Abstract
BackgroundThe laws governing abortion access vary across Europe. Even in countries with relatively liberal laws, numerous barriers to abortion access exist. In response to these barriers, evidence suggests that people living in countries with both restrictive and liberal laws travel outside of their home country for abortion care. England and Wales are common destinations for those who travel to seek abortions, but little is known about the motivations and experiences of those who undertake cross-country travel to England or Wales to obtain care. This paper aims to describe the abortion seeking and travel experiences of women and pregnant people who traveled to England and Wales for an abortion between 2017 and 2019.MethodsWe recruited 97 participants who had traveled cross-country from both liberal and restrictive contexts to seek abortion care at three participating BPAS clinics in England and Wales. Participants completed an electronic survey about their reproductive histories, abortion decision-making, experiences seeking abortion care, and traveling. We conducted a descriptive analysis, and include comparisons between participants who traveled from liberal and restrictive contexts.ResultsOver a third of participants considered abortion four weeks or more before presenting for care at BPAS, and around two-thirds sought abortion services in their home country before traveling. The majority of participants indicated that they would have preferred to have obtained an abortion earlier and cited reasons including scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. About seventy percent of participants reported travel costs between €101–1000 and 75% of participants reported that the cost of the abortion procedure exceeded €500. About half of participants indicated that, overall, their travel was very or somewhat difficult.ConclusionsThis analysis documents the burdens associated with cross-country travel for abortion and provides insight into the factors that compel people to travel. Our findings highlight the need for expanded access to abortion care throughout Europe via the removal of legal impediments and other social or procedural barriers. Removing barriers would eliminate the need for cumbersome abortion travel, and ensure that all people can obtain necessary, high-quality healthcare in their own communities.
Highlights
Access to legal abortion remains fragmented across Europe
Plain language summary In Europe, people who live in countries where abortion is severely restricted or illegal altogether lack access to abortion care entirely, but even people who live in countries with more liberal laws face barriers due to gestational age limits, waiting periods, and a lack of trained and willing providers
England and Wales are common destinations for people traveling within Europe to obtain abortion services, but little is known about the experiences of these travelers
Summary
Access to legal abortion remains fragmented across Europe. In countries with laws that permit abortion on broad social or economic grounds, including Germany, France, Italy, and Belgium, abortion access is constrained by gestational age limits, waiting periods, and a lack of trained and willing providers [1,2,3]. Existing evidence suggests that women and pregnant people living in countries with highly restrictive abortion laws, as well as those living in countries with relatively liberal laws that over-regulate the provision of abortion services may be compelled by any number of the aforementioned barriers to travel across borders to seek legal care [5, 6]. With abortion permitted on broad social or economic grounds until 24 weeks of pregnancy [4] and the proximity of Great Britain to countries in Europe with more restrictive policies, parts of Great Britain, England and Wales, are common destinations for people seeking abortion who travel due to limited access in their home countries. This paper aims to describe the abortion seeking and travel experiences of women and pregnant people who traveled to England and Wales for an abortion between 2017 and 2019
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