{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:11:20Z","timestamp":1787501480840,"version":"build-2736575974"},"reference-count":35,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1153592"],"award-info":[{"award-number":["1153592"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2019,12,14]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite the availability of medical abortifacients, and their potential use in primary care, only a small proportion of primary healthcare professionals provide medical abortion services. Understanding the perspectives of primary care providers on delivering medical abortion is pertinent to identifying barriers to medical abortion service provision and increasing access for women globally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To understand the knowledge, attitudes and practices of primary healthcare providers regarding medical abortion services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Four databases (Medline, EMBASE, Web of Science (WOS) and Scopus) were searched using search terms related to medical abortion and primary care. The Joanna Briggs Institute Critical Appraisal tools were used to appraise the methodological quality of studies included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Some 22 studies were identified, conducted across 15 countries, comprising 6072 participants. Study participants comprised doctors and residents (n=8), nurses and nursing students (n=5), and pharmacists (n=3) and six studies were conducted with mixed samples of providers. Medical abortion was deemed acceptable by some doctors, but fear of criminal prosecution, in countries where abortion is still restrictive, left doctors and nurses circumspect about providing medical abortion. Pharmacists referred women to other providers with only a small proportion dispensing medical abortifacients. General practitioners, nurses and trainees had mixed knowledge of medical abortion and emphasised the need for training on delivery of medical abortion and dissemination of guidelines. Conversely, pharmacists reported poor knowledge regarding medical abortion regimens and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Increased dissemination of training and resources is pertinent to supporting primary care providers delivering medical abortion services and to increasing access for women on a global scale.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsrh-2019-200487","type":"journal-article","created":{"date-parts":[[2019,12,30]],"date-time":"2019-12-30T17:15:20Z","timestamp":1577726120000},"page":"9-16","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Primary care providers\u2019 knowledge, attitudes and practices of medical abortion: a systematic review"],"prefix":"10.1136","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6045-2728","authenticated-orcid":false,"given":"Asvini K","family":"Subasinghe","sequence":"first","affiliation":[{"name":"Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema","family":"Deb","sequence":"additional","affiliation":[{"name":"Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Mazza","sequence":"additional","affiliation":[{"name":"Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,12,30]]},"reference":[{"key":"2025090221350962000_47.1.9.1","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1093\/humrep\/dex071","article-title":"Induced abortion","volume":"32","author":"Cameron","year":"2017","journal-title":"Hum Reprod"},{"key":"2025090221350962000_47.1.9.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30380-4"},{"key":"2025090221350962000_47.1.9.3","unstructured":"Singh SDJ . Adding it up: costs and benefits of contraceptive services. New York, NY, USA: Guttmacher Institute and UNFPA, 2012."},{"key":"2025090221350962000_47.1.9.4","unstructured":"Guttmacher Institute . Abortion worldwide 2017: uneven progress and unequal access; 2018. https:\/\/www.guttmacher.org\/report\/abortion-worldwide-2017"},{"key":"2025090221350962000_47.1.9.5","unstructured":"World Health Organization (WHO) . Medical management of abortion (Licence: CC BY-NC-SA 3.0 IGO. Geneva, Switzerland: WHO, 2018."},{"key":"2025090221350962000_47.1.9.6","doi-asserted-by":"crossref","unstructured":"Kulier R , Kapp N , G\u00fclmezoglu AM , et al . Medical methods for first trimester abortion. Cochrane Database Syst Rev 2011;123.doi:10.1002\/14651858.CD002855.pub4","DOI":"10.1002\/14651858.CD002855.pub4"},{"key":"2025090221350962000_47.1.9.7","unstructured":"Food and Drug Administration . Mifeprex (mifepristone) information, 2016."