School of Rural Health, Faculty of Medicine and Health, The University of Sydney, Orange, NSW, Australia.
SPHERE Centre for Research Excellence, Melbourne, Vic., Australia.
Rural Remote Health. 2024 Nov;24(4):9229. doi: 10.22605/RRH9229. Epub 2024 Nov 5.
Rural populations in Australia rely upon local primary health care for medication abortion access. Yet little is known about how individual primary healthcare providers themselves negotiate the unique complexities of the rural health system to provide local abortion services.
To address this gap, we conducted qualitative, semi-structured interviews with primary healthcare providers in rural New South Wales (NSW). Recruitment strategies included sending invitations to all GP clinics in Western NSW, distribution of flyers via professional networks and social media posts as well as snowballing. The Framework Method was used to conduct an inductive thematic analysis.
We interviewed 16 rural GPs, nurses, midwives and women's health clinic operational staff. Four themes were identified: (1) scarce abortion services place overreliance on availability and goodwill of local prescribers; (2) lack of back-up support, financial incentives and training deters providers; (3) there is interprofessional stigma, secrecy and obstruction; and (4) local abortion access requires workarounds through informal rural networks. Participants described abortion exceptionalism within Australia's health system and chronic rural workforce shortages in rural settings as unique and compounding challenges to local provision. Conversely, strong rural community networks were identified as important enablers of informal pathways to abortion within or around systemic barriers.
Improving rural abortion access in Australia requires attention to the numerous intersecting barriers that local primary care providers themselves face when providing services at the periphery of an unaccommodating health system.
澳大利亚的农村人口依赖当地的初级卫生保健来获得药物流产服务。然而，人们对个体初级保健提供者如何在农村卫生系统的独特复杂性中协商，以提供当地的堕胎服务知之甚少。
为了弥补这一空白，我们对新南威尔士州（NSW）农村地区的初级保健提供者进行了定性、半结构化访谈。招募策略包括向新南威尔士州西部的所有全科医生诊所发送邀请，通过专业网络和社交媒体发布传单，以及滚雪球式的招募。采用框架方法进行归纳主题分析。
我们采访了 16 名农村全科医生、护士、助产士和妇女健康诊所的运营人员。确定了四个主题：（1）堕胎服务稀缺，过度依赖当地开处方者的可用性和善意；（2）缺乏后备支持、经济激励和培训阻碍了提供者；（3）存在专业间的耻辱感、保密性和障碍；（4）当地的堕胎机会需要通过非正式的农村网络来解决。参与者描述了澳大利亚卫生系统中的堕胎例外主义，以及农村地区长期存在的劳动力短缺，这些都是当地提供服务所面临的独特且复杂的挑战。相反，强大的农村社区网络被认为是在系统障碍内或周围建立非正式堕胎途径的重要促成因素。
要改善澳大利亚的农村堕胎机会，需要关注当地初级保健提供者在提供不受欢迎的卫生系统边缘服务时所面临的众多相互交织的障碍。
