Seeking Abortion Care Research Articles

“I just was really scared, because it's already such an uncertain time”: Exploring women's abortion experiences during the COVID-19 pandemic in Canada

ObjectiveTravel restrictions, physical distancing and quarantine requirements, lockdowns, and stay-at-home orders due to COVID-19 have impacted abortion services across Canada. We aimed to explore the decision-making and care experiences of those who obtained abortion services during the COVID-19 pandemic and understand recent abortion patients’ perspectives on demedicalized models of medication abortion service delivery. Study designWe conducted 23 semi-structured, in-depth interviews with women across Canada who obtained abortion care after March 15, 2020. We audio-recorded and transcribed the telephone/Skype/Zoom interviews and managed our data with ATLAS.ti. We analyzed the English-language interviews for content and themes using inductive and deductive techniques. ResultsThe COVID-19 pandemic, and the associated economic and social support uncertainties, factored into many of our participants’ decisions to obtain an abortion. Participants expressed relief and gratitude for being able to secure abortion care during the pandemic. Although women in our study reflected positively on their abortion care experiences, many felt that service delivery changes initiated because of the public health emergency exacerbated pre-COVID-19 barriers to care and contributed to feelings of loneliness and isolation. Our participants expressed considerable enthusiasm for demedicalized models of medication abortion care, including telemedicine services and behind-the-counter availability of mifepristone/misoprostol. ConclusionsFor our participants, abortion care constituted an essential health service. Our findings demonstrate the importance of continuing to provide access to safe, effective, and timely abortion care during public health emergencies. Exploring additional models of demedicalized medication abortion service delivery to address persistent access barriers in Canada is warranted. ImplicationsPolicymakers and clinicians should consider patient experiences as well as clinical evidence when considering regulatory changes to facilitate access to abortion care during public health emergencies. Identifying a multitude of ways to offer a full range of abortion services, including demedicalized models of medication abortion care, has the potential to meet significant needs in the COVID-19 era and beyond. The COVID pandemic highlights the need for demedicalized models, not only for the sake of those seeking abortion care but also to ease the burden on medical professionals during public health emergencies.

Factors influencing abortion decisions, delays, and experiences with abortion accompaniment in Mexico among women living outside Mexico City: results from a cross-sectional study

Access to abortion throughout much of Mexico has been restricted. Fondo Maria is an abortion accompaniment fund that provides informational, logistical, financial, and emotional support to people seeking abortion care in Mexico. This cross-sectional study examines the factors that influenced decision-making and contributed to delays in accessing care and explores experiences with Fondo Maria’s support among women living outside Mexico City (CDMX). We describe and compare the experiences of women across the sample (n = 103) who were either supported by Fondo Maria to travel to CDMX to obtain an abortion (n = 60), or self-managed a medical abortion in their home state (n = 43). Data were collected between January 2017 and July 2018. Seventy-seven percent of participants reported that it was difficult to access abortion care in their home state and 34% of participants indicated they were delayed in accessing care, primarily due to a lack of financial support. The majority of participants (58%) who travelled to CDMX for their abortion did so because it seemed safer. The money/cost of the trip was the most commonly cited reason (33%) why participants who self-managed stayed in their home state. Eighty-seven percent of participants said Fondo Maria’s services met or exceeded their expectations. Our data suggest that people seeking abortion and living outside CDMX face multiple and overlapping barriers that can delay care-seeking and influence decision-making. Abortion accompaniment networks, such as Fondo Maria, offer a well-received model of support for people seeking abortion in restrictive states across Mexico.

Determinants of women\u2019s preferred and actual abortion provision locations in Nigeria

