In the early morning hours of October 28, 2012, a dentist named Savita Halappanavar died in Galway, on the west coast of Ireland.

Actually, she had been dying for days.

In a report released the following year, medical investigators found that Halappanavar, who was 17 weeks pregnant, had been showing signs of a possible pregnancy-related infection since her first visit to the hospital a week earlier.

But even after the amniotic sac ruptured—meaning that Halappanavar’s pregnancy couldn’t possibly be viable, and that her risk of developing a life-threatening infection was increasing by the hour—doctors failed to do the one thing that might have saved her life: give her an abortion. By the time Halappanavar miscarried on her own, it was too late. The infection had already invaded her blood. She died four days later.

Does this story sound familiar?

Maybe that’s because you’ve heard it before—or because it’s so similar to the stories of Josseli Barnica, Amber Thurman, and Candi Miller, three U.S. women whose abortion ban-related deaths were recently reported by ProPublica.

In Texas, where a near-total abortion ban went into effect in 2021, pregnancy-related deaths increased by 56 percent between 2019 and 2022, dramatically surpassing the national increase of 11 percent during that time. Barnica is just one of the names behind those numbers. There are many more names we don’t know, and may never know, in more states beyond just Texas.

Then there are the stories of people like Kate Cox, Amanda Zurawski, Lauren Miller, Lauren Hall, Anna Zargarian, Ashley Brandt, and at least 15 other U.S. women represented by the Center for Reproductive Rights who were denied abortions they needed for medical reasons. These women didn’t die, but they could have—just like countless others who have bled in parking lots, had care unnecessarily delayed in cases nearly identical to Halappanavar’s, or been life-flighted out of abortion-hostile states over the last few years.

In the wake of the U.S. presidential election, many readers have asked me: Why aren’t these stories of delays and denials of care enough? Why haven’t they affected Americans the way Halappanavar’s death seemed to affect the Irish?

For one thing, while Halappanavar certainly became a symbol—both in Ireland and abroad—her death was not the beginning nor the end of Ireland’s abortion rights fight. And the country’s 2018 abortion rights referendum and its aftermath offer some important lessons on both the power and the limits of these tragic stories.

Ireland’s long fight

Abortion was outlawed in Ireland in 1861, which is around the same time many U.S. states began restricting or banning abortion. But in 1983, a referendum added fetal “personhood” to the country’s constitution in the form of the Eighth Amendment, which established legal rights for fetuses that were equal to those of the pregnant people carrying them.

“This was very heavily influenced by the Catholic Church,” said Fiona de Londras, a law professor at the University of Birmingham in the United Kingdom. “It was also, by the way, very heavily influenced by American anti-abortion activists, for whom Ireland was a sort of constitutional laboratory.”

However, even after the passage of the Eighth Amendment, abortion rights advocacy continued in Ireland.

“While [Halappanavar’s] death may have mobilized more people, or … acted as a tipping point for people to take their individual objection to the Eighth Amendment into an active mobilization phase, there had already been decades of activism to try to do something about this intolerable legal situation,” de Londras said.

A series of high-profile legal cases from the 1990s onward, in both Irish and international courts, led to small reforms. For example, a 1992 referendum established Irish citizens’ right to travel for abortion care. And in 2013—nearly a year after Halappanavar’s death—the Oireachtas, or Irish parliament, passed a law clarifying the circumstances in which emergency abortions were permissible. However, these changes did very little to meaningfully improve access, said de Londras.

“Even in the years after that, if you talked to a politician, or if you heard some of the rhetoric, things felt slow to change,” said Anna Carnegie, an Irish abortion rights activist and writer living in London. From her perspective, repealing the Eighth Amendment didn’t become a realistic possibility until 2014 or 2015.

In 2016, amid mounting public pressure, the Oireachtas established a citizens’ assembly to advise the government on potential abortion law reform. Many activists saw this as a delaying tactic, Carnegie said, but were pleasantly surprised by the results: The assembly recommended that the Eighth Amendment be replaced, and 64 percent of its members agreed that “termination of pregnancy without restriction should be lawful.”

And though lawmakers dragged their feet, they eventually passed the legislation necessary for a referendum. In 2018, Irish voters repealed the Eighth Amendment with more than 66 percent of the vote.

In a 2019 paper, Carnegie and her colleague, Rachel Roth, a U.S. reproductive justice activist and writer who lived in Dublin during the repeal campaign, noted that only one Irish district voted no on the referendum. And even there, 48 percent voted yes.

