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

Footman, Katy (2023) Structural barriers or patient preference? A mixed methods appraisal of medical abortion use in England and Wales. Health Policy, 132. ISSN 0168-8510

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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.

Item Type:	Article
Official URL:	https://www.sciencedirect.com/journal/health-polic...
Additional Information:	© 2023 The Author
Divisions:	Health Policy
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited:	21 Mar 2023 13:45
Last Modified:	22 Apr 2024 07:30
URI:	http://eprints.lse.ac.uk/id/eprint/118473

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