BackgroundUnsafe abortion remains a leading cause of maternal mortality globally. Many factors can influence women’s decisions around where to seek abortion care; however, little research has been done on abortion care decisions at a population-level in low-resource settings, particularly where abortion is legally restricted.MethodsThis analysis uses data from a 2019–2020 follow-up survey of 1144 women in six Nigerian states who reported an abortion experience in a 2018 cross-sectional survey. We describe women’s preferred and actual primary abortion care provider/location by distinguishing clinical, pharmacy/chemist, or other non-clinical providers or locations. We also examine factors that influence women’s decisions about where to terminate their pregnancy and identify factors hindering women’s ability to operationalize their preferences. We then examine the characteristics of women who were not able to use their preferred provider/location.ResultsNon-clinical providers (55.0%) were more often used than clinical providers (45.0%); however, clinical providers were preferred by most women (55.6%). The largest discrepancies in actual versus preferred abortion provider/location were private hospitals (7.6% actual versus 37.2% preferred), government hospitals (4.3% versus 22.6%), chemists (26.5% versus 5.9%) and pharmacies (14.9% versus 6.6%). “Privacy/confidentiality” was the most common main reason driving women’s abortion provider/location choice (20.7%), followed by “convenience” (16.9%) and “recommended” by someone (12.3%), most often a friend (60.8%), although top reasons differed by type of provider/location. Cost and distance were the two most common reasons that women did not use their preferred provider/location (46.1% and 21.9%, respectively). There were no statistically significant differences in the sociodemographic characteristics between women who were able to use their preferred provider/location and those who were not able to implement their preferred choice, with the exception of state of residence.ConclusionsThese findings provide insights on barriers to abortion care in Nigeria, suggesting discretion is key to many women’s choice of abortion location, while cost and distance prevent many from seeking their preferred care provider/location. Results also highlight the diversity of women’s abortion care preferences in a legally restrictive environment.

The production of ignorance about medication abortion in Tunisia: between state policies, medical opposition, patriarchal logics and Islamic revival.

In Tunisia, medication abortion has been available in government reproductive and sexual health clinics since the early 2000s. Since its introduction, it has rapidly replaced the surgical method, and between 75% and 80% of abortions in the public sector were performed using the pharmacological protocol in 2016. In this article, I intend to discuss the various forms of ignorance about medication abortion that exist in Tunisia among several categories of actors in relation to the legal, medical and religious domains. I explore how the existing ‘varieties of ignorance’ are related to the specific political, social and economic positions of the involved actors, the dominant gender regime, specific institutional policies and economic interests. I also investigate how some forms of ignorance are wilfully produced by institutions and individuals, whereas others are the result of positionality or organizational features. I first describe when and how medication abortion was introduced in Tunisia and the forms of resistance it elicited; later, I examine the production of ignorance about this technology after the revolution of 2011. I mainly consider practices and discourses of health professionals, but also those of women seeking abortion care in the public sector, and those of the activists of a Tunisian non-governmental organization operating in the domain of women’s health and rights.

Selecting an Abortion Clinic: The Role of Social Myths and Risk Perception in Seeking Abortion Care.

Recent shifts in the abortion provision landscape have generated increased concern about how people find abortion care as regulations make abortion less accessible and clinics close. Few studies examine the reasons that people select particular facilities in such constrained contexts. Drawing from interviews with 41 Ohio residents, we find that people's clinic selections are influenced by the risks they associate with abortion care. Participants' strategies for selecting an abortion clinic included: drawing on previous experience with clinics, consulting others online, discerning reputation through name recognition and clinic type, and considering location, especially perceptions about place (privacy, legality, safety). We argue that social myths inform the risks people anticipate when seeking health care facilities, shaping care seeking in ways that are both abortion-specific and more general. These findings can also inform research in other health care contexts where patients increasingly find their options constrained by rising costs, consolidation, and facility closure.

The Critical Role of Midwives in Safe Self-Managed Abortion.

As access to legal abortion in the United States becomes more complex, there is increasing interest in self-managed abortion. Choosing to seek abortion care outside the clinical setting can also help people marginalized or harmed by existing health care systems to access needed care in a way that feels safe and empowering. However, patients and midwives alike often have a lack of information about expected outcomes and potential complications that may arise, as well as how to manage these in a health care system that may make appropriate follow-up difficult to access if needed. This article discusses patient education as a harm-reduction approach, and reviews ways that midwives may strategically and ethically participate in this patient education need. As trusted health care providers who are expert in pregnancy and reproductive health, midwives are ideally positioned to meet patient knowledge needs around self-managed abortion.

Accuracy of anemia screening by point-of-care hemoglobin testing in patients seeking abortion

