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. 2024 Jan 15;21(1):7.
doi: 10.1186/s12978-023-01729-2.

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

Alexandra Wollum  1 , Silvia De Zordo  2 , Giulia Zanini  3 , Joanna Mishtal  4 , Camille Garnsey  5 , Caitlin Gerdts  5
Affiliations

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

Alexandra Wollum et al. Reprod Health. .

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.

Keywords: Abortion; Delays; Europe; Financial barriers; Health system barriers; Travel.

Plain language summary

This paper explores delays in accessing abortion care associated with financial and medical system barriers. We focus on residents of countries in Europe where abortion is available on broad grounds in the first trimester seeking abortion care outside of their country of residence. This study demonstrates an association between difficulty covering abortion costs for people facing financial insecurity and in-country care seeking and delays in accessing abortion abroad. Policy barriers, medical system barriers, as well as financial barriers may interact to delay access to care for people in European countries with broad grounds for abortion access in the first trimester but restrictions thereafter, especially for people later in pregnancy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Cumulative proportion of participants that had presented at abortion clinic abroad from time since first considered abortion among those from contexts where abortion is legal on broad grounds (n = 164). a Difficulty paying for abortion and/or travel. b Difficulty paying for abortion and/or travel and availability of funds to cover basic living costs in past 30 days. c Contacted or visited abortion providers in country of residence. d No in-country care seeking, contact only, and visited abortion provider in country of residence. Highest means represent those who had no difficulty paying for abortion procedure and travel and had funds to cover basic living expenses in the past month “all the time” or “most of the time.” Mixed means represent those who had some difficulty paying for abortion procedure and travel and had funds to cover basic living expenses in the past month “all the time” or “most of the time.” Those with lowest means had some difficulty paying for abortion procedure and travel and had funds to cover their basic living expenses in the past month “sometimes”,  “rarely,” or “never"
Fig. 1
Fig. 1
Cumulative proportion of participants that had presented at abortion clinic abroad from time since first considered abortion among those from contexts where abortion is legal on broad grounds (n = 164). a Difficulty paying for abortion and/or travel. b Difficulty paying for abortion and/or travel and availability of funds to cover basic living costs in past 30 days. c Contacted or visited abortion providers in country of residence. d No in-country care seeking, contact only, and visited abortion provider in country of residence. Highest means represent those who had no difficulty paying for abortion procedure and travel and had funds to cover basic living expenses in the past month “all the time” or “most of the time.” Mixed means represent those who had some difficulty paying for abortion procedure and travel and had funds to cover basic living expenses in the past month “all the time” or “most of the time.” Those with lowest means had some difficulty paying for abortion procedure and travel and had funds to cover their basic living expenses in the past month “sometimes”,  “rarely,” or “never"
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