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

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. Methods The 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% Cl, 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.