Accurate and timely diagnosis of anemia in pregnancy is necessary for safe management of abortion care. Screening for anemia in abortion care is often accomplished using commercially-available point-of-care tests from capillary blood, but the validity of this test has not been investigated in the context of abortion care. We sought to determine the accuracy of a capillary hemoglobin (Hb) among pregnant patients seeking induced abortion. We conducted a retrospective study of patients seeking abortion care at the University of Illinois at Chicago. We identified 108 subjects with paired capillary Hb and venous complete blood count (CBC) hemoglobin measurements within 7 days of each other and within 14 days before abortion. Agreement analysis was performed using Passing-Bablok regression and Bland-Altman plots. More patients were deemed anemic by capillary than by venous Hb measurement (32% vs 19%, p=0.030). Capillary Hb correlated with venous Hb (r=0.85, p < 0.001). The average bias for capillary Hb was -1.1 ± 1.0 g/dL. Step-wise, multivariable linear regression identified venous Hb as the only determinant of capillary Hb, and failed to identify any other predictors of bias. The agreement analysis between capillary and venous Hb by Passing-Bablok regression demonstrated systematic and proportional differences. Results from capillary Hb may be biased toward diagnosing anemia and should be interpreted with caution. Misdiagnosing anemia in abortion care can have several consequences and may prevent timely medical abortion or cause delayed procedural abortion. Clinical correlation, and possibly confirmation by venous complete blood count measurement, should be considered before clinical decision-making based solely upon the capillary point-of-care assay.

Alone on an Island

Alone on an Island

Abortion information governance and women's travels across European borders

The World Health Organization considers the provision of information about safe, legal abortion essential for good-quality abortion care, but the question remains about who is responsible for providing information to people whose needs are not met in their own countries. Using data from a mixed-method research conducted with women travelling from France, Germany, Italy, and Ireland to seek abortion care in the UK, the Netherland, and Spain, we map the trajectories through which people receive information about accessing abortion abroad. We analyze the role of health professionals, activists, and online sources in people's accounts of information gathering. We argue that different formal approaches to information on national and international services distinctively affect women's experiences, and that transnational information flows occupy a crucial role in women's ability to travel. We also argue that managing information is an important aspect of how governments, practitioners or other actors navigate and exercise reproductive governance.

Contraceptive priorities among women seeking family planning services in Finland in 2017–2019

ObjectiveTo assess how women's reproductive history, contraceptive experience and need of abortion care are associated with priorities for contraception. Study DesignIn this cross-sectional survey study, we gathered information on women's history of births and abortions, previous use and satisfaction with contraceptive methods, and features of contraceptive methods they value most. Women were recruited at public family planning and outpatient abortion clinics in the capital region of Helsinki, Finland. ResultsOf the 1006 women responding, 502 were recruited during visits for abortion care and 504 for contraceptive counseling. Women seeking abortion care more often had a history of abortion than women seeking contraceptive counseling (44% vs 11%), presented with a higher mean number of different contraceptive methods used (69% vs 55% with more than 2 previous methods), and were less often satisfied with the methods used (36% vs 60% satisfied with 2 out of 3 methods), p < 0.001 for all. In addition, women seeking abortion care had lower odds of prioritizing effectiveness (aOR 0.3, 95% CI 0.2–0.5), and higher odds of prioritizing lower hormonal levels or non-hormonal alternatives (aOR 2.0, 95% CI 1.3–3.2). There was no difference between the groups regarding priorities of lesser pelvic pain (aOR 0.7, 95% CI 0.5–1.1), regular period (aOR 01.2, 95% CI 0.8–1.9), or the method being easy to use (aOR 1.2, 95% CI 0.8–1.8). ConclusionsThere is a contrast between guidelines emphasizing effectiveness in postabortion contraception, and many women's contraceptive priorities. Implication statementClinicians providing contraceptive counseling must be mindful of each individual's personal contraceptive priorities.

Cross-country abortion travel to England and Wales: results from a cross-sectional survey exploring people\u2019s experiences crossing borders to obtain care

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.

SOCIAL SCIENCE ORAL ABSTRACTS: Patient experiences with protestors while accessing abortion care in Jackson, Mississippi

