Every year thousands of Irish women travel abroad for abortions. Irish women's health organisations report increasing numbers are purchasing abortion-inducing products online and using them in their homes. However, the Irish government steadfastly refuses to confront the issue.

Abortion is generally illegal in Ireland, but the sticking point is that it is not always illegal. Since a 1992 supreme court ruling in the case of a teenage rape victim, there is actually a small category of cases in which one has a right to access a termination: where there is a real and substantial risk to the life of a pregnant woman from carrying a baby to term. Not only is Ireland one of a handful of European states where abortion is restricted to this extent, but its government has avoided introducing comprehensive legislation or guidelines to determine whether someone falls into that small category where abortion is lawful.

So there is no real way in which most women can exercise that limited constitutional right. Neither is it possible for medical practitioners to advise women effectively because they lack the guidelines they need. But today the European court of human rights handed down a judgment in the cases brought by three women, A, B & C v Ireland, that may compel the government into action.

The court's decision does not really change Ireland's current legal position: they didn't find that the restriction of abortion violates the European convention on human rights. What the court did instead, when deciding in favour of Ms C, is to confirm that the failure to put in place a proper framework within which one's right to an abortion can be exercised, violates the right to privacy. This means that as a matter of international law the Irish government is required to do something about abortion; what it will do is not yet clear.

There are a couple of options. First, a constitutional referendum to ask the people to either close off the exception or to extend the availability of abortion. Pro-life campaigners have called for a referendum; but the reality is that another national vote on this issue would be difficult to implement.

Agreeing on the wording of the proposed amendment would be tortuous, and the referendum campaign would be as ugly as the three previous ones in 1983, 1992 and 2002. The second, more likely, option is that the government will introduce regulation. That will also be difficult: how many doctors' authorisations will be required? Will we need special consent where the woman is a minor?

Difficult as crafting guidelines will be, they are necessary. Because it is unconscionable for a government to have spent the past 18 years, since the supreme court urged it to legislate, in a state of avoidance. Because there are cases where women's lives are at risk – a risk compounded by having to travel, borrow money and get abortions abroad. Because medical practitioners have no effective guidance when they are treating women who may fall into this small category of cases. Because although these women have a constitutional right to choose termination, the choice to have an abortion in their own country surrounded by their support networks is denied them in practice.

Even legislation will not end the abortion debate in Ireland. Women will still have to travel if they want a termination. Today's decision doesn't address that; it leaves the question of how broadly to cast access to abortion to the state itself. With an election looming and speculation as to the role abortion will play, these issues are central to our national discourse. But behind that discourse lie real women, real stories, and a regulatory vacuum that must be filled.