Women in Georgia face many challenges in accessing sexual and reproductive health care.   For starters, many live in rural communities where job opportunities are limited and poverty is high. Here, access to healthcare is complicated because clinics are few and far between. Public transport is scarce and, when available, expensive. Some women, like Natela, a woman living in a rural area near Signagi, a tiny town in the eastern region of Georgia, go years between visiting the doctor, and when they do it is only for emergency treatment. “It’s been 10 years since I last went to the doctors… it’s terribly expensive so now I don’t go,” she says. Natela visited the doctor for abortion care 10 years ago because, without access to contraception, she faced an unintended pregnancy and could not afford to have another child. The government neglects to provide young people with sexuality education in school, and many people have been denied information about family planning. 45 year-old Tamar (not her real name), a woman living in southwest Georgia, says that before her first abortion, “I couldn’t even recognise a condom, it was something very alien.” Contraceptive care is rarely accessible for people living in remote regions, and it is not free: many women simply cannot afford it. Irina Pshenichnaia, a gynaecologist working at a partner clinic of IPPF member HERA XXI in Senaki, a town in western Georgia, says that even when women manage to access contraception, the state’s failure to ensure education and information mean that they don’t always know how to use it correctly: “One woman was taking the pill three times a day because her friend told her to,” she says. Read the next blog in our series on obstacles to abortion care and women's reproductive freedom in Georgia. Photo credit: Jon Spaull/IPPF EN  

Georgia, a low-middle income country located at the crossroads between western Asia and eastern Europe, has come a long way since gaining independence from the Soviet Union in 1991. Back then, violent civil unrest against the authoritarian government caused war on the streets of the capital, Tbilisi, and sent the government fleeing to Armenia. A three-year-long civil war created political instability and crippled the economy. Severe, countrywide corruption marred public and private institutions for decades, and issues like healthcare and social welfare were sent to the very bottom of the priority pile. Since then, democratic reforms have been implemented and much of the country now dreams of joining the European Union. The iconic blue flags with a circle of gold stars hang everywhere – in youth centres, schools, hospitals and even people’s homes. To this day however, Georgia still faces major issues. Parts of the country are disputed and large chunks are under Russian control. Unemployment is high - currently 12.6% of the population are out of work, and this figure increases in rural regions. The outlook for women in the country is poorer than for men. Georgia is a patriarchal society with hangovers from Soviet times about the ‘traditional’ roles women should play – namely that they should be the main caregivers of the family. Georgia is also a religious country, with 83.4% of the population identifying as Orthodox Christian, and there is a lot of stigma surrounding abortion. The country has a long way to go when it comes to women’s reproductive freedom. Although Georgia’s legislation requires abortion care to be available to women who need it, in reality there are a number of barriers that harm women by making it difficult if not impossible for them to access compassionate, quality care. These include the limited number of care providers, high costs, biased and non-confidential counselling and mandatory waiting periods. When it comes to family planning, in a country-wide assessment of women’s sexual and reproductive health rights, IPPF's Georgian member HERA XXI estimates that only 17% of women in the country have received family planning information from professional sources.   The obstacles and barriers which prevent women from accessing compassionate abortion care in Georgia are part of a broader trend. Across Europe and in countries which are strongly influenced by ultraconservative, patriarchal values in neighbouring Russia, coordinated actions by reproductive bullies result in regressive pressures and policies. With little government support, HERA XXI is working to ensure sexual and reproductive health care and sexuality education for women and young people across the country. The organisation carries out political advocacy to encourage decision-makers to improve women’s access to care. They work with clinics to support the introduction of safer abortion methods, and thanks to a partnership with UNFPA, enable them to provide some contraceptive care free of charge. They also run a peer-to-peer sexuality education scheme, enabling young people to support their friends in developing crucial life skills needed to navigate relationships and sexuality.  However, with limited funding, HERA XXI alone cannot meet the need. In Akhaltsikhe, a small city in the southwest of Georgia with high levels of poverty and unemployment, for example, they are one of the few organisations providing sexual and reproductive health care and education. Yet they are only able to cover a relatively small part of the region, according to Youth Leader Marine Sudadze. “If we had more funding we would scale up and enter more villages. Large areas of the community are still not being reached,” she says. Read the next blog in our series on obstacles to abortion care and women's reproductive freedom in Georgia. Photo: Akhaltsikhe, southwest Georgia. HERA XXI is one of the few organisations providing sexual and reproductive health care and education in the city and surrounding villages. Credit Jon Spaull/IPPF EN  

25 May 2018 brought a landslide victory for the Yes campaign to repeal the eighth amendment in the Irish constitution, which effectively gave equal rights to the pregnant woman and the fetus. Before the repeal victory, abortion was only permitted if the woman’s life was at risk but not in cases of rape, incest or foetal abnormality. Such strict laws had dire, and in some instances, fatal consequences for women seeking abortion services. Many women were forced to turn to unsafe abortion methods or to seek safe abortion services in the UK. Following years of campaigning and perseverance, a seismic change in public opinion on abortion had taken place. With the 8th amendment now repealed, Ireland’s Government has committed to delivering legislation which legalizes abortion care on a woman’s own indication in the first twelve weeks of pregnancy. As of January this year, the Irish Family Planning Association provides early medical abortion up to 9 weeks of pregnancy. Abortion care is free for women living in the Republic of Ireland. For more details please visit www.ifpa.ie. Meet some of the people who tirelessly campaigned to repeal the eighth amendment, what it means to them and the future of women and girls in Ireland. Want to know more about how medical and surgical abortion works? You can watch our explainer videos here. Content originally published on the ippf.org website.

