The extent of home use

The official recorded numbers of women who reside in Ireland and access abortion services in England are unreliable, in that some women may give false addresses. Nonetheless, they show a trend that is so marked as to suggest real and significant change, coming close to halving over the past fifteen years. The drivers of this dramatic fall—from 6,672 in 2001 to 3,451 in 2015 (ONS 2002; Department of Health 2016)—are likely multiple (Sheldon 2016). However, the illegal home use of abortion pills has undoubtedly contributed substantially to it. An internet-literate population will quickly discover the many websites where abortion pills can be accessed online. There were over fifty thousand searches for self-induced abortion methods across all search engines within Ireland in 2015, with two-thirds of those searches relating to abortion pills.⁶

Two nonprofit groups have played a particularly important role in offering support to women seeking access to abortion pills: Women on Web and Women Help Women. Strongly motivated by values of social justice and solidarity (Prainsack and Buyx 2011), each offers advice and practical support by email, including supply of abortion pills to countries where abortion is illegal. Each group works closely with local activists, who help to facilitate supply and to spread awareness of abortion pills through a range of means, including posters, stickers on toilet doors, and publicity stunts—such as driving an “abortion bus” around Irish towns (Hayden 2015)—designed to publicize the groups’ websites.

WoW has recently published data regarding the women on the island of Ireland (including both the Republic and Northern Ireland) who access their services (Aiken, Gomperts, and Trussell 2017). Between January 1, 2010, and December 31, 2015, 5,650 women requested abortion pills, with the numbers more than doubling across that period. Some 1,438 women were treated in 2015. On the basis of their respective populations, it is reasonable to assume that over one thousand of these women were in the Republic. The more recently established WHW prefers not to share the number of pills supplied, emphasizing that it is the number of requests for help that illustrates the true extent of the need. However, they reported “daily contacts” from across the island of Ireland, suggesting that they also supply pills to a significant number of women in the Republic.⁷ Beyond these two groups, women are also attempting to access pills from other sources. Sixty consignments of abortion pills impounded by Irish Customs in 2014 clearly originated from other suppliers, as WoW and WHW refuse to ship directly to Ireland, with women generally asked to provide an address elsewhere of someone who can either forward the pills or hold them for the woman to collect.⁸ It is impossible to know what proportion of consignments evade detection and, further, the extent of any domestic black market in the pills. While the exact numbers of women who use abortion pills are unknown, there are thus clear indications that they are significant.

The safety of home use

A substantial clinical literature suggests strong grounds for believing that the online services offered by WoW and WHW are very safe and likely to be highly acceptable to women, particularly when compared to the alternatives available (Sheldon 2016). In interviews, this was confirmed by local activists who are in contact with the women who use the pills. Telemedical protocols are growing more common within national health services (Grossman et al. 2011; Wiebe 2013; Jabour 2015), and peer-reviewed studies confirm the safety and acceptability of WoW’s service (Gomperts et al. 2008, 2011). Almost all of the women who had accessed abortion pills from WoW and were included in the above survey felt that home use of pills had been the right choice (97 percent) and one that they would recommend to another woman (98 percent; Aiken, Gomperts, and Trussell 2017).

WoW and WHW are strongly committed to the well-being of the women who use their services. Each organization supplies abortion pills for use within the first nine weeks of pregnancy, after completion of an online questionnaire that screens for contraindications. They follow a common treatment protocol of oral mifepristone and, after twenty-four hours, sublingual misoprostol. While my interviews were conducted only with service providers and activists, rather than with women who had used the pills, these revealed no evidence that women struggle to follow the simple instructions. In interviews, I was given just one example of incorrect use: a woman who, desperate at finding herself pregnant as a result of rape, had been given pills by an activist, without the involvement of WoW or WHW. She was then believed simply to have swallowed everything at once.⁹ While this posed no significant risk to her health, she needed a second course of medication in order to end an ongoing pregnancy. For the activist who shared this story, it illustrated the importance of women having direct personal contact with WoW or WHW, so that they always receive clear and accurate information regarding correct use.

