Snapshot of medication abortion provision in the primary health care setting of regional and rural Victoria

Abstract

Objective This study aimed to identify enablers and barriers to the provision of medication abortion in the primary health care setting of regional and rural areas of Victoria, Australia. Design An online cross‐sectional questionnaire was used. Setting Regional and rural areas of Victoria, Australia. Participants Thirty‐nine GPs and 30 primary health care nurses. Main outcome measures Abortion views, medication abortion knowledge and practice, interest in medication abortion training and provision, and perceived uptake barriers. Results Most participants reported being consulted by women with unintended pregnancies and most of them included abortion counselling in their consultation. However, familiarity with provision of medication abortion was limited, and only five GPs and two primary health care nurses were currently medication abortion providers. The majority of participants expressed a high level of interest in receiving medication abortion training, but indicated a wide range of barriers to service provision, such as a lack of training opportunities, legal uncertainties or surgical access concerns in case of complications. Conclusions Findings demonstrate the need for education on medication abortion and training opportunities. Most identified barriers to service uptake are addressable and relate to a lack of local support services, including the absence of a 24‐hour contact advice service, insufficient follow‐up access and a lack of local ultrasound facilities. These barriers require educational programs at professional, organisational and community level to ensure that interested rural and regional primary health care providers can start offering medication abortion for their patients.

Primary care providers’ knowledge, attitudes and practices of medical abortion: a systematic review

“…In eight of the studies9 14–20 researchers investigated KAP of medical abortion among doctors and medical interns. Five studies21–25 were conducted on samples of nurses and nursing students, three research groups8 26 27 investigated KAP in pharmacists and six studies28–33 included data from mixed groups of health professionals.…”

“…In 12 of the studies14 15 18–25 32 33 researchers used surveys as their method of data collection. Interviews were used in five studies,17 27 28 30 31 and in the remaining five studies8 9 16 24 26 29 multiple methods of data collection were used such as focus group discussions, in-depth interviews, surveys and mystery client visits to pharmacies.…”

“…Legislative restrictions were perceived to be both a frustration and a necessity, depending on the location of the health professional. The majority of primary healthcare providers believed that medical abortion should be available on request 15 18 21–23 29 33. Some providers considered access to medical abortion as a right for women who requested it regardless of the law 16 22 30 32.…”

“…All primary care providers stated that there was a need for more resources and training materials related to medical abortion service provision 9 16 17 33. Lack of training opportunities was cited as the largest barrier to performing medical abortion or assisting another provider in performing medical abortion by nurse practitioners in California 32.…”

Medical abortion: it is time to lift restrictions

“…To the Editor : In their article, De Costa and colleagues clearly demonstrate the importance of making mifepristone freely available for prescription to all registered Australian medical practitioners, and they emphasise that the current need for special registration discourages general practitioners to become involved in medical abortion provision. We conducted a cross‐sectional study of 39 GPs and 30 primary health care nurses from regional or rural Victoria and identified additional uptake barriers …”