Family doctors say that "the threat of anti-abortion activities" is a major factor in deciding not to provide abortion services, an Oireachtas committee has heard.
The Joint Committee on Health heard that there is an "urgent need for safe access-zone legislation" to ensure that healthcare staff are "protected from harassment and intimidation".
Orla O'Connor, Director of the National Women's Council of Ireland, also revealed that only one in 10 GPs currently provide abortion services.
In 13 counties, fewer than 10 GPs are offering these services, she said.
Pointing to new figures from the HSE, Ms O'Connor revealed that "only four counties have a well-developed community network of providers", namely Dublin, Cork, Galway and Wicklow.
This lack of provision exists alongside a legal framework which is "restrictive", she said.
Ms O'Connor warned that the law is "acting as a gatekeeper, creating a series of obstacles, and are disproportionately affecting the most marginalised", including those who are disabled.
The committee is hearing testimony relating to the review of the Health (Regulation of Termination of Pregnancy) Act.
Ms O'Connor said the problem lies in both the act itself, and how it operates.
Social Democrats co-leader Róisín Shortall said she agreed that the review "won't count for anything" if it fails to address "the shortcomings in the legislation", and not just how it operates.
She said that it was "completely unacceptable" that "just over half of maternity hospitals" are providing abortion services.
Ms Shortall said that the recent commitment from the HSE that the National Maternity Hospital will provide "clinically appropriate" services means clinicians will decide, rather than women, which is "potentially very dangerous".
Ms O'Connor said that the wording "absolutely raises concern", and "it's absolutely an issue that the minister needs to address".
She said that the law has created a two-tier system, where for every three women who qualify for care in Ireland, "two women have to travel to the UK".
Abortion should "be available on request up to viability, to ensure that no woman or pregnant person is forced to travel abroad for essential reproductive healthcare", the NWCI believes.
In 2019, 375 women who gave Irish addresses accessed abortion services in the UK, and in 2020 - during the pandemic - the figure was 194, Alison Spillane of the Irish Family Planning Association (IFPA) said.
"Abortion services in England and Wales are under pressure", she added, meaning that some Irish women "are waiting weeks" to get an appointment.
Maeve Taylor, Director of Advocacy at the IFPA, noted that the legislation is based on a criminal statute, and said that this has created serious problems.
"Criminalisation of abortion relegates it to the margins of healthcare", she said, adding that "criminal laws, even when not aggressively enforced, create a chilling effect on healthcare providers".
Both the NWCI and IFPA are calling for the full decriminalisation of abortion in line with recommendations from the World Health Organization.
They told the committee that, doctors who provide abortions outside tightly defined circumstances could currently be jailed for 14 years.
The two organisations want an end to the mandatory three-day waiting period, a widening of the 12-week gestational limit, and the removal of the 28-day mortality clause for fatal foetal abnormalities.
That clause only permits abortions in cases where doctors are certain that a foetus will survive less than one month.
"This is critical", Ms O'Connor said. "This is a real cause for concern".
No-one in those circumstances should have to endure the trauma and heartbreak of having to travel abroad to get an abortion, she said.
She said people thought this "would be solved by the referendum".
The Pro Life Campaign has described the meeting of the Oireachtas Health Committee as a scene of some of "the most extreme rhetoric to date" by the pro-choice side.
In a statement, it described proposals to allow abortion until the point of viability as "barbaric".
It said that this was not what people voted for in 2018.
Its spokesperson Eilis Mulroy has said that the review should "be examining issues such as the directive counselling of the HSE MyOptions hotline, and ensuring that women receive a proper and full range of options including supports on alternatives to abortion".
She said other perspectives urgently needed to be heard.
Additional reporting: Ailbhe Conneely