Emily had an abortion last year at her home in Dublin. Her mother was with her, and a neighbour, who is a healthcare professional, helped to ease the stress by giving her Xanax.
Neither knew that Emily, who is 20, had induced what happened. She had imported the medication to do so from a website in the Netherlands.
“It was intensely painful,” she says, “with waves of pain coming in cycles every few seconds. I was lying in bed, getting up and walking, sitting down, waiting for it to pass. The pain was definitely worse than I expected. There was a lot of blood, and then, after about five hours, there was one final wave of pain. I could sense it was over, and I had this sense of relaxation come over me. It was relief that it was over. I felt, ‘It’s done.’ ”
And through all the pain, she says, on her mind constantly was the fact that what she was doing was against the law.
“That added to the stress, this fact that what you’re doing is technically illegal. There’s so much going on in your head. You’re scared anyway about what’s happening, and then you’re scared of breaking the law, all coupled with the pain.”
Emily is not her real name. She had wanted to use her name, and was willing to be photographed for this article, “happy and sure” that her decision to terminate her pregnancy was right for her, and ready to contribute to the “destigmatising” of the issue by talking frankly about it.
But given the possibility of her being arrested and facing 14 years in prison for importing and taking abortifacient medication, it was agreed that The Irish Times would protect her identity.
Emily tells how, when she found out that she was “two to three weeks” pregnant last year, there was never any question but that she would terminate.
She had been going out with her boyfriend for 18 months; fearing that he would pressure her to continue the pregnancy, she did not tell him about it. They are no longer together.
She lives at home with her mother.
‘It’s expensive, but cheaper than travelling’
“I was working part time and trying to get college projects finished. The thought of having a child on a meagre wage, living in an apartment I share with my mother . . . I wouldn’t be able to finish my education or look for work. What kind of start would that be for a baby?”
She had heard of a Netherlands-based NGO that posts abortion pills to women all over the world; she looked it up, then filled in its medical consultation form at home, on her laptop.
The site says that the pills cannot be posted to the Republic of Ireland but can be sent to Northern Ireland.
Emily paid €90 by PayPal – "It's not cheap, but it is a lot less than travelling for an abortion" – and arranged to have the drugs delivered to the Co Antrim depot of Parcel Motel, the north-south delivery service, and from there to a collection kiosk near her home.
Although Parcel Motel’s website says it cannot accept “controlled substances or illegal drugs”, Emily’s parcel made it to Dublin about a fortnight after she ordered it.
“I was sure ‘someone knows’, that there were going to be guards. I was certain something was going to happen. But it didn’t.”
The pills – mifepristone, or RU-486, and misoprostol – came in “a tiny cardboard box”. There was no indication of what it contained. “It could have been a DVD or a small box of jewellery” – although there was a return address in the Netherlands, she thinks.
She says she waited a couple of days before taking the drugs. The first, mifepristone, works by blocking progesterone, the hormone necessary to maintain a pregnancy. The second, misoprostol, she took about 48 hours later, she says, as she boarded a bus home from the city centre. It works by bringing on contractions, which induce the abortion.
After taking the first tablets, bleeding typically starts, and more heavily than in a normal period. It is usually accompanied by painful cramps and nausea, and sometimes by vomiting.
‘Like being punched in the stomach’
Although illegal here, except under medical supervision when a pregnancy threatens a woman’s life, mifepristone and misoprostol are widely and safely used in other jurisdictions to terminate pregnancies up to nine weeks.
But the State agency responsible for regulating medicines, the Health Products Product Regulatory Authority, sounds a warning about the purchase and use of such pills in Ireland.
“The authority is concerned at the supply of potent prescription medicines without adequate healthcare safeguards. It is also concerned for the medical wellbeing of any woman who uses these potent medicines without appropriate medical care and supervision,” it says.
The Health Products Regulatory Authority – formerly the Irish Medicines Board – says it strongly advises people not to take any medicines from unauthorised sources, including websites.
It adds, “The approach of the HPRA is to focus on those persons who illegally supply unauthorised medicines rather than on the vulnerable people who are at risk from any adverse effects of these medicines.”
When the authority discovers abortifacient pills in the post, it contacts the addressee, to tell them that the pills have been seized and why.
Emily expected to get home before the cramps started. “They give you a fact sheet of what to expect. But after about half an hour I felt like I was being punched repeatedly in the stomach. When we got to my stop I was sweating. I got off and vomited, and called my mother and told her I was having a really bad period and could she have the door open for me.”
She vomited again when she got home; the “pain was coming every few seconds”.
