Providers’ perspectives on the barriers to post-20-week Ground C abortion in Scotland
Abortion is the most common gynaecological procedure in the UK, with an estimated one in three women undergoing an abortion before the age of 45 years. In Scotland, the National Health Service (NHS) provides abortion free at the point of care. However, access to post-20-week gestation abortions (hereafter ≥20-week abortion) in Scotland has been a longstanding issue. Currently, no Scottish Health Boards routinely offer abortion up to the 24-week legal limit under Ground C of the Abortion Act 1967 (risk to the woman’s physical or mental health). Most Health Boards do provide abortions under Ground E (fetal abnormality) up to the legal limit. Consequently, some women travel to England for Ground C abortion care from independent sector providers.
Evidence suggests that since 2019, 282 women have travelled to England for this purpose, with the total number per year increasing since 2021. Research on the experiences of women from Scotland travelling for abortion has described the costs and how it induces feelings of stress and stigmatisation, but there is limited research on providers’ perspectives. In their 2013 study, Cochrane and Cameron found that providers in abortion services supported offering abortion beyond 16 weeks and preferred a single national service within Scotland. They also identified the need for further research.
We conducted a qualitative study to explore the views of abortion care providers in Scotland regarding barriers to providing Ground C ≥20-week abortion. Data were gathered via (1) an anonymous online qualitative survey with healthcare professionals involved in abortion care and (2) interviews with senior abortion leads. Online qualitative surveys were used to reach a diverse, geographically dispersed group of abortion providers, enabling the collection of rich qualitative data on their views and perspectives.
SOURCE: British Journal of Sexual and Reproductive Health, by Lucy Grieve, Jeni Harden, Nicola Boydell, November 2024.
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Abortion patients’ perspectives on enhancing a telemedicine model of post-abortion contraception: a qualitative study
Abstract
Background: Access to post-abortion contraception (PAC) is critical for reducing unintended pregnancies and supporting reproductive decision-making. Patients often face challenges in identifying, accessing and initiating their preferred contraceptive methods post-abortion. This may be particularly so with telemedicine models of care with absence of in-person appointments, and reduced opportunities to provide some contraceptive methods. This qualitative service evaluation explored patients’ perspectives on PAC consultations and decision-making to inform future PAC service models in the era of telemedicine.
Methods: Qualitative interviews with 15 patients who had telemedicine medical abortion at home up to 12 weeks’ gestation. Data were analysed using reflexive thematic analysis.
Results: Contraceptive discussions during pre-abortion consultations were valued for supporting informed choices about future contraceptive use. Decision-making was influenced by previous contraception experiences, emotional state at the time of abortion and concerns about contraceptive ‘failure’. Some preferred non-hormonal methods due to past negative experiences with hormonal contraceptives. However, limited information about ‘natural’ contraceptive methods and concerns about discussing these with healthcare professionals were described. Barriers to accessing preferred methods, particularly long-acting reversible contraception (LARC), included reduced availability of appointments and caring responsibilities. Fast-tracked appointments for LARC fitting post-abortion were valued. The need for flexible PAC consultations and access after abortion, for example, remote consultations complemented by personalised interactions with sexual and reproductive health experts, was emphasised.
Conclusion: The findings highlight the need for flexible and more accessible PAC service models in the era of telemedicine care to ensure timely access to preferred contraceptive methods.
BMJ Sexual & Reproductive Health, 4 September 2024. https://srh.bmj.com/content/early/2024/12/28/bmjsrh-2024-202428
by Nicola Boydell, Sophie Buijsen, John Joseph Reynolds-Wright, Sharon T Cameron, Jeni Harden