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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2024

Open Access 01-12-2024 | Research

Abortion care at 20 weeks and over in Victoria: a thematic analysis of healthcare providers’ experiences

Authors: Mary Malek, Caroline SE Homer, Clare McDonald, Catherine M Hannon, Paddy Moore, Alyce N Wilson

Published in: BMC Pregnancy and Childbirth | Issue 1/2024

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Abstract

Background

In many countries, abortions at 20 weeks and over for indications other than fetal or maternal medicine are difficult to access due to legal restrictions and limited availability of services. The Abortion and Contraception Service at the Royal Women’s Hospital in Victoria, Australia is the only service in the state that provides this service. The views and experiences of these abortion providers can give insight into the experiences of staff and women and the abortion system accessibility. The aim of this study was to examine health providers’ perceptions and experiences of providing abortion care at 20 weeks and over for indications other than fetal or maternal medicine, as well as enablers and barriers to this care and how quality of care could be improved in one hospital in Victoria, Australia.

Methods

A qualitative study was conducted at the Abortion and Contraception Service at the Royal Women’s Hospital. Participants were recruited by convenience and purposive sampling. Semi-structured interviews were conducted one-on-one with participants either online or in-person. A reflexive thematic analysis was performed.

Results

In total, 17 healthcare providers from medicine, nursing, midwifery, social work and Aboriginal clinical health backgrounds participated in the study. Ultimately, three themes were identified: ‘Being committed to quality care: taking a holistic approach’, ‘Surmounting challenges: being an abortion provider is difficult’, and ‘Meeting external roadblocks: deficiencies in the wider healthcare system’. Participants felt well-supported by their team to provide person-centred and holistic care, while facing the emotional and ethical challenges of their role. The limited abortion workforce capacity in the wider healthcare system was perceived to compromise equitable access to care.

Conclusions

Providers of abortion at 20 weeks and over for non-medicalised indications encounter systemic enablers and barriers to delivering care at personal, service delivery and healthcare levels. There is an urgent need for supportive policies and frameworks to strengthen and support the abortion provider workforce and expand provision of affordable, acceptable and accessible abortions at 20 weeks and over in Victoria and in Australia more broadly.
Appendix
Available only for authorised users
Footnotes
1
In our study we use the term ‘woman or pregnant person’ to recognise that those who are pregnant may identify as a pregnant woman, a pregnant person or both. We use this language to be inclusive to all people who may identify as such.
 
2
Abortion for indications other than fetal or maternal medicine (also referred to as ‘psychosocial’ or ‘non-medicalised’ indications) is defined as an abortion sought for reasons relating to the psychosocial conditions in a woman or pregnant person’s life, such as economic disadvantage, sexual assault and family violence, and excludes abortion sought for reasons of fetal abnormality and maternal health condition.
 
3
Morphology ultrasounds are a routine antenatal test undertaken at around 20 weeks’ gestation to assess the fetus’s growth and development.
 
4
Aftercare for a patient undergoing an induced abortion in birth suite can include creating a memory folder (of the baby’s photographs, handprints and footprints, weight etc.) and having time with the baby, if the patient wishes.
 
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Metadata
Title
Abortion care at 20 weeks and over in Victoria: a thematic analysis of healthcare providers’ experiences
Authors
Mary Malek
Caroline SE Homer
Clare McDonald
Catherine M Hannon
Paddy Moore
Alyce N Wilson
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2024
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-024-06299-0

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