Psychological, Physical and Financial Costs of Abortion
Twelve women travel from Ireland to the UK each day to access abortion services. These women are from all walks of life and each has her own reasons for deciding to have an abortion. Women’s experiences of abortion are diverse and complex and the decision to have an abortion is not one that women take lightly.
Women’s reasons for choosing abortion, such as financial worries, concern about the well-being of other children, diagnosis of serious foetal abnormality, pre-existing health problems, including mental health problems, and relationship issues, can all be extremely stressful. The stress involved in making the decision is exacerbated by having to travel to another country to access abortion services, by the expense involved, by feelings of fear and stigma, by secrecy, by a sense of isolation or by lack of support.
For these women, the need to travel abroad involves unnecessary hardship, and in many cases, significant psychological, physical and financial burdens:
1. Women and girls in Ireland who require abortion services experience stigma and discrimination, and receive a lack of support and information from the State.
2. For women in these circumstances the burden of accessing abortion services is placed on the woman rather than the health care system. Women who make this journey for medical reasons do so in the context of the legal uncertainty and the chilling effect of the current law and standard medical referral protocols may not be applied. Women in this context must leave the mainstream health care service. They must make their own way to a private medical facility in another country without the protection of the protocols that apply in other situations where people travel for health care. While some doctors make ad hoc arrangements, we know of women who have travelled without medical files detailing their medical history or proper referral by their doctor.
3. Women travelling from Ireland tend to have later abortions because of the need to raise significant funds, organise child care, negotiate time off work and make travel and accommodation plans:
Travelling to the UK for a surgical abortion below 14 weeks of gestation costs at least €1000. This includes clinic fees of €500-€600, flights and accommodation. This does not include indirect costs such as child care and loss of income;
Abortion in cases of foetal anomaly costs more due to the duration of the treatment, which can last 4-5 days. This is due to the fact that foetal anomalies are not usually detected until the later stages of a pregnancy, resulting in longer and more complex medical treatment.
4. Women who need visas to travel abroad and to re-enter Ireland may have to wait 6 to 8 weeks for the necessary documents, or in some cases, may not be able to travel. Asylum seekers must apply and pay for an emergency re-entry visa from the Department of Justice and a visa to enter the UK or the Netherlands. Most asylum seekers in Ireland are housed in reception centres until their refugee application is decided. They are not entitled to work and currently receive a weekly allowance of €19.10 from the State. The cost of a UK visa is £78 (€99 at August 2012) while a visa to enter the Netherlands is €60 (at August 2012).
5. Irish women are more likely to avail of surgical rather than medical abortion in order to shorten the period of stay abroad. Medical abortion is a less invasive procedure than surgical abortion. However it requires more than one clinic visit as it lasts 3-4 days, while a surgical abortion normally occurs during one clinic visit. The delay in accessing information on services also prevents women from seeking a medical abortion, which is available up to nine weeks gestation only. Irish women are less likely to receive pre- and post-abortion medical care due to the limited amount of time they can stay abroad.
6. Some women for whom travel is impossible are increasingly ordering medication online to self-induce abortions (i). Women who self-induce without medical supervision are also more likely to delay in presenting to hospital with complications and are less likely to attend for post-abortion care.
7. Some women for whom travel is impossible are forced to continue with an unwanted or problematic pregnancy.
8. Women and girls who experience most difficulty are those who are already marginalised and disadvantaged - those with little or no income, women with care responsibilities, women with disabilities, women with mental illness, women experiencing violence, young women and women of uncertain residency status.
2012: Stories of Abortion – Irish Times (ii)
On 25 February and 24 March 2012, the Irish Times published stories relating to the experience of travelling from Ireland to the UK for an abortion. The accounts highlighted the significant psychological, physical and financial burdens experienced by men and women in Ireland who are denied access to abortion services in the Irish State.
One couple described how they “drained their savings” and paid more than €2,360 for an abortion in the UK after receiving a diagnosis of fatal foetal abnormality. The maternity hospital failed to provide information on the options available to the couple and would not send the pregnant woman’s medical records directly to the abortion clinic in the UK, “[making] you feel like you did something wrong...”like you’re being judged”.
“The intensely lonely, isolating journey to a strange city”, “the wall of official secrecy” and “the euphemistic language” all magnified the couple’s hardship. On the journey home, the woman began to bleed while passing through the security gate at the airport: “I just wanted to go home and get in my bed and pretend it hadn’t happened. But we just had to get on that stupid plane, and they’re selling scratch cards and people are on their way to a hen party, and I was just sitting there, and our world had just ended”.
One woman described her experience of ordering medication online and self-inducing an abortion as “one of the loneliest experiences I ever had”. Upon taking the medication, she experienced bleeding and pain for a week. “I was just able to pay for the pills but had to sacrifice food and asked my partner to go skip-diving for both of us so we could eat”.
