Experiences of abortion care in Australia during the COVID-19 pandemic: examining multiple dimensions of access

Abstract

Background Universal access to sexual and reproductive health services is a global priority. Yet barriers to abortion access remain, including legal restrictions, cost, stigma, and limited availability of services and information. The COVID-19 pandemic exacerbated barriers to abortion care. The aim was to identify barriers to and facilitators of abortion by examining experiences of access during the COVID-19 pandemic. Methods This qualitative phenomenological study examined abortion access during the pandemic in Australia, where abortion is decriminalised. We used social media and flyers in clinics to recruit adults who sought abortion care since March 2020, then conducted in-depth interviews. We mapped participant experiences to five dimensions of access identified by Levesque et al.’s patient-centred access to healthcare framework: approachability, acceptability, availability and accommodation, affordability, and appropriateness. Results The 24 participants lived across Australia and sought abortion in a range of pandemic-related restrictions. Approachability: Most lacked information about abortion and where to seek it. Acceptability: Many were uncomfortable disclosing their abortion to family, friends, and healthcare providers, and providers demonstrated varying levels of support. Availability and accommodation: Regional participants travelled far and faced long wait-times, exacerbated by pandemic restrictions. Affordability: Participants described financial stress paying for the service, travel, and related expenses. Appropriateness: Most participants expected judgement in care. Providers commonly assumed they wanted to remain pregnant, and some provided unempathetic and rushed care. Some participants reported non-judgmental and supportive services with appropriate emotional support and time spent with providers. Discussion Abortion seekers experienced varying obstacles when seeking care, exacerbated by the COVID-19 pandemic. Challenges during the pandemic illustrated the importance of ensuring social support during care and choice between abortion modalities and service types. The findings illustrate the need for population- and system-level initiatives such as: providing accurate information about and normalising abortion; implementing system-level efforts to reduce wait times, travel, and costs, especially for rural populations; and developing regulatory and quality improvement initiatives to increase the workforce and its readiness to provide high-quality, non-judgemental abortion care. Consumer voices can help understand the diverse pathways to abortion care and inform solutions to overcome the multidimensional barriers to access.