title: Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Ultimo, NSW, 2007, Australia. angela.dawson@uts.edu.au.
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Dawson
authors.affiliation: The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Ultimo, NSW, 2007, Australia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Nicolls
authors.affiliation: The Sydney Medical School, Discipline, Gynaecology and Neonatology, University of Sydney and Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW, 2131, Australia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Bateson
authors.affiliation: The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Ultimo, NSW, 2007, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Doab
authors.affiliation: Evaluation and Research Operations, Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW, 2131, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Estoesta
authors.affiliation: The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney and Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW, 2131, Australia.
authors.forename: Ann
authors.initials: A
authors.lastname: Brassil
authors.affiliation: The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Ultimo, NSW, 2007, Australia.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sullivan
mesh_terms: D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage / Q000009:adverse effects; D000028:Abortion, Induced / Q000379:methods* / Q000523:psychology; D001291:Attitude of Health Personnel; D001315:Australia; D005260:Female; D017144:Focus Groups; D005500:Follow-Up Studies; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D008297:Male; D015735:Mifepristone / Q000008:administration & dosage / Q000009:adverse effects; D011247:Pregnancy; D036301:Qualitative Research
chemical_list: D000021:Abortifacient Agents, Steroidal; D015735:Mifepristone
keywords: General practitioner; MTOP; Medical abortion; Mifepristone; Primary health care