Barriers to accessing abortion services and perspectives on using mifepristone and misoprostol at home in Great Britain
Barriers to accessing abortion services and perspectives on using mifepristone and misoprostol at home in Great Britain
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DOI：
10.1016/j.contraception.2017.09.003
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发表时间：
2018-02-01
期刊：
影响因子：
2.9
通讯作者：
Gomperts, Rebecca
中科院分区：
文献类型：
--
作者：
Aiken, Abigail R. A.;Guthrie, Katherine A.;Gomperts, Rebecca
目的：检查在英国正规医疗保健系统之外寻求堕胎服务的原因，在那里堕胎是合法的。研究设计：我们对居住在英格兰、苏格兰和威尔士的妇女进行了一项混合方法研究，这些妇女在2016年11月22日至2017年3月22日期间通过在线远程医疗倡议妇女网络（WoW）要求在家用药流产。我们检查了所有要求早期药物流产的妇女的人口统计和情况，并对她们发给该服务的匿名电子邮件样本进行了内容分析，以探讨她们寻求帮助的原因。结果：在4个月的时间里，519名妇女联系了WoW寻求药物流产。这些女性在年龄、性别和环境方面各不相同。180名妇女报告了209个在正规保健机构之外寻求堕胎的理由。在所有原因中，49%是获取障碍，包括等待时间长、到诊所的距离远、工作或照顾孩子的承诺、缺乏免费NHS服务的资格，以及之前堕胎护理的负面经历；30%是隐私问题，包括服务缺乏保密性，感觉到或经历过耻辱，更喜欢在家里使用药丸的隐私和舒适；18%是控制性环境，包括伴侣暴力和伴侣/家庭控制。结论：尽管在英国有堕胎服务，一个不同的妇女群体仍然经历后勤和个人障碍，通过正规的医疗保健系统获得护理，或者更喜欢在自己的家中进行堕胎的隐私。如果得到政策框架的支持，保健服务委托机构可以解决现有障碍。(C) 2017爱思唯尔公司版权所有。
Objective: To examine reasons for seeking abortion services outside the formal healthcare system in Great Britain, where abortion is legally available.Study design: 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.Results: 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.Conclusion: 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. (C) 2017 Elsevier Inc. All rights reserved.