Abortion policy implementation in Ireland: successes and challenges in the establishment of hospital-based services

Exploring provider preference and provision of abortion methods and stigma: Secondary analysis of a United Kingdom provider survey

“…However, this analysis offers the first quantitative assessment of providers' method preference and its relationship with provision in the UK and is the first to test the association between method preference and abortion stigma. Although qualitative research from other contexts has suggested a relationship between stigma and providers' method provision or preferences, [23][24][25][26][27][28]30 our study did not identify a significant association. In the UK, most abortion providers have chosen to specialize in abortion care and their practice may be less affected by stigma than when abortion care is integrated into broader health services.…”

“…However, conscientious objection among health professionals more broadly has been found to limit the capacity of services to offer choice of abortion methods in the UK, which was not assessed in this study due to our focus on abortion providers. 12 Our quantitative measurement of abortion stigma may also not have picked up nuanced dimensions of stigma that affected method preference in qualitative research, [23][24][25][26][27][28]30 such as feelings relating to responsibility for or distance from the abortion. However, this relationship requires further exploration, as the assumption that there will be lower provider resistance to medication abortion care compared to instrumentation abortion care has informed decisions to only provide medication abortion care in countries where abortion is newly legalized.…”

“…21,22 Qualitative studies in the United States (US), Pakistan, Ireland, and South Africa have suggested providers may feel more comfortable providing medication abortion care than instrumentation abortion care because they feel less responsible for the abortion or less engaged in a stigmatized activity. [23][24][25][26][27][28] Quantitative studies in Ireland found hospital providers reported experiencing higher levels of stigma if they only provided instrumentation abortion care 29 and lower willingness to provide instrumentation abortion care among obstetrics and gynecology trainees as it was considered more "real". 30 However, studies have not assessed the association between provider preferences, provision practices, and stigma.…”

“…Abortion stigma has been conceptualized most broadly as “a shared understanding that abortion is morally wrong and/or socially unacceptable.” 13 International research has explored abortion providers' experiences of stigma 14–18 and studies suggest stigma can influence providers' willingness to offer abortion care, their treatment of patients, 15,19,20 and their preferences over how they deliver care 21,22 . Qualitative studies in the United States (US), Pakistan, Ireland, and South Africa have suggested providers may feel more comfortable providing medication abortion care than instrumentation abortion care because they feel less responsible for the abortion or less engaged in a stigmatized activity 23–28 . Quantitative studies in Ireland found hospital providers reported experiencing higher levels of stigma if they only provided instrumentation abortion care 29 and lower willingness to provide instrumentation abortion care among obstetrics and gynecology trainees as it was considered more “real” 30 .…”

“I suppose we’ve all been on a bit of a journey”: a qualitative study on providers’ lived experiences with liberalised abortion care in the Republic of Ireland

“…These findings are supported by a study that explored the implementation of care in Irish hospitals, which found that abortion care generally relies on a small number of dedicated champions. 46 Increasing the number of staff willing to provide abortion care could support hospital staff in their role.…”