Access to abortion in Australia: insights from health care professionals
Angela Dawson1, Deborah Bateson2, Rachel Nicholls1, Anna Doab1, Jane Estoesta2, Elizabeth Sullivan1, Ann Brassil2
1Faculty of Health, University of Technology Sydney, Sydney NSW, Australia, 2Family Planning New South Wales, Sydney NSW, Australia
Objectives: Recent changes in Australia's national policy with the approval of mifepristone and misoprostol for medical termination of pregnancy (MTOP) have led to increased choices for Australian women. In New South Wales (NSW), the largest and most populous state, there is no statewide data on abortion and incomplete information on MTOP. Further, there is limited research concerning the practices of trained and credentialled abortion service providers. We undertook a qualitative research study to investigate health professional views, perceptions and practices concerning MTOP.
Method: Eighty-one general practitioners (GPs), surgeons, gynaecologists, nurses and Aboriginal health workers in urban, rural and remote locations who do and do not provide abortion were interviewed. A deductive content analysis methodology was employed to analyse transcripts based upon a framework we developed to examine access to early abortion.
Results: Private clinic abortion providers noted that they were busy and were mainly involved in surgical procedures with MTOP accounting for half of their work. Gynaecologists viewed abortion at the fringes of the speciality. GP and gynaecologist non-providers thought of abortion as stigmatised work that ‘others' do in private clinics and referred accordingly. Abortion was not seen as a priority for the public system and only provided at the will of interested doctors. MTOP provision was regarded by GPs as difficult due to the follow up required and most were not interested in provision. GP MTOP providers felt isolated and reported demand was low as was women's awareness. Nurses and Aboriginal health workers play an advocacy and facilitation role for mostly disadvantaged women.
Conclusions: This study provides insight into access to abortion in the public sector and the low interest in provision from GPs who are at the forefront of primary care provision. Leadership from professional associations as well as the involvement of nurses may increase access for women.