IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v132y2023ics0168851023000842.html
   My bibliography  Save this article

Structural barriers or patient preference? A mixed methods appraisal of medical abortion use in England and Wales

Author

Listed:
  • Footman, Katy

Abstract

Although patient choice of abortion method is a key component of quality care, medical abortion (MA) has become the most common method (87%) in England and Wales, as in many countries worldwide. This research aimed to critically examine factors influencing the growth in MA use in England and Wales. Mixed methods were used, combining multi-level regression analysis of national abortion statistics (2011-2020) and key informant interviews with abortion service managers, commissioners, and providers (n=27). Overall trends have been driven by growth in MA use for abortions under 10 weeks in the private non-profit sector. Variation in MA use between patient sub-groups and regions has narrowed over time. Qualitative findings highlight health system constraints that have influenced the shift towards MA, including workforce constraints, infrastructure requirements, provider policies, cost, and commissioning practices involving under-funding and competition, which have caused the private non-profit sector to limit method choice across their services to remain financially viable. While removal of legal restrictions on MA has expanded choice, similar policy progress has not been seen for surgical methods. The study concludes that abortion method choice has been constrained by structural health system factors, with potential negative consequences for service acceptability, inequalities, and patient-centredness.

Suggested Citation

  • Footman, Katy, 2023. "Structural barriers or patient preference? A mixed methods appraisal of medical abortion use in England and Wales," Health Policy, Elsevier, vol. 132(C).
    • Handle: RePEc:eee:hepoli:v:132:y:2023:i:c:s0168851023000842
    DOI: 10.1016/j.healthpol.2023.104799
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168851023000842
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.healthpol.2023.104799?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Broussard, Kathleen, 2020. "The changing landscape of abortion care: Embodied experiences of structural stigma in the Republic of Ireland and Northern Ireland," Social Science & Medicine, Elsevier, vol. 245(C).
    2. Simonds, Wendy & Ellertson, Charlotte & Springer, Kimberly & Winikoff, Beverly, 1998. "Abortion, revised: participants in the U.S. clinical trials evaluate mifepristone," Social Science & Medicine, Elsevier, vol. 46(10), pages 1313-1323, March.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Footman, Katy, 2024. "The illusion of treatment choice in abortion care: A qualitative study of comparative care experiences in England and Wales," Social Science & Medicine, Elsevier, vol. 348(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Footman, Katy, 2024. "The illusion of treatment choice in abortion care: A qualitative study of comparative care experiences in England and Wales," Social Science & Medicine, Elsevier, vol. 348(C).
    2. Scott, Darius, 2022. "Uncaring landscapes and HIV peer support in the rural Southern United States," Social Science & Medicine, Elsevier, vol. 292(C).
    3. Altshuler, Anna L. & Ojanen-Goldsmith, Alison & Blumenthal, Paul D. & Freedman, Lori R., 2017. "A good abortion experience: A qualitative exploration of women's needs and preferences in clinical care," Social Science & Medicine, Elsevier, vol. 191(C), pages 109-116.
    4. Kimport, Katrina, 2022. "Reducing the burdens of forced abortion travel: Referrals, financial and emotional support, and opportunities for positive experiences in traveling for third-trimester abortion care," Social Science & Medicine, Elsevier, vol. 293(C).
    5. Bergen, Sadie, 2022. "“The kind of doctor who doesn't believe doctor knows best”: Doctors for Choice and the medical voice in Irish abortion politics, 2002–2018," Social Science & Medicine, Elsevier, vol. 297(C).
    6. Graham, Ruth H. & Robson, Stephen C. & Rankin, Judith M., 2008. "Understanding feticide: An analytic review," Social Science & Medicine, Elsevier, vol. 66(2), pages 289-300, January.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:132:y:2023:i:c:s0168851023000842. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.