By 10.30am, 10 minutes before her first appointment, Catriona is already grey-faced with exhaustion and so tired that talking is a struggle; her words fall out on top of each other. She is six weeks pregnant and has travelled overnight by boat from a small town an hour outside Belfast to Liverpool for an abortion. She took the boat because it was cheaper than flying and because she had no passport, and didn’t have the money or the time to get one; but it has been a difficult journey and she hasn’t slept. Tonight, after the procedure, she will go back by boat, a second night sitting bolt upright, trying to sleep. This is her first trip to England.

“A lot of bad things have happened to me in my life, but this has been the worst,” says the 28-year-old single mother who, like all the women I spoke to for this article, did not want to use her real name. It’s not the abortion itself that is troubling her; she has two sons already, and no desire to expand her family. It’s the difficulties involved in getting herself, at short notice, to England for a medical procedure considered a criminal offence punishable by life imprisonment in Northern Ireland. In total, the cost of the round trip and the abortion will come to about £570. Over the past three weeks, while saving for the journey, she has cut down on the food for the family and hasn’t bought oil to heat the house. “We’ve been going to my mum’s house, where there’s a fire; she’s been giving food to the boys.”

Catriona hadn’t realised abortion law in Northern Ireland was so restrictive. When she told her GP she didn’t want to keep the baby, the doctor said she couldn’t help her and that travelling to England was the only option; she gave her a piece of paper with a telephone number for the British Pregnancy Advisory Service, who booked her into the Liverpool clinic.

'I didn't tell the children, or my friends – I think they'd be sympathetic, but most are Catholic and think it's a sin'

Northern Ireland’s abortion laws have added multiple layers of stress to an already difficult situation for Catriona – expense, secrecy, stigma and logistical difficulties. “I’m not feeling too well,” she says. “I don’t know if it’s tiredness or the travelling, the thinking what is going to happen, the wondering if it’s a good thing or a bad thing.” Her mother’s boyfriend has made the journey with her, to give her support, but no one else apart from her mother knows she is away. “You feel like it has to be a big secret. I didn’t tell the children. I haven’t told my friends… I think they would be sympathetic, but most of them are Catholic and think it’s a sin, so I never mentioned it. There’s so much negativity about it. They make it out to be so bad. You still know it is right for you, but in your head you are thinking, maybe it is bad.”

In the BPAS clinic waiting room on a Saturday morning in October, there are six women from Northern Ireland and the Republic of Ireland waiting for terminations. The clinic, inside a converted, red-brick, double-fronted Victorian family home in Merseyside, sees about 30 people every week who have travelled from there for abortions. At least 4,500 come each year to England to terminate pregnancies, according to Department of Health statistics (although this is only the number of women who give their home addresses in Ireland, which some women don’t want to do; the true figure is higher).

Three of the women here today are in their late teens or early 20s, travelling alone. One of them “has got herself into a bit of a state”, the clinic’s manager says, and is quietly crying, observed in silence by the 20 or so other people in the pre-consultation waiting room. Some of the people who have accompanied women to Liverpool are sleeping, after the early start.

Helen, lead nurse at the British Pregnancy Advisory Service clinic in Liverpool, which treats around 30 women a week. Photograph: Christopher Thomond/The Guardian

For women, such as Sophie, 29, working in the Republic of Ireland but originally from France, the experience is a logistical headache which makes her incredulous about Ireland’s attitude towards women’s rights. “From my French point of view, it seems crazy,” she says. Because she has a good job and a supportive boyfriend, the trip has not caused a major upheaval, and she is composed and philosophical about this unexpected weekend stay in Liverpool. One of her Irish flatmates had made the same journey and gave her advice. For others, such as Anna, 23, a student from Dublin who already has a young child, the financial fallout from this trip will be with her for months. The cost of the flights, two nights in a bed and breakfast, and bringing a friend with her for moral support has come to about ¤1,000, of which €800 is money lent to her by friends.

“Not everyone can get the money and, if they can’t, they have to have the baby,” Anna says. “It was very stressful. It’s not nice asking people for money.” She thinks it will take at least six months to pay back the loans, and she worries that the extra financial pressure may make it harder to complete her degree. However, she’s reassured to know that there are other women here who have made similar journeys. “It’s comforting to know that you are not the only one.”

