Experiences of the Irish model of community medical abortion: adherence to self-managed, people-centred abortion care

Abstract

ABSTRACT The Irish abortion model of care, implemented in January 2019, is distinctive for being located primarily in the community and relying principally on medical abortion outside a clinical setting. The model facilitated mapping onto existing healthcare structures and thereby allowed abortion provision to commence quickly after Repeal of the 8th Amendment. This article considers the operation of the Irish model of abortion care under 12 weeks gestation which has been characterised as a community medical abortion model. It draws on data gathered through 46 in-depth interviews with people accessing abortion care under twelve weeks gestation between December 2019 and April 2021. These qualitative accounts of experiences of first-trimester abortion care portray what the Irish model of care entails in practice from the abortion seeker perspective. The community model of medical abortion is portrayed as involving a hybrid of self-managing abortion outside of clinical settings in the context of legally regulated provision of medication delivered through a network of community-based primary care doctors. The Irish model of care anticipated a significant shift in how self-management of medical abortion is viewed by the World Health Organization whose 2022 updated abortion guidelines included self-management of medical abortion for the first time as a fully recommended model of abortion care. The paper considers how the Irish model of community medical abortion relates to self-managed and people-centred abortion care and whether this hybrid model facilitates or circumscribes these features.