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Initiatives to close the gap in inequalities in abortion provision in a remote and rural UK setting
  1. Lucy Caird1,
  2. Sharon T Cameron2,
  3. Tracy Hough3,
  4. Lynn Mackay4,
  5. Anna Glasier5
  1. 1Consultant, Department of Obstetrics and Gynaecology, Raigmore Hospital, NHS Highland, Inverness, UK
  2. 2Consultant, Chalmers Centre, NHS Lothian, Edinburgh, UK
  3. 3Resarch Nurse, Department of Obstetrics and Gynaecology, Raigmore Hospital, NHS Highland, Inverness, UK
  4. 4Gynaecology Nurse, Department of Obstetrics and Gynaecology, Raigmore Hospital, NHS Highland, Inverness, UK
  5. 5Professor, Department of Reproductive and Developmental Sciences, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Lucy Caird, Department of Obstetrics and Gynaecology, Raigmore Hospital, NHS Highland, Inverness, UK; lucy.caird@nhs.net

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Why was change needed?

Women living in remote and rural areas of the UK face inequalities in provision of abortion services compared to their urban counterparts. Distances to travel, lack of providers, and legal restrictions that require administration of both mifepristone and misoprostol at the abortion service hamper access to, and provision of, abortion. NHS Highland provides care for women from a wide geographical area in the far north of Scotland, much of which is remote and rural and includes small islands. Abortion care is provided from a single National Health Service hospital department of obstetrics and gynaecology in Inverness. For some women, this means that they need to travel distances of over 100 miles to be assessed for an abortion, often using multiple modes of transport (including ferry and plane). Although abortion rates in this region are lower than the Scottish average (9.1 vs 11 per 1000 women aged 15–44 years), the total number of women having an abortion in the region is much lower than most parts of Scotland (fewer than 500 annually), reflecting the smaller population.1 This, combined with a lack of abortion providers in the region, means that the dedicated clinic for women requesting abortion takes place only once per week, adding to delays for some women. These factors undoubtedly contribute to the consistent failure to meet national standards for sexual health that recommend that 70% of women seeking abortion should undergo the procedure at 9 weeks’ gestation or earlier (i.e. 67% in 2014).1 ,2 We piloted and evaluated four new initiatives in the service aimed at improving access to abortion and minimising delays in provision.

How did we go about implementing change?

The chair of the local research ethics committees confirmed that ethical committee approval was not required for this health services research. The initiatives were piloted between June 2010 (or June 2011) and August …

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