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
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Article info
Publication history
Published online: September 20, 2017
Accepted:
September 11,
2017
Received in revised form:
September 4,
2017
Received:
June 6,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
