Towards comprehensive early abortion service delivery in high income countries: insights for improving universal access to abortion in AustraliaReport as inadecuate

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BMC Health Services Research

, 16:612

Organization, structure and delivery of healthcare


BackgroundImproving access to safe abortion is an essential strategy in the provision of universal access to reproductive health care. Australians are largely supportive of the provision of abortion and its decriminalization. However, the lack of data and the complex legal and service delivery situation impacts upon access for women seeking an early termination of pregnancy. There are no systematic reviews from a health services perspective to help direct health planners and policy makers to improve access comprehensive medical and early surgical abortion in high income countries. This review therefore aims to identify quality studies of abortion services to provide insight into how access to services can be improved in Australia.

MethodsWe undertook a structured search of six bibliographic databases and hand-searching to ascertain peer reviewed primary research in English between 2005 and 2015. Qualitative and quantitative study designs were deemed suitable for inclusion. A deductive content analysis methodology was employed to analyse selected manuscripts based upon a framework we developed to examine access to early abortion services.

ResultsThis review identified the dimensions of access to surgical and medical abortion at clinic or hospital-outpatient based abortion services, as well as new service delivery approaches utilising a remote telemedicine approach. A range of factors, mostly from studies in the United Kingdom and United States of America were found to facilitate improved access to abortion, in particular, flexible service delivery approaches that provide women with cost effective options and technology based services. Standards, recommendations and targets were also identified that provided services and providers with guidance regarding the quality of abortion care.

ConclusionsKey insights for service delivery in Australia include the: establishment of standards, provision of choice of procedure, improved provider education and training and the expansion of telemedicine for medical abortion. However, to implement such directives leadership is required from Australian medical, nursing, midwifery and pharmacy practitioners, academic faculties and their associated professional associations. In addition, political will is needed to nationally decriminalise abortion and ensure dedicated public provision that is based on comprehensive models tailored for all populations.

AbbreviationsGPGeneral practitioner

HICHigh income countries

ICPIntegrated care pathway

LMICLow and middle income countries

MTOPMedical termination of pregnancy

MVAManual vacuum aspiration

NZNew Zealand

RANZCOGRoyal Australian and New Zealand College of Obstetricians and Gynaecologists

RCOGRoyal College of obstetricians and gynaecologists

STISexually transmitted disease

STOPSurgical termination of pregnancy

UKUnited Kingdom

USUnited States

USAIDUnited States of America Aid Agency

WHOWorld Health Organization

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Author: Angela Dawson - Deborah Bateson - Jane Estoesta - Elizabeth Sullivan


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