2010: A, B and C v Ireland (iii)
In A, B and C v Ireland, three women challenged Ireland's restrictive abortion laws at the European Court of Human Rights. All three women travelled to the UK in 2005 and experienced substantial emotional, physical and financial hardship. Applicant A borrowed money from a moneylender at a high interest rate to pay for the abortion. She travelled alone and in secrecy. On her return to Dublin she began to bleed profusely and experience pain, nausea and bleeding for weeks thereafter. Applicant B borrowed money from a friend, travelled alone and suffered medical complications on her return. Applicant C was in remission from cancer when she became pregnant. She was unable to find a doctor willing to make a determination as to whether her life would be at risk if she continued with the pregnancy. On returning to Ireland, she suffered prolonged bleeding and infection, symptoms of an incomplete abortion and received inadequate follow-up medical care in Ireland.
The European Court of Human Rights acknowledged that “travelling abroad for an abortion was both psychologically and physically arduous for each of the Applicants [and] financially burdensome for the first Applicant”, stating that Applicants A and B experienced “the serious impact of the impugned restriction”.
2010: Michelle Harte (iv)
In 2010, Michelle Harte became pregnant whilst in remission from cancer. Doctors at Cork University Hospital advised her to terminate the pregnancy because of the risk to her health. The ethics committee at the hospital however decided against authorising Michelle Harte an abortion in Ireland on the basis that Ms Harte’s life was not under “immediate threat”. She subsequently suffered significant physical, emotional and financial hardship in being forced to travel to the UK for an abortion whilst severely ill.
At the time of travel, Ms Harte was “physically weak, nauseous and vomiting”, describing the experience as “horrendous”. “Why is it that such a simple medical treatment is not available, even when a mother’s life is at risk? Anyone else who was even half as sick as I am shouldn’t have to uproot themselves and fly over to England. It’s not fair and it’s not humane” stated Ms Harte in an Irish Times interview on 21 December 2010.
Michelle Harte and her partner received money from family to help finance the trip. They could not afford a taxi from the train station to the clinic. They took public transport and walked. Describing her experience upon returning to Ireland, Michelle Harte stated: “There was no follow-up support, either medically or emotionally. It was back to the hospital and continue with the cancer treatment as if nothing had happened”.
2010: A State of Isolation – Human Rights Watch Report (v)
In 2010, the international human rights watchdog Human Rights Watch released a 57-page report entitled "A State of Isolation: Access to Abortion for Women in Ireland
”. The report details how women in Ireland are faced with extreme physical, emotional and financial burdens imposed by restrictive laws on abortion that force women to seek medical treatment abroad, without support from the Irish State.
- Aoife was sixteen years old and living in a rural part of Ireland when she became pregnant. She was unable to access information on abortion services until she began university in Dublin and subsequently travelled to the UK “alone and extremely distressed”. As a result of the delay in accessing information, Aoife was almost 28 weeks pregnant when she had an abortion. She experienced much hardship in raising the necessary funds to travel: “I had to go to my ex-boyfriend. His first line was “are you sure it’s mine?”. It was very humiliating. He had to involve his brother, who was appalled”.
- Aisling experienced much difficulty in accessing diagnostic tests in the early part of her pregnancy. As a result, she discovered at a late stage that her foetus had developed a severe anomaly. “I saw the consultant at this visit. He was extremely quick and dismissive. He was very defensive…why these tests? Did I know they could lead to an abortion? Did I know they could be wrong and so I could abort a healthy child?”
Aisling paid for the diagnostic tests herself. After being refused a second scan by the ultrasound department, she arranged to have one abroad and subsequently accessed abortion services in a European country. “I was very angry, I felt let down, maltreated”.
When Aisling enquired about genetic testing upon her return to Ireland, the hospital told her to “come back when you’re pregnant again”.
- Sarah described what she called “the shame factor” in being forced to travel abroad to access abortion services. “Having to lie to everyone, the lies and the shame make you feel like you’re doing something really wrong, like a drug dealer. The travel part is so difficult. I don’t think people know this…It is still so traumatic even if you can afford it”.
In May 2007, the High Court granted a 17 year old girl with an anencephalic pregnancy the right to travel to the UK for an abortion. The girl, known as Miss D, was in the care of the Health Service Executive (HSE), who refused to give her permission to travel and contacted the Gardaí to prevent her from obtaining a passport. Miss D’s boyfriend brought proceedings on her behalf as she was a minor. Miss D experienced considerable hardship in being denied the right to travel abroad for an abortion by the HSE and in being forced to pursue a legal challenge in the High Court.
During the case, Gerard Hogan SC told the Irish Times that his client Miss D was deeply distressed. In her affidavit, Miss D described how her family circumstances had been strained due to the HSE attempting to stop her from travelling to the UK for an abortion.
