to acknowledge that we’ve made a decision that a woman should be able to have an abortion if she wants one and, big deal, you shouldn’t have to justify it or beg for one,” Dr P said.
“At the same time, I had one girl — a student — and she had three abortions in 18 months. I remember thinking, you know, that’s not what I voted yes for”, the doctor added.
The GPs referred to different reasons colleagues opted not to provide abortion care.
The researchers said this included “their practices were already overstretched, that this kind of work did not interest them, that they were nervous about being identified as a provider, and that they had a conscience-based objection to provision”.
“I think the majority of doctors that I know who don’t provide abortions would say it’s because they couldn’t be bothered, or they’re too busy, or they don’t want to have to do the training, or they might have a bit of a yuck factor about it”, said Dr S.
The study revealed that several doctors said felt that statutory protection for conscientious objection was stigmatising for providers.
“Part of the whole conscientious objection, the way it’s set up is that somehow the people who are conscientiously objecting are better people than the people who are providing. And I think that really feeds into that, you know, stigmatising people who are providing”, said Dr B.
The study published in the journal said that, for some doctors, the absence of any statutory recognition of conscientious provision was seen as reinforcing this narrative.
Dr C said: “I don’t have a particular issue with conscientious objection being protected. However, I think it gets overstated and it gets given undue importance and there’s no equivalent commitment to conscientious, you know, provision.”
Meanwhile, GPs in the study recalled being told by women that medical colleagues or other parts of the service — such as ultrasound providers — had obstructed women’s timely access to care or acted in a way that belittled or humiliated women seeking abortion care.
“You can tell the patient I don’t provide termination care, but the duty is very much on you to say: ‘Look, this is the direction you go if that’s what you need and yeah conscientious obstruction is different.’ It’s when you say ‘no, you can’t have an abortion because that’s wrong’.”, said Dr O’C.
The researchers said providers continue to face “nuanced ethical dilemmas as they negotiate the delivery of lawful abortion care in practice”.
“In navigating these new spaces, providers may have to reflect on their moral commitment to women’s autonomy and health — which motivated the initial decision to provide abortion care — and to recognise the ongoing importance of this commitment.”
