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Abortion: barriers and inconsistencies

This issue of the Journal contains several articles on the subject of abortion. This was not pre-planned, but rather a response to a wealth of submissions that we received within a short time frame. Studies came in with data from England, Scotland, Australia, Nepal, South Africa, Tunisia, Colombia and New Zealand, addressing questions such as: Why are women in the UK, where the incidence of induced abortion has risen by over 5% in 10 years, requesting abortion? How many choose to take up counselling when it is offered? How easy is it for women actually to access abortion across a range of countries where it is legal? And what are the barriers to accessing abortion in developed countries?

A repeating theme running through these otherwise disparate papers is one of barriers and inconsistencies. There is, it seems, wide medical, legal and organisational variation between and within societies in terms of access to abortion. For example, despite mifepristone being listed as an essential medicine by the World Health Organization since 2005, some countries such as Sweden and Switzerland use it widely; while in others, such as Canada, it is not licensed at all (see Doran and Nancarrow). While Scotland carries out nearly all abortions within National Health Service (NHS) settings, in England the equivalent figure is less than half, arguably with consequences for staff training and stigma (see Astbury-Ward). And while most European countries offer unrestricted access to abortion within the first 12 weeks, a minority including the UK require a medical indication (see Rowlands). However views might differ as to which system is preferable, the inconsistency between countries is striking.

Even where abortion is relatively freely available, it seems a range of barriers make access inequitable. These include practical challenges such as geographical distance, lack of staff training or costs, …

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