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).