June 29, 2015 — In developed countries, women continue to face barriers to obtaining abortion care during the first three months of pregnancy, even though such countries impose fewer legal restrictions on the procedure than others, according to an analysis in the Journal of Family Planning and Reproductive Health Care, Medical Xpress reports.
For the analysis, researchers looked at evidence published between 1993 and 2014 to determine what factors influence abortion access during the first trimester in developed countries. The researchers collected 2,511 articles and assessed 38 that addressed abortion during the first three months of pregnancy and the perspectives of the woman and provider.
The researchers found that the primary obstacle to abortion access among health care providers was providers' personal opposition to the procedure. According to the researchers, provider opposition rates varied from more than one out of every three physicians surveyed in rural Idaho compared with about one in every five physicians in the United Kingdom.
The researchers found several other provider-related obstacles, including a lack of adequate training, a shortage of providers who are capable and willing to perform an abortion, harassment from abortion-rights opponents and resource constraints.
Meanwhile, the study found that one of the primary obstacles to abortion care among women was providers' attitudes against the procedure, which also influenced how women experienced an abortion. For example, one Canadian study found that more than 10% of women reported that clinic staff were rude, and a separate study found that almost 50% of women said they did not have support from clinic staff.
According to the researchers, other issues that hindered abortion access among women were costs -- particularly in North America -- and lack of local services. They noted that the lack of local services was "a particular issue" for low-income women, those from minority groups and those living in rural areas.
The researchers wrote, "Despite fewer legal barriers to accessing abortion services, the evidence from this review suggests that women in developed countries still face significant inequities in terms of the level of quality and access to services as recommended by the (WHO)."
They gave several recommendations for boosting access, such as improving the range of available services, making abortion care more affordable and increasing provider training. The researchers also recommended that abortion care be included in multidisciplinary facilities to combat sigma and help integrate abortion care with general health care services. In addition, they called for clear guidance on abortion care that establishes referral protocols for providers who oppose abortion rights (Medical Xpress, 6/25).