Lesley Hoggart

Background Most patients in Britain undergoing medical abortion under 10 weeks’ gestation manage the entire process at home, with access to clinical support from qualified staff via telephone if needed. Artificial intelligence (AI) ‘chatbots’ are potential tools to support patients; however, little is known about patient views on their use in this regard. Methods We invited British Pregnancy Advisory Service (BPAS) patients who had a medical abortion under 10 weeks’ gestation to participate in an online, English-language, cross-sectional questionnaire (August 2025–October 2025). The questionnaire assessed demographics, self-reported likelihood of using a potential AI chatbot, perceived appealing features, reasons for hesitation and preferred features. Descriptive analysis, Chi-square statistics and p values were used to analyse responses. The desired sample size was 380. Results Of the 4684 patients invited, 396 completed the questionnaire (8%). Overall, 22.4% self-reported as very likely to use an AI chatbot, 13.1% as likely, 20.8% as neutral, 17.5% as unlikely and 26.2% as very unlikely. Self-reported likelihood of use did not vary by demographics. Perceived appealing features included: 24-hour access (57.6%), reduced wait time (47%), anonymous care (25.7%) and access to reliable personalised information (17.2%). Reasons for hesitation included: misinformation (54.2%), preference for human interaction (51.9%), conversations that loop (42.2%), data privacy (40.4%) and lack of trust in AI (38.3%). Preferred features emphasised flexibility, customisation and ability to contact staff. Conclusions Respondents’ views on a potential AI chatbot for medical abortion support were mixed, shaped by trust, reliability, flexibility and access to clinical staff. Such tools may be most acceptable as optional adjuncts within existing care pathways, requiring real-world evaluation.

Background: Recent research has shown that women often report that their concerns are not listened to in exchanges with clinicians when accessing reproductive healthcare, including contraceptive consultations. When people do not feel listened to, or have their concerns taken seriously, this can lead to disengagement with contraceptive services and distrust of healthcare professionals. Methods: A participatory approach, with 18 volunteer researchers interviewing 52 friends and family members about information-seeking and contraceptive methods. Results: Most participants were not satisfied with contraceptive consultations and felt that healthcare professionals did not give them all the information they wanted. Because of this, they found personal stories about contraception to be very important in their information-seeking and decision-making processes. Sharing these stories, both what they heard from others and their own experiences, helped them consider the potential side effects of different contraceptive methods. Participants thereby drew on vernacular knowledge (unofficial, informal and everyday culture of a group), some of which was accessed through social media. Vernacular knowledge also included experiential knowledge, as provided by friends and family members. This kind of knowledge was not covered in their contraceptive consultations. Conclusions: Patients’ understanding of side effects does not always align with medical evidence. Dismissing reported side effects can undermine patient experience, leading to disengagement or the seeking of counter-expertise. Practitioner knowledge and patient vernacular knowledge should be considered together when counselling about contraceptives. Our research suggests that a more prominent culture of active listening is required in clinician–patient exchanges that acknowledges and works with patient concerns and lived experiences.

Access to safe, affordable, and supported abortion care is a crucial component of reproductive justice and human rights. Abortion seekers consider nurses and midwives to be more supportive than other health professionals. Nurses and midwives have long been recommended providers of comprehensive abortion care, including second trimester care. This iterative scoping review aimed to explore the evidence on abortion learning mechanisms available to nurses and midwives and what can be improved about abortion training. Using the Arksey and O'Malley (2005) and Levac et al (2010) scoping review frameworks, four databases were searched, resulting in 879 articles published in English from 01.01.2010- 01.08.2024. The authors included 43 studies and identified five learning mechanisms. The evidence is presented under three themes: 1) the adequacy of abortion learning mechanisms for nurses and midwives, 2) listening to nurses and midwives' experiences, and 3) barriers to abortion training. This review found that in almost all legal and practice contexts, abortion training may be de-prioritised and hard to access because of institutional barriers, especially in centres of education. In conclusion, there is a low investment in abortion training for nurses and midwives. Policy makers, health care systems and educators should consider ways to continuously instil nurses and midwives with skills, confidence, and social authority to provide person-centred abortion care to combat harmful bias and mitigate the risk of reproductive coercion.

