New research on women's experiences of abortion has found that women in Scotland who seek abortions after 16 weeks gestation do so for a variety of complex reasons, and face a number of geographical and practical barriers in doing so. Dr Carrie Purcell comments on this new research.
Abortion is legal in England, Scotland and Wales up to 24 weeks' gestation. While the majority of abortions in Scotland take place before 9 weeks, a small and consistent number of women seek to have an abortion in the later stages of pregnancy. Except for medical reasons, abortions after 18-20 weeks are generally not available in Scotland, meaning women have to travel to England (typically London) for the procedure. The reasons for this are unclear; the expertise is available, but existing research suggests that there may be some 'distaste' amongst medical providers and senior health managers for providing the service.
Our research drew on the experiences of 23 women who requested an abortion at 16 or more weeks' gestation between January and July 2013. Women were asked about their reasons for seeking later abortion services, the consequences of doing so, as well as their experiences around the procedure. The women were from a range of backgrounds and varied in age.
The most common reasons for women seeking later abortions included: not recognising they were pregnant until a relatively later stage, changes in their life circumstances and relationships since they became pregnant, and conflicting feelings about whether or not to continue with the pregnancy. For women who already had children, a key reason for wanting an abortion was concern for the well-being of their family.
Most of the women we spoke to were satisfied that they were referred onto the relevant specialist service quickly. However, there appeared to be some confusion amongst GPs regarding later abortion provision in Scotland. A number of GPs were unsure of the local gestational limits after which women are required to travel to England. Some women said that learning that they would have to travel to England after a certain date created further urgency around their decision, as they contemplated coping with the financial burden and distress which travelling for the procedure might create.
While the procedure itself is usually funded by the woman's local NHS Board, our research found that those travelling to England for a termination often faced financial and logistical barriers to access. These included arranging time off work, and the high cost of travel and accommodation booked at necessarily short notice. The prospect of travelling away from home also raised emotional considerations for women: the cost and practicalities involved would mean having to tell more people than they might have if it was carried out locally, and it also took them away from friends and family who would typically have provided them with emotional support.
The reasons women in this study sought later abortion were largely unforeseen and unavoidable. Our findings suggest that women need sufficient time to consider the conflicting options of motherhood and having an abortion. They also suggest that the additional stress faced by women who have to travel to obtain a later abortion is a source of inequity in a context where the procedure is legally available. The burden of travelling presents on of the most significant barriers to later abortion for women in Scotland, exacerbating an already potentially difficult experience and contributing to the stigma and discrimination that surrounds abortion. The findings from this in-depth, exploratory study suggest that future efforts to improve services in Scotland should include a reconsideration of later abortion provision.
The paper, ‘Experience of Later Abortion: Accounts from Women in Scotland’ is currently available online, open-access in Perspectives on Sexual and Reproductive Health.
The study - Women's Experiences of Termination of Pregnancy (WELTOP) - was carried out by the MRC/CSO Social and Public Health Sciences Unit (SPHSU) at the University of Glasgow.
Dr Carrie Purcell is a researcher at the Centre for Research on Families and Relationships, currently working on a study on the provision of early medical abortion in an integrated sexual and reproductive health service.