The woman is the active agent: General practitioners and the agentive displacement of abortion in Ireland

Summary

When abortion is performed via medication rather than a procedure, doctors feel differently about their role in the process

Abstract

After the legalization of abortion in 2018, Ireland needed clinicians to become abortion providers and make this political win a medical reality. Yet Irish doctors had next-to-no training in abortion care, and barriers ranging from stigma to economic pressures in the healthcare system impacted doctors’ desire to volunteer. How did hundreds of Irish doctors make the shift from family doctor to abortion provider? Drawing on ethnographic research conducted between 2017 and 2020, this article explores the process by which Irish general practitioners became abortion providers, attending to the material impact of medical technologies on that journey. Drawing from medical anthropologists who have examined similar themes of agency, pharmaceuticals, and medico-legal frameworks within the topic of assisted dying, I build on Anita Hannig's idea of “agentive displacement” to frame the productive impact of abortion pills on this transition.

Main research questions 

1. When a country legalizes a previously unavailable and stigmatized medical procedure, how do they get their doctors to opt in to become providers?
2. How is a medical procedure different when it is a pill vs. a procedure?

What was already known?

As of 2020, over 50% of all abortions in the United States used medication, and that number continues to climb. In Ireland after legalization of abortion, estimates indicate over 98% of legal abortions took place in the first 12 weeks, where abortions are always done using pills unless there are medical reasons a patient cannot use them (see HSE, 2022). When medical processes that once required physical interactions now include pills that work with or without a provider's intervention, the roles and perception of responsibility of those involved change. For example, with the introduction of pre-exposure prophylaxis (PrEP) for HIV prevention, the focus on behavioral interventions (i.e., condom use) shifted to include the role of a medication, distributing the responsibility of “safe-sex” from the individuals to the individual, their provider, and their pills (Thomann, 2018). It required potential PrEP patients to think of themselves as people perpetually “at-risk” due to their behaviors and desires, rather than people who sometimes engage in a behavior that is defined as “risky” (Brisson, 2017). While research on pharmaceuticals and subjectivity have often focused on this impact on patients, I hypothesized that these shifts also affected how medical professionals perceive their role in the provision of care.

Novel methodology 

Ethnographic research and interviews with doctors

Implications for society

Relevant to on-going debates about abortion in the U.S., where medication abortion now makes up over 50% of abortions and where access to these very medications is now under threat.

Implications for research

One silver lining to the threat against medication abortion in the U.S. is that more people are paying attention to it. More research is now being done on the social implications of medical practices, for example, people who access medication outside of the formal healthcare system.

Funding 

NSF 1947249