Abortion and the referendum in Ireland  Maeve Taylor, Director of Advocacy and Communications, IFPA We’ve brought about profound change in Ireland from a position where abortion occupied a toxic political space, where it was a divisive issue for politicians and in public discourse. We had to create a cultural shift so that rather than thinking about abortion in some abstract or ideological way we framed a conversation to help parliamentarians, civil society and the wider public understand we’re talking about a fundamental issue of women's health. Dressing up abortion as a political issue or ideological issue can make it feel scary and keep it on the margins. But a conversation about something that should be part of a mainstream health service, having international experts talking in very measured expert ways allows people to think differently. We never took a view that we'll talk about this specific category of women because they are the most sympathetic. We resisted any of that. It was a ‘leave no one behind’ strategy of advocating for all women whatever their circumstance. All our advocacy and communications has been about this message. This is about a woman, about a woman's decision. It’s about her health, autonomy, dignity - her fundamental rights. You need to ensure people understand those terms. You do that by providing the story, the narrative and the language that allows those who still hold to conservative and/or Catholic views to understand that their own moral values must also mean caring for women who need abortions.

Abortion and the referendum in Ireland  Áine Kavanagh, Advocacy and Communications Assistant, IFPA I'm 23 years old and I grew up in a particularly rural and conservative part of Ireland. Our country has changed hugely since I was born in 1995. Homosexuality was decriminalized in 1993 just two years before I was born. And then just three years ago gay marriage was legalized. It's mind blowing for me to think that’s all happened in my lifetime, so I can't imagine how mind blowing it is to my parent’s generation. The only time I ever heard the word abortion mentioned in school was when we were doing a play in the Irish language. There was a scene where the characters were discussing abortion. I remember asking the teacher what the word translated as. She said, ‘It means murder’. I know now if you break the translation down it would be similar to the word for a fetus. That doesn't literally translate as murder. But that was how it was explained it to us. I studied reproductive biology at university and did my dissertation project in an abortion clinic in 2017. I was interviewing doctors and nurses working in the clinic in Edinburgh about their relationship with their patients. That spurred me into action. I decided to go home and help with the Yes campaign. Legislation is how social change is made, how rights are created. Young people are often seen as politically apathetic, but it’s important my generation are involved in the reproductive rights movement.

Abortion and the referendum in Ireland  Dr Catriona Henchion, Medical Director, IFPA As a doctor I heard so many stories of how abortion law in Ireland caused problems for women. At the IFPA we gathered those stories into different groups, and when we came to be asked for evidence, we realized we had gathered so much through our normal clinical work. We had stories from women who had problems in earlier pregnancies and were afraid to go through another or had been told it wouldn't be safe to be pregnant again. They wanted to have an abortion, they didn't know where to turn. For us it was difficult trying to look after those women. From a medical perspective we had to ensure they had enough medical information about their own history to be treated safely and to assess the best place for them to go where they would be looked after. And all of this without our being allowed to make an appointment on their behalf or calling the doctor in England that would be treating them. Because that was forbidden under the law.

Abortion and the referendum in Ireland  Alison Spillane, Policy Officer, IFPA Former Political Coordinator for the Together for Yes campaign The Together for Yes campaign was a coming together of a range of different civil society organizations that have been working on this issue for many years. I worked with parliamentarians across the political spectrum; it was my job to bring everyone around the table, ensuring they understood the campaign messaging, campaign activities, working collectively and coordinating our efforts effectively to secure that Yes vote. The IFPA had pre-existing relationships with a lot of these political parties due to our role as Secretariat to the All-Party Interest Group on Sexual and Reproductive Health and Rights, which was established in 2000. That was a huge benefit. It was important to engage politicians because the party in Government which called this referendum is a centre-right party, and they have historically never been a champion on this issue. It was essential we engaged with them and helped build their understanding of abortion and unintended pregnancy. Allies on the left also deserve huge credit for consistently being the ones raising this on the floor of Parliament year after year when for a long time they were the lone voices. But at the end of the day for a referendum you need the support of 51 percent of the people who turn out and vote, and 51 percent of the electorate in Ireland are not voting for the left parties. In early October, the Minister for Health introduced legislation with the hope of passing it quite quickly, with abortion service provision beginning in January next year. We're in a space now that even six months ago I didn't think we would be in. I never thought the victory would be so emphatic. If the win had been by a narrow margin, we would now be going into a serious battle in parliament over the content of the legislation, but because the majority was so significant - over two-thirds of voters voted Yes - it’s made it very difficult for politicians who oppose abortion to reject that democratic mandate. Even those politicians who are anti-abortion feel they need to allow this legislation to go through, rather than actively seeking to undermine it or to block it. The draft legislation was published before the referendum and I don't think it adequately reflects the strength of that support - the Irish public very clearly voted to allow women access to abortion when they need it. The new law is not good enough, but there will be an opportunity to review it in three years and assess whether it meets women’s needs. The Government is also looking at reforming sexuality education. This is the first time abortion has been positioned in public discourse as a health issue, the first-time politicians and the public really understood the entire relationship between contraception, sexuality education and abortion services.  

