The legal and non-legal barriers to abortion access in Australia: a review of the evidence

Moel-Mandel, Caroline de; Shelley, Julia

doi:10.1080/13625187.2016.1276162

Cited by 30 publications

(29 citation statements)

References 31 publications

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“…One national study found that 18% of women traveled more than 100 km (62 miles) to reach an abortion clinic and that younger woman and Aboriginal women traveled significantly further for services than older and white women [12]. A review of studies examining barriers to abortion access in Australia found that interstate travel for abortion was common, rural access to abortion was limited, and that greater travel distances were associated with greater costs [13]. In New Zealand, a study of access to first trimester abortion found that women in regions without an abortion provider had to travel on average 137 miles each way to reach abortion services, and that regions without a provider had higher than average native (Maori) populations [14].…”

Section: Introductionmentioning

confidence: 99%

Distance traveled for Medicaid-covered abortion care in California

Johns

Foster

Upadhyay

2017

BMC Health Serv Res

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BackgroundAccess to abortion care in the United States is limited by the availability of abortion providers and their geographic distribution. We aimed to assess how far women travel for Medicaid-funded abortion in California and identify disparities in access to abortion care.MethodsWe obtained data on all abortions reimbursed by the fee-for-service California state Medicaid program (Medi-Cal) in 2011 and 2012 and examined distance traveled to obtain abortion care by several demographic and abortion-related factors. Mixed-effects multivariable logistic regression models were constructed to examine factors associated with traveling 50 miles or more. County-level t-tests and linear regressions were conducted to examine the effects of a Medi-Cal abortion provider in a county on overall and urban/rural differences in utilization.Results11.9% (95% CI: 11.5–12.2%) of women traveled 50 miles or more. Women obtaining second trimester or later abortions (21.7%), women obtaining abortions at hospitals (19.9%), and rural women (51.0%) were most likely to travel 50 miles or more. Across the state, 28 counties, home to 10% of eligible women, did not have a facility routinely providing Medi-Cal-covered abortions.ConclusionsEfforts are needed to expand the number of abortion providers that accept Medi-Cal. This could be accomplished by increasing Medi-Cal reimbursement rates, increasing the types of providers who can provide abortions, and expanding the use of telemedicine. If national trends in declining unintended pregnancy and abortion rates continue, careful attention should be paid to ensure that reduced demand does not lead to greater disparities in geographic and financial access to abortion care by ensuring that providers accepting Medicaid payment are available and widely distributed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2241-0) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Distance traveled for Medicaid-covered abortion care in California

Johns

Foster

Upadhyay

2017

BMC Health Serv Res

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“…The lack of MA knowledge, awareness and provision, among this presumably pro‐abortion sample, indicates a need for improved abortion education in the curricula of medical and nurse students and for interventions that focus on the benefits, safety and feasibility of MA provision. Education also needs to address the perceived uncertainty regarding the legal restrictions involved with the provision of MA in Victoria, as the complex mix of inconsistent abortion laws across Australia might discourage those considering providing MA services …”

Section: Discussionmentioning

confidence: 99%

“…Access to abortion services in Australia is not without barriers. The legal differences and ambiguities in abortion laws across Australian jurisdictions, together with anti‐abortion views and the fear of stigma or harassment, can affect the willingness of doctors to provide abortions . Abortion provision remains predominantly confined to private clinics in metropolitan areas, and abortion access for women from Australia's regional and rural areas can therefore be highly restricted .…”

Section: Introductionmentioning

confidence: 99%

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

Moel-Mandel

Graham

Taket

2019

Australian J Rural Health

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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.

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“…In the present study, women who were hospitalized for an “abortion” that was not induced for legal reasons were 3.5 times more likely to receive contraceptive methods. Counseling about starting contraceptives to prevent a new pregnancy for women who have had a legal abortion induction can be difficult . Induced abortion in Brazil has restrictive laws and is associated with a moral stigma, which creates an obstacle to improving health care and hinders both practical actions and social and cultural aspects related to women's health problems.…”

Section: Discussionmentioning

confidence: 99%

Post‐abortion contraception before hospital discharge after installation of a surveillance network in Brazil

Veiga-Junior

Cavalari

Eugeni

et al. 2020

Intl J Gynecology & Obste

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Objective To evaluate the use of contraception soon after abortion, ectopic, or molar pregnancy following the establishment of a surveillance network (MUSA). Methods A cross‐sectional study of women admitted for abortion, or ectopic or molar pregnancy at UNICAMP Women's Hospital (part of the MUSA Network), Campinas, Brazil, between July 2017 and August 2019. Clinical and sociodemographic data were compared between women who initiated contraception before discharge and those who did not by using a Cochran‐Armitage test and multiple logistic regression. Results Overall, 382 women were enrolled (mean ± SD age, 29.6 ± 7.4 years). Most women (287, 75.2%) had abortions, and 146 (38.2%) initiated contraception before hospital discharge. The most common contraceptives were injectables (75, 51.4%) followed by pills (65, 44.5%). Use of contraception increased during the study period (Z=3.69, P<0.01), mostly due to injectables (Z=3.84, P<0.01). Factors independently associated with contraceptive initiation were admission in 2019 (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.36–5.17) and not having an abortion for legal reasons (OR, 3.54; 95% CI, 1.30–9.62). Conclusion Implementation of a surveillance network optimized the health service and quality of care. There was an increase in contraception use and a vulnerable population was identified.

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The legal and non-legal barriers to abortion access in Australia: a review of the evidence

Abstract: Although this review can form a base for the national improvement of abortion access, the gap found in Australian research demonstrates a need for additional studies.

Cited by 30 publications

References 31 publications

Distance traveled for Medicaid-covered abortion care in California

Distance traveled for Medicaid-covered abortion care in California

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

Post‐abortion contraception before hospital discharge after installation of a surveillance network in Brazil

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