1
|
Tamire A, Birhanu B, Negash A, Dechasa M, Masrie A, Shawel S, Dereje J, Gebru T, Kassa Tafesse O, Mengistu DA, Sertsu A, Daka DW. Mixed-methods approach in evaluating safe abortion care services at public health facilities in North Shewa zone, central Ethiopia: a multicenter institutional cross-sectional study. FRONTIERS IN HEALTH SERVICES 2024; 4:1352178. [PMID: 39036465 PMCID: PMC11258023 DOI: 10.3389/frhs.2024.1352178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/21/2024] [Indexed: 07/23/2024]
Abstract
Background Of the 55.7 million abortions that were performed globally, 25.1 million (45.1%) were not safe. Nearly 97% of these took place in developing countries. Approximately 71% of economically developed countries allow safe abortion care (SAC) services, whereas only 16% of developing countries permit it. In sub-Saharan Africa, 92% of mothers live in 43 countries where SAC services are restricted by law. Most Ethiopian women continue to self-terminate unwanted pregnancies in hazardous conditions. The aim of this evaluation was to assess input, care providers' compliance with national guidelines, and clients' satisfaction. Methods A multicenter cross-sectional study design with a mixed-methods approach was used. Seven public health facilities were randomly selected where 75 health caseworkers were directly observed; 296 clients and 14 key informants were interviewed, respectively. A resource inventory checklist was used to assess all inputs. The overall SAC services evaluation was summarized from 40 indicators: 13 resource availability indicators, 14 healthcare workers' compliance to national guidelines indicators, and 13 clients' satisfaction toward SAC services indicators. A multivariate logistic regression model was fit to determine factors that affect client satisfaction at a p-value <0.005. Results There were 75 healthcare providers in the maternal and child health departments in the study area. Except for the interruption of water and electricity, maternal waiting area, counseling, and procedural room, all are available making 94% of resources availability. All healthcare workers were compliant in providing anti-pain medication during procedures, identifying clients if they were targeted for an HIV/AIDS test, and providing their test results as per the guideline. Nevertheless, they were poorly compliant in respecting the clients (9, 12%) and taking vital sign (33, 44%). The overall compliance was 62.3%, while only 51% were satisfied with waiting time and privacy of counseling room. The overall client satisfaction was 65%. The overall evaluation of SAC services was 72.9%. Conclusion Resource availability was excellent, which was in line with national SAC expectations while the healthcare workers' compliance to national guidelines was fair, which deviated from expectations. The clients' satisfaction and the overall evaluation were good, which was below the hypothesized expectation.
Collapse
Affiliation(s)
- Aklilu Tamire
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Bezawit Birhanu
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| | - Abraham Negash
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mesay Dechasa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Awoke Masrie
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Samrawit Shawel
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Jerman Dereje
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilaye Gebru
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Obsan Kassa Tafesse
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Dechasa Adare Mengistu
- Department of Environmental Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Addisu Sertsu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dawit Wolde Daka
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| |
Collapse
|
2
|
Phung LC, Said JM, Neel A. A survey of obstetric and gynaecology doctors at an Australian metropolitan tertiary hospital to understand their views, training and confidence in abortion care. Aust N Z J Obstet Gynaecol 2024. [PMID: 38934327 DOI: 10.1111/ajo.13852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The barriers to comprehensive abortion care in Australian metropolitan tertiary hospitals are under-researched. Previous work has suggested that negative practitioner attitudes and lack of training may play a large role; however, this remains poorly understood. AIM The aim was to survey doctors practicing obstetrics and gynaecology to better understand their views, training experience and confidence in abortion care. METHOD The method involved a cross-sectional study via an anonymous survey at a single metropolitan tertiary hospital not providing substantive abortion services in Melbourne, Australia. Inclusion criterion was obstetric and gynaecology medical staff working at that hospital. Data were collected regarding views, training experiences and confidence in first-trimester medical and surgical abortion, and second-trimester surgical abortion. Data were analysed according to levels of training, categorised as RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) Fellows, prevocational/vocational trainees and general practitioner specialists. RESULTS Sixty-one valid responses were received from 90 eligible participants (response rate 68%). An overwhelming majority (96%) supported abortion services. The majority of RANZCOG Fellows felt confident performing first-trimester surgical abortion (89%) and first-trimester medical abortion (71%); however, only half felt confident performing second-trimester surgical abortion (50%). Prevocational/vocational trainees were overall less confident but overwhelmingly expressed interest in gaining further experience in abortion. CONCLUSION Doctors are generally confident in providing first-trimester abortion services (medical or surgical) in the metropolitan tertiary setting. However, further work is required to understand ongoing barriers to comprehensive abortion care. There may also be a skills shortage for second-trimester surgical abortion, requiring significant improvements in abortion training.
