Australian Government approval in 2012 for the use of mifepristone and misoprostol for medical termination of pregnancy (MTOP) allows general practitioners (GPs) to provide early gestation abortion in primary care settings. However, uptake of the MTOP provision by GPs appears to be low and the reasons for this have been unclear. This study investigated the provision of and referral for MTOP by GPs.
We undertook descriptive-interpretive qualitative research and selected participants for diversity using a matrix. Twenty-eight semi-structured interviews and one focus group (N = 4), were conducted with 32 GPs (8 MTOP providers, 24 non MTOP providers) in New South Wales, Australia. Interviews were recorded and transcribed verbatim. A framework to examine access to abortion services was used to develop the interview questions and emergent themes identified thematically.
Three main themes emerged: scope of practice; MTOP demand, care and referral; and workforce needs. Many GPs saw abortion as beyond the scope of their practice (i.e. a service others provide in specialist private clinics). Some GPs had religious or moral objections; others regarded MTOP provision as complicated and difficult. While some GPs expressed interest in MTOP provision they were concerned about stigma and the impact it may have on perceptions of their practice and the views of colleagues. Despite a reported variance in demand most MTOP providers were busy but felt isolated. Difficulties in referral to a local public hospital in the case of complications or the provision of surgical abortion were noted.
Exploring the factors which affect access to MTOP in general practice settings provides insights to assist the future planning and delivery of reproductive health services. This research identifies the need for support to increase the number of MTOP GP providers and for GPs who are currently providing MTOP. Alongside these actions provision in the public sector is required. In addition, formalised referral pathways to the public sector are required to ensure timely care in the case of complications or the provision of surgical options. Leadership and coordination across the health sector is needed to facilitate integrated abortion care particularly for rural and low income women.
Wu S. Medical abortion in China. J Am Med Womens Assoc. 2000;55(3 Suppl):197–199, 204.
WHO. Safe abortion: technical and policy guidance for health systems. 2nd ed. Geneva: World Health Organization, Department of Reproductive Health and Research; 2012.
Snook S, Silva M. Abortion services in a high-needs district: a community-based model of care. J Prim Health Care. 2013;5(2):151–3. PubMed
Registration of medicines for the medical termination of early pregnancy. [ https://www.tga.gov.au/registration-medicines-medical-termination-early-pregnancy]. Accessed 11 Mar 2017.
AIHW. Australia’s health 2016. In: Australia’s health no 15 Cat no AUS 199. Canberra: Australian Institute of Health and Welfare; 2016.
AIHW. National Health Workforce Data Set: Medical Practitioners 2014. In: National Health Workforce Data Set. Canberra: Australian Institute of Health and Welfare, Australian Government; 2014.
MS Health. MTOP. 2016.
AIHW. National Health Workforce Data Set. In: National Health Workforce Data Set: allied health practitioners 2014. Canberra: Australian Institute of Health and Welfare, Australian Government; 2014.
HealthStats NSW. Population by age. In: NSW Government. 2014.
de Crespigny LJ, Wilkinson DJ, Douglas T, Textor M, Savulescu J. Australian attitudes to early and late abortion. Med J Aust. 2010;193(1):9–12. PubMed
de Costa CM, Russell DB, Carrette M. Views and practices of induced abortion among Australian Fellows and specialist trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Med J Aust. 2010;193(1):13–6. PubMed
Elliott R, Timulak L. Descriptive and interpretive approaches to qualitative research. In: A handbook of research methods for clinical and health psychology. 2005. p. 147–59.
Patton MQ. Qualitative evaluation and research methods. Newbury Park: Sage; 1990.
Bowen GA. Naturalistic inquiry and the saturation concept: a research note. Qual Res. 2008;8(1):137–52. CrossRef
Creswell J. Qualitative Inquiry & Research Design: Choosing Among Five Approaches. Thousand Oaks: Sage Publications; 2007.
Dressler J, Maughn N, Soon JA, Norman WV. The perspective of rural physicians providing abortion in Canada: qualitative findings of the BC Abortion Providers Survey (BCAPS). PLoS One. 2013;8(6):1–5. CrossRef
Freedman L. Willing and unable: doctors’ constraints in abortion care. Nashville, Tennessee: Vanderbilt University Press; 2010.
Pregnancy Advisory Centre. [ http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+services/womens+health+services/unplanned+pregnancy+services/pregnancy+advisory+centre]. Accessed 11 Mar 2017.
Bootha M, Hilla G, Mooreb MJ, Dallab D, Moorec MG, Messengerd A. The new Australian Primary Health Networks: how will they integrate public health and primary care. Public Health Res Pract. 2016;26(1):e2611603.
ABS. Australian Statistical Geography Standard (ASGS): Volume 5 - Remoteness Structure, July 2011, catalogue number 1270.0.55.005. 2013. Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/1270.0.55.005?OpenDocument. Accessed 11 Mar 2017.
RACGP. Rural programs: definition of procedural GP. In. Victoria: Royal Australian College of General Practitioners; n.d. Available at http://www.racgp.org.au/education/rural-programs/training-grants/definitions/. Accessed 11 Mar 2017.
- Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study
Angela J. Dawson
Elizabeth A. Sullivan
- BioMed Central
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