Abortion and the referendum in Ireland  Maura Leahy, Director of Counselling, IFPA I have been the IFPA Director of Counselling in Crisis Pregnancy since May 2017. For 25 years I have worked with children in care, early school leavers, and women at risk of crisis pregnancy. The IFPA counsellors have been counselling women in crisis pregnancy for decades. Until now in Ireland we had to work within the context of the Information Act which meant we could talk to women about accessing abortion services outside of Ireland, but only if we also talked to them about parenting and adoption even if they had already decided to terminate. Regardless of the circumstances we still had to outline to them that there were three options or risk falling foul of the law. The Information Act was a layer of bureaucracy but with a menacing kind of tone. There were many times when you were counselling women just thinking ‘oh this is ridiculous’ because this might be a serious case of fetal abnormality, it’s clear this woman isn't going to have this child, or have it adopted. Why do I have to say this? I'm not helping her by being forced to say this. There was a sense of the absurd. Women were often fearful. They knew there is something illegal about abortion or they weren't sure if it was okay to talk about it. Some women also had experience of rogue agencies where they thought they were speaking to a counsellor, but they were tricked by a pro-life group trying to influence their decision and prevent them accessing abortion services. These rogue clinics had different tactics like setting an appointment for next week and then ringing and postponing, to create time delays in terms of women accessing services. Or they’d show graphic images of a fetus. That's exploitative and manipulative, taking advantage of women in a vulnerable situation. So, when we said, whatever your decision is we'll work with you to achieve that, there was often a sigh of relief, a feeling of: ‘Oh, we've come to somewhere where we can actually be supported.’ The way the laws were framed were suspicious of women, forcing them to justify their decision making.

Abortion and the referendum in Ireland  Dr Mark Murphy GP, Doctors for Choice I qualified as a doctor 13 years ago and I've been involved in reproductive rights issues for about a decade. I got involved after I researched the experiences of Irish women in crisis pregnancy. I was so shocked it led me to join Doctors for Choice. The constitutional prohibition of abortion, which is that recognizing that at any time after conception fetal products are equal in terms of rights to life than that of the pregnant woman, for Doctors created an impossible situation when managing severe clinical risk and illness in pregnant women. At what point when a woman is becoming unwell can you say it’s life-threatening? In 2013 there was the Savita case. A happily pregnant woman who unfortunately miscarried at 18 weeks. The obstetric team treating her said that they could not act because there was a fetal heartbeat. She was bleeding and in pain and they said, ‘I'm sorry, the fetal heartbeat will stop and then we will act. Your illness is not real and substantial enough.’ Unfortunately, by the time the heartbeat stopped it was too late. Sepsis had kicked in and Savita died. It is undisputable and has been found to be the case in medical inquiries after the event, that the eighth amendment was a major contributory factor to her death.

Abortion and the referendum in Ireland  Dr Cliona Murphy, Consultant obstetrician gynaecologist During my medical training abortion really didn't enter the sphere. Like most Irish people I accepted it wasn’t part of our culture. We knew patients might want a termination and we had to say, ‘we can't help you’. I never really questioned that. That changed once I became a consultant. You see people in very difficult situations and you know that in obstetrics and gynaecology everything isn't black and white. I recall one patient who had a scan with a devastating diagnosis. Here were a couple who would never have imagined themselves wanting a termination but dealing with a situation where they needed to. I saw the toll it took on them. I also met patients looking for what was called a ‘social termination, which has connotations of unnecessary or poorly thought out. And yet when you delve down into a patient’s social circumstances I would not want to walk in their shoes. If you’ve lost a job, lost rent allowance, have small children to look after and are desperately trying to keep your head above water and then an unplanned pregnancy comes into it, it can be the final straw that breaks someone. I certainly came across people who I felt were suicidal and yet there could be a difference of medical opinion on how suicidal. All this splitting of hairs over how sick somebody needed to be to have a termination. The process was horrendous. And for a doctor there was always the spectre of the law behind your back if you did the wrong thing.