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de Costa CM, Black KI, Russell DB. Medical abortion: it is time to lift restrictions. Med J Aust 2019; 210:248-249.e1. [PMID: 30861138 DOI: 10.5694/mja2.50060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Kirsten I Black
- University of Sydney, Sydney, NSW.,Royal Prince Alfred Hospital, Sydney, NSW
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2
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Sharman LS, Douglas H, Price E, Sheeran N, Dingle GA. Associations Between Unintended Pregnancy, Domestic Violence, and Sexual Assault in a Population of Queensland Women. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2018; 26:541-552. [PMID: 31984095 PMCID: PMC6763209 DOI: 10.1080/13218719.2018.1510347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/01/2018] [Indexed: 06/07/2023]
Abstract
This study aimed to establish the proportion of women seeking information regarding unintended pregnancy in the context of domestic violence (DV) and/or sexual assault (SA) experiences in Queensland. Mental health, sociodemographic variables, and gestation at first and repeated contacts were examined for 6249 women primarily seeking information regarding abortion options during an unintended pregnancy over the 5-year period from July 2012 to June 2017. Reports of DV and SA and associations with mental health issues increased significantly across the 5 years. First contact rates of disclosure were 12.2% for DV and 3% for SA, and higher among repeat contacts (38.1% for DV and 14.1% for SA), with recurring contact facilitating violence disclosure. Restricting access to abortions in the context of violence impedes a woman's agency in attempts to separate from violence and highlights the need for safe, supportive, and accessible services, to assist in screening and assisting with violence.
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Affiliation(s)
- Leah S. Sharman
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Heather Douglas
- T.C.Beirne School of Law, The University of Queensland, St Lucia, QLD, Australia
| | | | - Nicola Sheeran
- School of Applied Psychology, Griffith University, Mount Gravatt, QLD, Australia
| | - Genevieve A. Dingle
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
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3
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Black KI, Bateson D. Medical abortion is fundamental to women's health care. Aust N Z J Obstet Gynaecol 2017; 57:245-247. [DOI: 10.1111/ajo.12642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Kirsten I. Black
- Discipline of Obstetrics, Gynaecology and Neonatology; Central Clinical School, University of Sydney; Sydney New South Wales Australia
- Women's and Babies, Royal Prince Alfred Hospital; Camperdown New South Wales Australia
| | - Deborah Bateson
- Discipline of Obstetrics, Gynaecology and Neonatology; Central Clinical School, University of Sydney; Sydney New South Wales Australia
- Family Planning NSW; Sydney New South Wales Australia
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Dawson A, Bateson D, Estoesta J, Sullivan E. Towards comprehensive early abortion service delivery in high income countries: insights for improving universal access to abortion in Australia. BMC Health Serv Res 2016; 16:612. [PMID: 27770797 PMCID: PMC5075393 DOI: 10.1186/s12913-016-1846-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
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 hospital-outpatient 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.
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Affiliation(s)
- Angela Dawson
- Faculty of Health, University of Technology, Sydney (UTS), P.O. Box 123, Ultimo, NSW 2007, Sydney, NSW Australia
| | - Deborah Bateson
- Discipline, Gynaecology and Neonatology, University of Sydney, Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW 2131 Australia
| | - Jane Estoesta
- Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW 2131 Australia
| | - Elizabeth Sullivan
- Public Health, Faculty of Health, University of Technology, Sydney (UTS), Jones Street, Sydney, NSW Australia
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Baird B. Medical abortion in Australia: a short history. REPRODUCTIVE HEALTH MATTERS 2015; 23:169-76. [PMID: 26719008 DOI: 10.1016/j.rhm.2015.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 10/30/2015] [Accepted: 10/30/2015] [Indexed: 11/16/2022] Open
Abstract
Surgical abortion has been provided liberally in Australia since the early 1970s, mainly in privately owned specialist clinics. The introduction of medical abortion, however, was deliberately obstructed and consequently significantly delayed when compared to similar countries. Mifepristone was approved for commercial import only in 2012 and listed as a government subsidised medicine in 2013. Despite optimism from those who seek to improve women's access to abortion, the increased availability of medical abortion has not yet addressed the disadvantage experienced by poor and non-metropolitan women. After telling the story of medical abortion in Australia, this paper considers the context through which it has become available since 2013. It argues that the integration of medical abortion into primary health care, which would locate abortion provision in new settings and expand women's access, has been constrained by the stigma attached to abortion, overly cautious institutionalised frameworks, and the lack of public health responsibility for abortion services. The paper draws on documentary sources and oral history interviews conducted in 2013 and 2015.