<h3>Introduction</h3> In August 2019, the city council in Jackson, Mississippi passed a 15-foot buffer, 8-foot bubble and 100-foot quiet zone ordinance for all health clinics, aimed at discouraging protestor activity outside the state's only licensed abortion facility. After a series of legal challenges, Jackson repealed the ordinance in November 2020. We sought to learn about patients' encounters with protestors and how the ordinance would have affected their experiences obtaining abortion care. <h3>Method</h3> Prior to passage of the ordinance, patients seeking care at the Mississippi facility enrolled in a prospective study on their access to abortion care and contraception; we invited participants completing the 6-month follow-up survey after August 2019 to participate in an in-depth interview about their experiences with protestors at their visits. During the phone interviews, we asked participants about their encounters with protestors and the role of escorts and clinic security in mitigating interactions; we also provided a description of the city ordinance and then asked how this might have changed their experience had it been in place when they were obtaining care. We analyzed interview transcripts for content and themes using both inductive and deductive approaches. <h3>Results</h3> Of the 30 participants interviewed, the majority said they expected to see protesters at their visits; however, they frequently noted they were surprised by the number of protestors crowding the street and sidewalk near the facility and how close protestors were able to get to patients. Participants overwhelmingly described protesters as "pushy and determined," and some remarked they felt unsafe because they thought protestors were unpredictable and were aware of violence that had taken place at other facilities. Parking in the clinic lot or on the street largely shaped the intensity of patients' interactions with protestors. While most participants expressed a strong sense of reproductive autonomy, they also noted that protestors' presence and comments had a negative emotional impact. Participants credited clinic escorts and security with mitigating these negative experiences by demonstrating concern about patients' wellbeing, validating their abortion decision and preventing more involved encounters, but a few expressed that needing to have escorts, in general, increased their safety concerns. Nearly all participants stated that the city ordinance would have had a positive effect on their experience, noting they would have felt more at ease, safer, and had the privacy they desired. <h3>Conclusions</h3> Prior to the passage of Jackson's city ordinance, protestors created stressful and negative experiences for the majority of study participants seeking abortion care, even though the facility adopted strategies aimed at ameliorating protestors' impacts on patients. Although the city ordinance was short-lived, these results indicate that patients need additional protections to ensure they can obtain essential health care with respect.

The pandemic year: Research at the National Abortion Federation's 2021 Virtual Annual Meeting

The National Abortion Federation's Virtual Annual Meeting took place in May of 2021 and highlighted the work of researchers, advocates, providers, and activists who have worked tirelessly during this unprecedented year. Much of the Annual Meeting's proceedings were related to the dramatic events of the last year, both in clinical responses to the COVID-19 pandemic and in how the pandemic exposed broad inequities throughout the health care system and the effect of systemic racism and oppression on the health and lives of people seeking abortion care.

Family Physicians' Role in Simplifying Medication Abortion During the COVID-19 Pandemic.

Despite first trimester abortion being common and safe, there are numerousrestrictions that lead to barriers to seeking abortion care. The COVID-19 pandemic hasonly exacerbated these barriers, as many state legislators push to limit abortion accesseven further. During this pandemic, family physicians across the country haveincorporated telemedicine into their practices to continue to meet patient needs.Medication abortion can be offered to patients by telemedicine in most states, andmultiple studies have shown that labs, imaging, and physical exam may not beessential in all cases. Family physicians are well-poised to incorporate medicationabortion into their practices using approaches that limit the spread of the coronavirus,ultimately increasing access to abortion in these unprecedented times.

Permeability of abortion care in the Netherlands: a qualitative analysis of women’s experiences, health professional perspectives, and the internet resource of Women on Web

Despite a relatively permissive abortion law, women in the Netherlands encounter difficulties in accessing abortion care. Little is known about their experiences. This study explores women’s experiences with (online) abortion services and relevant health professionals’ experiences delivering care, with the goal of identifying key barriers encountered by abortion-seekers in the Netherlands. An exploratory qualitative research design with a constructivist approach and an abbreviated grounded theory method was used. Interviews with 20 women who had had an abortion and 14 health professionals who provide abortion care, and 200 emails of women seeking abortion care through the non-governmental organisation Women on Web, were coded inductively and deductively (using the Candidacy Framework) thereby generating themes. Abortion-seekers faced barriers including: (i) burden of taboo, (ii) vulnerability (emotional, financial, and social), (iii) health professional evaluation and (iv) disempowerment and distress. The overarching theme was women’s lack of autonomy in access to abortion care. The key barriers to abortion access in the Netherlands are the institutionalisation of taboo in abortion law and care, complex candidacy regulations, lack of permeability for certain marginalised groups, and women’s inability to speak openly about abortion. To increase the permeability of abortion care, and thereby women’s autonomy, legislators and policy-makers must trust women to make their own reproductive decisions and avoid actions that stigmatise abortion and hinder access to care, while actively developing systemic support for vulnerable groups.

Insurance Churn and Inconsistent Access to Reproductive Health Care among Abortion Patients in Mississippi

Changes in health insurance coverage, or insurance churn, is common in the months surrounding pregnancy, but there has been limited study of how churn affects women's experiences with reproductive health care. We conducted in-depth interviews with women seeking abortion care in Mississippi in 2016. We coded interview transcripts relating to experiences accessing reproductive health care before pregnancy and organized the codes into themes. Of the 38 women interviewed, one-third were uninsured and half described recent changes in their health insurance. This contributed to inconsistent care, as women shifted from private clinicians while insured to health department clinics while uninsured. For several women, these shifts created barriers to contraceptive use and were closely related to their unintended pregnancy. Insurance churn and associated disruptions in contraceptive use were common among Mississippi women seeking abortion in this study. Policies should support women's reproductive autonomy by facilitating consistent coverage and reliable access to contraception.

