The pathway to induced abortion: women's experiences and general practitioner attitudes

Abstract

Objective Secondary care services are struggling to manage demand for induced abortion, but less is known about what scope exists to improve the primary care of women requiring abortion. The study objective was to identify service-related delays and barriers faced by women seeking abortion care. MethodsThe study comprised case note review and cross-sectional surveys conducted in South Durham in the North East of England, UK. We surveyed and reviewed the case notes of women attending two fertility control clinics. We also surveyed general practitioners (GPs) who referred women to these clinics. The outcomes were waiting times within the pathway to induced abortion, women's rating of care, GPs' attitudes and self-reported practice.Results Of 210 women surveyed, 132 (63%) responded. Of 107 referred by GPs, 16 (15%) had to make a second appointment with another GP willing to refer them and 34 (32%) waited two or more days to receive a date for their hospital appointment. The national standard waiting time of 3 weeks from first appointment with the referring doctor to the procedure was achieved for 56/127 women (44%; 95% CI, 35-53). Women rated global satisfaction, provision of information and staff interaction more highly in secondary than primary care. Of 170 GPs surveyed, 140 (82%) responded; 33 (24%) considered themselves 'broadly anti-abortion'.Conclusions Women face delays in accessing induced abortion care, both before and after referral from primary care. Whilst scope exists for improving quality of care and access within present service configurations, alternative approaches that bypass traditional gatekeepers to abortion care should be evaluated. G Women seeking access to abortion services want their general practitioner to treat them with respect, provide information and arrange prompt referral.G Women seeking abortion experience barriers that will require alternative models of care to overcome. Some of these barriers contribute to delay, though their most important effect is on the patient experience.

A randomised preference trial of medical versus surgical termination of pregnancy less than 14 weeks' gestation

“…Another key attribute, also emphasised by many of the women interviewed, was waiting time. There is evidence of barriers to referral within primary care, 84 and similar concerns were identified by some of the women interviewed. As complication rates increase with gestational age at abortion, 2 it is important that women can access abortion services as quickly as possible; subsequent to completion of this trial a system of direct access has been introduced that allows women seeking abortion to refer themselves to the termination service.…”

“…84 This study identified delays both before and after referral from primary care and the barriers faced by women seeking abortion; 82% of 140 GPs surveyed considered themselves 'broadly anti-abortion' and the authors emphasised the need to evaluate alternative approaches that bypass traditional gatekeepers to abortion care. 84 These barriers were also highlighted by some women participating in the substudy (see below). Availability of counselling is also unlikely to have impacted on women's preferences for TOP method.…”

Barriers to accessing termination of pregnancy in a remote and rural setting: a qualitative study

“…Our data suggest that aspects of local culture were perceived by women as contributing to delays and negatively impacting upon GP service provision. Existing research suggests that around one in four GPs in England consider themselves broadly anti‐abortion . A 2011 study in the Republic of Ireland (where TOP is illegal under most circumstances) found that GPs viewed waiting periods as desirable, giving women time to ‘think over the decision’ .…”

Termination of pregnancy: Attitudes and clinical experiences of Irish GPs and GPs-in-training

“…Though Ireland ' s abortion laws are more restrictive than the UK, Finnie et al, (2006) in the North East of the UK, had a similar percentage (24%) of GPs ' broadly antiabortion (10). ' Studies of gynaecologist opinions in nations where abortion is restricted have shown varied results refl ecting the diff ering questions asked in the surveys; e.g.…”