Mifepristone and misoprostol are both listed in the World Health Organization guide to essential medicines (WHO 2015b) and can be safely supplied by appropriately trained and skilled nondoctors (WHO 2012; 2015a). Where correctly used, the pills are effective in over 95 percent of cases (Raymond et al. 2013; see also Kulier et al. 2011; Cleland and Smith 2015). Few women experience serious side effects or complications as a result of their use, with pain generally manageable with over-the-counter analgesics. However, in a small number of cases (fewer than two in 1,000), serious adverse events, such as excessive bleeding or infection needing treatment with intravenous antibiotics, can occur (Kulier et al. 2011; Cleland et al. 2013; Cleland and Smith 2015). WoW and WHW both advise women to determine in advance which local hospital they would attend if that becomes necessary. In interviews, they emphasized that such forward planning makes an induced miscarriage considerably safer than when a miscarriage occurs spontaneously. Only one interviewee, from neighboring Northern Ireland, which has a similarly restrictive law and where there are also strong indications that the pills are in widespread use, reported any knowledge (albeit secondhand) of a woman suffering serious health complications as a result of the use of the pills. The former director of the Family Planning Association in Northern Ireland (FPANI), Audrey Simpson, had been contacted by a doctor who reported treating a woman suffering from “life-threatening” problems after taking abortion pills. The doctor (erroneously) believed that the woman had been advised on how to access the pills by the FPANI and threatened to inform the police if the same thing happened again.¹⁰ No further details were available.

There is at least a hypothetical risk that heightened stigma regarding illegal abortion and fear of prosecution might lead to a reluctance to seek necessary aftercare. One doctor cited in a study of Irish general practitioners’ attitudes to abortions reported a patient who had suffered “significant complications requiring hospitalization” following use of abortion pills but had initially refused hospital treatment as her intimate partner was a medical professional, and she feared the “ramifications of discovery” (Murphy et al. 2012, 141). However, none of my interviewees had experience or knowledge of women failing to seek medically necessary aftercare, and none believed that this was likely to happen. Several emphasized how careful women were of their own health, and one noted that exaggerated claims regarding the dangers of abortion pills in the media and official guidance—discussed below—had contributed to extreme vigilance regarding any indication of a need to seek further medical care.¹¹

Individual women

“Empowerment” may be defined as a process that helps people to gain control over their own lives and foster power for use in their lives, their communities, and their society (Page and Czuba 1999). Abortion pills can serve to empower women, with significant echoes of the pro-choice vision with which I opened. One woman treated by WoW wrote to thank them “for enabling women to have control over their bodies,” with another explaining that the service had given her “another chance to continue my personal battle as a single mother to create a good quality of life for my child, working hard in three jobs to make ends meet and create opportunities and potential for her future” (Aiken, Gomperts, and Trussell 2017, 1212).

With abortion pills, a woman’s control of her own fertility is quite literally in her own hands. This is also true when pills are used legally, problematizing any tendency to describe just those terminations that occur outside of formal health facilities as “self-administered”; “independent”; or, in the characterization of the popular media, “DIY abortions.” Regardless of how the pills are accessed, women may then place them in their own bodies, monitor their own miscarriages, treat pain with mild analgesia as they judge necessary, confirm that the abortion is complete, and identify the symptoms that mean further medical care is necessary. While in this article I use the phrase “home use” to distinguish those terminations that are self-induced illegally from those offered legally in clinics or hospitals, this too may be deceptive. In many parts of the world, the law permits women to be given pills to take at home. Caution is also needed in attempting to distinguish between “supervised” and “unsupervised” use. This change in the technology of abortion decenters the role of the medical expert, with the level of supervision foreseen in different service provision models best seen as operating along a continuum. At one end lies tightly supervised use within a hospital or clinic, with pills prescribed following a screening and consultation and the woman remaining on site until her miscarriage is confirmed as being complete. At the other lies the purchase of pills for home use from an unknown internet supplier, with no prior screening or consultation, limited or no information as to correct use or how to recognize potential complications, and no further support. WoW and WHW’s service lies between these two extremes. Each group relies on clinical evidence and, at times, on medical expertise. They follow clinical trial treatment protocols, screen for recognized contraindications, and offer detailed and accurate medical information on their websites. However, each also offers more control to (and demands more responsibility of) individual women than is the case with many other abortion services.

First, women are trusted to report how advanced their pregnancies are, with pills supplied only for use within the first nine weeks of pregnancy. Each group emphasized that women generally seek help early, with contacts beginning from when a period is one day late.¹² However, each had also experienced a small number of cases where women had given false information in order to access pills. In those instances, they saw it as their responsibility to give neutral information regarding what a woman might expect were she to use the pills and, thus, how she could prepare herself emotionally and keep herself safe:

Second, an important and inevitable limitation of a telemedical abortion service is that it cannot provide aftercare for the small number of women who will require it. While WoW and WHW each offer ongoing support by email, the woman must plan for the possibility that something will go wrong and take responsibility for seeking any necessary further care in that case.

