The Right to Travel for Abortion Services: A Case Study in Irish 'Cross-border Reproductive Care'

A County Hospital Experience with Reproductive Travelers to the United States for Obstetric Care: Maternal and Neonatal Outcomes

Objective: To describe the maternal and neonatal outcomes, health care utilization, and cost to reproductive travelers for obstetric care (RTOC) at a single institution. Methods: A retrospective chart review was conducted of women identified as reproductive travelers who delivered at Stroger Hospital in Chicago, IL when a self-pay package of obstetrical services was offered. Data included maternal characteristics and obstetric and neonatal outcomes. Results: A total of 413 reproductive travelers delivered during the study period. The majority (88%) was of Nigerian citizenship. The median gestational age at first prenatal visit was 35 weeks with a median of three prenatal visits. The patients were in good health with a high prevalence of infectious disease and a low prevalence of chronic disease. Women had complex obstetric histories, and 28.6% had cesarean delivery, with the most common indication being prior uterine surgery. Severe maternal morbidity occurred in 4.1% of the women and admission to the neonatal intensive care unit (NICU) in 16.3% of the babies. Extra charges beyond those covered by the financial package were incurred by 230 (55.7%) of the women. Conclusion: Reproductive travelers have better obstetric outcomes and fewer NICU admissions than non-travelers who delivered at the same institution. However, the care of RTOC in this manner is fraught with challenges, including late presentation for care, lack of medical records, providers at times managing unfamiliar conditions, and unforeseen financial obligations assumed by patients.

Experiences of women in Ireland who accessed abortion by travelling abroad or by using abortion medication at home: a qualitative study

BACKGROUND

The Republic of Ireland has one of the world's most restrictive abortion laws, allowing abortion only to preserve a pregnant woman's life. We examined the impact of the law on women's options for accessing abortion, their decision-making regarding whichpathway to follow, and their experiences with their chosen approach.

METHODS

We conducted semi-structured in-depth interviews with 38 women who had either travelled abroad to access abortion in a clinic or had self-managed a medical abortion at home using online telemedicine, between 2010 and 2017. We coded interview transcripts according to an iteratively developed coding guide and performed a thematic analysis to identify key themes.

RESULTS

We identified four key themes: (1) self-managing a medical abortion at home using online telemedicine can be a preference over travelling abroad to access abortion services; (2) regardless of the pathway chosen, women experience a lack of pre- and post-abortion support in the Irish healthcare system; (3) feelings of desperation while searching for safe abortion care can lead to considering or attempting dangerous methods; and (4) Irish abortion law and attitudes have impacts beyond physical health considerations, engendering shame and stigma.

CONCLUSIONS

Despite the country's restrictive abortion law, women in Ireland do obtain abortions, using methods that are legal and safe elsewhere. However, the law negatively impacts women's ability to discuss their options with their healthcare professionals and to seek follow-up care, and can have serious implications for their physical and emotional health. This study's findings provide evidence to inform public and policy discourse on Ireland's abortion laws.