Abortion is legal in Ireland only if the woman's life is at risk, but there is no clear guidance on how to define that

Kally, the clinic manager, feels worried for the women who travel from Ireland. She works with the clinical lead nurse, Helen, to make sure they smooth over the extra problems these women face. They help to book them in on a Saturday, so they don’t need to miss work, and (if necessary) they can tell friends they are popping over to England for shopping, or accompanying a partner to the football. They let them stay later at the clinic, if they have a late-night flight. They advise any woman who is having a medical abortion (one that induces miscarriage) not to travel back by boat or plane that night because of the unpredictability of the bleeding; but often women can’t afford the extra cost of a night in a hotel.

“If they’ve had to book a really late flight, we advise them to go to the cinema, so they can sit down and relax. It is not ideal but it is better than lying down on the airport floor,” Helen says. “If you start getting a bit faint in the middle of the airport, they are going to refuse to let you on the flight; you have to be ready to travel.”

They are furious at the misinformation given by some pregnancy counsellors in Ireland. Kally pulls a stapled-together booklet from her in-tray, left by a woman from Northern Ireland earlier in the week. The sheets, which appear to be a simple consent form, go on to warn of a 72% higher risk of rectal and colon cancer among women who have had abortions and a 50% greater risk of breast cancer; they suggest that a woman who has had one may be more prone to seizures, tremors, comas, frigidity and committing child abuse. “This kind of thing sinks in,” Kally says, jabbing at the text with a pen.

‘The system is inhumane’: Kally, manager of the Liverpool clinic. Photograph: Christopher Thomond/The Guardian

She describes the system as “inhumane”. “It is very difficult for women from Ireland to come here. Lots of things contribute to the stress: they don’t want people to know; there is the extra cost, and they have to travel; there is still a stigma attached to abortion; they are afraid they may meet someone here who knows them. It has happened. I’m not saying that women from England aren’t anxious and worried, but they don’t have the added stress that the women from Ireland have.”

***

Abortion in Northern Ireland is lawful only in extremely restricted circumstances, where there is a risk to a pregnant woman’s life or a real and serious risk of long-term damage to her physical or mental health; just 23 legal abortions were carried out on the NHS in 2013-14. Under any other circumstances, a penalty of life imprisonment could be imposed on both the woman undergoing the abortion and anyone assisting her – even if the abortion is sought because of a fatal foetal impairment, for example, or because the pregnancy is the result of rape. This is the harshest criminal penalty for abortion anywhere in Europe.

In the Republic of Ireland, abortion is legal only if the woman’s life is deemed to be at risk, but there is no clear guidance on how to define that. Women and anyone who assists them face up to 14 years in prison for breaking this law. The eighth amendment to the Irish Constitution puts the foetus’s right to life on an equal footing with the woman’s, and the provision of information about abortion services is also restricted, under legislation that criminalises any information by healthcare providers that “advocates or promotes” abortion.

In practice, women who want to end a pregnancy in Northern Ireland or the Republic are faced with two options: travel abroad for a termination, or receive abortion pills by post. Mifepristone and Misoprostol can be taken in combination to trigger a miscarriage, up to the ninth week of pregnancy. These are widely available from online pharmacists, but they are expensive, and it is hard to know whether the online provider is genuine.

As the pills are illegal in Northern Ireland and the Republic, suspicious-looking parcels are routinely checked; about 1,200 packages containing the pills were seized by customs in Ireland last year. In Northern Ireland, a mother is being prosecuted for obtaining abortion pills for her pregnant underage daughter; she was charged with procuring “poison or other noxious substance” in the knowledge that they were to be used to cause a miscarriage. A trial is expected later this year; if found guilty, she faces a five-year sentence.

