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Impact of a case management programme for women seeking later second-trimester abortion: the case of the Massachusetts Access Program
  1. Stephanie Ho1,2,
  2. Elizabeth Janiak1,3,4,5
  1. 1 Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  2. 2 Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center, San Jose, California, USA
  3. 3 Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Department of Obstetrics, Gynecology, and Reproductive Biology Brigham, Women’s Hospital, Boston, Massachusetts, USA
  5. 5 Planned Parenthood League of Massachusetts, Boston, Massachusetts, USA
  1. Correspondence to Dr Stephanie Ho, Santa Clara Valley Medical Center, San Jose, California, USA; stephanie.ho{at}


Objective The Massachusetts Access Program is a statewide, centralised referral and case management program created to address barriers to later second-trimester abortions. This study outlines the scope of, describes provider experiences with, and evaluates provider acceptability of the Program.

Study design We invited physicians, nurses and staff working in hospitals within the later abortion provider referral network to participate in a mixed-methods study that included a web-based quantitative survey and/or a semi-structured qualitative interview. We used descriptive statistics to analyse survey data and inductive coding methods to analyse interview data.

Results From 2007–2012, 15–28% of abortions performed in Massachusetts at 19 weeks or greater gestational age annually were scheduled through the Access Program. We received 16 completed surveys and conducted seven interviews with providers who routinely receive referrals for later abortions through the Program. Providers overall reported positive experiences with the Program and found it highly acceptable. They described that the transportation, accommodation and financial assistance enabled patients access to care. The specialised and updated knowledge of the Access Coordinator in regards to abortion care also allowed her to act as a resource for providers.

Conclusions The Access Program, through its referral and case management network, was a valuable resource both to patients seeking later second-trimester abortions and providers involved in abortion care. It acts as one example of an effective, highly acceptable and potentially replicable intervention to reduce barriers to obtaining later second-trimester abortions.

  • abortion
  • qualitative research
  • reproductive health politics
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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was exempted from review by the Office of Human Research Administration at the Harvard T.H. Chan School of Public Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at Portions of the findings were described in posters presented at the National Abortion Federation Annual Meeting in Baltimore, Maryland, USA, April 2015 and the American Congress of Obstetricians and Gynecologists’ Annual Meeting in San Francisco, California, USA, May 2015.

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