title: Barriers around access to abortion experienced by rural women in New South Wales, Australia.
abstract: BACKGROUND
  Little is known about Australian rural women's overall experiences of accessing an abortion service and the barriers they encounter. Approximately one in three Australian women access an abortion at some time in their lives. Most abortions are undertaken during the first trimester of pregnancy in private clinics. Although both medical and surgical abortions are uncomplicated medical procedures, abortion remains a contentious area of women's health. Whilst it is clear that rural women experience disparities in relation to access to health care, there is a gap in the evidence on rural women's experiences of accessing an abortion. The aim of the present study was to identify factors that women in rural New South Wales (NSW) experience in accessing abortion services and suggestions about how rural women could be better supported when seeking access to an abortion service.
  
  
  METHODS
  In-depth qualitative interviews were undertaken with rural women living in NSW who had had an abortion in the previous 15 years. Participants self-selected for a phone or face-to-face interview, in response to promotion of the study through women's services, community flyers and press releases.
  
  
  RESULTS
  Rural women in this study experienced many barriers to accessing an abortion. Women travelled 1-9 hours one way to access an abortion in clinics. Several women borrowed money for the abortion fee. Five themes were identified: finding information about the provider; stigma, shame and secrecy; logistics involved in accessing the clinic related to travel, money and support; medical and surgical abortion; and ways rural women could be better supported in this process. Suggestions to improve rural women's access to abortion services included more affordable services that were 'closer to home' as a way to reduce travel and cost, and to normalise abortion as a women's health rights issue.
  
  
  CONCLUSIONS
  Despite welcome legal and pharmaceutical reform in Australia, results from this small study indicate that there is a long way to go remove barriers on issues rural women experience in their process of accessing reproductive care, including the pervasiveness of abortion stigma. Services closer to home may help reduce inequities in access to health care experienced by rural women. Strategies such as broader use of tele-health and willingness of general practitioners to become authorised prescribers for medical abortions could help to reduce long distances to travel to services and the financial burden experienced by rural women.
authors.affiliation: Southern Cross University, Lismore, New South Wales, Australia. frances.doran@scu.edu.au.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Doran
authors.affiliation: Mount Isa Centre for Rural and Remote Health, James Cook University, Queensland, Australia. julie.hornibrook@jcu.edu.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Hornibrook
mesh_terms: D000029:Abortion, Legal / Q000191:economics / Q000706:statistics & numerical data*; D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration*; D009517:New South Wales / Q000453:epidemiology; D011247:Pregnancy; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014186:Transportation; D055815:Young Adult
keywords: Australia/Pacific; Consumer perspectives; Determinants of Health; Health Service reform; Human Rights and Ethics; Medical; Nursing; Other; Public Health; Qualitative Research; Researcher; Women's Health