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Affiliation(s)
- Barbara Baird
- Associate Professor, Department of Women's Studies, Faculty of Social & Behavioural Sciences, Flinders University, Adelaide SA, Australia.
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Goldstone P, Michelson J, Williamson E. Early medical abortion using low‐dose mifepristone followed by buccal misoprostol: a large Australian observational study. Med J Aust 2012; 197:282-6. [DOI: 10.5694/mja12.10297] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Phillips T, Eltherington J, de Costa C, Woods C. Knowledge of abortion law and provision of abortion services amongst tertiary students in Far North Queensland. Aust N Z J Obstet Gynaecol 2012; 52:299-301. [PMID: 22413818 DOI: 10.1111/j.1479-828x.2012.01421.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 01/23/2012] [Indexed: 11/29/2022]
Abstract
Abortion is an important health issue for Australian women, yet there are large variations across Australia in abortion service provision and in state laws regulating abortion practice. We conducted a survey of tertiary students in Far North Queensland to ascertain their knowledge of local abortion services and of abortion law in Queensland. Important gaps were demonstrated in their knowledge of the law and of the availability of abortion services.
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Affiliation(s)
- Tegan Phillips
- James Cook University School of Medicine and Dentistry, Cairns, Queensland, Australia
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Taft AJ, Hobbs MK, Hussainy SY, Amir LH, Stewart K, Smith AMA, Shelley JM, Chapman CB. Unintended pregnancy in Australia: what more can we do? Med J Aust 2011; 195:166-7. [DOI: 10.5694/j.1326-5377.2011.tb03270.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 04/27/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Angela J Taft
- Mother and Child Health Research, La Trobe University, Melbourne, VIC
| | - Melissa K Hobbs
- Mother and Child Health Research, La Trobe University, Melbourne, VIC
| | - Safeera Y Hussainy
- Department of Pharmacy Practice, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC
| | - Lisa H Amir
- Mother and Child Health Research, La Trobe University, Melbourne, VIC
| | - Kay Stewart
- Department of Pharmacy Practice, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC
| | - Anthony M A Smith
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC
| | - Julia M Shelley
- Centre for Health through Action on Social Exclusion, School of Health and Social Development, Deakin University, Melbourne, VIC
| | - Colin B Chapman
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC
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Costa CM. We “never” train women in Sydney. Med J Aust 2010; 193:674-8. [DOI: 10.5694/j.1326-5377.2010.tb04101.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 10/18/2010] [Indexed: 11/17/2022]
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Garrett PW, Dickson HG, Whelan AK, Whyte L. Representations and coverage of non-English-speaking immigrants and multicultural issues in three major Australian health care publications. AUSTRALIA AND NEW ZEALAND HEALTH POLICY 2010; 7:1. [PMID: 20044938 PMCID: PMC2817687 DOI: 10.1186/1743-8462-7-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 01/03/2010] [Indexed: 05/26/2023]
Abstract
BACKGROUND No recent Australian studies or literature, provide evidence of the extent of coverage of multicultural health issues in Australian healthcare research. A series of systematic literature reviews in three major Australian healthcare journals were undertaken to discover the level, content, coverage and overall quality of research on multicultural health. Australian healthcare journals selected for the study were The Medical Journal of Australia (MJA), The Australian Health Review (AHR), and The Australian and New Zealand Journal of Public Health (ANZPH). Reviews were undertaken of the last twelve (12) years (1996-August 2008) of journal articles using six standard search terms: 'non-English-speaking', 'ethnic', 'migrant', 'immigrant', 'refugee' and 'multicultural'. RESULTS In total there were 4,146 articles published in these journals over the 12-year period. A total of 90 or 2.2% of the total articles were articles primarily based on multicultural issues. A further 62 articles contained a major or a moderate level of consideration of multicultural issues, and 107 had a minor mention. CONCLUSIONS The quantum and range of multicultural health research and evidence required for equity in policy, services, interventions and implementation is limited and uneven. Most of the original multicultural health research articles focused on newly arrived refugees, asylum seekers, Vietnamese or South East Asian communities. While there is some seminal research in respect of these represented groups, there are other communities and health issues that are essentially invisible or unrepresented in research. The limited coverage and representation of multicultural populations in research studies has implications for evidence-based health and human services policy.