Collapse
Affiliation(s)
- Laura C Phung
- Department of Obstetrics and Gynaecology, Joan Kirner Women's and Children's at Sunshine Hospital, Western Health, Melbourne, Victoria, Australia
| | - Joanne M Said
- Maternal Fetal Medicine, Joan Kirner Women's and Children's at Sunshine Hospital, Western Health, Melbourne, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Aekta Neel
- Department of Obstetrics and Gynaecology, Joan Kirner Women's and Children's at Sunshine Hospital, Western Health, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Malek M, Homer CS, McDonald C, Hannon CM, Moore P, Wilson AN. Abortion care at 20 weeks and over in Victoria: a thematic analysis of healthcare providers' experiences. BMC Pregnancy Childbirth 2024; 24:112. [PMID: 38321392 PMCID: PMC10845525 DOI: 10.1186/s12884-024-06299-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/28/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND In many countries, abortions at 20 weeks and over for indications other than fetal or maternal medicine are difficult to access due to legal restrictions and limited availability of services. The Abortion and Contraception Service at the Royal Women's Hospital in Victoria, Australia is the only service in the state that provides this service. The views and experiences of these abortion providers can give insight into the experiences of staff and women and the abortion system accessibility. The aim of this study was to examine health providers' perceptions and experiences of providing abortion care at 20 weeks and over for indications other than fetal or maternal medicine, as well as enablers and barriers to this care and how quality of care could be improved in one hospital in Victoria, Australia. METHODS A qualitative study was conducted at the Abortion and Contraception Service at the Royal Women's Hospital. Participants were recruited by convenience and purposive sampling. Semi-structured interviews were conducted one-on-one with participants either online or in-person. A reflexive thematic analysis was performed. RESULTS In total, 17 healthcare providers from medicine, nursing, midwifery, social work and Aboriginal clinical health backgrounds participated in the study. Ultimately, three themes were identified: 'Being committed to quality care: taking a holistic approach', 'Surmounting challenges: being an abortion provider is difficult', and 'Meeting external roadblocks: deficiencies in the wider healthcare system'. Participants felt well-supported by their team to provide person-centred and holistic care, while facing the emotional and ethical challenges of their role. The limited abortion workforce capacity in the wider healthcare system was perceived to compromise equitable access to care. CONCLUSIONS Providers of abortion at 20 weeks and over for non-medicalised indications encounter systemic enablers and barriers to delivering care at personal, service delivery and healthcare levels. There is an urgent need for supportive policies and frameworks to strengthen and support the abortion provider workforce and expand provision of affordable, acceptable and accessible abortions at 20 weeks and over in Victoria and in Australia more broadly.
Collapse
Affiliation(s)
- Mary Malek
- Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | | | - Clare McDonald
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Catherine M Hannon
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Paddy Moore
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Alyce N Wilson
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia.
| |
Collapse
|
4
|
Gialdini C, Ramón Michel A, Romero M, Ramos S, Carroli G, Carroli B, Gomez Ponce de León R, Vila Ortiz M, Lavelanet A. Multicountry research on comprehensive abortion policy implementation in Latin America: a mixed-methods study protocol. BMJ Open 2024; 14:e073617. [PMID: 38245008 PMCID: PMC10806677 DOI: 10.1136/bmjopen-2023-073617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/08/2024] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Access to comprehensive abortion care could prevent the death of between 13 865 and 38 940 women and the associated morbidity of 5 million women worldwide. There have been some important improvements in Latin America in terms of laws and policies on abortion. However, the predominant environment is still restrictive, and many women, adolescents and girls still face multiple barriers to exercise their reproductive rights. This research will systematically assess comprehensive abortion policies in five Latin American countries (Argentina, Colombia, Honduras, Mexico and Uruguay). The aim is to identify barriers, facilitators and strategies to the implementation of abortion policies, looking at four key dimensions-regulatory framework, abortion policy dynamics, abortion service delivery and health system and health outcomes indicators-to draw cross-cutting lessons learnt to improve current implementation and inform future safe abortion policy development. METHODS AND ANALYSIS A mixed-method design will be used in the five countries to address the four dimensions through the Availability, Accessibility, Acceptability and Quality of Care model. The data collection tools include desk reviews and semi-structured interviews with key actors. Analysis will be performed using thematic analysis and stakeholder analysis. A regional synthesis exercise will be conducted to draw lessons on barriers, facilitators and the strategies. ETHICS AND DISSEMINATION The project has been approved by the WHO Research Ethics Review Committee (ID: A66023) and by the local research ethics committees. Informed consent will be obtained from participants. Data will be treated with careful attention to protecting privacy and confidentiality. Findings from the study will be disseminated through a multipurpose strategy to target diverse audiences to foster the use of the study findings to inform the public debate agenda and policy implementation at national level. The strategy will include academic, advocacy and policy arenas and actors, including peer-reviewed publication and national and regional dissemination workshops.
Collapse
Affiliation(s)
- Celina Gialdini
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
- Blanquerna Ramon Llull University Faculty of Health Sciences, Barcelona, Spain
| | | | - Mariana Romero
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, (CONICET), Buenos Aires, Argentina
| | - Silvina Ramos
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | | | - Berenise Carroli
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Rodolfo Gomez Ponce de León
- Latin American Center of Perinatology Women and Reproductive Health (CLAP/WR), Pan American Health Organization, Montevideo, Uruguay
| | - Mercedes Vila Ortiz
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Antonella Lavelanet
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| |
Collapse
|
5
|
Srinivasan S, Botfield JR, Mazza D. Utilising HealthPathways to understand the availability of public abortion in Australia. Aust J Prim Health 2023; 29:260-267. [PMID: 36521168 DOI: 10.1071/py22194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/23/2022] [Indexed: 07/20/2023]
Abstract
BACKGROUND Access to publiclyfunded abortion in Australia is limited, with a considerable proportion carried out by private providers. There are no nationally reported data on public abortion services, and referral pathways are poorly coordinated between hospital and primary care sectors. HealthPathways is an online system for use in primary care that provides information on referral pathways to local services. The aim of this study was to describe abortion referral pathways for each HealthPathways portal in Australia. METHODS A review of Australian HealthPathways content on abortion was undertaken between January and June 2022. For each HealthPathways portal, data were extracted on referral options to abortion services. RESULTS Overall, 17 out of 34 Australian HealthPathways consented to be included. Nearly half (47%) had no public services listed for surgical abortion, and 35% had no public services for medical abortion. The majority (64% for surgical abortion, 67% for medical abortion) emphasised that public services should be considered only as a last resort. There was variation in information regarding gestation-specific options, the time-critical nature of referrals, and the importance of women's own preference when deciding between medical or surgical abortion. CONCLUSION Despite few remaining legal restrictions to abortion, many regions across Australia either do not have public abortion services or do not provide information about them. There is an urgent need for transparency around public abortion service availability, clear guidelines to support referral pathways, and commitment from State and Federal governments to expand the availability of accessible, no-cost abortion in Australia.
