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A woman pushes her bicycle past a Pro-Choice mural ahead of a 25th May referendum on abortion law, in Dublin, Ireland, May 7, 2018.CLODAGH KILCOYNE

Kitty Holland is social-affairs correspondent for The Irish Times.

Six years after the death of a young woman in an Irish hospital, arguably as a result of being refused an abortion, Ireland is preparing to vote on whether, finally, to allow abortion services.

The result of the referendum on May 25 will reflect not only how Ireland’s attitude to abortion has changed, but also the degree to which its difficult, often cruel, relationship with women has changed.

This vote is about more than just abortion – it’s a sort of reckoning about the kind of society Ireland has been and the kind it wants to be. The momentum continues from six years ago and it’s so enormous that no matter what the result of the referendum, this generation of young women will not stop mobilizing. They will wait no longer for a system that provides access to a safe, standard medical procedure.

Irish women have confronted the harsh reality that, despite growing up in a society they believed to be progressive and safe, the country has always had its own isolating, shaming, controlling and destructive form of misogyny – and one which most heinously affects the poorest women and their children.

Six years ago, the country witnessed the heartbreaking case of Savita Halappanavar. Her tragic story forced the country to come face to face with abortion laws that can have dire consequences.

Savita, 31, a dentist who had immigrated from India, was 17 weeks pregnant when she was admitted to University Hospital Galway in the west of Ireland, with severe back pain. She was told she was miscarrying – and the baby would not survive. It was Sunday, Oct. 21, 2012.

After a day in agonizing pain, Savita and her husband, Praveen, asked for the pregnancy to be terminated. They were told, because there was a fetal heartbeat, that this was not legal in Ireland.

On the Tuesday, Savita was in increasing pain and distress and asked again for a termination. Again she was refused. A midwife explained to her the law around abortion in Ireland that a pregnancy could not be terminated when the fetus was alive and the mother’s life was not in danger. Savita protested that she was neither Irish nor Catholic, but a Hindu, but was again refused.

Over the next few days, Savita deteriorated. She contracted sepsis and lost the fetus. By Saturday, she went into septic shock and multi-organ failure.

Late on Saturday night, a nurse came out of the ICU to get Praveen, who recently told me what happened. “‘Are you okay to be with Savita during her last few minutes?’ the nurse asked. ‘We are losing Savita.’ I said ‘yes.’”

“When we went in there was a big team around Savita. They were pumping her heart. . . . then . . . she passed away.” Savita died at 1:09 a.m. on Oct. 28, one week after arriving at the hospital.

Although there was a litany of catastrophic failures in her care – failure to read blood-test results properly, a failure to recognize rapidly developing sepsis, clinicians’ failure to communicate – no one has since disputed the facts as I first reported them. Nor has anyone ever denied that had Savita had the abortion she requested, she would be alive today.

That the narrative of why and how she died was so immediately contested by the anti-abortion lobby is a measure of how immediately they, too, recognized the importance of her death to the abortion debate.

The reason Savita was refused the abortion dated, legally, to 29 years previously, when Article 40.3.3. was inserted into the Constitution as the eighth amendment in late 1983, after a bitterly divisive campaign.

It reads: “The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.”

In short, unborn human life was endowed with the same right to legal and constitutional protection as the actual life of the woman or girl carrying it.

No woman under the age of 53 has ever had a say in this. The question before the people, on the last Friday of May, is whether to repeal the eighth amendment.

It’s worth noting that abortion was already illegal in Ireland in 1983 under the 1861 Offences Against the Person Act. In the early 1980s, there was no public demand this should change.

The determination by a powerful and wealthy Catholic right that legislation alone was not sufficient to “keep abortion out of Ireland” and that a constitutional bulwark was needed, underlines the anxiety clearly felt by many in the Irish, male establishment that women elsewhere were becoming too socially and economically empowered. This trend could eventually influence Irish women.

This was the Ireland where, in the 1950s, a government proposal to introduce free medical care for mothers and children was dropped following intense Catholic Church lobbying that GPs could not be trusted not to “interfere” in the Irish family, perhaps even providing contraception to women who wanted, or desperately needed, it.

This was the Ireland where unmarried women (and girls) who became pregnant, whether through rape or consensual sex, were still being sent to Church-run Magdalene laundries – in secret, in shame – to be incarcerated, to work for nothing and to have to give up all rights to their babies. By such means would they “atone for their sins.” The last of these laundries – to which poor women mainly were sent – was not closed until 1996.

Thousands of babies born in these institutions were effectively sold to what were regarded as good Catholic couples in the United States, while thousands more – born of supposed sin – died of neglect or ended up in Church-run orphanages where the savagery of beatings, emotional cruelty and sexual abuse have since been widely documented.

Britain had legalized abortion services under the 1967 Abortion Act. In the United States, Roe v. Wade saw access to abortion widened in 1973. And when the Irish courts legalized contraceptives for married couples in 1974, the country’s Catholic culture was put on notice that its way of life was under threat.