Introduction Abortion-related stigma negatively affects healthcare professionals providing abortion care, threatening workforce well-being and service provision. This global study, part of the Royal College of Obstetricians and Gynaecologists’ ‘Making Abortion Safe’ Project, explored healthcare providers' experiences of abortion stigma, its drivers and mitigating factors. Methods A global online survey was distributed to healthcare professionals trained to provide abortion and post-abortion care (PAC) through 16 partner organisations over a 6-week period in 2021. The Abortion Provider Stigma Scale (APSS) was adapted, and linear regression modelling was used to examine the relationships between demographic variables, attitudes towards abortion, workplace burnout and total APSS scores. Results In 1674 providers from 77 countries, stigma was universally experienced. Higher stigma levels were associated with countries with restrictive abortion laws; working in non-governmental organisation settings; and providing first- and second-trimester abortions compared with only PAC. A large majority (84%) of providers reported feeling burnout to some degree, with a strong correlation between APSS scores and workplace burnout. Providers exposed to both values clarification and attitude transformation (VCAT) training and other support workshops reported more positive attitudes and lower stigma compared with those with only VCAT or no training. Conclusions Legal reform is needed to reduce stigma for providers as part of broader initiatives on women’s reproductive rights in general. Meanwhile, ongoing support at the organisational level, alongside addressing stigmatising values and attitudes, can help create positive workplaces and resilient providers. Mainstreaming and integrating abortion services into public health systems would also help normalise abortion care.

Background: Social stigma and the marginalisation of abortion care within medical settings can negatively affect abortion providers. While some research has evaluated stigma interventions in legally restrictive settings, little work has explored the experiences of healthcare professionals (HCPs) providing abortion and post-abortion care (PAC) outside the USA. This study, part of the Royal College of Obstetricians and Gynaecologists’ ‘Making Abortion Safe’ programme, aimed to understand providers’ experiences of abortion stigma in four African countries with restrictive legislation. Methods: In-depth interviews with 44 abortion and PAC providers were conducted in Nigeria, Rwanda, Sierra Leone and Zimbabwe. Results: Four themes emerged: personal and professional effects of stigma, multiple manifestations of stigma, driving forces of stigma, and positivity and resilience. Stigma affects providers' professional identity, community belonging and relationships. Restrictive legal frameworks are the main driver of abortion stigma, operating at multiple levels that reinforce each other. The legal status of abortion labels it as ‘dirty work’, conflicting with healthcare principles. Judgmental attitudes from other HCPs negatively impact providers’ well-being and care quality. However, providers showed resilience through professional and personal commitment, and the belief in ‘doing the right thing’ helped them resist stigma. Conclusions: Legal changes are crucial for increasing access and reducing stigma among the workforce. In these countries, providers face challenges in offering legal healthcare. Organisational interventions are needed to address stigmatising values and create positive workplaces. Ongoing support is essential for HCPs to remain resilient against abortion stigma, helping to normalise abortion care and those who provide it.

Abortion stigma as reported globally has been inadequately documented empirically in Nigeria, Africa’s most populous country with a restrictive abortion law and a high rate of unsafe abortions. The objectives of this study were to investigate the ways in which abortion stigma is experienced by Nigerian health professionals and how such experiences influence health professionals’ practice of safe abortion and post-abortion care. The study utilized qualitative research consisting of in-depth interviews with 10 abortion providers. We elicited information with an open-ended interview guide that investigated the understanding of participants’ experiences of abortion stigma in Nigeria. The data were analysed qualitatively and thematically using Atlas.ti. The themes centred on perceptions and experiences of stigma among the providers interviewed. Participants’ experiences of abortion stigma included the following: being treated differently to other health professionals; experiencing disapproval and disrespect; name-calling and societal judgement; tagging and profiling of clinics by anti-abortionists; and social isolation. Participants attributed stigma to cultural and religious beliefs, the restrictive national abortion law, and pointed to hypocrisy. Some reported effects of stigma on providers included a feeling of insecurity, social exclusion, secrecy, and insincerity in clinical practice, discouragement, and guilt feelings. Despite the negative impacts, many respondents reported a sense of satisfaction stemming from their views that they were saving lives. Systematic efforts to address these adverse factors could reduce the level of stigma experienced by providers, with a potential follow-through effect of improving women’s access to safe abortion care in Nigeria.