Northern Ireland imposes the most severe penalty in Europe for abortion. Photograph: Christopher Thomond/The Guardian

In both the Republic and Northern Ireland, however, women cannot be prevented from seeking safe and legal abortion abroad; in the past 30 years, more than 160,000 women have travelled from Northern Ireland and the Republic for a termination. The phenomenon rarely attracts much attention: two-thirds of British people are unaware that the laws on abortion in Northern Ireland are different from those in the rest of the UK. After the success of the equal marriage referendum in Ireland earlier this year, campaigners are calling for a referendum on repealing the eighth amendment. Last month, thousands marched through Dublin in support of decriminalisation. But while popular support is growing across the UK for reform in Northern Ireland, there is little political will among politicians across the spectrum, Catholic and Protestant.

***

Lila, 25, a student who has two children, one of whom has special needs, found out she was pregnant late last November. She immediately knew she couldn’t manage another child. She was brought up in England, and although she has lived in Northern Ireland for the past five years, she didn’t realise the law would apply to her.

“I stupidly thought that I might be able to get around it because I was English,” she says. She decided the cheapest option was to fly to the BPAS’s Liverpool clinic; still, she needed to find £400 for the flights and the procedure. Women from Northern Ireland are not eligible for NHS abortions, even if they travel to England. “It was a shocking amount of money. I cut all my direct debits for that month – the phone bill, electricity, TV licence. I had to pull my eldest son out of pre-school. I felt terrible about that.”

'I felt wrecked… I thought, maybe if I fell down the stairs the right way I could end the pregnancy but not kill myself'

She didn’t feel able to discuss the issue with anyone, which made borrowing money impossible. Concerned that she wasn’t going to be able to save the money quickly enough, she pushed the date of the procedure back. This was the most difficult time – forced to continue with a pregnancy she didn’t want so she could save money for the abortion. “The worst was the waiting, and having to save up, and pretending everything was fine. It was just an awful experience. I didn’t want to be pregnant at all. I felt like a zombie; I could barely get out of bed; I didn’t want to eat. I had to put on a happy face because it was Christmas, but I felt wrecked. I remember thinking maybe if I fell down the stairs the right way I could hurt myself enough to end the pregnancy but not kill myself. It was just awful.”

She was able to afford the procedure only with the help of an English-based organisation called the Abortion Support Network, which offers grants to Irish women struggling with the costs of abortion. Recalling that month makes her cry but, most of all, the memory enrages her.

“Once the being upset wore off, I was very angry. It felt so demeaning – the sneaking out before dawn, feeling I couldn’t tell anyone. I had to lie to the taxi driver, who was really nice, and was asking me what I was doing.”

Waiting at Liverpool airport for the last flight back to Belfast, she noticed three or four women whom she had seen at the clinic earlier in the day. “One was very young, in her late teens. It hurt that she was on her own. One of them looked as if she was in a lot pain, so I bought some Paracetamol and gave some to her. I said, ‘I saw you before, earlier today, and you look like you could do with some.’ She just thanked me.”

The experience has made her feel very hostile to the country she calls home. “I like to think I am fairly intelligent and in a stable relationship. But I wonder about women who aren’t as well supported or educated – how do they cope? I worry about other women who are alone, who are in abusive relationships, or who don’t have that support. It’s just wrong. If I had daughters, I would be making plans to move. I would not be staying in this part of the world.”

Sara, 20, a student at Dublin University, originally from England, also found herself grappling with the cost of travelling to England for an abortion when she found out she was pregnant earlier this year. The doctor she consulted was sympathetic, but made it clear that there was nothing he could do to help.

She chose to go to a clinic in Manchester because that’s where the flights were cheapest; she and her boyfriend decided not to stay overnight because they didn’t have the money for a hotel. “It was the scariest thing that I have ever done – going into a place you don’t know anything about, the whole travelling aspect of it. I was a nervous wreck.”

The clinic told her to wait at a designated spot in Manchester airport, where she would find a taxi driver holding a board with her name on it. “There must have been 10 or 12 girls in exactly the same place, being taken away by taxi drivers. They were there at the clinic. Most of them in their 20s.”

