Decision making and referral prior to abortion: A qualitative study of women's experiences

Abstract

Background. Despite abortion being one of the most common gynaecological procedures performed in the UK, significant regional variation exists in access to services. Objective. This study explores women's experience of referral for abortion in three inner London boroughs to determine if services met their expectations. Method. In-depth interviews conducted with 21 women of varying ages, gestations and ethnicity, 3-9 weeks after termination of their pregnancy. The data were subjected to qualitative analysis. Results. Most women had made a decision to proceed with abortion before approaching the health service, and expected non-judgemental support, information and prompt referral. We found variations in the extent to which these expectations were met. Delays in referral occurred when health professionals either required women to have more thinking time, referred them elsewhere for pregnancy testing or avoided discussing abortion. This was further compounded by difficulties in making appointments via the centralised telephone booking service. The brief counselling session offered to most women by the abortion providers, although helpful to some women, was viewed as unnecessary and intrusive by others. Conclusions. Most women seeking an abortion prefer not to discuss their decision but expect information and prompt referral. Delays in referral cause distress and later abortions and should be avoided. High-quality counselling should be targeted at those in need.