“Cada paso es un obstáculo. ” -- Women’s Experiences Accessing Publicly Funded Abortion in the Wake of Policy Changes in Catalunya

Access to safe abortion is critical to women’s and public health. Women around the world encounter obstacles when they seek abortion care, which contribute to health care inequalities that disproportionately affect poor and marginalized women. The most marginalized women tend to encounter the most obstacles to abortion. In 2010, the Spanish government enacted policy changes affecting abortion availability in both Spain and Catalunya, an autonomous region with a contested relationship to Spain. These reforms expanded legal access to abortion and included it in the public health system for the first time. Using a mixed-methods approach combining quantitative surveys and demographic data with qualitative interviews and intensive participant-observation, this research explored women’s, providers’, and advocates’ perceptions of women’s experiences with the process of navigating the public health system to obtain legal, publicly funded abortion in Catalunya, in the wake of policy changes enacted between 2010 and the second half of 2013. Participants described the often-difficult course they had to follow to receive vouchers for care in the Catalan health system, as well as other logistical, social, and economic obstacles. Participants also reported that women mobilized social support and resisted structural inequalities inherent in the health care system, in order to successfully overcome obstacles, in the context of a widespread economic crisis in Catalunya and Spain that provoked austerity-related cuts to health care. Growing support for full Catalan independence also informed participants’ experiences