On Oct. 21, 2012, Dr. Savita Halappanavar, a 31-year-old dentist, arrived at Galway University Hospital in western Ireland complaining of back pain. She was 17 weeks pregnant. Staff sent her home, but she came back hours later. According to Ireland’s official 2013 investigation into her case, Halappanavar told staff that she “felt something coming down” and “pushed a leg back in.” The pain was “unbearable.” The hospital admitted her.
Two days later, on Oct. 23, 2012, a doctor told Halappanavar a miscarriage was inevitable. Membranes once shielding the fetus in her womb had ruptured. Halappanavar and her husband, who both wanted the pregnancy, absorbed the distressing news. Rather than delay the inevitable, the couple asked for a medically induced miscarriage, or an abortion.
But a doctor said that would not be possible, explaining that “under Irish law, if there’s no evidence of risk to the life of the mother, our hands are tied so long as there’s a fetal [heartbeat].”
That law the doctor was referencing was the Ireland Constitution’s Eighth Amendment, which criminalized abortion in almost all cases when it was added in 1983. At Galway University Hospital, with the doctor believing Halappanavar’s life not to be at risk, staff monitored the fetal heartbeat in her womb, intending to induce a miscarriage when it stopped.
All the while, an infection spread and worsened in Halappanavar. On Oct. 28, 2012, her own heart stopped. She died from septic shock.
Halappanavar’s parents and husband blamed her preventable death on “the Eighth,” as the amendment was known. When news of Halappanavar’s tragedy broke, thousands of people protested and held candlelit vigils across Ireland. Posters read, “She had a heartbeat too.”
That outrage spurred Ireland’s next generation of reproductive rights activism. Still, it took six years after Halappanavar’s death for the nation to hold a referendum that asked voters to keep or repeal the Eighth. On May 26, 2018, that referendum result came in: Two-thirds of voters wanted a repeal. As they learned of the results, supporters in Dublin chanted, “Sa-vi-ta! Sa-vi-ta! Sa-vi-ta!” in honor of Halappanavar.
Today, the Irish activists who led that victory are watching America unravel with “heartbreaking predictability.” Since the fall of Roe, they expect the U.S. to suffer not only one Halappanavar-like tragedy, but several.
Echoing Ireland’s Eighth, some states now have near-total abortions bans. Several bans include exceptions, such as for the pregnant person’s life or in instances of rape and incest. But the lack of clarity around these new regulations has already caused hospital staff to rely on lawyers—not doctors—to make decisions about care. Many experts agree such bans can create a “chilling effect” that may endanger women like Halappanavar. Doctors deciphering legislation in an emergency can become overly cautious about ending a pregnancy. America’s high maternal mortality rate, especially among Black women, is now predicted to climb.
“It is very difficult for me to look at the U.S. because you can feel the pain,” said Ailbhe Smyth, one of the three co-directors of Together for Yes, the umbrella group of grassroots organizations that led Ireland’s repeal campaign to liberalize abortion. Still, Smyth said there is nothing to be done except fight: “There comes a breaking point. It happened to us in Ireland, in Colombia, in many countries. Even though there has been this terrible setback in the U.S., it is now about rebuilding, state by state, because the pain will be too much to bear.”
The principles behind what worked in Ireland are perhaps most applicable to what is going to have to happen on the state level in the U.S. Ireland is home to about 5 million people, which is roughly the population size of South Carolina (though Lindsey Graham, senator from that state, wants to enshrine a 15-week ban for the whole country—yet he’s certainly facing pushback over that plan). This August’s election in Kansas, where a majority of voters protected an abortion safeguard in the red state’s constitution, deployed strategies that were also key in Ireland.
Irish activists focused on the people they most needed to persuade to secure a win—and they listened to those voters first. The repeal campaign knew moderate voters would not support “abortion” as a principle, but they may be willing to vote for abortion as “care.” Advocates went door to door, talking to voters with messages tailored to them. In Kansas, canvassers, who were mostly locals themselves, hit the pavement with similar tactics. Ads tapped into many Kansans’ aversion to government intrusion, calling for a vote against a “government mandate” and rarely saying “abortion.”
But Irish activists said that if Americans truly want to learn from their victory, they need to grasp what came before and after the country’s breaking point with Halappanavar’s death. Abortion had been outlawed for 35 years in Ireland before the campaign to legalize it succeeded. Fearing Roe v. Wade’s impact on Ireland, influential Catholics had designed the Eighth to solidify an 1861 abortion ban. Ten years after Roe, Irish people voted in a 1983 referendum to add the Eighth (by the same margin they later voted to abolish it).
The same year the amendment passed, medical student Mary Favier campaigned against the Eighth, albeit unsuccessfully. By 2002, she had grown “fed up” with only hearing medical voices that were anti-abortion “and usually male” in the news. So she founded Irish Doctors for Choice, an advocacy group for physicians supportive of abortion care. Yet months before Halappanavar’s death, Favier debated shutting that group down. She was one of the only members left.
