Termination of pregnancy in Tasmania: access and service provision from the perspective of GPs
Kathryn Ogden A B E , Emily Ingram A B , Joanna Levis A , Georgia Roberts A C and Iain Robertson DA Tasmanian School of Medicine, University of Tasmania, Locked Bag 1377, Launceston, Tas. 7250, Australia.
B Family Planning Tasmania, 269 Wellington Street, Launceston, Tas. 7250, Australia.
C Tasmanian Health Service, Department of Health and Human Services, GPO Box 125, Hobart, Tas. 7001, Australia.
D College of Health and Medicine, University of Tasmania, Locked Bag 1322, Launceston, Tas. 7250, Australia.
E Corresponding author. Email: Kathryn.Ogden@utas.edu.au
Australian Journal of Primary Health 27(4) 297-303 https://doi.org/10.1071/PY20288
Submitted: 8 December 2020 Accepted: 17 February 2021 Published: 20 May 2021
Journal Compilation © La Trobe University 2021 Open Access CC BY-NC-ND
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.
Keywords: family planning services, health services accessibility, primary health care, reproductive health services, women’s health services.
References
Australian Government Department of Health (2008) ‘Rural, Remote and Metropolitan Areas Classification (RRMA).’ Available at https://www1.health.gov.au/internet/publications/publishing.nsf/Content/work-res-ruraud-toc~work-res-ruraud-lis~work-res-ruraud-lis-e#:~:text=Rural%2C%20Remote%20and%20Metropolitan%20Areas%20Classification%20(RRMA)&text=RRMA%20allocates%20areas%20into%20seven,various%20sizes%20and%20population%20density [Verified 8 June 2020]Bateson DJ, Black KI, Sawleshwarkar S (2019) The Guttmacher–Lancet Commission on sexual and reproductive health and rights: how does Australia measure up? The Medical Journal of Australia 210, 250–252.e1.
| The Guttmacher–Lancet Commission on sexual and reproductive health and rights: how does Australia measure up?Crossref | GoogleScholarGoogle Scholar | 30861126PubMed |
Creswell JW, Creswell JD (2017) ‘Research design: qualitative, quantitative, and mixed methods approaches.’ (Sage Publications: CA, USA)
Culwell KR, Hurwitz M (2013) Addressing barriers to safe abortion. International Journal of Gynaecology and Obstetrics 121, S16–S19.
| Addressing barriers to safe abortion.Crossref | GoogleScholarGoogle Scholar | 23477700PubMed |
Dawson A, Bateson D, Estoesta J, Sullivan E (2016) Towards comprehensive early abortion service delivery in high income countries: insights for improving universal access to abortion in Australia. BMC Health Services Research 16, 612
| Towards comprehensive early abortion service delivery in high income countries: insights for improving universal access to abortion in Australia.Crossref | GoogleScholarGoogle Scholar | 27770797PubMed |
Dawson AJ, Nicolls R, Bateson D, Doab A, Estoesta J, Brassil A, Sullivan EA (2017) Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study. Reproductive Health 14, 39
| Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study.Crossref | GoogleScholarGoogle Scholar | 28288649PubMed |
de Moel-Mandel C, Shelley JM (2017) The legal and non-legal barriers to abortion access in Australia: a review of the evidence. The European Journal of Contraception & Reproductive Health Care 22, 114–122.
| The legal and non-legal barriers to abortion access in Australia: a review of the evidence.Crossref | GoogleScholarGoogle Scholar |
Deb S, Subasinghe AK, Mazza D (2020) Providing medical abortion in general practice: general practitioner insights and tips for future providers. Australian Journal of General Practice 49, 331–337.
| Providing medical abortion in general practice: general practitioner insights and tips for future providers.Crossref | GoogleScholarGoogle Scholar | 32464728PubMed |
Doran F, Hornibrook J (2014) Rural New South Wales women’s access to abortion services: highlights from an exploratory qualitative study. The Australian Journal of Rural Health 22, 121–126.
| Rural New South Wales women’s access to abortion services: highlights from an exploratory qualitative study.Crossref | GoogleScholarGoogle Scholar | 25039846PubMed |
Doran F, Nancarrow S (2015) Barriers and facilitators of access to first-trimester abortion services for women in the developed world: a systematic review. The Journal of Family Planning and Reproductive Health Care 41, 170–180.
| Barriers and facilitators of access to first-trimester abortion services for women in the developed world: a systematic review.Crossref | GoogleScholarGoogle Scholar | 26106103PubMed |
Family Planning Alliance Australia (2018) ‘Access to Abortion Services in Australia. Position Statement.’ Available at https://www.familyplanningallianceaustralia.org.au/wp-content/uploads/2018/11/FPAA-Abortion-Position-Statement-August-2018-FINAL.pdf [Verified 8 June 2020]
Galrao M, Hutchinson M, Joyce A (2019) Induced Abortions in Western Australia 2016–2018. Sixth Report of the Western Australian Abortion Notification System. Department of Health, Western Australia.
