Periodic Reporting for period 4 - BAR2LEGAB (Women travelling to seek abortion care in Europe: the impact of barriers to legal abortion on women living in countries with ostensibly liberal abortion laws)
Okres sprawozdawczy: 2021-04-01 do 2022-08-31
In most European countries, abortion is legal on request or on broad grounds. However, it remains restricted due to legal limits beyond the 1st trimester of pregnancy, mandatory waiting periods/counselling, and shortages of providers offering abortion due to insufficient training or conscientious refusal of care. These barriers may lead women and pregnant people to seek abortion illegally, or travel far from their area of residence to access the service elsewhere. This issue is of great significance in the EU debates about the long-term vision of health and social policy in Europe, individuals’ rights to access to reproductive health, and health professionals’ right to conscientiously refuse the service.
Almost no study exists on abortion travel and illegal abortion in countries where abortion is legal. Estimates on the number of illegal abortions in some countries exist (e.g. Italy), and some data exist on cross-border abortion travels in Europe, especially from the Republic of Ireland (before 2018 legalisation) and from countries with legal abortion (France, Germany, Belgium, and Italy) to England and the Netherlands. In some countries (Italy, Spain, France) existing data show that pregnant people also travel from one province/region to another to seek care.
The present research project, which was conducted from October 2016 to August 2022, aimed to collect and analyse quantitative and qualitative data, and to merge epistemological and public health approaches with an anthropological one to deepen the understanding of pregnant people's experiences with barriers to legal abortion and with abortion travel. Its main objectives were: 1) to provide extensive data on the legal, procedural, and social barriers that pregnant people face in countries with legal abortion and assess which ones lead them to travel within national borders or across borders; 2) to explore their experiences with abortion seeking, attempts to self-manage abortion, travel, and their perspectives on abortion laws; 3) to assess if and how specific barriers to legal abortion affect gestational age (GA) at termination, delaying access to care, which can imperil pregnant people’s reproductive health.
Almost no study exists on abortion travel and illegal abortion in countries where abortion is legal. Estimates on the number of illegal abortions in some countries exist (e.g. Italy), and some data exist on cross-border abortion travels in Europe, especially from the Republic of Ireland (before 2018 legalisation) and from countries with legal abortion (France, Germany, Belgium, and Italy) to England and the Netherlands. In some countries (Italy, Spain, France) existing data show that pregnant people also travel from one province/region to another to seek care.
The present research project, which was conducted from October 2016 to August 2022, aimed to collect and analyse quantitative and qualitative data, and to merge epistemological and public health approaches with an anthropological one to deepen the understanding of pregnant people's experiences with barriers to legal abortion and with abortion travel. Its main objectives were: 1) to provide extensive data on the legal, procedural, and social barriers that pregnant people face in countries with legal abortion and assess which ones lead them to travel within national borders or across borders; 2) to explore their experiences with abortion seeking, attempts to self-manage abortion, travel, and their perspectives on abortion laws; 3) to assess if and how specific barriers to legal abortion affect gestational age (GA) at termination, delaying access to care, which can imperil pregnant people’s reproductive health.
The first data collection phase (2017-2019) examined the phenomenon of cross-border abortion travel. We collected 291 surveys and 61 in-depth interviews (IDIs) with pregnant people traveling mainly from European countries where abortion is legal (e.g. Germany, France, and Italy) to clinics in the UK, the Netherlands, and Spain. We also recruited a sub-sample of people from countries with restrictive abortion laws (Republic of Ireland before the 2018 law change, Poland, Malta) for comparison. For the second phase on barriers to access and in-country abortion travel, first (2017-2019) we collected 174 surveys and 51 IDIs in Spain. Then (2019-2022) we collected data also in Italy and France. Despite the pandemic, which interrupted the project and prevented us from collecting data in some locations, in France we collected 172 surveys and 39 IDIs, and in Italy 156 surveys and 93 IDIs. Finally, we also interviewed prominent abortion providers and key informants (experts and advocates for abortion rights) in all the countries involved in the project.
We presented our study results at national and international scientific conferences organized by important organisations, such as FIAPAC (International Federation of Professional Abortion and Contraception Associates), EASA (European Association of Social Anthropology), AAA (American Anthropological Association), ECPG (European Conference of Politics and Gender), and SMA (Society for Medical Anthropology). We also presented our findings at meetings organized by major international organisations, such as the International Planned Parenthood Federation - European Network, and the World Health Organization. Simultaneously, the PI and the team published eight articles based on the study’s results in important international public health, gynaecology, anthropology and gender studies journals, including BJOG. An International journal of Obstetrics and Gynaecology Reproductive Health, and Medical Anthropology Quarterly.