Collapse
Affiliation(s)
- Sonia Srinivasan
- Department of General Practice, Monash University, Notting Hill, Vic. 3168, Australia
| | - Jessica R Botfield
- Department of General Practice, Monash University, Notting Hill, Vic. 3168, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Vic. 3168, Australia
| |
Collapse
|
6
|
Haas M, Church J, Street DJ, Bateson D, Mazza D. How can we encourage the provision of early medical abortion in primary care? Results of a best-worst scaling survey. Aust J Prim Health 2023; 29:252-259. [PMID: 36473159 DOI: 10.1071/py22130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/15/2022] [Indexed: 07/20/2023]
Abstract
BACKGROUND Almost onein four women in Australia experience an unintended pregnancy during their lifetime; of these, approximately 30% currently end in abortion. Although early medical abortion (EMA) up to 9weeks gestation is becoming more widely available in Australia, it is still not commonly offered in primary care. The aim of this study was to investigate the barriers and facilitators to the provision of EMA in primary care. METHODS A sample of 150 general practitioners (GPs) and 150 registered nurses (RNs) working in Australia responded to a best-worst scaling survey designed to answer the following question: what are the most important facilitators and barriers to the provision of EMA in primary care? RESULTS GPs believe that the lack of clinical guidelines, the amount of information provision and counselling required, and the fact that women who are not their patients may not return for follow-up are the most important barriers. For RNs, these three barriers, together with the stigma of being known as being involved in the provision of EMA, are the most important barriers. The formation of a community of practice to support the provision of EMA was identified by both professions as the most important facilitator. CONCLUSIONS Having access to a community of practice, enhanced training and reducing stigma will encourage the provision of EMA. Although clinical guidelines are available, they need to be effectively disseminated, implemented and endorsed by peak bodies. Primary care practices should consider using task sharingand developing patient resources to facilitate the provision of information and counselling.
Collapse
Affiliation(s)
- Marion Haas
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Broadway, NSW 2007, Australia
| | - Jody Church
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Broadway, NSW 2007, Australia
| | - Deborah J Street
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Broadway, NSW 2007, Australia
| | - Deborah Bateson
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Danielle Mazza
- Department of General Practice, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Vic. 3168, Australia
| |
Collapse
|
7
|
Bowler S, Vallury K, Sofija E. Understanding the experiences and needs of LGBTIQA+ individuals when accessing abortion care and pregnancy options counselling: a scoping review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023:bmjsrh-2022-201692. [PMID: 36635070 DOI: 10.1136/bmjsrh-2022-201692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Safe, accessible, and inclusive abortion care and pregnancy options counselling are essential components of sexual and reproductive health and rights. Research has documented LGBTIQA+ people are as likely, or more than likely, as the general population to experience an abortion in their lifetime yet face significant barriers to accessing abortion and related care, which undermines well-being. AIMS The present study undertakes a scoping review of research on the needs and experiences of the LGBTIQA+ population (representing lesbian, gay, bisexual, transgender, gender diverse, intersex, queer, asexual, and questioning) when accessing abortion care, pregnancy options, and post-abortion counselling to support improved understanding of pregnant people's preferences, needs, and experiences. METHODS The reporting of this scoping review is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension of Scoping Reviews (PRISMA-ScR). Academic databases were searched using terms relating to gender identity and sexuality, abortion, pregnancy options, and post-abortion counselling to identify peer reviewed papers published in English. Seven publications were included in the review that described experiences of LGBTIQA+ people accessing abortion-related care. RESULTS The included studies were predominantly conducted in the USA using quantitative and qualitative research designs. Thematic analysis highlighted participants' experiences of discrimination and exclusion in healthcare settings, healthcare avoidance, unsafe abortion, non-disclosure to providers, and poor health outcomes for LGBTIQA+ people. CONCLUSIONS Gender-inclusive services and training for health providers is necessary to provide safe and accessible abortion care and overcome generations of mistrust held by the LGBTIQA+ community. Research into the needs of LGBTIQA+ people when accessing pregnancy options counselling is critically needed.
Collapse
Affiliation(s)
- Sally Bowler
- School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Kari Vallury
- Children By Choice, Brisbane, Queensland, Australia
| | - Ernesta Sofija
- School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| |
Collapse
|
8
|
Munro SB, Dunn S, Guilbert ER, Norman WV. Advancing Reproductive Health through Policy-Engaged Research in Abortion Care. Semin Reprod Med 2022; 40:268-276. [PMID: 36746159 DOI: 10.1055/s-0042-1760213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Mifepristone medication abortion was first approved in China and France more than 30 years ago and is now used in more than 60 countries worldwide. It is a highly safe and effective method that has the potential to increase population access to abortion in early pregnancy, closer to home. In both Canada and the United States, the initial regulations for distribution, prescribing, and dispensing of mifepristone were highly restricted. However, in Canada, where mifepristone was made available in 2017, most restrictions on the medication were removed in the first year of its availability. The Canadian regulation of mifepristone as a normal prescription makes access possible in community primary care through a physician or nurse practitioner prescription, which any pharmacist can dispense. In this approach, people decide when and where to take their medication. We explore how policy-maker-engaged research advanced reproductive health policy and facilitated this rapid change in Canada. We discuss the implications of these policy advances for self-management of abortion and demonstrate how in Canada patients "self-manage" components of the abortion process within a supportive health care system.
