‘…a one stop shop in their own community’: Medical abortion and the role of general practice (original) (raw)
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Australian Journal of Rural Health, 2019
ObjectiveThis study aimed to identify enablers and barriers to the provision of medication abortion in the primary health care setting of regional and rural areas of Victoria, Australia.DesignAn online cross‐sectional questionnaire was used.SettingRegional and rural areas of Victoria, Australia.ParticipantsThirty‐nine GPs and 30 primary health care nurses.Main outcome measuresAbortion views, medication abortion knowledge and practice, interest in medication abortion training and provision, and perceived uptake barriers.ResultsMost participants reported being consulted by women with unintended pregnancies and most of them included abortion counselling in their consultation. However, familiarity with provision of medication abortion was limited, and only five GPs and two primary health care nurses were currently medication abortion providers. The majority of participants expressed a high level of interest in receiving medication abortion training, but indicated a wide range of barrier...
The Australian & New Zealand journal of obstetrics & gynaecology, 2016
Depending on availability, many Australian women seeking an abortion will be faced with the choice between surgical or medical abortion. Little is known about the factors that influence Australian women's choice of method. Through the perspectives of abortion service providers, this study aimed to explore the factors that contribute to Australian women's decision to have a surgical or medical abortion. In 2015, in-depth interviews were conducted with fifteen Victorian-based key informants (KIs) directly providing or working within a service offering medical abortion. Ten KIs were working at a service that also provided surgical abortion. Interviews were semi-structured, conducted face-to-face or over the telephone, transcribed verbatim and analysed thematically. KIs described varying levels of awareness of medical abortion, with poorer awareness in regional areas. When it comes to accessing information, women were informed by: their own research (often online); their own exp...
BMC Health Services Research, 2016
Background: Improving access to safe abortion is an essential strategy in the provision of universal access to reproductive health care. Australians are largely supportive of the provision of abortion and its decriminalization. However, the lack of data and the complex legal and service delivery situation impacts upon access for women seeking an early termination of pregnancy. There are no systematic reviews from a health services perspective to help direct health planners and policy makers to improve access comprehensive medical and early surgical abortion in high income countries. This review therefore aims to identify quality studies of abortion services to provide insight into how access to services can be improved in Australia. Methods: We undertook a structured search of six bibliographic databases and hand-searching to ascertain peer reviewed primary research in English between 2005 and 2015. Qualitative and quantitative study designs were deemed suitable for inclusion. A deductive content analysis methodology was employed to analyse selected manuscripts based upon a framework we developed to examine access to early abortion services. Results: This review identified the dimensions of access to surgical and medical abortion at clinic or hospitaloutpatient based abortion services, as well as new service delivery approaches utilising a remote telemedicine approach. A range of factors, mostly from studies in the United Kingdom and United States of America were found to facilitate improved access to abortion, in particular, flexible service delivery approaches that provide women with cost effective options and technology based services. Standards, recommendations and targets were also identified that provided services and providers with guidance regarding the quality of abortion care. Conclusions: Key insights for service delivery in Australia include the: establishment of standards, provision of choice of procedure, improved provider education and training and the expansion of telemedicine for medical abortion. However, to implement such directives leadership is required from Australian medical, nursing, midwifery and pharmacy practitioners, academic faculties and their associated professional associations. In addition, political will is needed to nationally decriminalise abortion and ensure dedicated public provision that is based on comprehensive models tailored for all populations.
Normalising abortion: what role can health professionals play?
BMJ Sexual & Reproductive Health
BackgroundDespite being a common gynaecological procedure, abortion continues to be widely stigmatised. The research and medical communities are increasingly considering ways of reducing stigma, and health professionals have a role to play in normalising abortion as part of routine sexual and reproductive healthcare (SRH). We sought to investigate how health professionals may normalise abortion and challenge prevailing negative sociocultural narratives.MethodsAs part of the Sexuality and Abortion Stigma Study (SASS), qualitative secondary analysis was conducted on two datasets containing health professionals’ accounts of providing abortion in Scotland and England. A subsample of 20 interviews were subjected to in-depth, thematic analysis.ResultsFour key themes were identified in heath professionals’ accounts: (1) encountering resistance to abortion from others working in SRH; (2) contending with prevailing negative sociocultural narratives of abortion; (3) enacting overt positivity ...
Contraception, 2019
To develop a nurse-led model of medication abortion provision for the primary health care setting of regional and rural Victoria, where, despite decriminalization, access to abortion services is restricted. Study design: This study used a three-round Delphi process to explore consensus about a nurse-led medication abortion model. We recruited a panel consisting of physicians, nurses and other experts involved with or interested in medication abortion provision. The research team thematically analyzed the responses to the seven open-ended questions of the first questionnaire. In subsequent rounds, panelists rated the 83 generated statements for agreement, using feedback and statistical summaries. Results: A total of 24 panelists participated; 17 completed all three rounds. Through the iterative process, the panel reached consensus (at least 75% agreement level) on 69 statements, relating to model construction and the barriers to model implementation and their solutions. Due to current health care system restrictions we not only developed a 'fully autonomous' nurse-led model, but also a 'legally feasible' model. For nurses working in primary health settings that lack GP support we additionally constructed an 'absence of a (medication abortion supportive) general practitioner' model. Conclusion: Nurse-led medication abortion provision is a recognized strategy to improve access to equitable, affordable and safe abortion services for women residing in underserved areas. The constructed models and recommendations for practice and policy can serve as a guide to expand the role of primary health care nurses in the provision of medication abortion in Victoria and beyond. Implications: The findings of this study indicate that a nurse-led model of medication abortion provision is feasible in service poor areas of Victoria and that model implementation has the potential to improve abortion access. The models are adaptable for use in other settings.
Obstacles to the Integration of Abortion Into Obstetrics and Gynecology Practice
Perspectives on Sexual and Reproductive Health, 2010
CONTEXT: Obstetrics and gynecology residents who are trained in family planning and intend to provide abortions after residency often do not ultimately do so. The extent of the professional barriers physicians face trying to integrate abortion into their practice is unknown.