Objective: To identify and remove barriers to medical abortion for low-income women seeking medical abortion.
Methods.: The process for obtaining abortion at Boston Medical Center was examined with emphasis on barriers to medical abortion.
Facility: Boston Medical Center serves a diverse clientele, but is one of few resources for indigent women seeking abortion. A small number of methotrexate abortions were performed in 1999.
Results: There are multiple institutional barriers to obtaining medical abortion at Boston Medical Center Barriers included: 1. Prolonged wait for initial appointment, often as long as 2 weeks. 2. Lack of information, or misinformation, about medical information on the telephone. 3. Misinformation about medical abortion among other specialty services. 4. Fragmentation of ultrasound services, resulting in multiple visits for patients. 5. Inability to obtain Rh immune globulin without antibody screening. 6. Hospital restrictions on handling of methotrexate. 7. Cultural barriers for some women to vaginal use of misoprostol. 8. Fragmented telephone support after hours. 9. Abundant use of emergency services with subsequent fragmentation of care.
Attempted solutions have included:
a. Dedicated sub-sessions for medical abortion patients and follow-up. b. Scripts for telephone staff. c. Intranet information for providers. d. Shifting ultrasound services to the gynecology services. e. Reorganizing dispensing of medications. f. Flexibility in misoprostol timing and route. g. The option of treatment of non-viable pregnancies by medical means
Conclusions: There are multiple barriers to medical abortion within existing systems for low-income women. Removing barriers is complex but possible and results in increased awareness and utilization.
Learning Objectives: The attendee will be able to: 1. identify barriers to medical abortion ofr low-income women 2. move toward overcominging those barriers
Keywords: Abortion, Barriers to Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.