Demographics

The overall response rate was 45% (n=169; 55% women; 88.2% <30 years of age; 66.7% Irish; 29.2% North American) (table 1). Totally, 84% of the students were single (no divorcees), 8.3% married and 7.7% in domestic partnerships; 5.3% of the participants had biological children. Responses were reasonably well dispersed across all 4 years of the medical programme and from the postgraduation intern year: 26.6% of responses were from year 1; 18.9% from year 2; 21.9% from year 3; 20.1% from year 4; and 12.4% from the intern year. Intended fields of medical specialisation indicated by participants were as follows: unsure (26.2%); general practitioner (GP) (20.8%); internal medicine—all disciplines (16.7%); surgery—all disciplines (10.1%); paediatrics (7.7%); psychiatry (4.2%); obstetrics and gynaecology (4.2%) and other (10.1%).

Attitudes to abortion

In the context of 72.8% of respondents being moderately/strongly prochoice (74% women/71% men/72% Irish/76% North American), responses received were as follows: abortion should not be legally available (7.1%); abortion should be allowed in limited circumstances only (35.5%); TOP should be legally available upon request (55%); unsure 2.4% (table 2). Where students indicated that they believed that TOP should be legal in Ireland, the most common reasons selected (of those provided) were that ‘the woman has the right to terminate or not terminate a pregnancy’ (76.2%), and ‘laws against abortion don't stop abortion, they simply make it less safe’ (68.9%). Other choices selected were: ‘the foetus is not yet a person’ (22.1%); ‘the foetus is not yet sentient’ (14.8%); ‘it should be a purely medical decision’ (17.2%); and ‘other’ (9.8%) (table 2). Where students indicated that they believed that abortion should not be legal in Ireland, the most frequently chosen reason was that ‘the foetus is a person’ (78.9%) (table 2). Religion was cited least frequently (21.1%). When asked whether education on TOP should be offered as part of the medical curriculum, a significant majority believed that it should be mandatory (76.3%); 18.9% preferred that such education should be optional, with 3.0% supporting non-provision of such information.

Influence of students’ nationality, gender and age

The majority of North American students were in favour of TOP being legally available on request (69% vs 49% Irish; 95% CI for difference 4% to 36%, p=0.02) while Irish students largely favoured abortion being legalised only under certain circumstances (43% vs 20% North American; 95% CI for difference 5% to 36%, p=0.006). In terms of gender, females irrespective of nationality tended to be more supportive of TOP being available on request than their male colleagues (58% women vs 51% men; p=0.36), although this difference was not statistically significant. Paradoxically, however, female students indicated greater reticence towards actually performing abortions if legalised (32% women vs 24% men; p=0.25); again this difference was not statistically significant. It is notable that older students (>30 years) and North American students declared themselves more willing than younger or Irish students to perform abortions if legally permitted to do so.

Attitudes towards abortion performed under limited circumstances

While 58.8% of the survey participants indicated that they might perform legal abortions once qualified, 25.7% stated that they would do so under limited circumstances only (table 3). Specifically, the majority of students expressing this opinion were of the view that eligible circumstances would include ‘where the foetus has severe abnormalities and is unlikely to survive’, ‘where pregnancy is of great risk to the life of the mother’, ‘where the pregnancy is the result of rape’ or ‘…result of incest’. However, considerably fewer students believed that psychological distress of the mother or poverty were eligible arguments for TOP (table 3).

Students’ comments regarding abortion

No direction was provided to participants regarding completion of the comments section of the survey; 33 respondents provided comments, a significant proportion of whom (16/33) expressed a prochoice opinion. Notably, however, in some of these cases, responders further stated that they did not agree with TOP at a personal level. The importance of the timing of TOP was also referred to with comments stating that participants would prefer, if TOP were legal, to perform chemical and early term abortions (up to 8–10 weeks). Later-term abortions, which are allowed in some jurisdictions, were commented on negatively. Some respondents stated that they would be willing to perform TOP in the case of a medical emergency only (ie, when the life of the woman was in danger) and that they believed that provision of such a service should be protected from abuse.

On the theme of medical information, opinions were expressed that education on all aspects of abortion provision is important—not necessarily limited to those medical professionals who may perform TOP—to allow for full care of, and to enable accurate information be provided to, patients. On a related theme, a number of participants were satisfied to provide information on availability of abortions outside of the Irish State, while expressing an opinion that Ireland should remain abortion-free.

Several respondents expressed views that have been explored by other researchers, such as the involvement of religion in the debate on TOP, and that while some physicians may object to performing abortions based on their own beliefs, this should not impact on them providing professional and fully inclusive care to patients.19 Similarly, that fathers should have an input into the decision as to whether the mother should terminate a pregnancy.20 Other comments were that: abortion should not be permitted in the case where the woman expresses suicidal feelings—as this could be used as a ruse for obtaining an abortion; the Irish State should not bear the cost of abortion, and a preference for performing TOP only where preabortion counselling had been provided.