Abortion care over 20 weeks gestation: a psychosocial exploration of patient experiences at the Royal Women’s Hospital, Victoria, Australia

Abortion is legal in every state of Australia, yet access to abortion over 20 weeks gestation is not universally guaranteed. Patients with indications outside of maternal medicine or fetal abnormalities experience particular challenges, including stigmatisation and limited service access. The aim of this study was to explore the lived experiences of women accessing abortion care over 20 weeks at the Royal Women's Hospital for non-medical reasons, identify enablers and barriers to care and understand experiences of abortion care. Participants were recruited via convenience sampling once their abortion care had been booked. Semi-structured interviews were conducted in person or online. Data were analysed via a reflexive thematic analysis. 15 women participated in the study. A total of five themes and 15 sub-themes were identified which described social stressors and systemic barriers to abortion access, including multiple competing personal stressors, compromised autonomy, navigating a complex abortion service system and late diagnosis of pregnancy as compounding reasons for delayed access to abortion care. Enablers to abortion care recognised the importance of safe, holistic, and time-sensitive care for all. Additional research is needed to understand the experiences of women who attempted to access abortion care over 20 weeks but were unable to do so and forced to continue their pregnancies Greater access to abortion at 20 weeks and over for reasons beyond maternal medicine and fetal abnormalities is needed throughout Victoria and Australia-wide.