Discussion
Our study shows that abortion remains difficult to access and approach for women in Turkey. While unavailability of abortion within formal services appears to be a significant barrier to accessing safe abortion, cost, concerns over privacy and confidentiality, as well as misinformation and censorship appear to hinder women’s access to formal abortion services even where it is supposedly available. We noted that the spousal consent requirement for married women violates women’s autonomy and becomes particularly problematic in cases of intimate partner violence. Our qualitative analysis revealed that women share some serious concerns with regard to healthcare workers’ attitudes toward patient confidentiality and having an electronic health record of their sexual and reproductive history. We also find it significant that additional difficulties were experienced by refugees and foreigners who feel disempowered and exploited in their search for safe abortion within formal healthcare in Turkey.
A major finding of our study was that 45% of the survey respondents indicated that they requested abortion through WoW because they prefer to have a medical abortion, which is not available in the country. This demand for medical abortion was further explained in some email correspondences with its capacity for autonomy such as at-home use or being with friends and/or relatives during the abortion process and concerns over surgical abortion methods and their risks.
This study reveals the unmet need for abortion care in Turkey is caused by policies and practices which hinder women’s access to abortion within formal services through women’s experiences. To increase the availability and affordability of formal abortion services, abortion services should be provided in all public and private healthcare settings in accordance with the abortion law. The spousal consent requirement for married women should be removed. The combined regimen for medical abortion (with mifepristone and misoprostol) should be made available for hospital use and home use, given the demand and its proven safety and benefits (9–11). Efforts shall be made to combat misinformation and censorship of abortion information. Key healthcare workers including but not limited to obstetrics and gynaecology specialists, family medicine specialists, midwives, nurses and reception staff should be trained in abortion regulations and counselling to provide accurate information and support to women in order to increase the approachability of these services (12).