Annarella Hardiman


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    Unplanned pregnancy and abortion decision making – a report on the circumstances and experiences of contemporary Australian women

    Annarella Hardiman, manager of the “Pregnancy Advisory Service”, at the Royal Women’s Hospital in Melbourne, Australia.

    Investigators: Annarella Hardiman, Maggie Kirkman, Heather Rowe, Shelley Mallet, Doreen Rosenthal

    Topic: This paper presents the results of a two part project on abortion: an audit of records of around 5500 women contacting the Pregnancy Advisory Service at the Royal Women’s Hospital in Victoria, Australia, and in depth interviews with 60 women who had contemplated or undergone abortion in Victoria.

    The project was funded by grants from the Australian Research Council and the Victorian Health Promotion Foundation, and the audit and the research was approved by the Hospital’s Research and Ethics Committee.

    Problem: In the context of little recent Australian research on women’s experiences of abortion or their demographic and social circumstances, Australia’s largest public hospital provider of abortion, in partnership with the University of Melbourne’s Key Centre for Women’s Health in Society, undertook to contribute to the knowledge in relation to this issue. Abortion research in Australia has lacked a coordinated national approach, for instance 7 separate States and Territories provide abortion services within their individual criminal laws (abortion is still located in the criminal laws of 5 states/territories) and health laws.

    Theoretical approach and method:A quantitative audit of 5462 (de-identified) electronic records of women

    who had contacted the Royal Women’s Hospital regarding their unplanned and/or unwanted  pregnancy during a 12 month period, in order to analyse and describe their  demographic and psycho-social circumstances.

    - In-depth qualitative interviews with 60 women regarding the circumstances of their pregnancy and their decision making and experience of abortion or continuing the pregnancy (the majority had chosen abortion.)

    Results: The audit demonstrated the variety of socio-demographic and personal circumstances of Australian women seeking abortion, and assists in challenging the negative stereotypes about the many Australian women who have unintended pregnancies and contributes to societal understanding and acceptance of this fundamental women’s health issue.

    The interviews revealed rich information about women’s complex lives within which they made decisions about abortion. Each woman’s story is different, yet women have much in common. In considering their own needs, desires, and capacities, the well-being of potential children, and their responsibility for children and adults already in their lives, these women were making considered decisions to terminate or continue their pregnancies, based on multiple and contingent factors.

    Together they provide evidence to inform policymaking, service provision, further research, and public debate. For instance, since the Victorian legislation had recently removed abortion law from the criminal law and formally acknowledged abortion as part of women’s health care, the findings and recommendations of this research will assist the health system to recognise service needs, identify gaps, and ensure the equitable provision of timely and affordable services across the state.

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    Supporting and promoting the provision of MTOP in Victoria, Australia

    Annarella Hardiman1, Paddy Moore1, Kylie Stephens2, Susie Allanson3
    1Royal Women's Hospital, Melbourne Victoria, Australia, 2Centre for Excellence in Rural Sexual Health, University of Melbourne, Melbourne Victoria, Australia, 3Fertility Control Clinic, Melbourne Victoria, Australia

    The Royal Women's Hospital ("the Women's") located in Victoria, Australia, is a specialist women's public hospital which has provided abortion for around 45 years. However because abortion is not provided in a strategic, equitably accessible way within the public health system across Victoria, the Women's cannot meet the high number of requests for abortion received. Victoria's reform of the abortion law in 2008 resulted in a decriminalised and progressive abortion law. Contemporary medications for MTOP also become available in Australia around this time as a result of social and policy reform. This was considered to be an opportunity for further development and provision of abortion services across this large geographical area. However since then, there have not been any strategic or policy initiatives addressing the gaps. In recognition of this, the Women's sought to prioritise a strategy of professional development, training, networking, mentoring and health promotion via a collabourative public / private partnership of academics, abortion providers and health promotion advocates. The Women's, Family Planning Victoria, Fertility Control Clinic and Centre for Excellence in Rural Health partnered to develop a strategy to increase the involvement of interested regional health professionals in the provision of abortion. The provision of MTOP was considered a suitable vehicle to encourage and support health professionals outside hospitals to contribute to the accessibility and choice of abortion for women across Victoria. The partnership delivered a number of free regionally based sessions for around 100 remote and rural health professionals in their own communities to receive professional development, networking and mentoring opportunities. Policies and guidelines developed by the Women's were made available to support the development of new services by new providers. This resulted in an increasing uptake of the provision of MTOP by general practitioners, health centres and others sites, which have developed local cooperative partnerships.