Collapse
Affiliation(s)
- Sarah B Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheila Dunn
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Edith R Guilbert
- Department of Obstetrics, Gynecology and Reproduction, Laval University, Québec City, Québec, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
9
|
Mainey L, O'mullan C, Reid-Searl K. Working with or against the system: Nurses' and midwives' process of providing abortion care in the context of gender-based violence in Australia. J Adv Nurs 2022; 79:1329-1341. [PMID: 35285985 DOI: 10.1111/jan.15226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 02/18/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to explain the process through which Australian nurses and midwives provide abortion care to people affected by gender-based violence (GBV). DESIGN A constructivist grounded theory study. METHODS This study took place between 2019 and 2021. The lead author conducted semi-structured interviews with 18 Australian nurses and midwives who provided abortion care. Participants were recruited through pro-abortion, nursing and midwifery networks using a snowballing technique. Data collection and analysis proceeded using purposive and theoretical sampling until we reached data saturation. FINDINGS Participants revealed they underwent a process of working with or against the system contingent on the degree to which the system (the interconnected networks through which a pregnant person, victimized by trauma, travels) was woman centred. When participants encountered barriers to person-centred abortion care, they bent or broke the law, local policy and cultural norms to facilitate timely holistic care. Though many participants felt professionally compromised, their resolve to continue working against the system continued. CONCLUSION Conservative abortion law, policies and clinical mores did not prevent participants from providing abortion care. The professional obligation to provide person-centred care was a higher priority than following the official or unofficial rules of the organizations. IMPACT This study addresses the clinical care of people accessing abortions in the context of GBV. Nurses and midwives may act out against the law, organizational policies and norms if prevented from providing person-centred care. This research is relevant for any location that restricts abortion through stigma, pro-life influences or politics.
Collapse
Affiliation(s)
- Lydia Mainey
- College of Nursing and Midwifery, CQUniversity, Cairns, Australia
| | - Catherine O'mullan
- College of Science and Sustainability, CQUniversity, Bundaberg, Australia
| | - Kerry Reid-Searl
- College of Nursing and Midwifery, CQUniversity, Cairns, Australia.,Rural and Remote Education, Queensland Health, Rockhampton, Australia
| |
Collapse
|
10
|
Desai A, Maier B, James-McAlpine J, Prentice D, de Costa C. Views and practice of abortion among Queensland midwives and sexual health nurses. Aust N Z J Obstet Gynaecol 2022; 62:219-225. [PMID: 35257360 PMCID: PMC9314146 DOI: 10.1111/ajo.13489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/30/2021] [Accepted: 01/24/2022] [Indexed: 11/26/2022]
Abstract
Background A significant barrier to the access of safe abortion is the lack of trained abortion providers. Recent studies show that with appropriate education, nurses and midwives can provide abortions as safely as medical practitioners. Aims To examine the attitudes and practices of registered midwives (RMs) and sexual health nurses (SHNs) in Queensland toward abortion. Materials and Methods A cross‐sectional mixed‐methods questionnaire was distributed to RMs and SHNs from the Queensland Nursing and Midwifery Union. Data were described and analysed both quantitatively and qualitatively. Results There was a 20% response rate (n = 624) to the survey from the overall study population. There were 53.5% who reported they would support the provision of abortion in any situation at all; 7.4% held views based on religion or conscience that would make them completely opposed to abortion. There were 92.9% who felt that education surrounding abortion should be part of the core curriculum for midwifery and/or nursing students in Australia. The qualitative responses demonstrated a variety of views and suggestions regarding the practice of abortion. Conclusions There was a wide variation in views toward induced abortion from RMs and SHNs in Queensland. While a proportion of respondents opposed abortion in most circumstances, a significant group was in support of abortion in any situation and felt involvement in initiating and/or performing abortion would be within the scope of RMs and SHNs.
Collapse
Affiliation(s)
- Aakanksha Desai
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Belinda Maier
- Queensland Nurses and Midwives Union, Brisbane, Queensland, Australia
| | - Janelle James-McAlpine
- Griffith University School of Nursing and Midwifery, Gold Coast, Queensland, Australia.,James Cook University College of Healthcare Sciences, Cairns, Queensland, Australia
| | - Daniel Prentice
- Queensland Nurses and Midwives Union, Brisbane, Queensland, Australia
| | - Caroline de Costa
- Cairns Institute James Cook University, Smithfield, Queensland, Australia
| |
Collapse
|
11
|
Mazza D, Seymour JW, Sandhu MV, Melville C, O Rsquo Brien J, Thompson TA. General practitioner knowledge of and engagement with telehealth-at-home medical abortion provision. Aust J Prim Health 2021; 27:456-461. [PMID: 34782057 DOI: 10.1071/py20297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/16/2021] [Indexed: 11/23/2022]
Abstract
In Australia, there are many barriers to abortion, particularly for women living in regional, rural and remote areas. Telehealth provision of medical abortion is safe, effective and acceptable to patients and providers. In 2015, Marie Stopes Australia (MSA) launched an at-home telehealth model for medical abortion to which GPs could refer. Between April and November of 2017, we interviewed 20 GPs who referred patients to MSA's telehealth-at-home abortion service to better understand their experiences and perspectives regarding telehealth-at-home abortion. We found that there was widespread support and recognition of the benefits of telehealth-at-home abortion in increasing access to abortion and reducing travel and costs. However, the GPs interviewed lacked knowledge and understanding of the processes involved in medical abortion, and many were unaware of the availability of telehealth as an option until a patient requested a referral. The GPs interviewed called for increased communication between telehealth-at-home abortion providers and GPs. Increasing GP familiarity with medical abortion and awareness of the availability of telehealth-at-home abortion may assist people in accessing safe, effective medical abortion.
