What is this project about?

The Health (Regulation of Termination of Pregnancy) Act 2018 came into legislation in Ireland on January 1^st, 2019. Under Section 12 of this Act, pregnant women less than 12 weeks’ gestation are entitled to access termination of pregnancy (TOP) services without restriction nationally.

Many of the logistical aspects of providing a TOP service (for example, staffing, funding, allocation of time and resources, training) had not been addressed in the lead up to its implementation and the future of service provision within maternity hospitals remained largely unknown. The various phases of this project aim to provide vital evidence to support the implementation and development of TOP services within Ireland.

Phase 1 aimed to:

• Examine the level of knowledge on TOP, and need for training, among staff and students in high/middle income countries.
• Assess knowledge levels of TOP procedures, complications and legislation, among staff in a large maternity unit in Ireland.
• Investigate staff perceptions of the main challenges to implementation of TOP services.
• Analyse the uptake of the TOP service (<12 weeks gestation) in a large maternity hospital in Ireland, during its first year and the resources required to facilitate this.

Phase 2 aimed to:

• Expand on the previously conducted audit of the uptake of the TOP service (<12 weeks gestation) in a large maternity hospital in Ireland, during its first year by assessing early (< 12 weeks’ gestation) TOP services across the first four years of service provision in the same maternity unit to identify any improvements or deteriorations in current services.
• Examine cases of termination of pregnancy performed for major fetal anomaly over the first three years of service implementation.

Phase 3 aims to:

• Evaluate the experiences of women accessing TOP services up to 12 weeks gestation in a tertiary level maternity hospital with full TOP services.

Phase 4 aims to:

• Determine the incidence and nature of early medical abortion (EMA) complications requiring medical review in hospital in our region. Under the Irish TOP model of care individuals may have EMA up to nine completed weeks gestation with their general practitioner. Approximately 90% of all abortions in Ireland are EMA.

Phase 5 aims to:

• Evaluate a workshop for non-consultant hospital doctors (NCHDs) on manual vacuum aspiration (MVA; surgical outpatient uterine evacuation) and long-acting reversible contraception (LARC) insertion.

Phase 6 aims to:

• Assess whether documented care for women/couples undergoing TOPFA aligns with national clinical guidance and bereavement standards, including communication, choice, privacy, continuity, memory-making, investigations, specialist-team involvement and follow-up.

What is involved?

Phase 1 (2020-2022)

• A systematic review of the knowledge on TOP legislation and clinical practice among healthcare professionals and students in high/middle-income countries.
• A questionnaire-based study of the level of knowledge on TOP among clinical staff in a large maternity unit, the training received and main challenges to the service.
• An audit of the first year of early TOP services (less than 12 weeks gestation) in a Irish maternity hospital to understand care provided, protocols followed, demands on staff and potential areas for improvement.

Phase 2 (2022-2023)

• Retrospective medical chart review of patients that underwent early termination of pregnancy at Cork University Maternity Hospital from 1^st January 2019 to 31^st December 2022 inclusive. [Led by Dr Katie Togher]
• Retrospective study of all pregnancies diagnosed with Trisomy 18 from 2019-2022 in a single tertiary centre. [Led by Dr Hadas Miremberg]
• Retrospective service evaluation of tertiary fetal medicine clinics in two tertiary maternity hospitals between 2019 and 2021 to compare pregnancies of patients diagnosed with major fetal anomaly who underwent termination of pregnancy in Ireland with those of patients who did not meet the legal criteria and hence travelled outside Ireland for termination of pregnancy. [Led by Dr Hadas Miremberg]

Phase 3 (2024-)

• Survey of TOP service users aged >18 years who had a TOP at 10-12 weeks in a large tertiary maternity hospital between December 2024 and May 2026. [Led by Dr Kayleigh Lacerda]

Phase 4 (2025-)

• Retrospective review of all individuals who attended one tertiary maternity hospital owing to suspected EMA complications from January 2021 to December 2024. [Led by Dr Sophie Boyd and Dr Anthony Sheppard]

Phase 5 (2025-)

• Post-workshop survey of three cohorts (August 2025, March 2026 and October 2026).

Phase 6 (2026-)

• Retrospective review of hospital records of women/couples who underwent a Section 11 TOP in a large tertiary maternity hospital between January 2019 to December 2025. [Led by Dr Anthony Sheppard]

Who is involved?

Project team

Dissemination activities

Journal articles

• O'Shaughnessy E, Leitao S, Russell N, O'Donoghue K. Termination of pregnancy services: A year in review in a tertiary maternity hospital. BMJ Sexual and Reproductive Health. 2021;47(3):231-232. https://doi.org/10.1136/bmjsrh-2021-201049.
• O'Shaughnessy E, O'Donoghue K, Leitao S. Termination of pregnancy: Staff knowledge and training. Sexual & Reproductive Healthcare. 2021;28:100613. https://doi.org/10.1016/j.srhc.2021.100613. 
• Leitao S, O'Shaughnessy E, San Lazaro Campillo I, O'Donoghue K. Healthcare professionals and students’ knowledge on termination of pregnancy legislation and clinical practice: a systematic review. Sexual & Reproductive Healthcare. 2022;33:100762100762. https://doi.org/10.1016/j.srhc.2022.100762.
• Miremberg H, Uribe C, O'Donoghue K. The outcome of trisomy 18 pregnancies following the legalisation of termination of pregnancy. Irish Medical Journal. 2023;116(10):P873. https://imj.ie/wp-content/uploads/2023/12/The-outcome-of-trisomy-18-pregnancies-following-the-legalisation-of-termination-of-pregnancy.pdf. 
• Miremberg H, Oduola O, Morrison J, O'Donoghue K. Fetal anomaly diagnosis and termination of pregnancy in Ireland; a service evaluation following implementation of abortion services in 2019. American Journal of Obstetrics & Gynecology MFM. 2023. https://doi.org/10.1016/j.ajogmf.2023.101111. 
• Uribe C, Togher KL, Leitao S, O’Donoghue K, Hayes-Ryan D. Termination of early pregnancy in Ireland: Review of the first four years of inpatient service at a tertiary maternity unit. Irish Journal of Sociology. 2025;33(1-2):149-162. https://doi.org/10.1177/07916035251342113. 

Policy brief

• Pregnancy Loss Research Group. Termination of pregnancy: Training and clear guidance can have a meaningful impact on services. PLRG Policy Brief 8. October 2022.

Project status

Ongoing: 2022 to 2027

Further information

Please email:

• Dr Deirdre Hayes Ryan: Deirdre.HayesRyan@hse.ie
• Professor Keelin O'Donoghue: k.odonoghue@ucc.ie