Privacy is fundamental to a woman’s empowerment in this context in two important senses. First, the promise of privacy may be key to opening up the option of home use of pills: were privacy regarding their use not guaranteed, a woman might feel that the option of home use of pills was unavailable to her. Second, privacy reflects an exercise of autonomy, where a person has the choice to divulge or not to divulge information, for whatever set of reasons she finds appealing or convincing (Sanger 2017, 61). Privacy may mean the possibility of ending a pregnancy with no need to justify a decision to professional gatekeepers or to explain one’s absence from home, work, or the classroom. One Irish activist explained in an interview that the home use of pills is particularly attractive in a small country, where “it is impossible to fly out of Dublin airport without meeting an acquaintance.”

Communities of women

Abortion pills also open significant possibilities for fostering the power of communities of women to avoid the restrictions on access to services that may be imposed by the state or professional medical gatekeepers. Women across diverse geographical and historical settings have long shared knowledge of fertility control methods (e.g., McLaren 1978, 241; Kaplan 1995; Schiebinger 2008, 158), offering support to each other in more or less formalized ways (e.g., Kaplan 1995). Indeed, the knowledge of local communities of women was key to the development of abortion pills. Having read patient safety leaflets warning against use during pregnancy, women in Brazil began to use and share knowledge about misoprostol (which was available as a treatment for gastric ulcers) as an abortifacient (Arilha and Barbosa 1993).

While practices of solidarity and knowledge sharing in this context are thus both historically and geographically pervasive, they have been revolutionized by the internet. WoW and WHW are international nonprofit collectives, staffed primarily (if not exclusively) by women, motivated by a powerful concern for social justice and working either unpaid or for low salaries. They also promote awareness of the harmful effects of restrictive abortion laws, fight abortion stigma (WHW 2016), and attempt to foster solidarity among the women they support. Each group is funded by a trust-based donation system, with women who can so afford invited to offer €70–€90 (US $80–$105) to cover the cost of their own treatment and, where possible, to give more to support services for others. They thus aim to empower communities and to expand solidarities between women across geographical boundaries. A member of the WoW help desk explained: “Everyone that can give more does give more, even if it’s just 5 or 10 euros. Women are very happy to donate money. They connect what’s happening to them to the situation of other women. … They realize that they are not alone, that the world is full of women in similar situations. Sometimes they write to us that they’re inspired to do something … that they’ll make a donation to help another, to spread the word, to join a group locally. Women often write to us, ‘I was always against abortion but now I understand.’”¹⁷

The empowerment of female communities has a further important corollary: decentering the role of the credentialed medical expert. There is an important difference of emphasis between the two groups here. WHW rejects the need for routine medical oversight:

Rebecca Gomperts, founder of WoW, offers a slightly different view, seeing no tension between the value of empowering women and her work as a doctor, with a desire to work for social justice fundamental to her decision to practice medicine.¹⁹ However, her vision of the medical relationship—as intrinsically and strongly based on partnership and trust—is a radically nonhierarchical one, diverging sharply from that which has traditionally existed in many formal health-care settings.

Where abortion pills are accessed outside of formal health services, this may affect how their use is viewed. Academic and activist Goretti Horgan suggested to me that women who use abortion pills may not “quite see it as an abortion in the way that they would if they were having to go to a doctor and go through all the medical palaver,” noting that this may serve to “reduce any angst” relating to ending a pregnancy.²⁰ Activists have attempted to develop community-based methods of supporting women in home use, through a text- and email-based service.²¹ In neighboring Northern Ireland, they have even considered the creation of a system of “abortion doulas.”²²

Individual women

While the home use of abortion pills has done much to enable individual women to bypass restrictive legislation and to seize control of their own fertility, not all women experience this as empowerment. The women surveyed by WoW most commonly reported feeling “relieved” (70 percent) and “satisfied” (36 percent) after their abortions, with women also describing their anger, disappointment, shame, and isolation at not being able to access legal abortion within their own country. Fewer than 10 percent reported having felt “empowered.” Further, when abortion services are accessed illegally, this denies the legitimation of legal and medical sanction, thus risking compounding the stigmatization of abortion (Taylor 2015; WHW 2016). As Kinga Jelinska, director of WHW, explained: “The potential of the technology of self-administration of medical abortion [abortion pills] is incredible. It can empower women, and they can do it in the privacy of their own home. It is really revolutionary on many levels. But we also need to acknowledge that, as an individual experience, it is alienating.”²³