One reason abortion felt less urgent in Ireland was that the procedure was legal everywhere else in the U.K. except Northern Ireland. That meant Irish women could travel to nearby Britain to end pregnancies. But like in the U.S. today, pregnant people without the money, time off work, child care, immigration papers, or mobility status were left out. There was also still a lot of stigma about abortion, leading Irish activists to struggle in their efforts at first.
Then one morning in 2012, Favier got a call from a reporter asking about Halappanavar. Favier had no idea what the reporter meant; the story had just broke. But “from then on, [Irish Doctors for Choice] didn’t have a quiet day,” she said.
Activists channeled outcry over Halappanavar into a simple goal: Repeal the Eighth. To do that, the Irish parliament needed to call a referendum asking voters to abolish or keep the amendment. But many politicians still saw abortion as too controversial, fearing that backing a referendum would tank their appeal with constituents. Over the next few years, activists would have to ramp up public pressure to convince politicians that avoiding the Eighth no longer protected their careers but risked them.
At the same time in Ireland, LGBTQI+ activists were calling for marriage equality, which needed a referendum of its own. Smyth, who is also an LGBTQI+ activist, encouraged reproductive rights advocates to help marriage equality across the finish line first. That move promised to build solidarity between movements, weaken anti-abortion groups that align with anti-LGBTQI+ groups, and show politicians there may be enough public will to tackle the Eighth next. In a 2015 referendum, marriage equality won.
All the while, young advocacy groups like the Abortion Rights Campaign (founded in 2012) and more-established groups like the National Women’s Council of Ireland (started in 1973) worked at the grassroots level to strengthen repeal support. A referendum on the Eighth had not yet been announced, but activists were lobbying politicians as public cries mounted.
The Coalition to Repeal the Eighth Amendment, co-founded by Smyth as an alliance of more than 60 groups, was also preparing for an eventual referendum. In 2016, the alliance commissioned focus group research to gauge what undecided voters thought of the Eighth. These voters would need to support a repeal for the campaign to win. The research showed, however, that such voters still found it tough to talk about abortion. People rejected the question, “Will you legalize abortion?”
So, the groups decided to tweak their approach. “But if you said something a bit different, which was, ‘We have a constitution that kills women. What do you think about this?,’ then they would say, ‘Oh, that’s horrendous. That should never have happened,’ ” said Smyth, recalling public grief over Halappanavar’s death. “So, you see, this gave you another way of talking about the issue.”
And that may be a lesson: Knowing what to ask for proved as critical as knowing when and whom to ask for it. Irish activists’ “ask” could strategically appear moderate. Abolishing the Eighth would allow Ireland to legislate abortion. But supporting repeal did not directly mean supporting abortion in all or most cases. That “fudge,” as Smyth put it, brought more folks into the tent.
Focus group research also found moderate voters were not persuaded to repeal the Eighth as a “rights” or “pro-choice” issue. It was talking about abortion as health care and about a repeal vote as a compassionate vote that resonated. Campaign posters would later draw on what activists called the two C’s: “care” and “compassion.” Like in Kansas in August, their signs did not state “abortion.” One repeal poster simply read, “Someone you love may need your yes.”
Around December 2017, with a referendum all but certain, Together for Yes formed as an umbrella group of more than 70 organizations committed to abolishing the Eighth. In March 2018, a referendum date was set for May 25, leaving roughly 68 days to reach voters. The umbrella group deployed the grassroots-level efforts. “They did that through canvassing: going door-to-door, knocking, and having conversations,” said Sinéad Kennedy, a member of Together for Yes’ national executive committee and co-founder of the Coalition to Repeal the Eighth Amendment. “I think that was how the campaign was won: through conversations.”
Years of work meant people in local Together for Yes chapters were looped into the plan and could help canvass. An outpouring of abortion storytelling also swayed voters in the runup to the referendum. For example, members of Terminations for Medical Reasons, an advocacy group of parents who received a fatal fetal anomaly diagnosis, spoke of the cost of needing to travel for health care.
“Those stories showed that when you say ‘abortion care,’ these are the people you’re talking about,” said Sarah Monaghan, a member of Together for Yes’ national executive committee. “People who had to take a flight to terminate a wanted pregnancy, then bring their child home in a little coffin.”
To Julie F. Kay, the American attorney who litigated the landmark ABC v. Ireland case in the European Court of Human Rights in 2010, the success of this campaign was thanks to how patiently Irish activists worked to make abortion relevant and approachable.
“People are going to listen the most on these issues to the people they know,” said Kay, who co-wrote the 2021 book Controlling Women: What We Must Do Now to Save Reproductive Freedom. “When someone they love and respect shares what this personally means to them, that matters a lot.”
