Accessing Abortion Care in England: A Multi-method Exploration of Barriers, Policies, and Policymaking within the National Health Service (NHS) in England.

Abortion care is an essential component of reproductive health in the United Kingdom (UK). The Abortion Act 1967 permits women to have abortion under specified grounds, despite this it is argued that women continue to face barriers when attempting to access abortion care. It is unclear how abortion services are organised and provided at National Health Service (NHS) trust level, or how local variation may contribute to inequalities in access. The aim of the study is to examine how NHS trusts in England organise, commission and provide abortions, and to understand the factors which influence these. The study will adopt a multi-method approach guided by the Levesque conceptual framework of access to healthcare (2013). The methodology comprises three interconnected workflows. Workflow 1 consists of a scoping and narrative review to map existing studies on the access and accessibility of abortion care in the UK. Workflow 2 consists of a deductive document analysis of NHS policy, exploring variations of abortion provision between NHS trusts. The document analysis will incorporate descriptive quantitative analysis to explore variation in referral methods, abortion methods, gestation limits and terminology. Workflow 3 will involve semi-structured qualitative interviews with NHS policymakers to explore decision-making processes underpinning local abortion and identifying the factors which may contribute to abortion provision.