Meeting women's need for a flexible abortion service: retrospective study of a specialist day-care unit

Background Services for women seeking termination of pregnancy under the Na tional Health Service have persistently failed to meet targets on accessibi lity and quality of care. A specialist day-care service was established in Lincoln in April 1993, taking referrals from general practitioners and fami ly planning doctors via a dedicated telephone line and offering specialist counselling and the option of medical termination. The impact of this servi ce was investigated in a retrospective study. Methods Women attending Lincoln County Hospital with an unwanted pregnancy between April 1991 and March 1996 were included. Demographic details and da ta on in-hospital care were obtained from the Patient Administration System ; resident population data were obtained from routine sources; dates of las t menstrual period and referral were obtained from samples of patient recor ds and entries in ward diaries; patient satisfaction was assessed by questi onnaire in a consecutive sample of 44 women. Results The number of terminations provided at Lincoln County Hospital incr eased from 24 to 40 per month at the time the service began. The proportion of the resident population's demand met by the local provider increased fr om 48 per cent to 83 per cent. Terminations before nine weeks increased fro m 24 per cent to 43 per cent; those beyond 12 weeks fell from 15 per cent t o 7 per cent. Median gestational age at termination fell from 76 days to 60 days. Forty per cent of suitable women opted for medical termination. Conclusions The new service was associated with a pronounced and sustained improvement in National Health Service termination of pregnancy. When offer ed the choice, many women opted for medical termination.