From across the pond, Favier was not surprised by the fall of Roe earlier this year in the U.S., but the Dobbs decision still felt like a “gut punch.” That did surprise her. For much of Favier’s career, she “looked to the U.S. for leadership.” Intellectually, she’s known the U.S. has not been that leader in recent years. “But emotionally, I think I still believed it,” said Favier, who is today co-chair of Global Doctors for Choice, an international advocacy group, and past president of the Irish College of General Practitioners. “It has been quite a shift to acknowledge it is over: the U.S. is now an international outlier.”
And yet, abortion rights are still broadly popular in the U.S. A Pew Research Center survey from March 2022 found that 61 percent of U.S. adults say abortion should be legal all or most of the time. Ireland offers urgent lessons for how the U.S. can galvanize that support, including the power of discussing abortion one on one and lifting the issue above partisanship.
On how to create dialogue about abortion, Irish activists advised listening to people who are on the fence—without telling them what to think. Smyth explained the goal is not to change minds but to open them. To humanize an often-abstract issue, repeal canvassers in Ireland also told stories of people who needed abortions. They used evidence-based points from Irish Doctors for Choice to tackle misinformation as well. The Irish activists discouraged arguing with people whose minds were fully made up against abortion. Doing so often spoke over, rather than to, voters in the middle.
Still, Ireland’s anti-abortion movement was much weaker in 2018 than America’s anti-abortion movement is today. The Catholic Church’s declining power in Ireland—and the American anti-abortion movement’s rising influence in the Republican Party—can help explain that difference. Noting this contrast is key for the U.S. to draw any lessons from Ireland.
For decades in Ireland, the Catholic Church’s leaders drove anti-abortion sentiment. But as reports of widespread child abuse in the church surfaced over the past decade, many Irish people lost trust in the once-dominant institution. Yet generations had still been raised Catholic and taught to see abortion as a sin. During the 2018 repeal campaign, undecided voters’ ambivalence about the Eighth often hailed back to a Catholic upbringing. These voters did not want pregnant people to die under the Eighth, but they also did not want abortion to be legal in all cases. Ireland’s anti-abortion movement may have won by pushing a toned-down version of the Eighth. But while Together for Yes tweaked their approach to reach moderates, Ireland’s anti-abortion movement rarely veered from an older playbook.
One anti-abortion poster during the referendum showed a fetus and read, “A License to Kill?” Another depicted a floating fetus next to the caption, “I am 9 weeks old/ I can yawn and kick/ Don’t repeal me.” The pregnant person, the woman, was almost always absent. This fetus-centric, confrontational messaging recalled the abortion rhetoric of 1980s Ireland and the U.S. It also underscored how Irish and American anti-abortion movements had diverged by 2018.
In the years before Roe fell in the U.S., American anti-abortion groups had adopted a “value them both” message that no longer talked about the fetus alone. This approach speciously claims abortion harms the “mother” as well as the “unborn.” Because abortion bans were—and still are—unpopular, a “value them both” approach made restricting abortion more palatable in many states. This was part of the movement’s state-level strategy to chip away at abortion access until the procedure became out of reach. That strategy, however, was foreign in Ireland.
Prior to 2018, the Irish anti-abortion movement had lived for decades with a near-total abortion ban. An incrementalist strategy was not needed. The movement was not practiced in reaching moderate voters because they had rarely needed to compromise beyond their base before the repeal campaign. However, this inflexible stance on the Eighth, one that all but ignored the “mother,” helped turn moderates away and bolstered the repeal campaign.
The anti-abortion movement in the U.S. is not as tied to the Catholic Church; several other religious and secular groups now fall under the American pro-life umbrella too. So, the scandals in the church did not damage the anti-abortion movement here like it did in Ireland. And in recent years, American anti-abortion groups’ political power surged as their alliance with the Republican Party strengthened. But the U.S. could look to how Irish abortion rights activists disentangled the repeal vote from partisanship—and follow that road map.
In the Irish activists’ focus group research, moderate voters said they distrusted politicians. Repealing the Eighth was deliberately framed as a nonpartisan issue. Together for Yes did not officially attach itself to a political party. The U.S. could similarly lift abortion out of partisan divides by making the issue a ballot initiative in state elections, taking a cue from Kansas. Independent and Republican voters who oppose abortion bans may rally, slowly turning the tide in what will likely be a long struggle.
Now 76, Smyth began fighting to end the Eighth in the 1980s in Ireland. America’s battle may also take decades. But Smyth hesitated to draw too neat a comparison, recalling when an American came to help with the repeal campaign and asked, “Why don’t you do something like we do in the States?”
“And I replied, ‘Well, because you’re not winning,’ ” she said. “But my point was, ‘We have to do what works for us.’ For the U.S., nobody can tell you what to do. We can only say, if you ask us, that we see that what we did worked. It also worked because the timing was right, and we knew that. We were clever enough to seize the moment.”
Monaghan offered a final word of advice from Ireland post-repeal to the U.S. post-Roe: “The most important thing is to not give up. America has done it before, and it will do it again. I am certain of it because they have to.”