Ireland's Abortion Vote Topples 150 Years of Restriction

Tara Haelle

May 29, 2018

With Ireland's recent referendum on abortion poised to topple 150 years of restriction on nearly all abortions, eyes are now on Northern Ireland, where terminating a pregnancy isn't permitted, even though the region is part of the United Kingdom and women can travel to get publicly funded procedures.

In the United States, a patchwork of evolving state abortion regulations has healthcare providers' heads spinning as they navigate the fast pace of change.

Several sessions at the recent American College of Obstetricians and Gynecologists 2018 Annual Meeting in Austin, Texas, focused on ways obstetrician–gynecologists can keep up with changes to abortion laws and help their patients navigate them.

We as obstetrician–gynecologists can make a tremendous difference in our patients' lives even if we ourselves don't provide abortion services.

"Onerous regulations happening throughout the US are only increasing and prohibiting women's access to abortion, or at least presenting incredible obstacles," said Maureen Paul, MD, from Beth Israel Deaconess Medical Center in Boston. "We, as obstetrician–gynecologists, can make a tremendous difference in our patients' lives even if we ourselves don't provide abortion services," she told Medscape Medical News.

But the presence of the American Association of ProLife OB/GYNS (AAPLOG) booth in the conference exhibition hall was a reminder that even within the medical community, opinions on abortion diverge widely.

The stated purpose of the prolife organization — which has approximately 2500 members who are board-certified obstetrician–gynecologists — is "to reaffirm the unique value and dignity of individual human life in all stages of growth and development from fertilization onward."

"Studies have shown that 85% of practicing obstetrician–gynecologists do not perform elective abortion in their practices," said Donna Harrison, MD, executive director of the AAPLOG.

"There is no medical need to perform an elective abortion to save the life of a woman," Harrison explained. "And the body of laws surrounding abortion provision has arisen to protect women from the abusive practices of abortion providers who do not provide standard informed consent, do not have adequate abortion facilities, and do not provide standard coverage for complications."

Given the shifting landscape of abortion laws, it is more important than ever that healthcare providers know the laws in their own and surrounding regions and are aware of the resources available that can help them advise and refer patients, said Paul.

Resources for Physicians

Resources available to obstetrician–gynecologists are keeping up with these laws, said Talcott Camp, JD, a lawyer with the Reproductive Freedom Project at the American Civil Liberties Union (ACLU). These include the legal counsel at medical centers, the Guttmacher Institute, ACLU state offices, and national legal organizations such as the Center for Reproductive Rights.

"It's not as simple as saying, 'I'm going to refer this patient to this provider'," Paul told Medscape Medical News. "You really have to be aware of the restrictions in your state and in surrounding areas."

For women seeking an abortion, there can be difficulties related to finding a provider and a supportive hospital system, making arrangements for the procedure, and the often confusing presence of crisis pregnancy centers, which can be "quite a traumatic experience" for some patients, Paul pointed out.

"People in the Midwest have to travel the farthest, but people in the South have to travel far, too," she explained.

Physicians must consider the specific situation of each patient. In addition to resources to help with referrals, funding assistance is also available. "By asking the right questions, you can be sure you're sending a woman to the right place," Paul said.

Paul and Camp have disclosed no relevant financial relationships.

American College of Obstetricians and Gynecologists (ACOG) 2018 Annual Meeting. Presented April 28, 2018.

Follow Medscape OBGYN on Twitter @MedscapeObGyn and Tara Haelle @TaraHaelle