'They're at their wits end – it's nothing to do with the decision to have an abortion, but the fact they can't get one'

Delays at the clinic meant Sara was still waiting at 4pm. “I hadn’t got to the theatre yet and I was thinking to myself, I have to be at the airport in a couple of hours. It was an absolute nightmare.” They made the flight with very little time to spare. “It was the worst thing, to have to get on a flight afterwards. I wanted to get into a clean bed and go to sleep. I didn’t want to be worrying about getting bags on and off a plane, and organising a taxi to get home. I was worried about what would happen if I got on to the flight and started bleeding uncontrollably. I didn’t know what was going to happen.”

In retrospect, she is angry that the enduring stigma associated with abortion in Northern Ireland meant she was unable to talk about what she was doing. “It is your right as a woman to decide what you want to do with your body, and the fact that they do their best to stop that is a disgrace.”

***

Mara Clarke, an energetic New Yorker who lives in London, set up the Abortion Support Network in 2009, startled to learn that thousands of women were coming from Ireland to seek help in England. “I knew if that many are coming over, then there’s 500 or 50 or five who aren’t coming over because they don’t have the money,” she says. “That’s always the cost of restricting abortions – women who have money have abortions, women without money have babies, or they do really, really desperate things to not be pregnant. When we started, we wondered if the phone would ring; the phone hasn’t stopped ringing.”

Mara Clarke, who set up the Abortion Support Network, which offers women grants to travel and negotiates lower fees for their terminations. Photograph: Karen Robinson/The Guardian

Not only does her organisation offer grants to help women to travel, it also advises on flights and the best clinics to travel to, and helps negotiate fees down if women are struggling with the cost of the procedure.

In 2009 the clinic helped four women; in 2014 it helped 552. “We’ve had teenagers, we’ve had women who have attempted suicide, refugees pregnant as a result of rape. Because they don’t happen to have £400 to £2,000 [depending on how many weeks pregnant they are], they are put into this spiral of despair in terms of how to come up with the money. As you are trying to find the money, you get further into the pregnancy; at 14 weeks the price doubles and at 19 weeks the price trebles.”

Clarke views her job with bleak humour, explaining how she has tried without success to get Ryanair and Virgin to offer these women free flights. “If only women could plan their unplanned pregnancies better, so they could take advantage of the reduced advance booking fares on Ryanair,” she says. But she finds the details of the situation depressing. “Fewer than 1.4% of the abortions in England, Scotland and Wales happen at over 20 weeks. With our clients, it’s 8%, because they spend so long trying to raise the money.”

The organisation has 60 volunteers, who take turns to look after the mobile phone and reply to emails from women asking for help. It can be a difficult job. “They are at their wits’ end; you can hear it in their voices. All this turmoil has got nothing to do with the decision to have an abortion: it’s to do with the fact that they live in a country where they can’t get one. Sometimes people will give us all the justifications for why they want to have an abortion, and we say, ‘You’re welcome to tell me this, but it’s not my business.’ The women with money don’t have to throw reasons in front of a panel for judgment. We don’t judge; we’re the money people.”

As you're trying to find the money, you get further into pregnancy. At 14 weeks the price doubles, and at 19 it trebles

Then there are the desperate stories they hear. “I drank floor cleaner. I drank bleach. I took all the pills in the medicine cabinet. I have been trying to think how to crash the car to injure myself permanently but not die – a mother of four. I found poison bottles under my daughter’s bed, that’s how I found out she was pregnant. I’ve taken scalding hot baths, I’ve asked my boyfriend to punch me in the stomach. People say, oh, you’re just making stuff up. No, I wish I was.”

As well as offering money, the organisation has an address book of carefully vetted host families, who live close to the most popular clinics and can offer a bed to women so that they don’t have to fly back home immediately after the abortion.

Sally and Fred have had about 15 women to stay in their home in Manchester over the past two years. “They usually feel very relieved,” Sally says. “We bring them home, they have a cup of tea and something very simple to eat, and then have a lie down.” They warn women in advance that they are vegan, and that they don’t have a television, but they keep milk and snacks for their visitors. They also keep spare toothbrushes, because sometimes women are scared to pack their overnight bags.

“They daren’t bring their own with them because they’re frightened that someone might ask where they are going. Some women come with euros, because they’re frightened to be seen with sterling. One came with her son’s school bag, rather than an overnight bag, in case someone questioned what she was doing.” Some want to be left alone in the spare room; others enjoy the couple’s company.

