Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study (Dawson et al)

Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study

Angela J. Dawson, Rachel Nicolls, Deborah Bateson, Anna Doab, Jane Estoesta, Ann Brassil and Elizabeth A. Sullivan



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.