Table 1 A framework for examining access to early abortion services

Availability: The number of existing abortion services meet women’s needs

How many and what types of abortion services exist? Which organizations offer these services? Are there enough willing and skilled personnel to deliver abortion services? Do the services offer choices that correspond with the needs of financially disadvantaged women? Are the services and supplies of abortion drugs and associated equipment and tests sufficient to cover the demand?

Accessibility: Abortion services are near where women live, or accessible in their homes and referral timely

What is the geographical distance between abortion services and the homes of women? Can services be reached and women referred in a timely and stress-free manner? How has technology been employed to address issues of distance?

Affordability: The prices of terminations are aligned with women’s income and ability to pay

What are the direct costs of abortion services and the associated commodities? What are the indirect costs in terms of transportation, childcare, lost time and income? Are payment options available for women? What are the costs to the health system and are they affordable?

Adequacy: The organization of abortion services meet women’s expectations

How are/is the abortion service/s organized? Does the organizational structure meet women’s expectations? Do opening hours match the schedules of women? Are facilities clean, organized and well managed?

Acceptability: The services are satisfactory and used by women

Does the information, explanation, and service provided accommodate social norms and values? Do women find self-management aspects such as drug taking and pregnancy testing satisfactory and easy to use? Do women feel welcome and cared for? Do women trust in the competence and character of the health care providers?

Quality: The services are scientifically and medically appropriate and of good quality

Are there service delivery standards and quality management systems? How are women’s complaints dealt with? What quality assurance, control and improvement mechanisms are in place? Quality also extends to the manner in which women are treated, and how underlying determinants of health are addressed. Is there provider sensitivity training (i.e. in appropriate language use, cultural safety, privacy) or/and incentive schemes for providers to offer services? Are providers accredited, and regulated? Do providers collect accurate data? Is family planning/contraceptive advice provided? How are abortifacient drugs packaged? Is treatment observed if required? What family planning training and peer support is available for providers?