Sally and Fred, part of a network of volunteers who offer the women an overnight stay after their abortion – many dread travelling immediately after the procedure. Photograph: Christopher Thomond/The Guardian

“We are both from Belfast; we chat. We talk about family. We have two dogs and a cat, and that helps break the ice. Some people use this period as an opportunity to take stock of their lives. You might be a sounding board – it’s like talking to strangers on a train, it is a safe thing, because you are never going to see them again,” Sally says. “When they leave I feel happy that they have got their lives back. I am delighted to be able to contribute to that in a small way.”

***

The fact that the numbers of women coming to England for terminations have declined in recent years (from a high of about 9,000 in 2003) reflects the growing use of medical abortion tablets that can be taken at home. The difficulty is in getting hold of them, but here, too, organisations have sprung up to help Irish women. In the Netherlands, Women on Web and Women Help Women send tablets to women in Northern Ireland in exchange for a donation, and offer online support for the usually straightforward process. They no longer send tablets to the Republic of Ireland, however, as the postal services routinely seize the packets.

“When you cannot guarantee that it is going to arrive, then it is bad help,” says Rebecca Gomperts, founder of Women on Web, “because one of the harmful things is when somebody waits for weeks, the pregnancy advances and it never comes. It’s harmful because people are not taking the proper decisions to get care; the longer women wait, the riskier an abortion becomes and the more expensive it becomes.”

The organisation advises about 200 women from Ireland every month; pills are sent to Northern Ireland by a partner organisation in India. “Medical abortion is so easily available now. You can get it over the counter in Nepal, Cambodia and India. In Vietnam it is really widely available; in China it is very easy to get. These are good medicines. Sometimes the government tries to scare people by saying they are bad quality – but these are medicines normally available on the open market.”

Kinga Jelinska of Women Help Women, which assists about 200 women a month in Ireland, says getting pills posted is the easier option for those women who have no time or money to contemplate travelling to England. “The bottom line is that access to abortion is a matter of social justice. The ones who have the money will always find a way, no matter what the legal situation is. The women with the least resources and the least skills to navigate this difficult situation are the ones who suffer the most.”

Anna, 20, a student from Dublin, took abortion pills late last year, when she found out she was three weeks pregnant. She had them sent by Women on Web to an address in Northern Ireland, then had them couriered to Dublin (at a cost of €90). She resented the secrecy that had to accompany what was otherwise a straightforward procedure, and she hated having to do something illegal.

“I was very worried that it would be intercepted and I would have the guards knocking on the door,” she says. “Or, when I went to the depot, that I’d turn around and there would be a squad car behind me. It is so uncertain what the law actually is and what they might do. The fear was all-pervading. For weeks after, I was still thinking, oh God, will they come knocking?”

'My mum, her cousin, my granny… they've gone 30, 40 years and never told anyone. None of us feels able to talk about it'

Online advisers from Women on Web are there to answer questions during the procedure, and the website explains what the experience should feel like. “They advise you, if you feel something is not right, to go to the hospital and say you think you might be having a miscarriage, but don’t tell them about the pills, because then you could be prosecuted. It’s hard to know what it is meant to feel like, to know what normal is, as opposed to abnormal. You do worry.”

She has told a few friends, but she hasn’t enjoyed having to reassure them when they express shock at what she did. “I felt like I had to comfort them, tell them it’s not that awful. I made my decision.”

Some weeks later, Anna’s mother found out what she had done, after spotting and questioning the PayPal transfer on her daughter’s bank statement. Unexpectedly, she was understanding, revealing that she had travelled to England for an abortion herself in the 1980s, when she was 21 and not ready to look after a child. In the days following, it emerged that her mother’s cousin had made the same journey, as had her own mother, Anna’s grandmother. None of them had spoken about it.

“My mum, her cousin, my granny – they’ve gone for 30 or 40 years and never told anyone,” Anna says. “If I’d known about my mum’s experience, maybe I could have told her, and maybe it wouldn’t have been such an ordeal. To have the moral support would have been great. But none of us feels able to talk about it.”

• Some names have been changed.