‘It was going to be two days, and it’s been a month’: A feminist critique of legal time limits for the process of abortion

‘It was going to be two days, and it’s been a month. I’m exhausted,’ shared a person I (Marcin) met in an English abortion clinic recently. Earlier that day, she had returned to the clinic because her Early Medical Abortion (EMA)—a treatment involving mifepristone and misoprostol tablets completed a month prior—had not fully worked. Since the initial treatment, she had been experiencing severe pain and heavy bleeding. An ultrasound scan at the clinic just before our conversation confirmed that some pregnancy tissue remained in her uterus. This tissue was still producing pregnancy hormones, which explained why a test carried out by the midwife that day showed she was still pregnant. ‘Tomorrow this will hopefully end,’ she told me, having just been booked in for surgical removal of the tissue the following morning. Crucially, the clinic staff classified her case as a ‘failed EMA’ and her surgery as the ‘continuation of treatment’.

Such cases are rare, as the vast majority of EMAs are completed without complication. In England, patients are usually asked to take a pregnancy test three weeks after treatment to confirm the EMA has been successful. Yet, as standard consent forms for EMA in England outline, up to 1 in 100 patients may experience a failed treatment where the pregnancy continues, and between 3 and 6 in 100 may experience an incomplete abortion.

Whether an intervention following an EMA is considered a ‘continuation of treatment’—as in the case above—or an entirely new treatment depends heavily on the context. This classification has significant implications that shift according to the legal, social, and cultural environment. For instance, if a person is self-funding their care, they may not be charged separately for the follow-up surgery if it is deemed part of the initial EMA. We have observed this scenario in our ongoing fieldwork into abortion care in England as part of the ‘Pregnancy Dating Challenges’ (PregDaT) study.

In other contexts, however, this classification can have far more profound consequences. In the Republic of Ireland, for instance, abortion is permitted upon request up to 12 weeks’ gestation. If a pregnant person undergoes a legal EMA before this threshold but experiences a continuation of pregnancy, they may require surgical completion, or a further dose of abortion pills, at a point when the pregnancy is more than 12 weeks gestation. As reported by Professor Ruth Fletcher (Queen Mary University of London), due to a rigid interpretation of Irish abortion law, these patients are usually denied this follow-up care and may be forced to travel abroad—often to Great Britain, where the legal gestational limit is 24 weeks.

This denial of care is not inevitable, as demonstrated by the English case that opens this post, where post-EMA surgery was straightforwardly classified as a continuation of treatment. Advocating for a similarly patient-centred and flexible interpretation of abortion law was a central theme at the ‘Witnessing Abortion Pathways’ workshop, convened by Professor Fletcher at Queen Mary University of London in May 2026. The event brought together two dozen medical professionals, legal scholars, practitioners, activists, artists, third-sector workers, and social scientists working in abortion care across the Republic of Ireland, Northern Ireland, England, and internationally.

The specific interpretation and practical application of Irish abortion law provided a guiding question for the workshop: what happens in cases of a failed EMA if a patient needs to complete treatment after the 12-week gestational limit? Crucially, how might these cases be handled if a feminist, patient-centred approach to the law were adopted? Furthermore, why is the ‘12 weeks’ threshold strictly interpreted as ‘under 12 weeks’—serving as just one example of the broadly conservative application of current Irish abortion legislation?

As noted by Dr. Trish Horgan from START Ireland, a GP practising in Ireland who attended the workshop, the law acts as if abortion is a discrete event. In reality, it is a process with variable outcomes and timelines. This reality is also reflected in our ongoing PregDaT fieldwork across the United Kingdom, Italy, France, and Greece, where gestational age limits for abortion vary. Conventionally, the beginning of a pregnancy is calculated from the first day of the pregnant person’s last menstrual period (LMP). This standard measure is clinically recognised and successfully applied—for instance, within the telemedicine model used for EMA in the UK. Only if there are specific medical reasons not to rely on LMP (such as irregular menstrual cycles, breastfeeding, or conditions like PCOS or polycystic ovary syndrome) is a person referred for a mandatory ultrasound scan, which is also standard practice prior to a surgical termination.