Collapse
Affiliation(s)
- Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Vic. 3168, Australia
| | | | | | | | | | - Terri-Ann Thompson
- Ibis Reproductive Health, Cambridge, MA 02140, USA; and Corresponding author.
| |
Collapse
|
12
|
Subasinghe AK, McGeechan K, Moulton JE, Grzeskowiak LE, Mazza D. Early medical abortion services provided in Australian primary care. Med J Aust 2021; 215:366-370. [PMID: 34553385 DOI: 10.5694/mja2.51275] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine primary care provision of early medical abortion services in Australia. DESIGN Cross-sectional study; analysis of Pharmaceutical Benefits Scheme (PBS) dispensing data. SETTING, PARTICIPANTS Women of child-bearing age (15-54 years), Australia, 2015-2019. MAIN OUTCOME MEASURES Age-standardised rates of MS-2 Step prescriptions dispensed by year for 2015-2019, and age-standardised rates by state, remoteness area, and level 3 statistical areas (SA3s) for 2019. Numbers and proportions of SA3s in which MS-2 Step was not prescribed by a GP or dispensed by a community pharmacy during 2019 (unweighted and weighted by number of women of reproductive age), by state and remoteness area. RESULTS During 2015-2019, 91 643 PBS prescriptions for MS-2 Step were dispensed; the national age-standardised rate increased from 1.63 in 2015 to 3.79 prescriptions per 1000 women aged 15-54 years in 2019. In 2019, rates were higher in outer regional Australia (6.53 prescriptions per 1000 women aged 15-54 years) and remote Australia (6.02 per 1000) than in major cities (3.30 per 1000). However, about 30% of women in Australia lived in SA3s in which MS-2 Step had not been prescribed by a GP during 2019, including about 50% of those in remote Australia. CONCLUSIONS The rate of early medical abortion is greater among women in remote, outer regional, and inner regional Australia than in major cities, but a considerable proportion of women live in areas in which MS-2 Step was not locally prescribed or dispensed during 2019. Supporting GPs in the delivery of early medical abortion services locally should be a focus of health policy.
Collapse
Affiliation(s)
| | | | | | - Luke E Grzeskowiak
- Flinders University, Adelaide, SA.,South Australian Health and Medical Research Institute, Adelaide, SA
| | | |
Collapse
|
13
|
Moulton JE, Subasinghe AK, Mazza D. Practice nurse provision of early medical abortion in general practice: opportunities and limitations. Aust J Prim Health 2021; 27:427-430. [PMID: 34548127 DOI: 10.1071/py20304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/08/2021] [Indexed: 11/23/2022]
Abstract
Approximately one in three Australian women with an unintended pregnancy will have an abortion, yet significant barriers remain to ensure the delivery of equitable and timely medical abortion services, including lack of trained providers, high out-of-pocket costs, abortion stigma, conscientious objection and large geographical distance to services. Practice nurses can be suitably trained to provide early medical abortion in general practice; however, there remain several key limitations to the implementation of nurse-led models of care. This forum article discusses these limitations, including issues concerning legislation, funding models, lack of access to medical abortion training, practice structure and systems, and makes recommendations as to how increased access to medical abortion in Australia can be achieved.
Collapse
Affiliation(s)
- Jessica E Moulton
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia; and Corresponding author.
| | - Asvini K Subasinghe
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| | - Danielle Mazza
- National Health and Medical Research Council SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| |
Collapse
|
14
|
Ireland S, Belton S, Doran F. 'I didn't feel judged': exploring women's access to telemedicine abortion in rural Australia. J Prim Health Care 2021; 12:49-56. [PMID: 32223850 DOI: 10.1071/hc19050] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/27/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Regardless of geographical location, safe and legal abortion is an essential reproductive health service. Accessing an abortion is problematic for women in rural areas. Although telemedicine is globally established as safe and effective for medical abortion in urban settings, there is a paucity of research exploring access to telemedicine abortion for women in rural locations. AIM The aim of this qualitative research is to explore and better understand women's access to telemedicine abortion in Australian rural areas. METHODS Structured interviews were conducted with women (n=11) living in rural areas who had experienced a telemedicine abortion within the last 6 months. Phone interviews were recorded and transcribed verbatim. Data underwent a Patient-Centred Access framework analysis and were coded according to the domain categories of approachability/ability to perceive, acceptability/ability to seek, availability/ability to reach, affordability/ability to pay, and appropriateness/ability to engage. RESULTS Rural women had severely limited access to abortion care. The five domains of the Patient-Centred Access model demonstrated that when women with the prerequisite personal skills and circumstances are offered a low-cost service with compassionate staff and technical competence, telemedicine can innovate to ensure rural communities have access to essential reproductive health services. DISCUSSION Telemedicine offers an innovative model for ensuring women's access to medical abortion services in rural areas of Australia and likely has similar applicability to international non-urban contexts. Strategies are needed to ensure women with lower literacy and less favourable situational contexts, can equitably access abortion services through telemedicine.
Collapse
Affiliation(s)
- Sarah Ireland
- Charles Darwin University, Ellengowan Drive, Casuarina, NT, Australia; and Corresponding author.
| | - Suzanne Belton
- Menzies School of Health Research, Ellengowan Drive, Casuarina, NT, Australia
| | - Frances Doran
- Southern Cross University, Military Road, East Lismore, NSW, Australia
| |
Collapse
|
15
|
Ogden K, Ingram E, Levis J, Roberts G, Robertson I. Termination of pregnancy in Tasmania: access and service provision from the perspective of GPs. Aust J Prim Health 2021; 27:297-303. [PMID: 34011432 DOI: 10.1071/py20288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/17/2021] [Indexed: 11/23/2022]
Abstract
Termination of pregnancy (TOP) is considered an important component of sexual and reproductive health internationally, but there are known barriers in Australia and countries worldwide. This study investigated the issues for GPs regarding aiding access to TOP and providing early medical abortion (EMA) services for Tasmanian women. Specifically, the aims of the study were to identify the knowledge and attitudes of Tasmanian GPs regarding TOP services and to determine which known barriers to providing EMA are most significant for GPs in Tasmania, Australia. A survey was developed and piloted based on previous qualitative research that identified known barriers to accessing TOP. Surveys were posted to all identified GPs in Tasmania with a reply-paid envelope. In all, 211 (27.4%) responses were returned. GPs identified difficulty accessing TOP services, particularly for rural women and those on a low income. Almost half the GPs, excluding conscientious objectors, indicated they would be interested in providing EMA services, but perceived barriers were significant. The most significant barriers related to accessing appropriate training and support. There was uncertainty around financial reward, support services, medical indemnity and access to the medical abortifacient medications mifepristone and misoprostol. In conclusion, accessing TOP remains an issue for Tasmanian women. Many Tasmanian GPs are interested in providing EMA services if barriers are addressed, but there is a lack of knowledge about the practicalities of implementing EMA. Providing practical support to GPs and increasing knowledge pertaining to EMA provision in general practice could improve access in primary care.
