Cousin marriage and premarital carrier matching in a Bedouin community in Israel: attitudes, service development and educational intervention

Background. Despite abortion being one of the mostcommon gynaecological procedures performed in the UK,significant regional variation exists in access to services.Objective. This study explores women’s experience ofreferral for abortion in three inner London boroughs todetermine if services met their expectations. Method. In-depth interviews conducted with 21 women ofvarying ages, gestations and ethnicity, 3–9 weeks after termination of their pregnancy. The data were subjected toqualitative analysis. Results. Most women had made a decision to proceed withabortion before approaching the health service, andexpected non-judgemental support, information andprompt referral. We found variations in the extent to whichthese expectations were met. Delays in referral occurredwhen health professionals either required women to havemore thinking time, referred them elsewhere for pregnancytesting or avoided discussing abortion. This was furthercompounded by difficulties in making appointments via thecentralised telephone booking service. The briefcounselling session offered to most women by the abortionproviders, although helpful to some women, was viewed asunnecessary and intrusive by others.Conclusions. Most women seeking an abortion prefer notto discuss their decision but expect information and promptreferral. Delays in referral cause distress and laterabortions and should be avoided. High-quality counsellingshould be targeted at those in need.Key message points lMost women prefer not to discuss their decision to have anabortion, but seek information and prompt referral. lUnnecessary delay is traumatic, results in later abortions andshould be avoided. lCounselling resources would be best utilised by targeting them atthose in need. IntroductionInduced abortion is one of the most commongynaecological operations performed in Great Britain withone in three women undergoing an abortion by the age of45 years.1,2 The Royal College of Obstetricians andGynaecologists (RCOG) guidelines on ‘The Care ofWomen Requesting Abortion’ sets quality standards forabortion services but there remains significant regionalvariation in access to and quality of services provided.1,3,4The National Health Service (NHS) Plan requires eachNHS Trust in England to obtain feedback from patientsabout their experiences of care5 but there has been littlework to date on women’s experience of abortion services.Questionnaire surveys provide some information6–9 butcannot provide a detailed account of women’s experienceof this procedure, and in-depth qualitative data arescarce.10–12 Data on the experience of women using theNHS abortion service in three inner London boroughs arepresented, from the time the women suspected that theywere pregnant until their first visit for assessment prior tothe abortion procedure.group.bmj.comon June 15, 2017 Published byhttp://jfprhc.bmj.com/Downloaded from