These are worrying times for abortion rights activists around the world. To date, eight US States have passed laws which restrict the circumstances in which abortion is allowed. A draconian bill was passed in Alabama last week – which amounts to an almost outright ban on abortion. Even that, however, is less severe than the system currently in place in Northern Ireland.

In comparison, Ireland can look like a beacon of hope for abortion rights after the historic success of the Repeal campaign last year.

“Within six months of the law being introduced, abortion services are actually being implemented,” academic, activist and Together for Yes co-Director Ailbhe Smyth tells us. “I can’t stress enough just how important it is that the service has been made free for everyone across the country. It’s one of the most positive things we’ve seen in our healthcare system in years.”

“It has settled remarkably quickly,” notes Dr Caitriona Henchion of the IFPA. “One of the main issues is the link between primary and secondary care, because it is not an ‘emergency room’ issue, but there is still a degree of urgency. By and large, for Dublin that is resolved – we have very good links with the hospitals. But there are parts of the country that don’t have that level of service. And there are places that have little or no service at all.”

Around the country, out of our 19 maternity hospitals, as yet, only 10 are offering the full range of abortion services.

“Women living in places like Donegal, Leitrim or Roscommon could be a serious distance away from a hospital,” Smyth argues. “It’s very important that those remaining nine hospitals get their training completed, and resolve whatever problems they have.”

The need for the best possible healthcare for women is underlined by the sad case of a woman, who had an abortion at the National Maternity Hospital, following a scan which indicated a fatal foetal anomaly – with a second test apparently contradicting the original finding.

“Quite clearly this is very distressing and painful for the couple,” Ailbhe Smyth says. “It is totally understandable that they are absolutely bereft. But the situation, as I understand it, is that Holles Street is conducting its own investigation into the precise nature of the incident. Similarly the Minister for Health said he felt that an external review of the case would be appropriate, and I would support that.

“Without commenting on the case itself, it does bring into public prominence again that it’s so important in all cases involving a pregnancy that women should receive really accurate information; and it is particularly sensitive obviously in the case of fatal foetal anomalies.”

There are currently fewer than 320 GPs signed up to carry out abortion services. For many GPs, there is the constant fear of protests or even attacks by anti-achoice groups.

“Legislation for safe access zones is so important,” Ailbhe Smyth says. “It can be a very obvious deterrent for the anti-abortion groups, who want to stand in women’s way to make them change their minds. This is the only area of health in which this happens, and it can’t be allowed. While we haven’t seen a repeat of the highly visible attacks that occurred in the first week of January, there have been isolated incidents.”

The mandatory three-day waiting period for terminations is also a serious concern.

“The problem with the three-day wait is that there is no leeway,” states Dr Henchion. “There is no discretion, even when it makes things very difficult for women. For some it is two days they have to take off work – plus possibly a third, if they are in pain after the medication.”

“The three-day wait was a political decision. There’s absolutely no need for it,” Smyth says. “It places an undue burden on women in disadvantaged or vulnerable circumstances, as they have to transport themselves to their GP on a number of occasions in order to have an abortion. Not every woman has the money or the ability to go to the GP and come back again three days later. The fear is that women will miss their timeframe for an abortion as a result.”

A full review of the legislation will not be carried out until 2022, after services have been running for three years–but Smyth believes some concerns can be addressed more immediately.

“It’s very important for the Minister for Health to track aspects of the act which can be clarified now,” she says. “I suspect we’ll have to wait until the full-scale legislative review before anything is done about the three-day waiting period, but there are many more specific problems that can be cleared up in the meantime.”

“One of my main concerns,” adds Dr Henchion, “is with the 1% or 2% of cases in which the abortion medication does not end the pregnancy and harmful effects can occur. If you have seen someone at nine weeks, the follow-up is two weeks later. If the medications have failed, you have five days to get them a hospital space which is hugely challenging.”

The lack of availability of free contraception is another major issue.

“It is really important that it doesn’t just get forgotten,” Dr Henchion urges. “It would be gravely wrong if we continue to provide abortion but only contraception if you can afford it or if you have a medical card.”