Collapse
Affiliation(s)
- Kathryn Ogden
- Tasmanian School of Medicine, University of Tasmania, Locked Bag 1377, Launceston, Tas. 7250, Australia; and Family Planning Tasmania, 269 Wellington Street, Launceston, Tas. 7250, Australia; and Corresponding author.
| | - Emily Ingram
- Tasmanian School of Medicine, University of Tasmania, Locked Bag 1377, Launceston, Tas. 7250, Australia; and Family Planning Tasmania, 269 Wellington Street, Launceston, Tas. 7250, Australia
| | - Joanna Levis
- Tasmanian School of Medicine, University of Tasmania, Locked Bag 1377, Launceston, Tas. 7250, Australia
| | - Georgia Roberts
- Tasmanian School of Medicine, University of Tasmania, Locked Bag 1377, Launceston, Tas. 7250, Australia; and Tasmanian Health Service, Department of Health and Human Services, GPO Box 125, Hobart, Tas. 7001, Australia
| | - Iain Robertson
- College of Health and Medicine, University of Tasmania, Locked Bag 1322, Launceston, Tas. 7250, Australia
| |
Collapse
|
16
|
Assifi AR, Kang M, Sullivan EA, Dawson AJ. Abortion care pathways and service provision for adolescents in high-income countries: A qualitative synthesis of the evidence. PLoS One 2020; 15:e0242015. [PMID: 33166365 PMCID: PMC7652292 DOI: 10.1371/journal.pone.0242015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/25/2020] [Indexed: 11/29/2022] Open
Abstract
Limited research in high-income countries (HICs) examines adolescent abortion care-seeking pathways. This review aims to examine the pathways and experiences of adolescents when seeking abortion care, and service delivery processes in provision of such care. We undertook a systematic search of the literature to identify relevant studies in HICs (2000–2020). A directed content analysis of qualitative and quantitative studies was conducted. Findings were organised to one or more of three domains of an a priori conceptual framework: context, components of abortion care and access pathway. Thirty-five studies were included. Themes classified to the Context domain included adolescent-specific and restrictive abortion legislation, mostly focused on the United States. Components of abortion care themes included confidentiality, comprehensive care, and abortion procedure. Access pathway themes included delays to access, abortion procedure information, decision-making, clinic operation and environments, and financial and transportation barriers. This review highlights issues affecting access to abortion that are particularly salient for adolescents, including additional legal barriers and challenges receiving care due to their age. Opportunities to enhance abortion access include removing legal barriers, provision of comprehensive care, enhancing the quality of information, and harnessing innovative delivery approaches offered by medical abortion.
Collapse
Affiliation(s)
- Anisa R. Assifi
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | - Melissa Kang
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Elizabeth A. Sullivan
- Office of the PVC Health and Medicine, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Angela J. Dawson
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
| |
Collapse
|
17
|
Lattof SR, Coast E, Rodgers YVDM, Moore B, Poss C. The mesoeconomics of abortion: A scoping review and analysis of the economic effects of abortion on health systems. PLoS One 2020; 15:e0237227. [PMID: 33147223 PMCID: PMC7641432 DOI: 10.1371/journal.pone.0237227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the high incidence of abortion around the globe, we lack synthesis of the known economic consequences of abortion care and abortion policies at the mesoeconomic level (i.e. health systems and communities). This scoping review examines the mesoeconomic costs, benefits, impacts, and values of abortion care and policies. METHODS AND FINDINGS Searches were conducted in eight electronic databases. We conducted the searches and application of inclusion/exclusion criteria using the PRISMA extension for Scoping Reviews. For inclusion, studies must have examined at least one of the following outcomes: costs, benefits, impacts, and value of abortion care or abortion policies. Quantitative and qualitative data were extracted for descriptive statistics and thematic analysis. Of the 150 included mesoeconomic studies, costs to health systems are the most frequently reported mesoeconomic outcome (n = 116), followed by impacts (n = 40), benefits (n = 17), and values (n = 11). Within health facilities and health systems, the costs of providing abortion services vary greatly, particularly given the range with which researchers identify and cost services. Financial savings can be realized while maintaining or even improving quality of abortion services. Adapting to changing laws and policies is costly for health facilities. American policies on abortion economically impact health systems and facilities both domestically and abroad. Providing post-abortion care requires a disproportionate amount of health facility resources. CONCLUSIONS The evidence base has consolidated around abortion costs to health systems and health facilities in high-income countries more than in low- or middle-income countries. Little is known about the economic impacts of abortion on communities or the mesoeconomics of abortion in the Middle East and North Africa. Methodologically, review papers are the most frequent study type, indicating that researchers rely on evidence from a core set of costing papers. Studies generating new primary data on mesoeconomic outcomes are needed to strengthen the evidence base.
