Outcomes and experiences of women with complex health needs accessing a national specialist referral abortion service: a service evaluation

BACKGROUND: National guidance emphasises the importance of offering women requesting abortion timely access to care and choices about abortion method. Women with complex health needs face particular challenges due to restrictions in where their procedure can be safely performed. In England, a specialised commissioned service operates, offering care in five National Health Service (NHS) centres.

METHODS: A service evaluation collecting clinical and patient-reported data from 277 women attending (a) an NHS specialist abortion service and (b) a local abortion service for low-risk women at the same NHS provider during 2023/2024 in the North East of England.

RESULTS: Clinical outcomes were similar between groups. Women accessing the specialist service had higher gestation at abortion (+14 days, 95% CI 6.0 to 22.0), waited longer between referral and procedure (+8.0 days, 95% CI 7.0 to 10.0), were less likely to have accessed their preferred abortion method (-37.4%, 95% CI -49.3 to-25.5), travelled for longer (+30.0 min, 95% CI 20.0 to 50.0), spent more money to access care (+£22.2, 95% CI 9.0 to 45.0) and were more likely to report financial hardship as a consequence (+27.6%, 95% CI 13.3 to 41.9). This group also rated their pre-hospital care lower and described specific challenges about their care.

CONCLUSIONS: While specialised abortion services for women with complex health needs have improved opportunities to access safe care, differences remain in important elements of the service. This creates disparities in relation to timely access, experience and choice of abortion method. Streamlining referral mechanisms between providers may reduce delay and improve efficiency and consistency. Services should consider how to support women who need to travel to access care.