Our results show that abortion travel is a significant phenomenon in Europe and the search for care can be very difficult despite “relatively liberal” abortion laws. Women and pregnant people face a number of legal, procedural, and social barriers in abortion access in countries with legal abortion, which may lead to exceeding the GA limits, forcing them to travel abroad. This is the first study showing that GA limits are the main reason why thousands of pregnant people travel cross-border from countries with legal abortion. It also shows that GA limits delay access to care, creating potential risks to pregnant people’s health. Some participants tried to self-manage abortion prior to traveling, using unsafe methods (e.g. hitting their abdomen), which shows that GA limits can potentially harm pregnant people’s health. This study also shows that abortion travel, especially cross-border travels, pose many hardships, including economic burdens of travel and the care abroad. Furthermore, our results highlight the importance of key social agents for overcoming these barriers (e.g. family planning organizations, pro-choice websites, health professionals). Finally, our study raises questions about the impact of fragmented European abortion policies, which are deemed “liberal”, while they are actually restrictive, in exacerbating inequalities, and the meanings of “safe” / “legal” abortion when travel is necessary. We are publishing the results on the project’s website, which is a major dissemination tool to a wide audience, and an information hub for individuals seeking abortion care in Europe.
We presented our study results at national and international scientific conferences organized by important organisations, such as FIAPAC (International Federation of Professional Abortion and Contraception Associates), EASA (European Association of Social Anthropology), AAA (American Anthropological Association), ECPG (European Conference of Politics and Gender), and SMA (Society for Medical Anthropology). We also presented our findings at meetings organized by major international organisations, such as the International Planned Parenthood Federation - European Network, and the World Health Organization. Simultaneously, the PI and the team published eight articles based on the study’s results in important international public health, gynaecology, anthropology and gender studies journals, including BJOG. An International journal of Obstetrics and Gynaecology Reproductive Health, and Medical Anthropology Quarterly.
Our results show that abortion travel is a significant phenomenon in Europe and the search for care can be very difficult despite “relatively liberal” abortion laws. Women and pregnant people face a number of legal, procedural, and social barriers in abortion access in countries with legal abortion, which may lead to exceeding the GA limits, forcing them to travel abroad. This is the first study showing that GA limits are the main reason why thousands of pregnant people travel cross-border from countries with legal abortion. It also shows that GA limits delay access to care, creating potential risks to pregnant people’s health. Some participants tried to self-manage abortion prior to traveling, using unsafe methods (e.g. hitting their abdomen), which shows that GA limits can potentially harm pregnant people’s health. This study also shows that abortion travel, especially cross-border travels, pose many hardships, including economic burdens of travel and the care abroad. Furthermore, our results highlight the importance of key social agents for overcoming these barriers (e.g. family planning organizations, pro-choice websites, health professionals). Finally, our study raises questions about the impact of fragmented European abortion policies, which are deemed “liberal”, while they are actually restrictive, in exacerbating inequalities, and the meanings of “safe” / “legal” abortion when travel is necessary. We are publishing the results on the project’s website, which is a major dissemination tool to a wide audience, and an information hub for individuals seeking abortion care in Europe.
This mixed-methods multi-disciplinary research project is a ground-breaking investigation that provides new data on an understudied topic, therefore poorly understood by European policy makers, despite its academic, public health, legal, and human rights relevance. It thus fills a significant gap in the existing literature and contributes to current debates beyond academia, including national/international debates on human rights, reproductive governance and justice. The WHO invited us to discuss our study results in June 2019, while it was elaborating the new “Abortion care guideline” (2022), which recommends removing regulations such as GA limits, mandatory waiting periods and counseling from abortion laws. Between 2020 and 2021 the PI and her team were invited to participate in the French scientific and political debate on the extension of gestational age (GA) limits and to present the study findings at numerous meetings, including with the French Ministry of Health, and the National Ethics Committee, which recommended the government to support the GA extension in a report that included our study results (https://www.ccne-ethique.fr/fr/actualites/opinion-du-ccne-sur-lallongement-du-delai-legal-dacces-livg-de-12-14-semaines-de). GA limits were finally extended in France in March 2022. The active participation of the PI and her team in national and international debates on reproductive health and rights shows the international impact of this study in the domain of public health and human rights. With further upcoming publications, we expect continued impact of our research on these debates, and on reproductive policy decisions in Europe.