Access to abortion: what women want from abortion services

Ellen R Wiebe, S Sandhu

Journal of Obstetrics and Gynaecology Canada
Journal of Obstetrics and Gynaecology Canada

Abstract
Objective: Whether Canadian physicians can refuse to refer women for abortion and whether private clinics can charge for abortions are matters of controversy. We sought to identify barriers to access for women seeking therapeutic abortion and to have them identify what they considered to be most important about access to abortion services.

Methods: Women presenting for abortion over a two-month period at two free-standing abortion clinics, one publicly funded and the other private, were invited to participate in the study. Phase I of the study involved administration of a questionnaire seeking information about demographics, perceived barriers to access to abortion, and what the women wanted from abortion services. Phase II involved semi-structured interviews of a convenience sample of women to record their responses to questions about access. Responses from Phase I questionnaires were compared between the two clinics, and qualitative analysis was performed on the interview responses.

Results: Of 423 eligible women, 402 completed questionnaires, and of 45 women approached, 39 completed interviews satisfactorily. Women received information about abortion services from their physicians (60.0%), the Internet (14.8%), a telephone directory (7.8%), friends or family (5.3%), or other sources (12.3%). Many had negative experiences in gaining access. The most important issue regarding access was the long wait time; the second most important issue was difficulty in making appointments. In the private clinic, 85% of the women said they were willing to pay for shorter wait times, compared with 43.5% in the public clinic.

Conclusion: Physicians who failed to refer patients for abortion or provide information about obtaining an abortion caused distress and impeded access for a significant minority of women requesting an abortion. Management of abortion services should be prioritized to reflect what women want: particularly decreased wait times for abortion and greater ease and convenience in booking appointments. Since many women are willing to pay for services in order to have an abortion within one week, this option should be considered by policy makers.


Wiebe ER, Sandhu S. Access to abortion: what women want from abortion services. J Obstet Gynaecol Can. 2008 Apr;30(4):327-331.

Abortion induced with methotrexate and misoprostol

Ellen R Wiebe

Canadian Medical Association Journal, CMAJ
Canadian Medical Association Journal

Abstract
Objective:
To determine the outcome and side effects of a new drug protocol to induce abortion.

Design: Case series.

Setting: An urban primary care practice.

Patients: One hundred consecutive patients who requested elective termination of pregnancies of less than 8 weeks’ gestation.

Intervention: Subjects received methotrexate (50 mg/m2 body surface area, administered intramuscularly) and, 3 days afterward, misoprostol (800 pg, given vaginally).

Outcome measures: Number of abortions induced within 24 hours and within 10 days of misoprostol administration, number of surgical aspirations conducted because of incomplete abortion, mean amount of bleeding and pain and the number of women who, if faced with the same situation, said they would again choose a drug-induced abortion over a surgical one.

Results: Abortion occurred within 24 hours of misoprostol administration among 48 women and within 10 days among 69 women. In total, 89 women had an abortion without surgical aspiration. Of these women, 71 said they would choose a drug-induced abortion if faced with the choice again.

Conclusion: Abortion induced with methotrexate and misoprostol appears to be a feasible alternative to surgical abortion and deserves further study.


Wiebe ER. Abortion induced with methotrexate and misoprostol. Can Med Assoc J. 1996 Jan 15;154(2):159-164.

(Correspondence) Methotrexate and misoprostol used in abortions (Author responds)

Ellen R Wiebe

Canadian Medical Association Journal, CMAJ
Canadian Medical Association Journal

Extract
Of course methotrexate is contraindicated for a wanted pregnancy: it causes abortion in approximately 95% of pregnancies of less than 7 weeks’ gestation. This is why we are using it as an abortifacient. . . . if abortion failed in a women given methotrexate and she refused to undergo surgical abortion, there would be a risk to the fetus. From the experience with RU 486 in Europe we know that women rarely change their minds about abortion in such cases.


Wiebe ER. (Correspondence) Methotrexate and misoprostol used in abortions. Can Med Assoc J. 1994;151(5):518.

(Correspondence) Methotrexate and misoprostol used in abortions

Anthony T Kerigan

Canadian Medical Association Journal, CMAJ
Canadian Medical Association Journal

Extract
. . . methotrexate is contraindicated during pregnancy. If Wiebe and the University of British Columbia Ethics Committee have information on the safety of this drug during pregnancy perhaps they could share it with readers.


Kerigan AT. (Correspondence) Methotrexate and misoprostol used in abortions. Can Med Assoc J. 1994 Sep 01;151(5):518.

(Correspondence) Methotrexate and misoprostol used in abortions

Ellen R Wiebe

Canadian Medical Association Journal, CMAJ
Canadian Medical Association Journal

Extract
Medically induced abortion rather than surgical abortion has many advantages and could improve access to abortion in Canada . . . In December 1993 I received permission from the University of British Columbia Ethics Committee to start a pilot study of abortion induced with methotrexate and misoprostol; the study is under way. I would like to hear from other physicians who may be interested in this method.


Wiebe ER. (Correspondence) Methotrexate and misoprostol used in abortions. Can Med Assoc J. 1994 May 01;150(9):1381-1382.

Retention of products of conception after therapeutic abortion

Ellen R Wiebe

Canadian Medical Association Journal, CMAJ
Canadian Medical Association Journal

Extract
Failure to remove all the products of conception during a therapeutic abortion is an acknowledged complication whose incidence increases with increased gestational age. In the following case, symptoms of an incomplete abortion were experienced for 2 1/2 years after the abortion.


Wiebe ER. Retention of products of conception after therapeutic abortion. Can Med Assoc J. 1986 Mar 1;134(5):505.