Factors that affect the provision of medical abortion services in Australian primary care: a mixed methods systematic review

Abstract

Objectives: To synthesise primary research findings about factors that affect medical abortion provision by general practitioners, nurses, midwives, and pharmacists in Australia.

Study design: Mixed methods systematic review of peer-reviewed primary publications of qualitative, quantitative, and mixed methods studies of the provision of medical abortion in Australian primary care, 1 January 2013 - 18 January 2025.

Data sources: MEDLINE, Scopus, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature).

Data synthesis: Twenty-three publications satisfied our inclusion criteria. We undertook a thematic synthesis of the qualitative study findings to identify barriers and facilitators of medical abortion provision, and assessed the confidence of each review finding using the GRADE-CERQual approach; we also compared the qualitative synthesis with quantitative study findings. We developed ten review findings grouped under three themes: moral, legal, and regulatory influences on abortion care (three review findings; very low to moderate confidence); the absence of a systems-based approach to abortion provision (six review findings; moderate to high confidence); and early medical abortion belongs in primary care (one review finding; high confidence). Barriers to providing medical abortion include the absence of a supportive service delivery strategy, insufficient Medicare remuneration, geographic isolation, limited access to training, and colleagues who conscientiously object to abortion. Facilitators of its provision include clinician support networks and personal motivation to improve access to reproductive health care.

Conclusions: A range of individual, service level, and system factors exacerbate the effects of geographic location and financial considerations on the provision of medical abortion in Australian primary care. Our findings indicate that financial and structural support is needed for the geographic decentralisation of medical abortion training and services, the establishment of nurse-led models of care, and the integration of abortion care into primary care.

Keywords: Abortion; Health services; Primary care; Qualitative research; Rural health services; Women’s health; induced.