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Reproductive Health
Published in: Reproductive Health 1/2024

Open Access 01-12-2024 | Research

Barriers and delays in access to abortion care: a cross-sectional study of people traveling to obtain care in England and the Netherlands from European countries where abortion is legal on broad grounds

Authors: Alexandra Wollum, Silvia De Zordo, Giulia Zanini, Joanna Mishtal, Camille Garnsey, Caitlin Gerdts

Published in: Reproductive Health | Issue 1/2024

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Abstract

Introduction

This study characterized the extent to which (1) financial barriers and (2) abortion care-seeking within a person’s country of residence were associated with delays in abortion access among those travelling to England and the Netherlands for abortion care from European countries where abortion is legal on broad grounds in the first trimester but where access past the first trimester is limited to specific circumstances.

Methodology

We drew on cross-sectional survey data collected at five abortion clinics in England and the Netherlands from 2017 to 2019 (n = 164). We assessed the relationship between difficulty paying for the abortion/travel, acute financial insecurity, and in-country care seeking on delays to abortion using multivariable discrete-time hazards models.

Results

Participants who reported facing both difficulty paying for the abortion procedure and/or travel and difficulty covering basic living costs in the last month reported longer delays in accessing care than those who had no financial difficulty (adjusted hazard odds ratio: 0.39 95% CI 0.21–0.74). This group delayed paying other expenses (39%) or sold something of value (13%) to fund their abortion, resulting in ~ 60% of those with financial difficulty reporting it took them over a week to raise the funds needed for their abortion. Having contacted or visited an abortion provider in the country of residence was associated with delays in presenting abroad for an abortion.

Discussion

These findings point to inequities in access to timely abortion care based on socioeconomic status. Legal time limits on abortion may intersect with individuals’ interactions with the health care system to delay care.
Footnotes
1
At the time of study, abortion in France was available on request only until 12 weeks of pregnancy. France modified the law to extend gestational age limits to 14 weeks in 2022 [13].
 
2
In our recruitment materials for this study, we used the word “women” to describe the population of interest to the study. We did not, however, ask about gender identity in the process of recruitment, nor did we survey participants on their gender identity. Because we cannot report on our participants gender identity and we acknowledge that not all people who are capable of pregnancy and/or desiring of abortion identify as women we will primarily use the gender-inclusive term “people” to refer to and acknowledge the experiences of women and any other pregnant people who participated in our study. We will use gender-specific terms (e.g., “women”) when reporting the results of other research studies, where participants identified as such.
 
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Metadata
Title
Barriers and delays in access to abortion care: a cross-sectional study of people traveling to obtain care in England and the Netherlands from European countries where abortion is legal on broad grounds
Authors
Alexandra Wollum
Silvia De Zordo
Giulia Zanini
Joanna Mishtal
Camille Garnsey
Caitlin Gerdts
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Reproductive Health / Issue 1/2024
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/s12978-023-01729-2

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