Alone woman scales a brick building, turning to look at a number 8 chained to her ankle, hampering her progress. The animation appeared this month, projected on to Dublin’s Treasury building, and images quickly spread on social media under the hashtag #TheWeightOfTheEighth. It was a striking symbol of a debate that has engulfed Ireland in recent months, playing out on the walls and streets of its cities.

On 25 May, Ireland will vote on whether to repeal the eighth amendment to its constitution – a clause that protects the right to life of the unborn – and clear a path to legalising abortion in the country. The question challenges the Irish state’s conservative, patriarchal foundations, from which many people in Ireland – its urban dwellers in particular – feel increasingly disconnected.

Old tropes have been fleshed out during a heated referendum campaign: the city versus the countryside, the capital versus “the rest”. That divide concerns pro-repeal campaigners. “The polls keep telling us that the rest of Ireland outside Dublin is less likely to vote Yes,” says Ailbhe Smyth, leader of the pro-repeal Together For Yes coalition. “But there is still a very high proportion of don’t knows.”

The pro-repeal campaign’s message – “care, compassion and change” – was “designed to reach that middle ground” and unite the country, Smyth says.

An urban/rural divide has been evident for previous “moral issue” referendums in Ireland, says electoral geographer Adrian Kavanagh. When Ireland voted to legalise divorce in 1995 – by a margin of just 9,000 ballots – the number of those voting in favour was 14% lower in rural than in urban areas. For the 2015 vote to endorse same-sex marriage, the differential was 10%.

As conservative governments from Poland to the US have increasingly fostered a hostile climate for abortion services, the role of cities as safe havens for reproductive rights has been reinforced. The UN predicts that as much as 70% of the world’s population will be living in urban areas by 2050; as a result, the power and influence of mayors and other locally elected officials is expected to grow. Those offices could act as a counterpoint to anti-abortion forces at national or federal level.

In the US, cities have already demonstrated their legal power and social mandate to resist efforts by the Trump administration to target migrant rights and the Paris climate agreement. The National Institute for Reproductive Health aims to harness this power for change at a local level, encouraging cities to lead on access to abortion. Its Local Reproductive Freedom Index determines the best and worst performing US cities in terms of reproductive health services. The index was set up to show the impact of local policy-making, says Andrea Miller, president of the NIRH.

The NIRH index illustrates the inequality in abortion services across the US, with access largely clustered in coastal cities. But that picture is slowly changing. “What we’re seeing are blue [Democrat] dots in red [Republican] states,” says Miller. “Cities that are moving in a more progressive trajectory, even in some of the most restrictive and conservative states.”

She singles out St Louis, Missouri, and Columbus, Ohio. “They’re a great example of states that have passed law after law to try to eliminate access to care and yet we’re seeing the cities themselves stepping up.”

In 2016 Ohio politicians passed the “heartbeat bill”, which sought to ban abortion after six weeks of pregnancy (the state’s governor vetoed the bill, approving a 20-week ban instead). State lawmakers have also moved to defund family planning clinics. But Columbus has strengthened laws protecting access to clinics and punishing harassment of clinic employees.

“Having said that, there’s still room for improvement,” Miller says. She believes the key is for women to get involved in local politics as well as supporting existing bodies. “Change trickles up. It rarely comes from the top down.”

Abortion in Italy has been legal since 1978, but recent government studies found that seven in 10 Italian gynaecologists refuse to carry out the operations on moral grounds. In regions such as Sicily and Lazio, which contains the capital Rome, that percentage is higher still. According to Laiga,an association of pro-choice gynaecologists, only seven doctors in Lazio will carry out an abortion past the first trimester – and all of those are based in Rome.

“In Italy women aren’t aware of the restrictions on abortions until they need one,” says Silvana Agatone, president of Laiga. “In the city of Trapani in Sicily there was one doctor who took care of all abortions in the area, 80 a month. He retired this year. What do we do now?”

It’s up to urban hospitals and individuals to educate and take action, she says, which is why Laiga prioritises lobbying regional and local government to enforce Italy’s abortion laws.

Efforts to undermine abortion rights in Poland have been more overt. The conservative Law and Justice party wants to ban abortions even in cases of foetal abnormality, grounds that account for 95% of terminations in the country and one of the few exceptions to strict laws already in place.

“This is the most serious threat yet,” says Krystyna Kacpura, a director at the Federation for Women and Family Planning. Thousands took to the streets of Warsaw in March to protest against the plans, with the city serving as a hub for wider mobilisation aimed at educating the public.

“In March 2016, only around 14% of the Polish population described themselves as pro-choice,” Kacpura says. “But by September 2017 that had risen to 42%.”

If Ireland does vote Yes next week, it will still fall to cities to safeguard women’s access to safe abortion services. That these battles are still being fought around the world, often many decades after reproductive rights were won, is a reminder that such freedoms cannot be taken for granted.