‘People are generally way ahead of politics’

Ireland’s “Together for Yes” referendum campaign focused heavily on abortions for medical reasons, emphasizing compassion and the idea that people facing severe pregnancy complications or fatal fetal diagnoses should be able to receive care at home.

“There was a widely-held perception that we needed to pull the conservative middle ground into a pro-choice position,” Carnegie said. This was occasionally borne out in some conversations with voters, she added, who would say they didn’t want abortion to be available “on demand.”

But overall, “when you kind of dig down into what people actually think … most people have a far more pro-reproductive agency position,” de Londras said. “People are generally way ahead of politics on these things.”

“A hyper-weighting of these cases, which are terrible but actually marginal and very unusual, does create perceived social hierarchies of different kinds of abortions,” she added. “And this exacerbates abortion-related stigma, which is actually pretty bad for health.”

The long shadow of stigma shows in the abortion law Ireland ended up with.

Following the repeal vote, abortion rights groups including Abortion Rights Campaign, Amnesty Ireland, the Irish Family Planning Association, and Lawyers for Choice, urged the government to fully decriminalize abortion, make it available for free without a waiting period, ban “conscientious objections” to providing abortion care, and avoid the use of vague and non-medical language in any abortion law.

One of these demands was met: Abortion care is now free in Ireland.

However, the law allows abortion on request only until 12 weeks of pregnancy. There is a three-day waiting period.

Beyond this point, abortions for health indications have to meet very specific criteria. For example, in cases of fetal health issues, two medical practitioners have to certify that the fetus will die within 28 days of birth.

“Even though the law doesn’t require it, if you have a fetal anomaly, you end up with these multidisciplinary medical teams who sit around and debate whether it’ll be exactly 28 days, or could it possibly live for 30 days, even if the fetus is going to live in extreme pain,” de Londras said.

Similar certification requirements exist when an abortion is necessary to save a pregnant person’s life. And doctors who provide abortion care outside the constraints of the law still face criminal sanctions, which creates a chilling effect exactly like the one that made Halappanavar’s care team hesitate to treat her appropriately.

This is not just an Irish problem: We’re seeing it right now in the U.S. with debates and legal fights over abortion ban exceptions. De Londras led a team at Birmingham Law School that did a systematic review finding similar problems all over the world.

“It’s very clear that if you have qualifications for abortion in a law, and particularly—but not exclusively—if you have criminalization, anything that comes anywhere near those border lines of gestational duration or of a ground on which you’re allowed to have an abortion, the closer to the line you come, the more cautious the physicians become,” she said.

For example, the availability of abortion up to 12 weeks in Ireland quickly became 11 weeks, six days, because doctors were afraid to go over the line, de Londras said. Then there’s the issue of the waiting period, which moves that functional deadline even earlier. Because of all these concerns, those beyond nine weeks of pregnancy are often forced to seek care in a hospital instead of in a community health setting, “which is a total waste of everybody’s resources,” she added.

There are many obvious differences between the U.S. and Ireland. For one, Ireland has a multi-party parliamentary system, and though there are partisan aspects to the debate, abortion rights haven’t been used as a political football in quite the same way they have in the U.S. two-party system.

The recent U.S. presidential election was also a multi-issue election, and not a direct referendum on abortion rights. However, many people saw it as one—or, perhaps, it’s more correct to say they hoped it would be.

Following voters’ overwhelming support for abortion-related ballot measures in 2022 and 2023, Democrats hoped that abortion rights would be a decisive factor in the presidential election, and that the ten abortion measures on the ballot in 2024 might further boost Democratic-leaning turnout.

And Democrats relied heavily on stories where people were denied abortion care in emergencies, or after receiving a fatal fetal diagnosis. This approach was featured prominently at the Democratic National Convention, with Cox, Zurawski, and Katilyn Joshua all sharing such stories. Kamala Harris often referenced these cases in debates and speeches.

Ballot measure campaigns also placed significant focus on denials of emergency care, and on the lack of meaningful exceptions to some states’ abortion bans for rape and incest, something that concerned many of my sources in the reproductive justice movement.

Even while they worked on these ballot measure campaigns—recognizing the critical importance of restoring even some abortion rights—my sources consistently expressed concerns that campaign leaders chose messaging that was stigmatizing. Most people who have abortions don’t have them because they were raped or because their life was in danger, but because they simply didn’t want to be pregnant or have a child at that time.

