Access to later termination of pregnancy in Scotland: the impact of travel

Melville, C.; Brown, A.; Cameron, S.; Caird, L.; Flett, G; Laird, G.; McDaid, L. and Purcell, C. (2015). Access to later termination of pregnancy in Scotland: the impact of travel. BJOG: An International Journal of Obstetrics & Gynaecology, 122 pp. 11–12.

DOI: https://doi.org/10.1111/1471-0528.13366

Abstract

Introduction
The legal limit for termination of pregnancy (TOP) in Great Britain is 24 weeks (except for significant fetal or maternal medical indications). However, the provision of later TOP varies between NHS health board areas in Scotland and most do not provide TOP after 18/20 weeks of gestation (unless for the above exceptions). Currently women requesting TOP after 18/20 weeks have to travel to England for the procedure, which is normally undertaken at a British Pregnancy Advisory Service clinic. This may necessitate a return journey of up to 1400 miles (2250 km).

Methods
A qualitative study of women’s experiences of later TOP in Scotland was undertaken. Exploratory in-depth interviews were conducted with 23 women requesting later TOP (≥16 weeks of gestation) in five health board areas between January and June 2013. Thirteen participants had terminations locally, five continued their pregnancy, and five travelled to England to undergo the TOP. Participants were aged between 17 and 39 years. NVivo 10 software facilitated thematic analysis of interview data.

Results
The possibility of travel for the procedure was highlighted as a factor which not only influenced the decision to proceed with a TOP, but also magnified the need for a quick decision. In combination with the fact that they would be at a later gestation, travelling to England emerged as a potential barrier. In general, participants expressed that this would create significant practical problems (such as paying for travel and accommodation, telling their family or work, or obtaining childcare). For those who did so, travelling to England created additional feelings of anxiety, distress and stigmatisation. Variation in local gestational limits also appears to be a source of confusion amongst general practitioners, who generally act as gatekeepers to TOP services in Scotland. This may raise questions about the consistency of advice being given to women seeking later TOP.

Conclusion
The study highlighted the impact on women of restricting access to TOP. The need to travel for the procedure not only adds additional barriers for women but has the potential to cause further distress during an already difficult experience.

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