BackgroundDespite the availability of medical abortifacients, and their potential use in primary care, only a small proportion of primary healthcare professionals provide medical abortion services. Understanding the perspectives of primary care providers on delivering medical abortion is pertinent to identifying barriers to medical abortion service provision and increasing access for women globally.ObjectiveTo understand the knowledge, attitudes and practices of primary healthcare providers regarding medical abortion services.DesignFour databases (Medline, EMBASE, Web of Science (WOS) and Scopus) were searched using search terms related to medical abortion and primary care. The Joanna Briggs Institute Critical Appraisal tools were used to appraise the methodological quality of studies included.ResultsSome 22 studies were identified, conducted across 15 countries, comprising 6072 participants. Study participants comprised doctors and residents (n=8), nurses and nursing students (n=5), and pharmacists (n=3) and six studies were conducted with mixed samples of providers. Medical abortion was deemed acceptable by some doctors, but fear of criminal prosecution, in countries where abortion is still restrictive, left doctors and nurses circumspect about providing medical abortion. Pharmacists referred women to other providers with only a small proportion dispensing medical abortifacients. General practitioners, nurses and trainees had mixed knowledge of medical abortion and emphasised the need for training on delivery of medical abortion and dissemination of guidelines. Conversely, pharmacists reported poor knowledge regarding medical abortion regimens and complications.ConclusionsIncreased dissemination of training and resources is pertinent to supporting primary care providers delivering medical abortion services and to increasing access for women on a global scale.

Background and objectiveMedical abortion is safe and effective and, when provided by general practitioners (GPs), can increase access for women. However, little is known about which models Australian GPs use to deliver medical abortion. The aim of this study was to describe GP medical abortion delivery models. MethodsSemi-structured telephone interviews were conducted with GPs providing medical abortion nationwide. Data were transcribed, thematically analysed by two researchers and interpreted using six quality dimensions. ResultsTwenty-five GPs used three medical abortion models in private practice: common, streamlined and ultrasonography-inclusive. The most common model comprised three appointments. Some participants provided medical abortion over 1-2 appointments ('streamlined'), and few provided ultrasonography themselves ('ultrasonography-inclusive'). Clinician networks supported participants and enhanced medical abortion delivery. DiscussionUsing three appointments for delivering medical abortion may be less acceptable and accessible to women than streamlined or ultrasonography-inclusive models. Increased awareness of the alternative medical abortion models may encourage GP medical abortion delivery and increase access for women.ABORTION is a common experience for women globally. In Australia, 16% of women have had an abortion by the age of 34 years. 1 While both surgical and medical methods of abortion are available in Australia, they can be difficult to access, with many women travelling long distances 2 or interstate 3 and incurring high out-of-pocket costs 3,4 to receive abortion care. Provision of medical abortion in general practice can improve access to abortion care. General practices tend to be more proximal than tertiary centres and frequently visited by women, 5 particularly for assistance with pregnancy and family planning issues. 6 There is evidence that women prefer to receive their abortion care from a known health provider, such as a general practitioner (GP). 7 GPs are also well placed to provide other related services such as contraceptive care. Thus, GPs are ideally positioned to provide medical abortion in the community setting.Currently, medical abortifacients in the form of MS-2 Step (mifepristone and misoprostol) are available for GPs to prescribe under the Pharmaceutical Benefits Scheme in all Australian states and territories excluding South Australia (SA). 8 In SA, abortions must occur on hospital grounds, not in a general practice. 8 MS-2 Step can be prescribed at up to nine weeks' gestation. For a GP to legally prescribe medical abortion, they are required to undertake mandatory certification through online training (available at www.ms2step.com.au/register).Although no nationwide data exist, it appears that some Australian GPs are willing to provide medical abortion but do not. 9 Evidence suggests that lack of training, lack of support, fear of or actual stigmatisation and fear of demand are key barriers to GPs establishing and providing medical abortion services, both internati...

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