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Abstract
Limited research in high-income countries (HICs) examines adolescent abortion care-seeking pathways. This review aims to examine the pathways and experiences of adolescents when seeking abortion care, and service delivery processes in provision of such care. We undertook a systematic search of the literature to identify relevant studies in HICs (2000–2020). A directed content analysis of qualitative and quantitative studies was conducted. Findings were organised to one or more of three domains of an a priori conceptual framework: context, components of abortion care and access pathway. Thirty-five studies were included. Themes classified to the Context domain included adolescent-specific and restrictive abortion legislation, mostly focused on the United States. Components of abortion care themes included confidentiality, comprehensive care, and abortion procedure. Access pathway themes included delays to access, abortion procedure information, decision-making, clinic operation and environments, and financial and transportation barriers. This review highlights issues affecting access to abortion that are particularly salient for adolescents, including additional legal barriers and challenges receiving care due to their age. Opportunities to enhance abortion access include removing legal barriers, provision of comprehensive care, enhancing the quality of information, and harnessing innovative delivery approaches offered by medical abortion.
Highlights
Universal access to safe medical and surgical abortion is an essential element of comprehensive, high-quality adolescent reproductive healthcare [1]
Despite adolescent fertility falling in many high-income countries (HICs), unprotected sex, contraceptive failure, sexual violence, maternal illness, or fetal anomaly may lead to a need for access to safe abortion
The term HICs is used as defined by the World Bank classification which is based on Gross National Income (GNI) per capita calculated using the atlas method [2]
Summary
Universal access to safe medical and surgical abortion is an essential element of comprehensive, high-quality adolescent reproductive healthcare [1]. Despite adolescent fertility falling in many high-income countries (HICs), unprotected sex, contraceptive failure, sexual violence, maternal illness, or fetal anomaly may lead to a need for access to safe abortion. The term HICs is used as defined by the World Bank classification which is based on Gross National Income (GNI) per capita calculated using the atlas method [2]. Abortion remains a relatively common outcome of adolescent pregnancy despite an overall downward trend in abortion incidence among adolescents in HICs [3].
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