The language about fetal viability included in several of these ballot measures was also a source of controversy and infighting, as many advocates worried that restoring this flawed framework from Roe v. Wade could impair future advocacy efforts.

This echoes what happened in Ireland.

“Most of the activists that we worked with, at least, would agree that when there’s a lot of focus on certain stories … you do wind up reinscribing the dichotomy between ‘good’ abortions and ‘bad’ abortions,” Roth said. “I know a lot of people were really upset to be put in that position.”

Abortion is more popular than Democrats

In the end, abortion-related measures—even the unsuccessful ones—outperformed Harris in every single state where they appeared on the ballot, often by more than 10 or 15 points. They outperformed many down-ballot Democrats as well, particularly in Senate races. You could use this fact to argue that voters were, indeed, motivated by stories of abortion denial in emergency or other tragic situations.

But, as was the case in Ireland, public opinion is ahead of politics here. A majority of Americans have believed that abortion should be legal in all or most cases ever since Roe, and the share of Americans who believe abortion should be legal—including later in pregnancy—has recently surged to the highest number ever recorded.

And though public opinion polls typically show that support for abortion rights wanes later in in pregnancy, newer polling shows that even among people who say they believe abortion should be illegal in the last three months of pregnancy, when asked more nuanced questions, 58 percent agree that people should be able to make their own abortion decisions throughout pregnancy. Eighty percent agree that laws can’t account for every situation where an abortion might be needed.

Many observers have suggested that the performance of abortion ballot measures compared to Democrats’ performance overall indicates that many people—especially white women—simply voted to protect themselves, and not the many others who will suffer under a second Donald Trump administration. This is likely true, although we can’t be sure as to what degree.

But what might have happened if Democrats had run a more honest campaign, based on the idea—the truth—that abortion is popular? Could this have led to the voter turnout that Democrats failed to inspire?

Harris, and the Democratic Party more broadly, never articulated a specific plan to restore abortion rights at the federal level. Nor did they spend much time communicating what it really would have taken to achieve national abortion rights reform: Democratic majorities in the House and Senate, with every member on board with plans to reform or abolish the filibuster, and reform the Supreme Court.

Nor did ballot measure campaigns, in their attempts to stay apolitical, communicate to voters how easily their votes in favor of ballot measures could be undermined by Republicans at both the state and federal levels.

Conventional wisdom may suggest that all this information is simply too complicated for voters. But is it, really? Republicans educated voters on the importance of the Supreme Court and other judicial nominees for decades, and as a result, successfully transformed the U.S. judiciary at the federal level and in many states.

Harris did say she would support doing away with the filibuster “for Roe,” and also expressed tepid support for Supreme Court reform. In August, one poll found that a striking 70 percent of Republicans support the idea of a code of conduct for Supreme Court justices, and 51 percent endorse term limits. Backing was even higher among Democrats, with 89 percent supporting a code of conduct and 83 percent supporting term limits. But getting rid of the filibuster and enacting court reform were not major features of the Harris campaign—another missed campaign opportunity given the Supreme Court’s wild unpopularity.

Another uncomfortable truth is that abortion denial is not a new phenomenon in the U.S. It’s just happening on a larger scale now. Treating this as a new problem obfuscates the reality, which is that Roe always left our most marginalized and vulnerable behind—and that the Democratic Party of 2024 has yet to articulate any kind of stance on abortion that doesn’t simply involve restoring that same flawed framework.

The same states that now ban abortion had already legislated abortion rights nearly out of existence before Dobbs v. Jackson Women’s Health Organization, especially for young people, low income people, and people of color. The Hyde Amendment, which bars federal funds from being used for abortion care, has been harming and even killing people like Rosie Jimenez since 1977.

Incarcerated people often had no access to abortion. Catholic hospitals routinely denied emergency abortion care for decades before Roe was overturned, and even hospitals without religious affiliations often limited access to abortion above and beyond the requirements of state law.

And from the Turnaway Study, we know that being denied an abortion—even when it doesn’t result in grave medical consequences—affects the lives of pregnant people and their children for years to come.

None of this is to say that people’s stories of abortion denial under tragic circumstances don’t matter or shouldn’t be shared. They do matter. But so do all the other stories—and so does the dignity of these storytellers.

How long will we ask people to bare their open wounds for the world, and stand by when nothing happens?