Abortion policy implementation in Ireland: Lessons from the community model of care.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2022
2022
Historique:
received:
30
06
2021
accepted:
11
02
2022
entrez:
9
5
2022
pubmed:
10
5
2022
medline:
12
5
2022
Statut:
epublish
Résumé
In 2018, the right to lawful abortion in the Republic of Ireland significantly expanded, and service provision commenced on 1 January, 2019. Community provision of early medical abortion to 9 weeks plus 6 days gestation delivered by General Practitioners constitutes the backbone of the Irish abortion policy implementation. We conducted a study in 2020-2021 to examine the barriers and facilitators of the Irish abortion policy implementation. We collected data using qualitative in-depth interviews (IDIs) which were conducted in-person or remotely. We coded and analysed interview transcripts following the grounded theory approach. We collected 108 IDIs in Ireland from May 2020 to March 2021. This article draws on 79 IDIs with three participant samples directly relevant to the community model of care: (a) 27 key informants involved in the abortion policy development and implementation representing government healthcare administration, medical professionals, and advocacy organisations, (b) 22 healthcare providers involved in abortion provision in community settings, and (c) 30 service users who sought abortion services in 2020. Facilitators of community-based abortion provision have been: a collaborative approach between the Irish government and the medical community to develop the model of care, and strong support systems for providers. The MyOptions helpline for service users is a successful national referral model. The main barriers to provision are the mandatory 3-day wait, unclear or slow referral pathways from primary to hospital care, barriers for migrants, and a shortage and incomplete geographic distribution of providers, especially in rural areas. We conclude that access to abortion care in Ireland has been greatly expanded since the policy implementation in 2019. The community delivery of care and the national helpline constitute key features of the Irish abortion policy implementation that could be duplicated in other contexts and countries. Several challenges to full abortion policy implementation remain.
Sections du résumé
BACKGROUND
In 2018, the right to lawful abortion in the Republic of Ireland significantly expanded, and service provision commenced on 1 January, 2019. Community provision of early medical abortion to 9 weeks plus 6 days gestation delivered by General Practitioners constitutes the backbone of the Irish abortion policy implementation. We conducted a study in 2020-2021 to examine the barriers and facilitators of the Irish abortion policy implementation.
METHODS
We collected data using qualitative in-depth interviews (IDIs) which were conducted in-person or remotely. We coded and analysed interview transcripts following the grounded theory approach.
RESULTS
We collected 108 IDIs in Ireland from May 2020 to March 2021. This article draws on 79 IDIs with three participant samples directly relevant to the community model of care: (a) 27 key informants involved in the abortion policy development and implementation representing government healthcare administration, medical professionals, and advocacy organisations, (b) 22 healthcare providers involved in abortion provision in community settings, and (c) 30 service users who sought abortion services in 2020. Facilitators of community-based abortion provision have been: a collaborative approach between the Irish government and the medical community to develop the model of care, and strong support systems for providers. The MyOptions helpline for service users is a successful national referral model. The main barriers to provision are the mandatory 3-day wait, unclear or slow referral pathways from primary to hospital care, barriers for migrants, and a shortage and incomplete geographic distribution of providers, especially in rural areas.
CONCLUSIONS
We conclude that access to abortion care in Ireland has been greatly expanded since the policy implementation in 2019. The community delivery of care and the national helpline constitute key features of the Irish abortion policy implementation that could be duplicated in other contexts and countries. Several challenges to full abortion policy implementation remain.
Identifiants
pubmed: 35533193
doi: 10.1371/journal.pone.0264494
pii: PONE-D-21-21367
pmc: PMC9084516
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0264494Subventions
Organisme : World Health Organization
ID : 001
Pays : International
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Best Pract Res Clin Obstet Gynaecol. 2020 Jan;62:11-24
pubmed: 31230835
Sex Reprod Health Matters. 2021 Dec;29(1):1907027
pubmed: 33910479
Int J Gynaecol Obstet. 2018 Oct;143 Suppl 4:3-11
pubmed: 30374987
BMC Fam Pract. 2021 Feb 20;22(1):40
pubmed: 33610171
Contraception. 2021 Oct;104(4):414-419
pubmed: 33864811
Matern Child Health J. 2012 Jan;16(1):212-6
pubmed: 21107667
Health Hum Rights. 2019 Dec;21(2):109-120
pubmed: 31885441
Br J Gen Pract. 2020 Jun 25;70(696):e489-e496
pubmed: 32482628
Int J Equity Health. 2018 Nov 21;17(1):172
pubmed: 30463561
Eur J Gen Pract. 2012 Sep;18(3):136-42
pubmed: 22954192
Aust N Z J Obstet Gynaecol. 2016 Dec;56(6):648-654
pubmed: 27440477
Sex Reprod Health Matters. 2019 Nov;27(3):1686197
pubmed: 31823693
Contraception. 2021 Nov;104(5):502-505
pubmed: 34118270
Qual Quant. 2018;52(4):1893-1907
pubmed: 29937585
Acad Med. 2014 Sep;89(9):1245-51
pubmed: 24979285
Global Health. 2020 Sep 30;16(1):91
pubmed: 32993694