Moreover, while home use of abortion pills can offer privacy, this readily collapses into secrecy. While privacy and secrecy may overlap “in purpose, in method, and in ordinary conversation,” they are importantly different (Sanger 2017, 61). As Carol Sanger has argued, “secrecy” registers as “more desperate and more necessary,” often being “a response to the threat or prospect of harm, whether harassment, stigmatization, loss of one’s self-conception, or fear of violence” (Sanger 2017, 61). While fixing the exact motive for nondisclosure in any one instance may be difficult, Sanger’s account nonetheless offers an important analytical distinction between privacy and secrecy and grounds a powerful empirical observation that was also borne out in the current study: that abortion concealment in contemporary society aligns not so much with privacy as with secrecy, “a much darker, more psychologically taxing, and socially corrosive phenomenon” (62).

“Privacy” in home use of pills does not necessarily mean that women are isolated but rather that they have control over who is told about an abortion. Just over three-quarters of those surveyed by WoW were able to talk to family and friends about their abortions. However, that leaves almost one in four lacking this emotional support, and these women were also likely to have the fewest economic resources, suggesting a particularly vulnerable group (Aiken, Gomperts, and Trussell 2017). A member of the WoW help desk staff explained that “women feel much more free to tell us what is happening, to discuss the real situation, to say things that they would never tell their own doctor.” However, she immediately went on to note that she also worried about women feeling isolated and having no support, explaining that “we get many emails saying that you’re the only one who knows, I can’t tell anyone.”²⁴ While the offer of privacy is thus an important aspect of women’s empowerment, this readily blurs into secrecy, which functions as an important brake upon it.

Practices of nondisclosure around abortion are, of course, not a uniquely Irish phenomenon (see, e.g., McLaren 1978; Kaplan 1995; Sanger 2017), nor are they absolute. Irish feminist scholars have worked to disrupt silence around abortion (Rossiter 2009; see also Fletcher 1995), and Irish women have spoken about their own abortions, sometimes at considerable personal cost and often with the explicit aim of helping others and challenging the silence around abortion. Social media has played an increasingly important role in such interventions.²⁵ High-profile activist interventions have likewise challenged secrecy regarding abortion, capitalizing on media interest to publicize the existence of abortions pills and where they might be safely obtained. To this end, activists have swallowed pills on a train traveling from Belfast to Dublin (Stack 2014), driven an “abortion bus” around Irish towns (Hayden 2015), and, most recently, delivered pills by drone plane to Northern Ireland (Press Association 2016).

While the secrecy surrounding abortion is thus far from absolute, it is nonetheless significant. After describing her own experience, Irish Times columnist Roisin Ingle writes: “I know there are some women who regret their decisions to have abortions and I understand that must be a terrible pain to carry in their lives. But I also know it has been the right choice for thousands upon thousands of women in Ireland who I hope will not be silenced any longer. Who will, when the time comes, say ‘me too’ even though that’s one of the most difficult ‘me toos’ an Irishwoman can utter” (2015). Another woman recently told a British newspaper that it was only after traveling to England for an abortion that she had discovered that her mother and other close relatives had done the same: “My mum, her cousin, my granny—they’ve gone for 30 or 40 years and never told anyone. If I’d known about my mum’s experience, maybe I could have told her, and maybe it wouldn’t have been such an ordeal. To have the moral support would have been great. But none of us feels able to talk about it” (Gentleman 2015). Abortion pills’ promise of a private abortion is readily accommodated within this silence, clearly aligning with a more “socially corrosive” secrecy (Sanger 2017, 9).

Communities of women

The fact that home use of pills is readily accommodated within a more general silence about abortion is also double-edged in broader, societal terms. As the academic and activist Sinéad Kennedy puts it:

Finally, while abortion pills offer the potential to empower communities of women, communities have limits, and the networks thus built are inevitably precarious. The empowerment offered by pills is available only to those women who are willing and able to risk flouting the law. Moreover, a focus on securing relief for individual women may result in a desire to avoid rocking the boat or the diversion of attention away from the fight for legal reform and the development of local services. This can operate as an important point of tension within pro-choice communities in the context of ongoing debates about how best to challenge restrictive abortion laws (Culhane 2015). It is also inevitably the case that some women are beyond the reach of WoW and WHW’s services. Activists described to me the particular problems faced by women living in “direct provision,” where asylum seekers are accommodated by the state in residential institutions (see Thornton 2014). Given restrictions on their travel, these women are generally unable to access services overseas (Fletcher 2005). They are also less likely to have contacts who can share knowledge of abortion pills and how to obtain them, they may lack access to the internet, and even a minor infraction of the law can leave them at risk of deportation.