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Affiliation(s)
- Pamela W Garrett
- Simpson Centre for Health Services Research, University of New South Wales, 2-4 Speed St Liverpool, BC1871, Sydney, Australia
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MOHORIC-STARE D, DE COSTA C. Knowledge of emergency contraception amongst tertiary students in far North Queensland. Aust N Z J Obstet Gynaecol 2009; 49:307-11. [DOI: 10.1111/j.1479-828x.2009.01005.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Dwyer JM, Jackson T. Unwanted pregnancy, mental health and abortion: untangling the evidence. AUSTRALIA AND NEW ZEALAND HEALTH POLICY 2008; 5:2. [PMID: 18442413 PMCID: PMC2390567 DOI: 10.1186/1743-8462-5-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Accepted: 04/29/2008] [Indexed: 11/10/2022]
Abstract
Abortion policy is still contentious in many parts of the world, and periodically it emerges to dominate health policy debates. This paper examines one such debate in Australia centering on research findings by a New Zealand research group, Fergusson, Horwood & Ridder, published in early 2006. The debate highlighted the difficulty for researchers when their work is released in a heightened political context. We argue that the authors made a logical error in constructing their analysis and interpreting their data, and are therefore not justified in making policy claims for their work. The paper received significant public attention, and may have influenced the public policy position of a major professional body. Deeply held views on all sides of the abortion debate are unlikely to be reconciled, but if policy is to be informed by research, findings must be based on sound science.
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Affiliation(s)
- Judith M Dwyer
- Department of Health Management, Flinders University, Adelaide, Australia
| | - Terri Jackson
- Australian Centre for Economic Research on Health, University of Queensland, Brisbane, Australia
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Abstract
OBJECTIVE This study used social science methodology to illuminate an important clinical question that had been inaccessible to researchers until the 1970s. The question was what effect did an abortion have on normally rule abiding women. Abortion had been presumed to be illegal until a judicial decision in 1969. In 1972 Australia's first abortion clinic was established, and the participants in this study were the women who attended it in 1974. This study was the first of its kind in Australia. METHOD Interviews were conducted with 32 women who had a lawful termination of pregnancy and who agreed to be interviewed one year later. 84% of women agreed to follow-up contact, and 34 were contacted. Social science theory about deviance, social stigma and norm violation was used to inform the study. RESULTS Single, nulliparous women, were troubled by the potential exposure of their rule breaking sexual activity. The abortion was in part an action taken to preserve their persona as competent, moral beings capable of taking care of themselves. The abortion was the sensible next step in managing a missed menstrual period, the back up when contraception or plans for love and marriage failed. These women took mothering seriously and had an abortion to avoid becoming inadequate mothers. Abortion was a challenge to the married women's sense of themselves as good mothers, and their motives related to good mothering. The working class women had histories of managing tough and challenging life events, and they used the strengths, skills and networks they had established and applied those to the abortion decision. CONCLUSION The most important and frequent effect of abortion was to make women feel more competent in managing their lives. The skills required to locate and access an abortion clinic against a backdrop of general social disapproval, expanded their sense of themselves as actors in their own lives. Their stories, as well as networks of support, enabled them to integrate abortion into their sense of themselves as good women.
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Affiliation(s)
- Jo Wainer
- Gender and Medicine Research Unit, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Viv., Australia.
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de Costa CM, Russell DB, de Costa NR, Carrette M, McNamee HM. Early medical abortion in Cairns, Queensland: July 2006 – April 2007. Med J Aust 2007; 187:171-3. [PMID: 17680745 DOI: 10.5694/j.1326-5377.2007.tb01179.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 05/06/2007] [Indexed: 11/17/2022]
Abstract
Mifepristone (RU486), which is used for early medical abortion, can only be obtained in Australia under the Authorised Prescriber legislation (Section 19[5] of the Therapeutic Goods Act 1989 [Cwlth]); two of the authors have permission to obtain, prescribe and administer this drug in Cairns, Queensland. From July 2006 to April 2007, 10 women who fulfilled the Therapeutic Goods Administration (TGA) criteria of "life-threatening or otherwise serious" indications underwent medical abortion with mifepristone/misoprostol, and 12 women conforming with abortion requirements of Queensland law, but not TGA legislation for mifepristone administration, had medical abortions with the less preferable methotrexate/misoprostol combination. Although it is now more than a year since the cross-party vote in federal Parliament in February 2006 confirmed wide support for the right of Australian women to a medical abortion, we believe we are at present the only medical practitioners in Australia with permission to use mifepristone. Obtaining Authorised Prescriber status from the TGA is of necessity a complex and protracted process, involving ethics committee approval and auditing, and regular reporting to the TGA. Because of the current restrictions, we believe that women seeking medical abortion in Australia face barriers not experienced by women in other comparable countries, and that drug manufacturing and distributing companies may be discouraged from seeking to market mifepristone in Australia.
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de Costa CM. Early medical abortion in Australia: more common than statistics suggest? Med J Aust 2006; 185:341. [PMID: 16999681 DOI: 10.5694/j.1326-5377.2006.tb00594.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 08/03/2006] [Indexed: 11/17/2022]
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