Barriers, Facilitators and Improvements to Abortion Care

by Jodie Smith

In 2017 we celebrated 50 years since abortion was legalised in Great Britain under the 1967 Abortion Act, putting an end to the unsafe back-street abortions that were causing high frequencies of maternal death and severe morbidity. In these 50 years, there have been numerous clinical developments in abortion care, including the introduction of surgical abortion under local anaesthesia and medical abortion using mifepristone and misoprostol. Nevertheless, there remains both legal and sociocultural barriers to accessing abortion services and provision of abortion care.


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In our new paper in BMJ Sexual and Reproductive Health, we decided to delve deeper into defining what barriers exist to women accessing abortion services, and to understand the weighting of each barrier present. We were also interested to understand what aspects of an abortion clinic facilitate women’s ability to access care, and to obtain women’s ideas regarding service improvement. We designed a questionnaire that would enable us to answer these queries.

Self-administered anonymous questionnaires were distributed to women presenting for abortion care at a Sexual Health Centre with a specialist abortion clinic in Edinburgh. Questionnaires were distributed to 165 women throughout the study period; of these, 154 were completed and returned.

The most common barrier was fear about what the abortion process would involve, highlighting the need for accurate, standardised information to be more easily available and widely publicised, and that the stigma surrounding abortion is still considerable. The wait to get an appointment at the clinic and work/childcare commitments were also indicated as substantial barriers to seeking abortion care.

The questionnaire also demonstrated that women felt the clinic provided adequate facilitators to seeking abortion care, such as self-referral, information on the website and a text message reminder for their appointment. These will be continued by the clinic and we hope that our paper allows for other clinics to adopt similar methods to facilitate service provision.

The improvement most commonly suggested by women was to expand the range of providers for abortion care, including GPs, nurses, or midwives. Scottish legislation now allows for misoprostol to be taken in a patient’s home but does not permit mifepristone to be provided from GP premises, and non-doctors are not allowed to prescribe abortion medication. Women in this study were shown to be in favour of GPs, midwives, and nurses providing abortion care up to 10 weeks of gestation; this is a feasible development, with countries such as France and the Netherlands already displaying this model of service delivery working efficiently, and a similar model being adopted recently in the Republic of Ireland, with GPs delivering medical abortion care.

Providing this service in Great Britain would increase the accessibility of abortion services (and potentially reduce waiting times). But, more than this, I believe the wider range of healthcare providers would contribute to normalising and lessening stigma and fear many women experience when seeking an abortion.


Read the full paper: Smith JL, Cameron S. Current barriers, facilitators and future improvements to advance quality of abortion care: views of women. BMJ Sex Reprod Health Published Online First: 26 April 2019. doi: 10.1136/bmjsrh-2018-200264


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