Optimising abortion care: Perspectives of care providers and community stakeholders in Melbourne, Australia

Abstract

Background In Australia, there are a range of barriers that may delay or inhibit a woman/pregnant person from accessing abortion, with these barriers disproportionately affecting marginalised populations. The northern metropolitan region of Melbourne, Australia, is home to a large population of women/gender diverse people of reproductive age, many of whom face significant socio-economic disadvantage. This study aims to understand health care provider and community stakeholder perspectives regarding barriers to, and patient experience of, abortion care in Melbourne’s north.Methods This qualitative study used individual in-depth semi-structured interviews. Twelve key informants were purposively selected based on their professional work and included abortion care providers, and representatives from local reproductive health, multicultural, and Aboriginal and Torres Strait Islander advocacy services. Interviews were conducted via Zoom between June to August 2022. Data were analysed using reflexive thematic analysis.Results Informants identified a range of barriers to abortion across individual, service, and socio-political levels. Informants expressed concern that individual level barriers such as financial disadvantage meant it could be difficult for consumers to access the services they need (e.g. GP appointments and ultrasound). They highlighted that these barriers can be further amplified for consumers from culturally and linguistically diverse backgrounds, who may face language barriers, racism and difficulty navigating the health care system. The concept of patient resourcefulness and resilience emerged as a novel finding. Informants also identified key factors that impact patient experience of abortion care, including service-based factors (eg. ease of locating a service) and the provision of respectful care. Factors that create barriers to access and negatively impact patient experiences of abortion are interlinked, demonstrating the importance of considering both elements for service quality improvement.Conclusion Known barriers to abortion are exacerbated in the region due to the concentration of marginalised populations and lack of affordable abortion services. Quality improvement approaches in this space need to address barriers at the individual, service, and socio-political levels to optimise patient experience and make a meaningful impact. Further research is planned to explore local consumers’ experiences of abortion care and ideas for quality improvement using co-design.