Collapse
Affiliation(s)
- Samantha R. Lattof
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Ernestina Coast
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Yana van der Meulen Rodgers
- Department of Labor Studies and Employment Relations, Rutgers University, Piscataway, New Jersey, United States of America
- Department of Women’s and Gender Studies, Rutgers University, Piscataway, New Jersey, United States of America
| | - Brittany Moore
- Ipas, Chapel Hill, North Carolina, United States of America
| | - Cheri Poss
- Ipas, Chapel Hill, North Carolina, United States of America
| |
Collapse
|
18
|
Botfield JR, Newman CE, Bateson D, Haire B, Estoesta J, Forster C, Schulz Moore J. Young migrant and refugee people's views on unintended pregnancy and abortion in Sydney. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2020; 29:195-210. [PMID: 33411657 DOI: 10.1080/14461242.2020.1764857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 04/30/2020] [Indexed: 06/12/2023]
Abstract
Although abortion rates appear to be declining in high-income nations, there is still a need for accessible, safe abortion services. However, limited attention has been paid to understanding the social contexts which shape access to abortion information and services for communities who are less engaged with sexual and reproductive health care more generally. This paper explores the views and experiences of 27 migrant and refugee young people (16-24 years old) living in Sydney, Australia, regarding unintended pregnancy and abortion. Pregnancy outside marriage was described by all participants as a shameful prospect as it revealed pre-marital sexual activity. Even when abortion was described as culturally and/or religiously unacceptable, it was believed many families would find an abortion preferable to continuing an unintended pregnancy outside marriage. However, a pervasive culture of silence regarding sexual and reproductive health may limit access to quality information and support in this area. To better meet the needs of these young people, greater attention must be paid to strengthening youth and community awareness of the availability of contraception including emergency contraception, pregnancy options, and access to abortion information and services.
Collapse
Affiliation(s)
- Jessica R Botfield
- Family Planning NSW, Ashfield, Australia
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
| | - Deborah Bateson
- Family Planning NSW, Ashfield, Australia
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
| | - Bridget Haire
- The Kirby Institute, UNSW Australia, Kensington, Australia
| | | | | | | |
Collapse
|
19
|
Cations M, Ripper M, Dwyer J. Majority support for access to abortion care including later abortion in South Australia. Aust N Z J Public Health 2020; 44:349-352. [PMID: 32510724 DOI: 10.1111/1753-6405.12997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To measure public opinion about access to abortion in South Australia. METHODS An online survey conducted in 2019. SPSS statistical package version 22 was used for data analysis, with data weighted by age, gender, and region. RESULTS The majority (65%) of the 1,012 respondents supported the ready availability of abortion care and an additional 25% supported availability in certain circumstances. Most (70%) were unaware that abortion remains in criminal law and 80% supported decriminalisation. Support for safe access zones (88%) and the application of existing protections (69%) and obligations (94%) for conscientious objectors was high. A majority (63%) considered that later abortion should be available 'when the woman and her healthcare team decide it is necessary'. CONCLUSIONS These results confirm the trend of increasing support for access to abortion and add two new insights. There was majority support for using existing general protections for the rights and obligations of those with a conscientious objection to abortion. Second, there was strong support for decisions about later abortion to be decided through normal clinical consultation. These results indicate general community approval of abortion being normalised as healthcare, with the safeguards and accountabilities that status entails. Implications for public health: These results invite repeal of special laws about abortion care, to enable better access.
Collapse
Affiliation(s)
- Monica Cations
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | | | - Judith Dwyer
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| |
Collapse
|
20
|
Danet Danet A. [Women's emotional accounts of induced abortion]. GACETA SANITARIA 2020; 35:361-373. [PMID: 32451189 DOI: 10.1016/j.gaceta.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To explore women's emotional accounts of induced abortion, analyzing qualitative scientific publications. METHOD Qualitative systematic review of 19 studies published in PubMed, Science Direct and Scopus from 2010 onwards. The articles based on qualitative research design were revised using inductive content analysis. RESULTS The analysis identified three main themes regarding women's emotional experiences: access to abortion, emotional impact during medical assistance, and individual, relational and sociocultural determinants. The studies showed the variability in women's emotional accounts, mainly determined by the following factors: Access and waiting times, health system, type of intervention, degree of awareness and participation regarding the use of technical and medical technologies, interaction with health professionals, and specificity of individual, relational and sociocultural context. The main emotional difficulties were related to the ethical conflict, the decision-making, the relation with the social and health system and stigma. As main facilitating aspects, women highlighted autonomy in decision-making and emotional support, while barriers referred to social rejection and negative messages perceived from the political, social and health system. CONCLUSIONS The emotional accounts around induced abortion depend on individual and relational factors, as well as on health assistance, all mediated by gender inequalities and bias. Improvements in health assistance refer to an integral and individualized attention, adapted to women's needs.
Collapse
Affiliation(s)
- Alina Danet Danet
- Departamento de Organización de Empresas, Marketing y Sociología, Área de Sociología, Universidad de Jaén, Jaén, España.
