Women in Northern Ireland who want an abortion are caught between the costs, stigma and complexities of travelling to Great Britain and the risk of prosecution if they access pills online to take at home, according to new research.

A policy change by the UK government last year allowed women from Northern Ireland to have a free abortion in England on the NHS, but it has not solved the problems they face, says a study based on a series of interviews published in a medical journal.

Northern Ireland has some of the most restrictive abortion rules in the world and is now out of kilter with the Irish Republic, which voted this year to overturn a ban. In the north, abortion is only permitted where the woman’s life is at risk or to save her from permanent mental or physical damage. Next week, a bill to decriminalise abortion in Northern Ireland will be presented to the UK parliament.

Q&A What is the law on abortion in Northern Ireland? Show Hide The 1967 Abortion Act which liberalised the law in England, Scotland and Wales never extended to Northern Ireland. The region permitted abortion only if a woman’s life was at risk or if there was a risk of permanent and serious damage to her mental or physical health. The story of Sarah Ewart, who travelled to England for an abortion after being told her baby would not survive outside the womb, galvanised change. The legislation brought in by Westminster, which takes effect on Tuesday, decriminalises abortion. After consultations, the UK government will have to put in place regulations for abortion services by next April; until then, women will be offered free transport and accommodation to access abortion services in England. In England, Scotland and Wales, the limit on abortions except in cases of fatal foetal abnormality or risk to life is 24 weeks. But anti-abortion campaigners in Northern Ireland claim that the change could mean abortion up to 28 weeks.

The research in the BMJ Sexual and Reproductive Health journal, by Abigail Aiken and colleagues of the Population Research Center at the University of Texas at Austin, USA, involves 30 in-depth interviews with women who have had an abortion, just under half of whom did so after the policy change in July 2017.

The women, who are given pseudonyms, say there are significant barriers to travelling to England. They speak of the cost of flights – none knew there was financial help for those below a certain income – but also the need to keep the trip secret from family, friends and colleagues who would not approve.

“Even though the procedure is covered now for Northern Irish women in England, there’s other factors as well,” Sonya, a 40 year-old mother of two, told researchers. “It would have been a whole host of lies: ‘Why are you getting up so early? Where are you going? Why will you not be back until late? Where have you been?’ I speak to lots of people in my family two or three times a day, and to have no contact with them would have made them suspicious.”

Pamela, 33, said: “Being a single mum of quite a few children I’d have to somehow find childcare. And on top of that I’d have to try to hide it, because there’s a massive stigma attached to it in this country. You feel like a criminal no matter what pathway you take.”

Women who would rather take abortion medication at home were fearful that packages of pills would be intercepted by customs and that police would arrive at their address. Two women have been prosecuted for attempting to bring about an abortion in Northern Ireland with pills and one has been cautioned.

“There would be such a traumatic side to having to travel instead of being in the comfort of your own home,” said Pearl, a 36-year-old mother of five. “But I was absolutely frightened. I never slept for weeks tracing that parcel.

“Oh my god, it was a scary time, and I probably never settled for even a week after receiving it, because I was so scared that the police were going to land on my door … I just thought, my god, is this really what it could actually come to? Where you can get an hour’s flight, and not get into any trouble. But you get it sent to your home and you could be arrested.”

Emma Campbell, co-chair of Alliance for Choice in Northern Ireland, said the study provided the evidence to back up the calls they had received ever since the funding for abortions in England was announced.

“The women in this study recall being terrified, not of taking abortion pills at home, but of being arrested,” she said. “Travel is an insurmountable barrier for many, as we can see by the scant drop in figures accessing these pills … The current situation forcing abortion seekers to travel is untenable and inhumane.”