Objective To explore experiences of pain in the context of early medical abortion (EMA) in the UK and to guide best practice around anticipatory guidance on pain. Methods From late 2020 to early 2021, we recruited individuals from across the UK who had undergone abortion during the COVID-19 pandemic to participate in in-depth, semi-structured telephone interviews. A storytelling approach was used and data were analysed thematically using NVivo 12 software. Results Focused coding and thematic analysis addressed accounts of pain, which were prominent in many interviews. We constructed the following subthemes: expected pain is manageable for some; the problem with unexpected pain; pain (co)produces fear; and problematising ‘period-like pain’. The key issue which our analysis draws out is that while EMA pain experience might vary, for some it may be much worse than anticipated. Moreover, the common trope of likening it to ‘period pain’ can be misleading and a source of additional uncertainty at a potentially already challenging time. Conclusions For some individuals, pain experienced in EMA will be severe and/or worse than expected. Insufficient preparation for pain can result in extremely negative experiences of EMA. Alongside development of improved analgesia, improvements should be made to anticipatory guidance on pain, particularly for those self-manging EMA at home. Framings of ‘period-like pain’ do not clarify expectations and should be avoided.

Background Routine ultrasound scanning to determine gestational age and pregnancy location has long been part of pre-abortion assessment in Britain, despite not being legally required or recommended in national clinical guidelines. To support implementation of fully telemedical abortion care (implemented in Britain in April 2020), the Royal College of Obstetricians and Gynaecologists (RCOG) issued clinical guidance for an ‘as-indicated’ approach to pre-abortion ultrasound, removing the need for a clinic visit. We aimed to understand patient experiences of ultrasound in abortion care by conducting a qualitative study with individuals who had abortions with and without an ultrasound scan. Methods Between November 2021 and July 2022, we recruited patients who had a medical abortion at home without a pre-procedure ultrasound at 69 days’ gestation or less at British Pregnancy Advisory Service (BPAS), and also had at least one other abortion with an ultrasound from any provider in Britain. We conducted interviews using a semi-structured interview guide to explore our participants’ experiences and conducted reflexive thematic analysis. Results We recruited 24 participants and included 19 interviews in our analysis. We developed three themes from our data. These were ‘Ultrasound scans and their relationship with autonomy and decision-making’, ‘Intrusive and out of place: the ultrasound as an inappropriate technology’ and ‘Towards preference-centred, quality care’. Conclusions Further research and user-testing of strategies to improve the scan experience should be undertaken. Patient testimonies on the negative impact of ultrasound scans in abortion care should reassure providers that omitting them according to patient preference is a positive step towards providing patient-centred care.

Young mothers often encounter stigma and discrimination, affecting their lives and that of their children. This paper explores stigma management strategies and their effectiveness for young mothers in rural Nigeria. Ten key informants and 24 young mothers were recruited from Ife-East in South-Western Nigeria. Data from semi-structured interviews showed that societal disapproval of pregnant teenagers and young mothers were common experiences. Women used a range of strategies to actively cope with stigma including: belief in predestination, avoidance, concealment, and cohabitation. These strategies could be seen as tools to mitigate negative stereotypes and discrimination. However, they also had the unintended consequences of compounding many young women's difficult circumstances and exposing them to adverse outcomes, including gender-based violence, repeat pregnancies, poor mental health, and low uptake of services. The results show the need for policy frameworks to actively combat stigma by addressing the negative framing of early pregnancy and motherhood and promoting supportive environments for young mothers. Health professionals need to be trained to offer de-stigmatising services to encourage young mothers to seek help and reduce pre-existing inequities in access to services, and policies need to include measures that address the rights of young mothers and protect them from violence and abuse.