Tackling Inequalities Accessing Comprehensive Abortion CARE

BACKGROUND Since the legalization of abortion in Spain in 1985, abortion rates per 1,000 women in reproductive age have increased from 1.7 in 1987 to 11.78 in 2008. Women belonging to the most vulnerable groups are less likely to access available services and to seek advice for contraceptives. They also have higher abortion rates by age and are at greater risk of repeat abortions. DESIGN & METHODS The program “Attention to Maternity at Risk” coordinated by an NGO in Catalonia is implementing two strategies to improve equity and accessibility to comprehensive abortion care: Co-financing abortion's cost, and offering counseling and provision of long acting contraception. RESULTS Between 1991–2009, the program attended 53,642 women requesting abortion services (20% of all abortions in Catalonia) About 85-90% of women were eligible for co-payment, with contributions of 25% and 50% as the most common Most women requested abortion during the first trimester, did not effectively use modern contraception, had not accessed health-care services during the previous year for family planning purposes, and were in a highly vulnerable socio-economic position. CONCLUSIONS Private and public partnerships guarantee the sustainability of the program. The program is equitable, succeeding in improving access to comprehensive abortion care for vulnerable women. The program is effective in terms of reproductive health, offering an integrated package of abortion care services. The program is flexible and adaptable, maintaining quality and coverage during the major demographic and social changes seen in Spain over the last decade.