• AikenAbigail R AARALBJ School of Public Affairs, University of Texas at Austin, Austin, TX, 78712, USA; Population Research Center, University of Texas at Austin, Austin, TX, 78712, USA. Electronic address: araa2@utexas.edu., Katherine A Guthrie, Marlies Schellekens, James Trussell, and Rebecca Gomperts.
• LBJ School of Public Affairs, University of Texas at Austin, Austin, TX, 78712, USA; Population Research Center, University of Texas at Austin, Austin, TX, 78712, USA. Electronic address: araa2@utexas.edu.
• Contraception. 2018 Feb 1; 97 (2): 177-183.

ObjectiveTo examine reasons for seeking abortion services outside the formal healthcare system in Great Britain, where abortion is legally available.Study DesignWe conducted a mixed-methods study among women resident in England, Scotland, and Wales who requested at-home medication abortion through online telemedicine initiative Women on Web (WoW) between November 22, 2016, and March 22, 2017. We examined the demographics and circumstances of all women requesting early medication abortion and conducted a content analysis of a sample of their anonymized emails to the service to explore their reasons for seeking help.ResultsOver a 4-month period, 519 women contacted WoW seeking medication abortion. These women were diverse with respect to age, parity, and circumstance. One hundred eighty women reported 209 reasons for seeking abortion outside the formal healthcare setting. Among all reasons, 49% were access barriers, including long waiting times, distance to clinic, work or childcare commitments, lack of eligibility for free NHS services, and prior negative experiences of abortion care; 30% were privacy concerns, including lack of confidentiality of services, perceived or experienced stigma, and preferring the privacy and comfort of using pills at home; and 18% were controlling circumstances, including partner violence and partner/family control.ConclusionDespite the presence of abortion services in Great Britain, a diverse group of women still experiences logistical and personal barriers to accessing care through the formal healthcare system, or prefer the privacy of conducting their abortions in their own homes. Health services commissioning bodies could address existing barriers if supported by policy frameworks.ImplicationsThe presence of multiple barriers to accessing abortion care in Great Britain highlights the need for future guidelines to recommend a more woman-centered approach to service provision. Reducing the number of clinic visits and designing services to meet the needs of those living in controlling circumstances are particularly important goals.Copyright © 2017 Elsevier Inc. All rights reserved.

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