Advertisement

Barriers to accessing abortion services and perspectives on using mifepristone and misoprostol at home in Great Britain

      Abstract

      Objective

      To examine reasons for seeking abortion services outside the formal healthcare system in Great Britain, where abortion is legally available.

      Study design

      We conducted a mixed-methods study among women resident in England, Scotland, and Wales who requested at-home medication abortion through online telemedicine initiative Women on Web (WoW) between November 22, 2016, and March 22, 2017. We examined the demographics and circumstances of all women requesting early medication abortion and conducted a content analysis of a sample of their anonymized emails to the service to explore their reasons for seeking help.

      Results

      Over a 4-month period, 519 women contacted WoW seeking medication abortion. These women were diverse with respect to age, parity, and circumstance. One hundred eighty women reported 209 reasons for seeking abortion outside the formal healthcare setting. Among all reasons, 49% were access barriers, including long waiting times, distance to clinic, work or childcare commitments, lack of eligibility for free NHS services, and prior negative experiences of abortion care; 30% were privacy concerns, including lack of confidentiality of services, perceived or experienced stigma, and preferring the privacy and comfort of using pills at home; and 18% were controlling circumstances, including partner violence and partner/family control.

      Conclusion

      Despite the presence of abortion services in Great Britain, a diverse group of women still experiences logistical and personal barriers to accessing care through the formal healthcare system, or prefer the privacy of conducting their abortions in their own homes. Health services commissioning bodies could address existing barriers if supported by policy frameworks.