Her mother, concerned, suggested that they go to hospital. She called her neighbour, who helped with pain relief, but in the end the abortion was completed without Emily’s having to admit what was happening.
The bleeding lasted for about two more weeks, after which, she says, she was back to normal. Emily did not seek follow-up medical advice, “mainly for fear of my doctor knowing something was awry. After the abortion I actually felt okay – nothing out of the ordinary that hadn’t been outlined.”
A few weeks later, however, Emily’s mother found her bank statements, which included the PayPal transfer.
“She was upset I had not trusted her. I wish I had been brave enough to tell her. It took a couple of months for us to build up trust again. We talk a lot about it now, and she supports me talking to a journalist about it. She agrees it shouldn’t be something we’re afraid to talk about.”
‘A truly global phenomenon’
Emily is one of tens of thousands of Irish women whose experience of abortion remains hidden, as they procure their terminations by subterfuge or illegally.
Of those who travel abroad for abortions, England remains the most common destination, although, as Alison Begas of the Well Woman clinics puts it, Irish abortion now is a "truly global phenomenon".
Irish women are also travelling to the Netherlands, Spain, Scandinavia, the United States, Canada and even India and Africa.
The numbers giving Irish addresses at British and Dutch clinics are falling, although more than 10 women still go there every day.
The numbers in Britain have fallen from a high of 6,673, in 2001, to 3,679 in 2013. They increased slightly last year, to 3,735, according to the British Office for National Statistics.
In the seven years from 2006, almost 1,500 women gave Irish addresses to Dutch abortion clinics, according to the HSE Sexual Health and Crisis Pregnancy Programme. Again, the annual figures are falling: from 461 in 2006 to just 12 in 2013, with a total of 1,497 in the seven years.
Research by the British Pregnancy Advisory Service, a provider of abortions in Britain, found that almost 20 per cent of women who had abortions in England last year were married. Another 47 per cent were in relationships and unmarried.
Ninety per cent were aged between 10 and 39; more than two-thirds of the abortions took place between three and nine weeks’ gestation, and a further 16 per cent between nine and 12 weeks. About half of the women having abortions had used contraception that failed.
In contrast to those travelling, the numbers inducing at home may be increasing. The Health Products Regulatory Authority, working with Customs officials, seized 28 packages, containing 635 tablets, in 2011.
By last year the numbers had almost doubled, to 1,017 tablets detained from 60 importations, suggesting that more pills are being imported.
‘In contact with a doctor by email’
The vast majority are coming via internet orders. Two of the best-known sites, Women on Web and Women Help Women, are based in the Netherlands; they were established, the owners of the sites say, in solidarity with women in countries where abortion or contraceptive services are illegal or severely restricted. They are run on a not-for-profit basis.
Kinga Jelinska, one of the founders of Women Help Women, says it is a recognised nongovernmental organisation, run by doctors and counsellors. “We work with partners worldwide to put contraception and abortion pills in the hands of women, where they belong,” she says.
The site asks the woman questions that she would be asked at any pre-abortion medical consultation, including why she wants an abortion, whether she is certain about her decision, whether she has been coerced in any way, how far along she is in her pregnancy, and about allergies and possible contraindications.
It asks for a donation of between €70 and €90 but says that women who cannot afford this will not be denied help.
Jelinska says that women can stay in touch with a doctor and counsellor by email throughout the process, describing the service as a “chain of solidarity”. They send pills to women in Poland, Malta, Southeast Asia and Latin America, as well as in the Republic of Ireland and Northern Ireland.
Dr Peter Boylan, chairman of the Institute of Obstetricians and Gynaecologists, expresses disapproval. “Online medical consultations are inherently defective and no substitute for face-to-face consultation, particularly in an area as sensitive and potentially complicated as this.”
He also points out that it is illegal to prescribe abortifacient medicine in Ireland or to refer patients for an abortion.
Parcel Motel says it “restricts prohibited items of any kind being delivered” through its service. “Upon the discovery of any such items we alert Customs and the relevant authorities. We take all security issues extremely seriously and co-operate proactively with all relevant authorities.”
Royal Mail in Northern Ireland says that it "does not knowingly carry any illegal items in its network. Where Royal Mail has any suspicion that illegal items are being sent through our system, we work closely with the police and other authorities to assist their investigations and to prevent such activities from happening."
Although women can talk without fear of arrest about travelling for an abortion, the self-induced, mail-order medical abortion – being illegal – remains a risky topic to talk about openly. We know little about how many women have used this method of abortion here, or about their experiences.