Estimating pregnancy duration is crucial for providing appropriate abortion care. Yet, as our research illustrates, pregnancy dating does not guarantee perfect accuracy. Precision depends on many factors, including the point in the pregnancy at which the estimation is made. Moreover, different ultrasound machines and the varying fetal growth charts integrated into their software can produce assessments of gestational age (GA) that differ by days. The margins of error in dating are well documented in medical literature. Consequently, clinical guidelines recommend that providers use pregnancy dating to determine the most suitable treatment for each patient and to minimise associated health risks, rather than as an absolute measure.

However, in many contexts, providers are compelled to use the dating process to establish legal eligibility. In other words, strict gestational limits force providers to use GA assessment as a tool of discrimination between legal and potentially illegal abortions, leading them to refuse care to those whose pregnancies appear to fall beyond the time threshold. This transforms GA assessment from an instrument of care into an instrument of discipline. Overlaying rigid gestational limits onto a healthcare process allows a single request for care to be misinterpreted as two separate treatment accesses, resulting in the refusal of any necessary care that falls beyond the limit. In the Irish cases discussed at the workshop, professionals refusing care are treating GA limits as the overriding principle of abortion provision, rather than focusing on the abortion as an ongoing process of care.

Under these conditions, re-dating a pregnancy in the event of a ‘failed EMA’—a standard clinical step to ensure appropriate follow-up care—can paradoxically lead to a refusal of care, even when the pregnancy was initially deemed eligible for termination. One of the cases concerned a patient who had initially been dated at 11 weeks and 3 days’ gestation. A later scan indicated she was 11 weeks and 6 days, which meant that she would not be able to meet the three day mandatory waiting period requirement before passing the 12 weeks + 0 days time limit. The resulting uncertainty about the exact GA led health professionals to refuse care due to the legal risks associated with gestational limits. A framework of criminalisation, rather than one centred on the patient, turned a necessary clinical assessment (re-dating) into a source of legal peril, creating a chilling effect on healthcare provision and pushing the patient to travel abroad for a termination.

During the workshop, Professor Fletcher argued that the hybrid concept of time embedded within Section 12 of Ireland’s Health (Regulation of Termination of Pregnancy) Act 2018 could serve as a foundation for interpreting time in a less rigid, authoritative manner. The statute employs both calendar time (the 12-week limit) and menstrual time (calculated from the last menstrual period). As Section 12(5) stipulates: ‘For the purposes of this section, “12 weeks of pregnancy” shall be construed in accordance with the medical principle that pregnancy is generally dated from the first day of a woman’s last menstrual period.’ This built-in flexibility, Fletcher suggested, should encourage a more nuanced legal interpretation.

For now, however, the workshop highlighted a grim reality: people in the Republic of Ireland who experience a failed EMA and need to complete their termination beyond 12 weeks are forced to travel. Their most frequent destination is England, where travel and private treatment costs can easily amount to several thousand pounds. Dr. Lyndsay Creswell—who, alongside Dr. Laura McLaughlin, has developed termination services in Belfast—suggested that travelling to closer clinics in Northern Ireland may offer a viable interim option for some. Yet, as Dr. Dyuti Chakravarty (Radical Humanities Lab/Sociology, University College Cork) highlighted, rigid gestational limits disproportionately impact marginalised groups, particularly those who must factor lengthy visa application processes into their abortion travel timelines.

As Professor Fletcher noted in her concluding remarks: ‘Time limits are legal procedures, and there are methods for interpreting them. In this case, we should go for a method that is more rights-protecting, which would also be more constitutional.’ Indeed, our ongoing PregDaT fieldwork confirms that there are various ways to interpret legal time limits—and, consequently, more legal avenues available to protect patients. Ultimately, what is urgently needed is feminist strategy and imagination to ensure legal frameworks centre the actual needs of the people relying on them.

Marcin Smietana, Giulia Zanini and Alessandra Brigo are sociologists and anthropologists and work in the ERC-funded project: PregDaT, Pregnancy dating challenges: technologies and unequal geographies of abortion and childbirth care, at Ca’ Foscari University of Venice, in Italy.