A qualitative study of women's experiences of professional referrals for abortion in South Carolina
Margo, Judy Nathalie
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BACKGROUND: Women seeking abortion services in the U.S. often encounter challenges of stigma, cost, transportation, and other logistics. In 2011, 1.7% of women aged 15–44 had abortions, and 89% of counties had no abortion clinic. Many states regulate abortion through prohibition of insurance coverage and other restrictions. Accurate, non-judgmental referrals from health care professionals may lessen obstacles and counteract stigma. STUDY QUESTION: What are women’s experiences accessing abortion care, and what is the role of professional referrals? METHODS: I conducted semi-structured qualitative interviews with 45 women seeking abortions to learn what steps they took to obtain abortion care, whether they sought or received professional referrals, and what obstacles or supports they encountered. All interviews were conducted at three clinics in South Carolina. Using Zurek et al’s (2015) conceptual framework, process mapping and thematic analysis were conducted to understand the sequence and variations of steps taken. RESULTS: Nearly half of participants had contact with a health professional for pregnancy confirmation, but only seven received referrals. Professional referrals ranged in their perceived helpfulness. Positive referrals included direct, supportive communication without judgment. Negative experiences were characterized by stigmatizing action or language. Some women indicated they did not seek a referral due to social pressure or stigma. Without a referral, women located abortion clinics through online searches, previous experience, and information from friends or family. Women encountered structural and social obstacles when arranging abortion care, such as out of pocket costs, transportation challenges, and stigma at multiple levels. Social support and help with logistics and finances counteracted these obstacles. CONCLUSIONS: Resourcefulness is evident in women’s stories of accessing abortion, particularly in the absence of referrals, but positive professional referrals carry some benefit. Abortion access may be improved through expanding health provider capacity to make accurate, supportive referrals. IMPLICATIONS: To improve abortion access, obstacles and stigma must be reduced through increased support and reduction of systematic obstacles. Health system policies should ensure that providers know how to appropriately refer for abortion, and how to support women navigating predictable challenges.