Ignorance regarding the extent of illegal home use of pills

The Irish government claims that “about 4,000 women from Ireland have a termination procedure every year” (CPP n.d.c), admitting a modest amount of uncertainty beyond the numbers recorded in English clinics but failing to acknowledge that substantial numbers are using abortion pills at home. It remains to be seen whether this claim will be revised in the light of the WoW data discussed above (Aiken, Gomperts, and Trussell 2017), but at the time of this writing it remains prominently displayed on a government website. There has been no apparent official attempt to disrupt this fiction through the collection of more robust data regarding the extent of home use or women’s experience of it. Indeed, maintaining the fiction of an unfeasibly low abortion rate serves a broader political purpose, supporting a positive story of the government’s work in combating “crisis pregnancies” and, further, a postcolonial imaginary of a culturally authentic “pro-life” Irishness (Fletcher 2001; see further Smyth 1998, 2005). Ignorance can also have clear advantages in avoiding the repercussions of troubling knowledge: where knowledge has never been brought into existence, it is difficult to hold someone accountable for having failed to act upon it (McGoey 2012a, 559). Notably here, the lack of official knowledge that increasing numbers of women are using abortion pills without apparent significant negative health consequences avoids the need for an official response that moves beyond blanket assertions of the potential dangers of illegal abortion to women’s health.

The widespread use of abortion pills also appears to be ignored within the criminal justice system: there have been no prosecutions under Irish abortion law in the past ten years, with only two files relating to illegal abortion considered by Irish prosecutors over that period and just one initial decision to prosecute, which was subsequently withdrawn.²⁷ None of my Irish interviewees could foresee a future set of circumstances where a woman would be prosecuted for ending her own pregnancy. Indeed, the CPP advises that women who seek medical aftercare following home use of pills will not be reported to the police, with medical confidentiality protecting them other than in exceptional circumstances (e.g., where there is evidence of abuse; CPP n.d.a, n.d.b). The legal merits of this view are moot (Sheldon 2016), and robust empirical evidence to support it is lacking: the one small relevant study found that 12 percent of hospital doctors would be prepared to report an illegal abortion, with a further 14 percent unsure (Aitken, Patek, and Murphy 2017). However, the advice reflects a more general understanding that, at least with regard to women who have had abortions, the law will remain unenforced.

This lack of prosecutions also reinforces the important official fiction that illegal abortions occur only in small numbers, reflecting the attitude that Kennedy characterized as “we don’t care, as long as you don’t tell us about it, we don’t really know it’s happening.”²⁸ None of the well-publicized activist interventions noted above provoked criminal investigation. Indeed, the police who monitored the journey of the “abortion bus” around Ireland were reported as having received instructions merely to look out for public order offenses. Notwithstanding the fact that one woman was reported to have gone home with abortion pills following a Skype consultation with WoW, police apparently considered no more serious action than issuing a parking ticket (Hayden 2015).

Ignorance regarding different sources of pills

Irish law prohibits the mail order supply of pharmaceuticals, and consignments of abortion pills are regularly impounded at the border (Sheldon 2016). While not wishing to be interviewed for this study, the state agency responsible for the regulation of medicines offered a statement about its work. This statement explained that any supply of pharmaceuticals from outside the “legitimate supply chain” raises potential problems in terms of ensuring the quality or authenticity of medicines (which are of “unknown” quality or may be “falsified or substandard”), the adequacy of information supplied to patients, and the availability of appropriate follow-up medical support in the event of adverse reactions. This is said to create risks to the safety and well-being of the public.²⁹ Advice published by the CPP similarly relies on blanket statements regarding the danger of sourcing abortion pills online (CPP n.d.a).

These general claims regarding the dangers of online purchase rely on a studied ignorance of the important differences between various online suppliers. Published, peer-reviewed evidence refutes any suggestion that WoW offers poor-quality or inauthentic medicine, inadequate patient information, or insufficient follow-up (within the limits of a telemedical service, as described above; Gomperts et al. 2008, 2011; Aiken, Gomperts, and Trussell 2017). Moreover, the Irish government has direct, judicial confirmation that WoW’s service meets the standards expected of medical practice within another EU state. Apparently at Ireland’s instigation, Dr. Rebecca Gomperts of WoW was subject to disciplinary complaint for her activities in prescribing pills from Austria to Irish women. Finding that she had acted within the terms of relevant domestic law, an Austrian court noted that her work made a positive contribution to the health and survival of women in Ireland.³⁰ My own research suggests that WHW is operating to a similar standard.