Grayson N, Hargreaves J, Sullivan E (2005) Use of routinely collected national data sets for reporting on induced abortion in Australia. Australian Institute of Health and Welfare, Sydney, NSW, Australia.
Grossman D, Goldstone P (2015) Mifepristone by prescription: a dream in the United States but reality in Australia. Contraception 92, 186–189.
| Mifepristone by prescription: a dream in the United States but reality in Australia.Crossref | GoogleScholarGoogle Scholar | 26096369PubMed |
Hulme-Chambers A, Temple-Smith M, Davidson A, Coelli L, Orr C, Tomnay JE (2018) Australian women’s experiences of a rural medical termination of pregnancy service: a qualitative study. Sexual & Reproductive Healthcare : Official Journal of the Swedish Association of Midwives 15, 23–27.
| Australian women’s experiences of a rural medical termination of pregnancy service: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
Keogh L, Croy S, Newton D, Hendron M, Hill S (2019) General practitioner knowledge and practice in relation to unintended pregnancy in the Grampians region of Victoria, Australia. Rural and Remote Health 19, 5156
| General practitioner knowledge and practice in relation to unintended pregnancy in the Grampians region of Victoria, Australia.Crossref | GoogleScholarGoogle Scholar | 31675244PubMed |
Mazza D (2020) Achieving better sexual and reproductive health for women. Australian Journal of General Practice 49, 301–302.
| Achieving better sexual and reproductive health for women.Crossref | GoogleScholarGoogle Scholar | 32464726PubMed |
Mazza D, Burton G, Wilson S, Boulton E, Fairweather J, Black KI (2020) Medical abortion. Australian Journal of General Practice 49, 324–330.
| Medical abortion.Crossref | GoogleScholarGoogle Scholar | 32464732PubMed |
Pregnancy Outcome Unit Prevention and Population Health Branch (2019) Pregnancy Outcome in South Australia 2017. Government of South Australia, Adelaide, SA, Australia.
Primary Health Tasmania (2020) ‘Tasmanian Health Directory.’ Available at https://www.tasehealthdirectory.com.au/ [Verified 24 November 2020]
Rowe H, Holton S, Kirkman M, Bayly C, Jordan L, McNamee K, McBain J, Sinnott V, Fisher J (2016) Prevalence and distribution of unintended pregnancy: the Understanding Fertility Management in Australia National Survey. Australian and New Zealand Journal of Public Health 40, 104–109.
| Prevalence and distribution of unintended pregnancy: the Understanding Fertility Management in Australia National Survey.Crossref | GoogleScholarGoogle Scholar | 26456762PubMed |
Saxena H (2020) Fewer than 2,500 GPs prescribing abortion drugs, figures suggest. Australian Doctor. 17 September 2020. Australian Doctor Group, Australia.
Shankar M, Black KI, Goldstone P, Hussainy S, Mazza D, Petersen K, Lucke J, Taft A (2017) Access, equity and costs of induced abortion services in Australia: A cross-sectional study. Australian and New Zealand Journal of Public Health 41, 309–314.
| Access, equity and costs of induced abortion services in Australia: A cross-sectional study.Crossref | GoogleScholarGoogle Scholar | 28110510PubMed |
SPHERE CRE (2020) ‘SPHERE, the NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care.’ Available at https://www.spherecre.org/about [Verified 24 November 2020]
Subasinghe AK, Deb S, Mazza D (2021) Primary care providers’ knowledge, attitudes and practices of medical abortion: a systematic review. BMJ Sexual & Reproductive Health 47, 9–16.
| Primary care providers’ knowledge, attitudes and practices of medical abortion: a systematic review.Crossref | GoogleScholarGoogle Scholar |
World Health Organization (WHO) (2012) Safe abortion: technical and policy guidance for health systems. WHO, Geneva, Switzerland.