Magnitude and Determinants of the Late Request for Safe Abortion Care Among Women Seeking Abortion Care at a Tertiary Referral Hospital in Ethiopia: A Cross-Sectional Study.

BackgroundSecond-trimester abortions disproportionately contribute to the increased medical cost, maternal morbidity, and mortality compared to the first trimester. Therefore, the aim of the current study was to determine the magnitude and determinants of late presentation for safe abortion care at a tertiary hospital in Ethiopia.MethodsWe conducted a cross-sectional study among pregnant women who requested safe abortion care from January 2019 to April 2020. Participants were selected using systematic sampling and data were collected using the interviewer-administered questionnaire. P-value adjusted odds ratios (AOR) with their 95% confidence interval (CI) were used to determine the association between variables.ResultsThe prevalence of second-trimester abortion was 53.4%. Young age, ≤ 19 years (AOR= 6.37, 95% CI=1.84–22.06), decision ambivalence (AOR=5.64, 95% CI=1.71–18.61), delay to suspect pregnancy (AOR= 8.56, 95% CI=2.11–34.57), delay to diagnose pregnancy (AOR=3.83, 95% CI=1.51–9.75), lack of awareness on pregnancy signs and symptoms (AOR=4.22, 95% CI=1.59–11.23), delay to get the service (AOR =4.43, 95% CI=1.43–13.67), and lack of information where to get the abortion service (AOR=3.90, 95% CI=1.53–9.96) were significantly associated with presentation in second trimester.ConclusionMore than half of women who request safe abortion at Saint Paul’s Hospital Millennium Medical College do so in the second trimester. Young age, delay in diagnosis of pregnancy, delayed decision, and lack of information where to get service were contributing factors. Therefore, comprehensive adolescent sexuality education, increasing access to contraception, and safe abortion service including self-care interventions are very imperative to avert late gestation abortion and its consequences.

Abortion care pathways and service provision for adolescents in high-income countries: A qualitative synthesis of the evidence.

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.

Get PrEPPT (pre-exposure prophylaxis and pregnancy termination): an exploration of the values, attitudes and preferences regarding HIV and PrEP among women seeking abortion

IntroductionPre-exposure prophylaxis (PrEP) for the prevention of HIV transmission is under utilised by women in the US. Women seeking abortion have a higher HIV prevalence than women who continue prenatal...

“I didn’t doubt my choice, but I felt bad”: A qualitative exploration of Canadian abortion patients’ experiences with protesters

ObjectivesAlthough a body of research has focused on violence, disruption, and harassment targeting abortion clinics and clinic staff, little research has explored Canadian abortion patients’ experiences with protesters. Through this national qualitative study we aimed to address this gap. MethodsBetween 2012 and 2016, we conducted in-depth interviews with 305 Canadian women who had an abortion in the previous five years. Thirty participants reported encountering protesters when seeking abortion care. We focused on this sub-set of interviews and analyzed these data for content and themes using inductive and deductive techniques. ResultsAcross the country, participants reported encountering protesters holding signs, chanting slogans, and shouting insults. These interactions were concentrated at clinics in New Brunswick, Newfoundland and Labrador, and Ontario. Although no participants reported that these encounters made them reconsider their decision, they did report that seeing and interacting with protesters was at times unsettling, stigmatizing, and frustrating. Participants who struggled with the decision to have an abortion and those who made the decision in the context of health issues or violence found these encounters especially upsetting. Participants discussed how their interactions with protesters and the additional security measures put in place by clinics contrasted with their experiences accessing other kinds of health care and they wished that the protesters had not been there. ConclusionsFor some Canadian abortion patients, encountering protesters is upsetting and stigmatizing. Exploring ways to minimize interactions between protesters and those seeking abortion care, such as enacting and enforcing safe access zone legislation, appears warranted. ImplicationsAlthough several Canadian provinces have enacted safe access zone laws, these do not currently exist across all jurisdictions. In addition to protecting clinics and clinic staff, implementation of these buffer zones have the potential to improve some patients’ experiences obtaining a medically necessary and essential service.