      Implications

      The presence of multiple barriers to accessing abortion care in Great Britain highlights the need for future guidelines to recommend a more woman-centered approach to service provision. Reducing the number of clinic visits and designing services to meet the needs of those living in controlling circumstances are particularly important goals.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. The abortion act 1967.
        • Mills S.
        Brief background to Irish abortion law.
        BJOG. 2017; 124: 1216
      2. Britain's abortion law: what it says and why. Bpas reproductive review may 2013.
        • Royal College of Obstetricians and Gynaecologists
        Evidence-based guideline number 7. The Care of Women Requesting Induced Abortion. November 2011.
      3. Offences against the person act 1861.
        • Goldbeck-Wood S.
        Reforming abortion services in the UK: less hypocrisy, more acknowledgment of complexity.
        J Fam Plann Reprod Health Care. 2017; ([Online Ahead of Print]): 3-4
        • Gomperts R.J.
        • Jelinska K.
        • Davies S.
        • Gemzell-Danielsson K.
        • Kleiverda G.
        Using telemedicine for termination of pregnancy with mifepristone and misoprostol in settings where there is no access to safe services.
        BJOG. 2008; 115: 1171-1175
      4. Safe abortion: Technical and policy guidance for health systems. 2nd ed. World Health Organization, 2012
      5. Women on Web website.
        • Hsieh H.F.
        • Shannon S.E.
        Three approaches to qualitative content analysis.
        Qual Health Res. 2005; 15: 1277-1288
        • British Pregnancy Advisory Service
        Information on abortion prices.
        • UK Department of Health
        Report on abortion statistics in England and Wales for 2016.
        • Information Services Division Scotland
        Termination of pregnancy statistics year ending December 2016.
        • Care Quality Commission
        Overview and CQC inspection ratings. 20th December 2016.
        • UK Office for National Statistics
        Internet access – households and individuals: 2017.
        • Caird L.
        • Cameron S.T.
        • Hough T.
        • Mackay L.
        • Glasier A.
        Initiatives to close the gap in inequalities in abortion provision in a remote and rural UK setting.
        J Fam Plann Reprod Health Care. 2016; 42: 68-70
        • Heller R.
        • Purcell C.
        • Mackay L.
        • Caird L.
        • Cameron S.T.
        Barriers to accessing termination of pregnancy in a remote and rural setting: a qualitative study.
        BJOG. 2016; 123: 1684-1691
        • Baum S.E.
        • White K.
        • Hopkins K.
        • Potter J.E.
        • Grossman D.
        Women's experience obtaining abortion Care in Texas after implementation of restrictive abortion Laws: a qualitative study.
        PLoS One. 2016; 11: e0165048
        • Jerman J.
        • Frohwirth L.
        • Kavanaugh M.L.
        • Blades N.
        Barriers to abortion care and their consequences for patients traveling for services: qualitative findings from two states.
        Perspect Sex Reprod Health. 2017; 49: 95-102
        • Doran F.M.
        • Hornibrook J.
        Barriers around access to abortion experienced by rural women in new South Wales, Australia.
        Rural Remote Health. 2016; 16: 3538
        • Foster A.M.
        • LaRoche K.J.
        • El-Haddad J.
        • DeGroot L.
        • El-Mowafi I.M.
        “If I ever did have a daughter, I wouldn't raise her in New Brunswick:” exploring women's experiences obtaining abortion care before and after policy reform.
        Contraception. 2017; 95: 477-484
        • Hall M.
        • Chappell L.C.
        • Parnell B.L.
        • Seed P.T.
        • Bewley S.
        Associations between intimate partner violence and termination of pregnancy: a systematic review and meta-analysis.
        PLoS Med. 2014; 11: e1001581
        • Bahk J.
        • Yun S.C.
        • Kim Y.M.
        • Khang Y.H.
        Impact of unintended pregnancy on maternal mental health: a causal analysis using follow up data of the panel study on Korean children (PSKC).
        BMC Pregnancy Childbirth. 2015; 15: 85
        • Gelman A.
        • Rosenfeld E.A.
        • Nikolajski C.
        • Freedman L.R.
        • Steinberg J.R.
        • Borrero S.
        Abortion stigma among low-income women obtaining abortions in western Pennsylvania: a qualitative assessment.
        Perspect Sex Reprod Health. 2017; 49: 29-36
        • Ngo T.D.
        • Park M.H.
        • Shakur H.
        • Free C.
        Comparative effectiveness, safety and acceptability of medical abortion at home and in a clinic: a systematic review.
        Bull World Health Organ. 2011; 89: 360-370
        • Bizjak I.
        • Fiala C.
        • Berggren L.
        • Hognert H.
        • Sääv I.
        • Bring J.
        • et al.
        Efficacy and safety of very early medical termination of pregnancy: a cohort study.
        BJOG. 2017; ([Online Ahead of Print])https://doi.org/10.1111/1471-0528.14904
        • Lohr P.A.
        • Wade J.
        • Riley L.
        • Fitzgibbon A.
        • Furedi A.
        Women's opinions on the home management of early medical abortion in the UK.
        J Fam Plann Reprod Health Care. 2010; 36: 21-25
        • Kallner H.K.
        • Fiala C.
        • Gemzell-Danielsson K.
        Assessment of significant factors affecting acceptability of home administration of misoprostol for medical abortion.
        Contraception. 2012; 85: 394-397
        • Purcell C.
        • Cameron S.
        • Lawton J.
        • Glasier A.
        • Harden J.
        Self-management of first trimester medical termination of pregnancy: a qualitative study of women's experiences.
        BJOG. 2017; ([Online Ahead of Print])https://doi.org/10.1111/1471-0528.14690
        • Raymond Elizabeth G.
        • Chong Erica
        • Hyland Paul
        Increasing access to abortion with telemedicine.
        JAMA Intern Med. 2016; 176: 585-586
        • Grossman D.A.
        • Grindlay K.
        • Buchacker T.
        • Potter J.E.
        • Schmertmann C.P.
        Changes in service delivery patterns after introduction of telemedicine provision of medical abortion in Iowa.
        Am J Public Health. 2013; 103: 73-78
        • Aiken A.R.A.
        • Digol I.
        • Trussell J.
        • Gomperts R.
        Self-reported outcomes and adverse events following medical abortion via online telemedicine: a population-based study in Ireland and Northern Ireland.
        BMJ. 2017; 357: j2011
        • Wise J.
        Reform UK abortion law, say health organisations.
        BMJ. 2016; 28: 355
        • Sheldon S.
        Abortion law reform in Victoria: lessons for the UK.
        J Fam Plann Reprod Health Care. 2017; 43: 25