BACKGROUND: In 2002, by popular vote, Swiss citizens accepted to legalise termination of pregnancy (TOP), up to the 12th week of amenorrhoea (WA). As a result, the cantons formulated rules of application. In 2002, medical TOP was authorised. Health institutions then had to modify their procedures and practices.
QUESTIONS: One of the objectives of these changes was to simplify the clinical course for women who decide to terminate a pregnancy. Have the various health institutions in French-speaking Switzerland attained this goal? Are there differences between cantons? Are there any other differences, and if so, which ones? What are the views of healthcare professionals on the modifications of procedures and practices implemented in French-speaking Switzerland?
METHODS: Quantitative and qualitative method. Comparative study of cantonal rules of implementation. Study by questionnaire with 281 women having undergone a TOP. In-depth interviews with 77 healthcare professionals (doctors, nurses, midwives sexual and reproductive health social workers). Thematic analysis with content analysis software.
RESULTS: The comparative legal study of the six cantonal rules of implementation showed differences between cantons. The clinical course for women are defined by four quantifiable facts: 1) the number of days to wait between the woman’s decision (first step) and TOP; 2) the number of appointments attended before TOP; 3) the method of TOP; 4) the cost of TOP. On average, the waiting time was 12 days and the number of appointments was 3. The average cost of TOP was 1360 CHF. The differences, sometimes quite large, are explained by the size of the institutions (large university hospitals; average-sized, non-university hospitals; private doctors’ offices). Most professionals have a balanced point of view on their practices. There is no point of view specific to each different category of professionals interviewed. They are unanimous on the elimination of the need for a second opinion. The points of view diverge on the usefulness of imposed waiting time to think before TOP, minors’ access to TOP without parental consent, access to medical TOP
and the right to refuse to practice TOP for personal reasons in public hospitals.
CONCLUSIONS: The cantonal rules of implementation and the size of the health care institutions play an important role in women’s courses. The professionals do not question women’s right to have TOP up to 12 WA, but they do diverge over procedures and practices. Institutional and cantonal cultures are probably behind these differences.
Key words: termination of pregnancy; law reform; time span; women’s clinical course; medical costs; gynaecologists; healthcare professionals; medical abortion; conscientious refusal