Irish and Northern Irish Women's Experiences with At-Home Medical Abortion Using Online Telemedicine

Abigail R. A. Aiken

Introduction

Abortion laws in the Republic of Ireland and in Northern Ireland are among the most restrictive across the globe. Abortion is illegal except to save a woman’s life, or in Northern Ireland only, to preserve her permanent physical or mental health. But even these provisions have a murky legal interpretation. Doctors in both countries, fearing prosecution, rarely perform abortions. Women also face criminal prosecution for attempting their own abortion or for helping others. In Northern Ireland, the maximum sentence is life imprisonment, the harshest criminal penalty in Europe. The criminal penalty for having an abortion outside of the law in Ireland is 14 years in prison.

For decades, Irish and Northern Irish women have traveled abroad to access abortion services. But more recently, women in Ireland and Northern Ireland have had another option: medical abortion they can perform at home using pills provided by online telemedicine services.

Researchers from The University of Texas at Austin and Princeton University analyzed six years of data from Irish and Northern Irish women who requested and accessed abortion pills using the online telemedicine service Women on Web (WoW). The aim of the study was to learn about who requests and accesses abortion using online services and their experiences both with their unwanted pregnancies and their abortions.

Key Findings

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Exhibit 1. The number of Irish and Northern Irish women contacting WoW to request abortion has increased over time. In 2010, 548 women contacted WoW seeking abortion. By 2015, this number had more than doubled to 1,438. By contrast, the number of women traveling to get abortions abroad decreased. Between January 2010 and December 2015, 5,650 women contacted WoW to request abortion.

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Exhibit 2. Irish and Northern Irish women seeking abortion from WoW come from all sectors of society. They are married mothers who feel their families are complete; young women with dreams of completing their education; single mothers working hard to make ends meet; migrant workers starting new lives; and survivors of rape and sexual violence. Many women reported experiencing some degree of financial hardship and were unable to travel to abroad to access abortion care, while 35% reported difficulty with finding money to make a donation to the WoW service.


feelings bar graph


Exhibit 3. Women who had an abortion using pills with support from WoW had overwhelmingly positive experiences. The vast majority of women were grateful for the option of abortion at home using online telemedicine (94%), felt it was the right choice for them (97%), and would recommend it to other women in a similar situation (98%).


feelings complete bar graph


Exhibit 4. Many women experienced a mix of feelings after their abortion. By far the most common was relief, followed by satisfaction, and happiness. (Percentages do not sum to 100 because women could report more than one feeling.)


  • “I am extremely grateful this service exists. Ireland's Anti-Choice agenda puts women's lives in danger everyday and it is so appreciated to have control over my health and my life put back in my hands.”
  • “I felt incredibly grateful to have this service, which greatly dissipated my previous anger and rage at the inequitable rights of women in Northern Ireland. My rights, as a women are greatly impeded by my local government…the restriction of abortion in this country can lead to overwhelming distress, depression, despair. In that respect the law is a brutality against women.”
  • I am very grateful to have found this service but I am saddened that women have to dig around for this information feeling alone and scared. Doctors should be able to give women this information.”

Exhibit 5. By far the most negative experience of women who had an abortion at home using WoW was the need to maintain secrecy and silence because of Ireland and Northern Ireland’s existing abortion laws. One quarter reported lacking social or emotional support from friends or family. Women expressed anger and disappointment at the “shame and disgrace” and “stigma attached to abortion” caused by its current illegal status, and the government’s treatment of women as “stupid, second-class citizens.”


  • “I am so very grateful. You saved me from shame and disgrace because of my pregnancy and also possible death because I would have tried something unsafe if I could not find help.”
  • “Thank you so much for your help. I know that I would have took my own life if I had never got your help. Because of you I am thankful to be in a happy place in my mind and life.”
  • “My life was in a mess because of my unwanted pregnancy and now I have been able to find a job and am getting back on track. I can’t thank you enough. My life would have been destroyed if I had to go through with the pregnancy.”

Exhibit 6. The consequences of being forced to continue an unwanted pregnancy because safe abortion is not supported by the law can be severe. Women described their experience of unwanted pregnancies as severe psychological suffering. Many described access to abortion through WoW as “literally lifesaving.”

Policy Recommendations

An increasing number of Irish and Northern Irish women from all sectors of society have abortions at home using pills obtained through online telemedicine. These women provide first-hand evidence of the essential public-health role played by the ability to choose abortion. They also express overwhelming confidence in their choices. The only aspects of the abortion experience women do not find positive are the silence, fear and secrecy caused by the illegal status and stigma surrounding abortion.  In light of this evidence, the governments of Ireland and Northern Ireland must:

  • Recognize that despite current restrictive laws, abortion is inevitable and normal.
  • Recognize that abortion is health-promoting for women who would otherwise be forced to carry unwanted pregnancies to term.
  • End the double standard of criminalizing poor women who cannot afford to travel abroad for an abortion.
  • Change current laws to allow women to obtain safe, legal abortion through the Irish and Northern Irish healthcare systems.

Study Design and Methods

This study included both a quantitative and qualitative component using anonymized data provided by WoW. The quantitative component included analysis of the characteristics of 5,650 Irish and Northern Irish women who contacted WoW seeking abortion between 2010 and 2015. These data were collected using the consultation forms women fill out when requesting an abortion. The quantitative component also included analysis of the experiences of 1,023 women who completed an abortion between 2010 and 2012. These data were collected using the evaluation forms women are asked to fill out after their abortion. Follow-up information was available for 72% of women to whom abortion pills were shipped. In the context of previous studies examining post-abortion outcomes, 72% represents high follow-up. The qualitative component of this study included a content analysis of emails from Irish and Northern Irish women who received abortion pills through WoW between 2010 and 2012.

Reference

Aiken, A. R. A., Gomperts, R., & Trussell, J. (2016). Experiences and characteristics of women seeking and completing at-home medical termination of pregnancy through online telemedicine in Ireland and Northern Ireland: A population-based analysis. British Journal of Obstetrics & Gynaecology.

Suggested Citation

Aiken, A. R. A. (2016). Irish and Northern Irish women’s experiences with at-home medical abortion using online telemedicine. PRC Research Brief, 1(5). doi: 10.15781/T2B853P3G

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