Patient experiences in the Catalan public health system years after abortion liberalization

Access to safe, high-quality abortion has long been a global public health priority. Liberalization of abortion laws expanded access in Spain, and by extension, in Catalunya, in 2010. Since then abortion is by policy available through the Catalan public health system, yet research demonstrates delays and obstacles persist, appearing to especially impact the most marginalized. Using opportunistic and convenience sampling, this study ethnographically documented patient experiences of navigating the Catalan public health system to obtain publicly funded abortions at the only contracted clinic then providing full-spectrum abortion care for the public health system. Participants reported persistent delays, misinformation, and abortion stigma in the public health system; including in the form of pressure to undergo pharmacologic abortion. Participants also described socioeconomic motivations for seeking abortion, particularly in the context of existing child-rearing responsibilities. Years after abortion liberalization, overall health system delays and obstacles persisted. This was true even in an ostensibly ‘ideal’ setting of abortion legality and public funding.