Should violence services be integrated within abortion care? A UK situation analysis

Quality of care in abortion in the era of technological and medical advancements and self-care

Background

Discussions around quality of abortion care have been focused mainly on service-delivery aspects inside healthcare facilities. More recently, with availability of medical abortion (MA), increase in its self-use, and emergence of other delivery platforms such as telemedicine, the responsibility of quality care has broadened to actors outside of facilities.

Body of text

This commentary discusses the meaning of quality of abortion care with the paradigm shift brought by medical and technological advancement in abortions, and raises questions on the role of the state in ensuring quality in abortion management—especially in settings where abortion is decriminalized, but also in countries where abortion is permitted under certain circumstances. It consolidates the experience gained thus far in the provision of safe abortion services and also serves as a forward-thinking tool to keep pace with the uptake of newer health technologies (e.g., availability of medical abortion drugs), service delivery platforms (e.g., telemedicine, online pharmacies), and abortion care providers (e.g., community based pharmacists).

Conclusions

This commentary provides context and rationale, and identifies areas for action that different stakeholders, including health advocates, policymakers, program managers, and women themselves, can adopt to fit into an alternative regime of abortion care.

The Relationship Between Partner Violence and Number of Abortions in a National Sample of Abortion Patients

The purpose of the study was to examine the association between women's experience of two types (sexual and physical) of intimate partner violence (IPV) and number of previous abortions among a national sample of 4,586 abortion patients between the ages of 13 and above 38 years in the United States. Using data from the nationally representative Abortion Patients Survey 2008, χ² tests were conducted to examine the bivariate associations between all independent and dependent variables. Prevalence ratios were calculated to determine the association between IPV, physical and sexual, and number of abortions, controlling for whether the coconceiving partner knew about the pregnancy and the abortion, and demographic factors including age, education, income, poverty rate, race, and type of union. Results indicate that approximately 51% of the sample of women seeking abortion services had never gotten an abortion before. Reports of IPV were low among this sample-5.6% reported physical violence and 2.4% reported sexual violence, while 82.3% of the coconceiving partners knew about the abortion, and 87.1% knew about the pregnancy. Prevalence ratios revealed that physical violence was positively associated with number of abortions (PR = 1.31, p < .001), but sexual violence was negatively associated with number of abortions (PR = 0.74, p < .05) when all control variables were accounted for. Findings suggesting that physical and sexual violence are differentially associated with a history of multiple abortions were unexpected and suggest the need for additional research in this area. Implications for practice, policy, and directions for future research are discussed.