Dawson Angela, Bateson Deborah, Estoesta Jane, Sullivan Elizabeth
Faculty of Health, University of Technology, Sydney (UTS), P.O. Box 123, Ultimo, NSW 2007, Sydney, NSW, Australia.
Discipline, Gynaecology and Neonatology, University of Sydney, Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW, 2131, Australia.
BMC Health Serv Res. 2016 Oct 22;16(1):612. doi: 10.1186/s12913-016-1846-z.
Improving 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.
We 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.
This 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.
Key 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.
改善安全堕胎服务的可及性是提供普及生殖健康保健的一项重要策略。澳大利亚人在很大程度上支持提供堕胎服务及其合法化。然而，数据的缺乏以及复杂的法律和服务提供情况影响了寻求早期终止妊娠的女性获得服务的机会。从卫生服务角度来看，尚无系统评价来帮助指导卫生规划者和政策制定者改善高收入国家全面医疗堕胎和早期手术堕胎服务的可及性。因此，本评价旨在确定有关堕胎服务的高质量研究，以深入了解如何在澳大利亚改善服务的可及性。
我们对六个文献数据库进行了结构化检索，并进行手工检索，以确定2005年至2015年间以英文发表的经同行评审的原发性研究。定性和定量研究设计均被认为适合纳入。采用演绎性内容分析法，根据我们开发的一个框架来分析选定的手稿，该框架用于研究早期堕胎服务的可及性。
本评价确定了在诊所或医院门诊堕胎服务中获得手术堕胎和药物堕胎服务的维度，以及利用远程远程医疗方法的新服务提供方式。发现一系列因素（大多来自英国和美国的研究）有助于改善堕胎服务的可及性，特别是灵活的服务提供方式，为女性提供具有成本效益的选择和基于技术的服务。还确定了标准、建议和目标，为服务和提供者提供有关堕胎护理质量的指导。
对澳大利亚服务提供的关键见解包括：制定标准、提供手术选择、改善提供者教育和培训以及扩大药物堕胎的远程医疗服务。然而，要实施这些指令，澳大利亚的医学、护理、助产和药学从业者、学术机构及其相关专业协会需要发挥领导作用。此外，需要政治意愿在全国范围内将堕胎合法化，并确保基于为所有人群量身定制的综合模式提供专门公共服务。