| |
Collapse
|
21
|
Mainey L, O’Mullan C, Reid‐Searl K, Taylor A, Baird K. The role of nurses and midwives in the provision of abortion care: A scoping review. J Clin Nurs 2020; 29:1513-1526. [DOI: 10.1111/jocn.15218] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/24/2019] [Accepted: 02/03/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Lydia Mainey
- School of Nursing, Midwifery and Social Sciences CQUniversity Rockhampton Queensland Australia
- Queensland Centre for Domestic and Family Violence Research Brisbane Queensland Australia
| | - Catherine O’Mullan
- School of Health, Medical and Applied Sciences CQUniversity Bundaberg Queensland Australia
| | - Kerry Reid‐Searl
- School of Nursing, Midwifery and Social Sciences CQUniversity Rockhampton Queensland Australia
| | - Annabel Taylor
- School of Nursing, Midwifery and Social Sciences CQUniversity Rockhampton Queensland Australia
- Queensland Centre for Domestic and Family Violence Research Brisbane Queensland Australia
| | - Kathleen Baird
- Griffith University Meadowbrook Queensland Australia
- Gold Coast University Hospital Southport Queensland Australia
| |
Collapse
|
22
|
LaRoche KJ, Wynn L, Foster AM. “We’ve got rights and yet we don’t have access”: Exploring patient experiences accessing medication abortion in Australia. Contraception 2020; 101:256-260. [DOI: 10.1016/j.contraception.2019.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 11/12/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
|
23
|
Hulme-Chambers A, Clune S, Tomnay J. Medical termination of pregnancy service delivery in the context of decentralization: social and structural influences. Int J Equity Health 2018; 17:172. [PMID: 30463561 PMCID: PMC6249871 DOI: 10.1186/s12939-018-0888-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/08/2018] [Indexed: 11/24/2022] Open
Abstract
Background Medical termination of pregnancy (MToP) is a safe and acceptable abortion option. Depending on country context, MToP can be administered by general practitioners and mid-level healthcare providers in the first and second trimesters of pregnancy. Like other high-income countries, a range of social and structural barriers to MToP service provision exist in Australia. To counter some of these barriers, geographic decentralization of MToP was undertaken in rural Victoria, Australia, through training service providers about MToP to increase service delivery opportunities. The aim of this study was to investigate the factors that enabled and challenged the decentralization process. Methods Face-to-face and telephone interviews were undertaken between April and June 2016 with a purposeful sample of six training providers and 13 general practitioners (GP) and nurse training participants. Study participants were asked about their perceptions of motivations, enablers and challenges to MToP provision. A published conceptual framework of synergies between decentralization and service delivery was used to analyse the study findings. Results Three key themes emerged from the study findings. First, the effort to decentralize MToP was primarily supported by motivations related to making service access more equitable as well as the willingness of training providers to devolve their informal power, in the form of MToP medical expertise, to training participants. Next, the enablers for MToP decentralization included changes in the regulatory environment relating to decriminalization of abortion and availability of required medication, formation of partnerships to deliver training, provision of MToP clinical resources and local collegial support. Finally, challenges to MToP decentralization were few but significant. These included a lack of a state-wide strategy for service provision, provider concerns about coping with service demand, and provider stigma in the form of perceived negative community or collegial attitudes. These were significant enough to create caution for GPs and nurses considering service provision. Conclusions Decentralization concepts offer an innovative way for reframing and tackling issues associated with improving MToP service delivery. There is scope for more research about MToP decentralization in other country contexts. These findings are important for informing future rural MToP service expansion efforts that improve equity in service access.
Collapse
Affiliation(s)
- Alana Hulme-Chambers
- Centre for Excellence in Rural Sexual Health, Department of Rural Health, The University of Melbourne, PO Box 386, Wangaratta, VIC, 3677, Australia.
| | - Samantha Clune
- Centre for Excellence in Rural Sexual Health, Department of Rural Health, The University of Melbourne, PO Box 386, Wangaratta, VIC, 3677, Australia
| | - Jane Tomnay
- Department of Rural Health, The University of Melbourne, 49 Graham Street, Shepparton, VIC, 3055, Australia
| |
Collapse
|
24
|
Tomnay JE, Coelli L, Davidson A, Hulme-Chambers A, Orr C, Hocking JS. Providing accessible medical abortion services in a Victorian rural community: A description and audit of service delivery and contraception follow up. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:175-180. [DOI: 10.1016/j.srhc.2018.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 04/10/2018] [Accepted: 04/10/2018] [Indexed: 11/30/2022]
|
25
|
Hulme-Chambers A, Temple-Smith M, Davidson A, Coelli L, Orr C, Tomnay JE. Australian women’s experiences of a rural medical termination of pregnancy service: A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 15:23-27. [DOI: 10.1016/j.srhc.2017.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/10/2017] [Accepted: 11/20/2017] [Indexed: 12/01/2022]
|
26
|
Dawson AJ, Nicolls R, Bateson D, Doab A, Estoesta J, Brassil A, Sullivan EA. Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study. Reprod Health 2017; 14:39. [PMID: 28288649 PMCID: PMC5348908 DOI: 10.1186/s12978-017-0303-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Australian Government approval in 2012 for the use of mifepristone and misoprostol for medical termination of pregnancy (MTOP) allows general practitioners (GPs) to provide early gestation abortion in primary care settings. However, uptake of the MTOP provision by GPs appears to be low and the reasons for this have been unclear. This study investigated the provision of and referral for MTOP by GPs. METHODS We undertook descriptive-interpretive qualitative research and selected participants for diversity using a matrix. Twenty-eight semi-structured interviews and one focus group (N = 4), were conducted with 32 GPs (8 MTOP providers, 24 non MTOP providers) in New South Wales, Australia. Interviews were recorded and transcribed verbatim. A framework to examine access to abortion services was used to develop the interview questions and emergent themes identified thematically. RESULTS Three main themes emerged: scope of practice; MTOP demand, care and referral; and workforce needs. Many GPs saw abortion as beyond the scope of their practice (i.e. a service others provide in specialist private clinics). Some GPs had religious or moral objections; others regarded MTOP provision as complicated and difficult. While some GPs expressed interest in MTOP provision they were concerned about stigma and the impact it may have on perceptions of their practice and the views of colleagues. Despite a reported variance in demand most MTOP providers were busy but felt isolated. Difficulties in referral to a local public hospital in the case of complications or the provision of surgical abortion were noted. CONCLUSIONS Exploring the factors which affect access to MTOP in general practice settings provides insights to assist the future planning and delivery of reproductive health services. This research identifies the need for support to increase the number of MTOP GP providers and for GPs who are currently providing MTOP. Alongside these actions provision in the public sector is required. In addition, formalised referral pathways to the public sector are required to ensure timely care in the case of complications or the provision of surgical options. Leadership and coordination across the health sector is needed to facilitate integrated abortion care particularly for rural and low income women.
Collapse
Affiliation(s)
- Angela J Dawson
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Ultimo, NSW, 2007, Australia.
| | - Rachel Nicolls
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Ultimo, NSW, 2007, Australia
| | - Deborah Bateson
- The Sydney Medical School, Discipline, Gynaecology and Neonatology, University of Sydney and Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW, 2131, Australia
| | - Anna Doab
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Ultimo, NSW, 2007, Australia
| | - Jane Estoesta
- Evaluation and Research Operations, Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW, 2131, Australia
| | - Ann Brassil
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney and Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW, 2131, Australia
| | - Elizabeth A Sullivan
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Ultimo, NSW, 2007, Australia
| |
Collapse
|