Aiken Abigail R A, Guthrie Katherine A, Schellekens Marlies, Trussell James, Gomperts Rebecca
LBJ School of Public Affairs, University of Texas at Austin, Austin, TX, 78712, USA; Population Research Center, University of Texas at Austin, Austin, TX, 78712, USA.
Women on Web, Amsterdam, The Netherlands.
Contraception. 2018 Feb;97(2):177-183. doi: 10.1016/j.contraception.2017.09.003. Epub 2017 Sep 20.
To examine reasons for seeking abortion services outside the formal healthcare system in Great Britain, where abortion is legally available.
We conducted a mixed-methods study among women resident in England, Scotland, and Wales who requested at-home medication abortion through online telemedicine initiative Women on Web (WoW) between November 22, 2016, and March 22, 2017. We examined the demographics and circumstances of all women requesting early medication abortion and conducted a content analysis of a sample of their anonymized emails to the service to explore their reasons for seeking help.
Over a 4-month period, 519 women contacted WoW seeking medication abortion. These women were diverse with respect to age, parity, and circumstance. One hundred eighty women reported 209 reasons for seeking abortion outside the formal healthcare setting. Among all reasons, 49% were access barriers, including long waiting times, distance to clinic, work or childcare commitments, lack of eligibility for free NHS services, and prior negative experiences of abortion care; 30% were privacy concerns, including lack of confidentiality of services, perceived or experienced stigma, and preferring the privacy and comfort of using pills at home; and 18% were controlling circumstances, including partner violence and partner/family control.
Despite the presence of abortion services in Great Britain, a diverse group of women still experiences logistical and personal barriers to accessing care through the formal healthcare system, or prefer the privacy of conducting their abortions in their own homes. Health services commissioning bodies could address existing barriers if supported by policy frameworks.
The presence of multiple barriers to accessing abortion care in Great Britain highlights the need for future guidelines to recommend a more woman-centered approach to service provision. Reducing the number of clinic visits and designing services to meet the needs of those living in controlling circumstances are particularly important goals.
在英国（堕胎在该国合法），研究在正规医疗系统之外寻求堕胎服务的原因。
我们对居住在英格兰、苏格兰和威尔士的女性进行了一项混合方法研究，这些女性在2016年11月22日至2017年3月22日期间通过在线远程医疗项目“网络上的女性”（WoW）申请在家进行药物流产。我们研究了所有申请早期药物流产女性的人口统计学特征和情况，并对她们发送给该服务机构的匿名电子邮件样本进行了内容分析，以探究她们寻求帮助的原因。
在4个月的时间里，519名女性联系了WoW寻求药物流产。这些女性在年龄、生育状况和情况方面各不相同。180名女性报告了在正规医疗环境之外寻求堕胎的209个原因。在所有原因中，49%是获取障碍，包括等待时间长、距离诊所远、工作或育儿事务、不符合免费国民保健服务资格以及之前堕胎护理的负面经历；30%是隐私担忧，包括服务缺乏保密性、感知或经历的耻辱感以及更喜欢在家服用药物的隐私和舒适度；18%是控制性情况，包括伴侣暴力和伴侣/家庭控制。
尽管英国有堕胎服务，但仍有不同群体的女性在通过正规医疗系统获得护理方面面临后勤和个人障碍，或者更喜欢在自己家中进行堕胎的隐私性。如果有政策框架支持，卫生服务委托机构可以解决现有障碍。
英国在获取堕胎护理方面存在多种障碍，这凸显了未来指南需要推荐一种更以女性为中心的服务提供方式。减少诊所就诊次数以及设计服务以满足处于控制性情况的人群的需求是特别重要的目标。