The official silence regarding abortion is also shaped by a specific piece of legislation: the Abortion Information Act.³¹ While the chilling effect of this law has been such that some have misread it as prohibiting the provision of even basic information (Amnesty International 2015), its wording is less restrictive than often supposed. The act allows for the provision of “truthful and objective” information that does not “advocate or promote” abortion, provided that a woman is counseled about “all the courses of action that are open to her” (sec. 5). Specifically, it provides that information may be offered regarding services that “are lawfully available in the place where they are provided … by persons who are acting lawfully in providing them” (sec. 3). Given that WoW and WHW operate lawfully within the jurisdictions within which they are registered and from which pills are prescribed and supplied, the act would appear to allow for advice to be offered regarding their services. However, current official guidance states that offering such information may be considered to be aiding and abetting the criminal offenses committed by a woman who imports and uses abortion pills (CPP 2015, 9.4.2). While the accuracy of this advice is open to debate (Sheldon 2016), this carefully scripted silence—offering detailed advice regarding what counselors may and may not say (CPP 2015)—leaves women who want to know more about abortion pills reliant on negotiating the mass of information of variable quality available from other sources.

Ignorance regarding clinical evidence

Finally, official advice to the public (e.g., CPP n.d.a, n.d.b) systematically and significantly overstates the clinical dangers of using abortion pills and the need for medical supervision, in a way that implies ignorance of the substantial clinical evidence base. While this bolsters the case for the criminal prohibition of abortion (suggesting that it can be justified by a concern for women’s health as well as in the interests of the “unborn”), it also risks increasing the anxiety of women who use the pills. Claims that abortion pills are “designed to be used in abortion clinics” (CPP n.d.a) ignore the substantial clinical evidence demonstrating that home use is both safe and highly acceptable to women (Kulier et al. 2011; Ngo et al. 2011; Cleland and Smith 2015). Advice that “abortion pills should be prescribed only after a face-to-face medical consultation in a country where abortion is legal, and taken under medical supervision, where staff can act quickly if complications arise” (CPP n.d.a) disregards the development of legal telemedical delivery protocols in a growing number of settings internationally (Grossman et al. 2011; Wiebe 2013; Jabour 2015). It also implies that “medical supervision” must involve observation of the woman not merely while she takes the pills but also during her miscarriage (allowing staff to act quickly where necessary). This would require a level of medical oversight that exceeds not merely how abortion pills are used in induced abortions elsewhere in the world but also how misoprostol is used in the management of spontaneous miscarriage within Ireland. The stated need for a face-to-face consultation is likewise not supported by medical evidence (Grossman et al. 2011).

While official discourse thus systematically overplays the dangers of abortion pills, a genuine prioritization of public health would support the provision of accurate information, ensuring that women know how to keep themselves safe (Sheldon 2016). A clear and accurate statement of the medical facts regarding the safety of the home use of pills, however, would potentially risk the appearance of condoning the commission of a serious criminal offense, forcing open the fault line between criminal prohibitions and public health concerns within which the CPP operates. It would also involve treating women as competent decision makers, challenging what one of my interviewees identified as “a tendency in official discourse to view women as helpless and hopeless, with no idea of their own best interests.”³² Maintaining ignorance regarding the extent and safety of home use offers a potentially useful strategy for papering over this fault line, avoiding the acquisition of the official knowledge that might generate a responsibility to act. A choreographed ignorance regarding abortion can explain the paradox of the appalling suffering inflicted on Ms. Y in the name of upholding the law, on the one hand, and the lack of action taken against the many who flout it, sometimes quite openly, on the other.

Ignorance is not always inevitably and straightforwardly a bad thing (Proctor 2008, 2). Beyond its clear political value to official bodies, the failure to acknowledge the widespread home use of pills in Ireland has carved out a space whereby many women have found a private solution to their unwanted pregnancies, offering significant relief to individuals and important public health benefits to society. This creates an important dilemma for pro-choice activists. Maintaining silence around abortion comes at a heavy cost to women in the Republic. Revealing the extent of home use of pills would highlight that existing law is widely flouted, ineffective, and unfair, most heavily impacting those who lack the resources to travel. However, challenging the official silence also inevitably risks provoking calls to clamp down on illegal abortions or to step up efforts to impede the flow of pills.