The Pro-Life Amendment Campaign was established in January, 1981, made up of Catholic organizations, and with breathtaking success, it achieved passage of the eighth Amendment in a referendum in September, 1983. Some 67 per cent voted for it, and 33 per cent against.

Since then, 170,000 women and girls have travelled to Britain to access abortion services, and 3,000 a year still do. In addition, about 2,000 a year are importing abortion pills illegally, online, and taking them without medical supervision and facing a 14-year prison sentence if they’re caught.

An abortion, free to British women on the National Health Service, costs an Irish woman anywhere between €600 ($908) and €2,000 ($3,024), the costs rising as the pregnancy progresses. Add to that flights and accommodation and the right to choose abortion really is the preserve only of those who can pay for it.

In Ireland, abortion is a class issue as much as it a woman’s.

And there have been the tragedies.

Among the most notorious, the 1992 “X” case, in which a 14-year-old girl, suicidal and pregnant as a result of rape, was prevented from travelling to Britain for an abortion. Her case went to the Supreme Court, which overturned the injunction on her travelling, establishing that suicidality was a “real and substantial threat” to the girl’s life and so she had the right to an abortion.

The 1997 “C” case involved a 13-year-old child, pregnant after rape, but unable to travel to Britain as she was in state care. She, too, was eventually allowed to travel with social workers because she was suicidal and the court deemed her life was in danger.

There were further horrendous cases – D, a woman who, having received a diagnosis of a fatal fetal abnormality, had to travel to Britain for a termination; another known as Miss D, a 17-year-old in state care, pregnant and wanting an abortion; and “C”, a woman who had cancer and who had to leave Ireland to have an abortion as she was being refused cancer treatment that would kill her unborn child.

Savita Halappanavar’s death six years ago shocked and horrified Ireland because, whereas in past tragedies we had no idea who the women and girls were, now we had a face, a name and a grieving family – confused and bewildered over why their Savita had been refused what they viewed as a standard medical procedure.

On the Wednesday evening that the story broke, around 3,000 people gathered outside the Irish parliament – the Dail – holding candles, weeping, clutching images of Savita. On the Saturday, around 20,000 marched through Dublin chanting, “Never Again.”

For young women in particular, who had grown up in an Ireland they regarded as modern, outward-looking and sophisticated, the juxtaposition between that perception and the seemingly medieval circumstances of Savita’s death was horrifying.

New organizations, such as the Abortion Rights Campaign (ARC) and for Reproductive rights against Oppression, Sexism and Austerity (ROSA) have grown enormously, to the point now where they are campaigning in their thousands for change.

Over the past six months opposing canvassing teams have been knocking on doors in neighbourhoods across the country, asking people to vote Yes or No. I have spoken to people – almost all women – campaigning for Yes who have become politically active for the first time. Many said they were nervous about getting involved in campaigning, but said they had to do this.

Long-time political activists such as Michael O’Brien, a Socialist Party councillor in Dublin City, told me in other political campaigns one of the biggest problems is persuading people to canvass.

“But people are involved in huge number in this. Canvassing teams of 60 to 80 people, where normally you’d have 10 or 12, are out. I’ve never seen a campaign like it.”

Older women, too, who have lived through some of the cruelties of womanhood and motherhood in Ireland-past, are finding their voice. Many in their 60s and 70s whom I have spoken to in the past few weeks say they are voting Yes, and tell of having lost babies in childbirth, of having had babies with severe disabilities, and of being told to simply “Go home and have another.”

For those opposing repeal, in such groups as Love Both and Save the 8th, there is a cherished sense of an Ireland where family, faith, children and community are prized, and one in which abortion – synonymous with individualism and even selfishness – is antithetical.

The outcome of the vote is far from clear. Polls are tightening and the Yes campaign’s lead – which appeared unassailable weeks ago – has narrowed. People are telling canvassers they are concerned repeal could mean abortion being used as a form of contraception, and a British-style “abortion on demand” culture would emerge here. (The government’s proposed legislation would permit abortion on request up to 12 weeks and then only under certain circumstances thereafter.)

May 26 will be a hugely emotional day for Ireland – one of enormous celebration and shattering disappointment.

The result of the referendum will reverberate for women and girls across the developed world, particularly in the Americas – in the United States and in Central America, from which anti-abortion activists are closely observing what happens here.

For this lobby, Ireland – developed, affluent and with one of the most restrictive abortion regimes in the world – is the jewel in the pro-life crown. Win or lose here next weekend, the result will be hugely significant.

Whatever happens, a new generation of young women is mobilized. If their hopes are dashed by the referendum, these women will not wait another 35 years.

Abortion rights are firmly on the Irish political agenda – put there by thousands of mobilized and active women and girls, and by ‘X’, ‘C’ and ‘D’, and by Savita.

The issue is not going away. Nor are Irish women until the goal, of free, safe and legal abortion services, at home, has been achieved.