The Sunday Tribune’s editorial of 6 May 2007 described Miss D’s hardship as follows: “Miss D has had to summon a legal team, prepare an affidavit, talk to psychiatrists. She has had to sit in a courtroom packed with five sets of legal teams and journalists, her every move watched and reported on, her relationship with her boyfriend described, her relationship with her mother analysed. She has had to leave the courtroom while detailed textbook descriptions of the medical condition the foetus she is carrying suffers from are described in terms no doctor would ever use when talking to a patient”.
Applicant D was a woman who was pregnant with twins and travelled to the UK in 2002 for an abortion, after she discovered that one of the foetuses she was carrying had stopped developing while the other foetus had a severely fatal anomaly.
D subsequently lodged a case with the European Court of Human Rights arguing that Ireland's ban on abortion in cases of foetal anomalies violated her rights under Articles 3, 8 and 10 of the European Convention on Human Rights. In 2006, the European Court of Human Rights ruled D v Ireland inadmissible because the case did not go through the Irish Courts and exhaust domestic legal remedies.
In her submission to the Court, Applicant D described the severe hardship she experienced in being forced to access medical services abroad. Her doctors were “very guarded” in their responses and did not give her a referral letter for the clinic in the UK. The hospital where Ms D was being treated told her she could not take her medical records if she travelled abroad for an abortion. Ms D submitted that she did not have time to remain in the UK to have counselling on the genetic implications for future pregnancies due to her care responsibilities as a mother of two children.
When Ms D discussed her experience with her doctor in Ireland, he advised her “to get over it”. When she confided in a second doctor, the latter gave her “a sympathetic nod” but no counselling. Ms D suffered post-abortion complications and felt unable to tell the hospital she attended or her family doctor that she had had an abortion. Ms D submitted that as a result of the strain, she and her partner separated and she stopped working.
In a 2007 letter to the Irish Times, the woman known as Applicant D describes how she suffered “excessive trauma” and “inhuman treatment” in not being able to avail of appropriate medical services in Ireland and in being forced to travel abroad for an abortion. “My partner and I are forced to secretly seek contact numbers, book flights and accommodation, take trains and taxis to a strange hospital in a foreign city, to meet strange medical staff who see me as yet another statistic of the Irish problem […] or else to carry on for a further five months, with all the attendant mental and physical strain, knowing that there will be a burial and not a baby to look forward to”.
1983: Sheila Hodgers (viii)
Sheila Hodgers lived in Co. Louth with her husband Brendan and two daughters. In August 1981, she discovered a lump on her breast which was removed. Ms Hodgers was subsequently diagnosed with breast cancer and underwent a mastectomy. The operation was successful and she was prescribed with anti-cancer medication.
Sheila Hodgers became pregnant a year later. After one month, Our Lady of Lourdes Hospital in Drogheda stopped her anti-cancer drugs, claiming it would harm the pregnancy. She began to experience severe back pain from a suspected tumour. Due to her pregnancy, an x-ray, pain relief and cancer treatment were withheld from Sheila Hodgers by the hospital.
By December 1982, Sheila Hodgers’ health had rapidly deteriorated, she experienced symptoms indicating the cancer had returned and had difficulty walking and standing. Her partner Brendan Hodgers requested that a Caesarean section or an induced delivery be performed on his wife so she could return to her cancer treatment but this was refused by the hospital, on the grounds that it would interfere with the foetus.
In March 1983, Sheila Hodgers was admitted to Our Lady of Lourdes Hospital. Her partner Brendan subsequently recalled: “I went to see Sheila one night and she was in absolute agony. She was literally screaming at this stage. I could hear her from the front door of the hospital and she was in a ward on the fourth floor”.
Sheila Hodgers was moved to the maternity ward where on 17 March 1983 she delivered her baby two months premature. The baby died almost immediately after birth. Sheila Hodgers died two days later on 19 March 1983. She was twenty-six years old.
For more stories on the hardship that women and girls experience as a result of not being able to access abortion services in Ireland, please see the Irish Family Planning Association's 2000 publication The Irish Journey
i The Irish Times, October 26, 2010 Customs seized 1,216 packs of illegal abortion drugs
ii The Irish Times, February 25 & March 24, 2012 Stories of Abortion
iii A, B and C v. Ireland, No. 25579/05 Eur. Ct. H.R. (2010)
iv The Irish Times, December 21, 2010 ‘Why is simple treatment not available even when a mother’s life is at risk?’ and ‘Woman with cancer tells of her abortion ordeal’
v Human Rights Watch, A State of Isolation: Access to Abortion for Women in Ireland (2009)
vi D (A Minor) v. District Judge Brennan, the Health Services Executive, Ireland and the Attorney General, unreported judgment of the High Court , 9 May 2007
vii D v Ireland, No 26499/02 Eur. Ct. H.R. (2007)
viii The Irish Times, May 8, 2003 Michael Neary and butchering women
The Irish Independent, March 4, 2006 Dr Neary