},{"key":"2025090221350962000_47.1.9.8","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.ijgo.2011.12.017","article-title":"Pharmacy workers\u2019 knowledge and provision of abortifacients in Ho Chi Minh City, Vietnam","volume":"117","author":"Ngo","year":"2012","journal-title":"Int J Gynecol Obstet"},{"key":"2025090221350962000_47.1.9.9","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.contraception.2004.03.011","article-title":"Physicians' knowledge and opinions about medication abortion in four Latin American and Caribbean region countries","volume":"70","author":"Espinoza","year":"2004","journal-title":"Contraception"},{"key":"2025090221350962000_47.1.9.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0067070","article-title":"The perspective of rural physicians providing abortion in Canada: qualitative findings of the BC Abortion Providers Survey (BCAPS)","volume":"8","author":"Dressler","year":"2013","journal-title":"PLoS One"},{"key":"2025090221350962000_47.1.9.11","unstructured":"Joanna Briggs Institute . Critical appraisal tools for use in JBI systematic reviews, 2017. Available: https:\/\/joannabriggs.org\/sites\/default\/files\/2019-05\/JBI_RCTs_Appraisal_tool2017_0.pdf [Accessed 19 Feb 2019]."},{"key":"2025090221350962000_47.1.9.12","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-8-45","article-title":"Methods for the thematic synthesis of qualitative research in systematic reviews","volume":"8","author":"Thomas","year":"2008","journal-title":"BMC Med Res Methodol"},{"key":"2025090221350962000_47.1.9.13","first-page":"309","article-title":"Attitudes toward Michigan's abortion law and experience of Michigan physicians with requestss for abortion","volume":"70","author":"Serena","year":"1971","journal-title":"Mich Med"},{"key":"2025090221350962000_47.1.9.14","doi-asserted-by":"crossref","first-page":"S57","DOI":"10.1016\/j.ijgo.2012.05.012","article-title":"Introducing medical abortion in turkey: perceptions of physicians","volume":"118","author":"Akin","year":"2012","journal-title":"Int J Gynaecol Obstet"},{"key":"2025090221350962000_47.1.9.15","doi-asserted-by":"publisher","DOI":"10.1783\/147118901101195614"},{"key":"2025090221350962000_47.1.9.16","doi-asserted-by":"crossref","DOI":"10.1186\/s12978-017-0303-8","article-title":"Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study","volume":"14","author":"Dawson","year":"2017","journal-title":"Reprod Health"},{"key":"2025090221350962000_47.1.9.17","first-page":"560","article-title":"Manufacturing mental illness (and lawful abortion): doctors' attitudes to abortion law and practice in New South Wales and Queensland","volume":"20","author":"Douglas","year":"2013","journal-title":"J Law Med"},{"key":"2025090221350962000_47.1.9.18","doi-asserted-by":"crossref","DOI":"10.1542\/peds.101.5.e4","article-title":"Attitudes of the physician membership of the Society for Adolescent Medicine toward medical abortions for adolescents","volume":"101","author":"Miller","year":"1998","journal-title":"Pediatrics"},{"key":"2025090221350962000_47.1.9.19","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.2105\/AJPH.85.10.1423","article-title":"Abortions in rural Idaho: physicians' attitudes and practices","volume":"85","author":"Rosenblatt","year":"1995","journal-title":"Am J Public Health"},{"key":"2025090221350962000_47.1.9.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2004.08.011"},{"key":"2025090221350962000_47.1.9.21","first-page":"10","article-title":"A survey of the knowledge, attitude and practice of induced abortion among nurses in Kisii district, Kenya","volume":"10","author":"Kidula","year":"1992","journal-title":"J Obstet Gynaecol East Cent Africa"},{"key":"2025090221350962000_47.1.9.22","doi-asserted-by":"publisher","DOI":"10.1016\/0091-2182(94)90130-9"},{"key":"2025090221350962000_47.1.9.23","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/1049-3867(95)90570-I","article-title":"Community health nurses' perceptions, knowledge, and involvement in abortion services","volume":"4","author":"Swenson","year":"1994","journal-title":"Womens Health Issues"},{"key":"2025090221350962000_47.1.9.24","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1111\/j.1471-6712.1991.tb00089.x","article-title":"Nursing students' attitudes towards abortion and family planning in Italy and Sweden","volume":"5","author":"Agostino","year":"1991","journal-title":"Scand J Caring Sci"},{"key":"2025090221350962000_47.1.9.25","first-page":"410","article-title":"Turkish nursing students' attitudes towards voluntary induced abortion","volume":"68","author":"Yanikkerem","year":"2018","journal-title":"J Pak Med Assoc"},{"key":"2025090221350962000_47.1.9.26","doi-asserted-by":"publisher","DOI":"10.1136\/jfprhc-2013-100821"},{"key":"2025090221350962000_47.1.9.27","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-017-1394-5","article-title":"Knowledge and provision of misoprostol among pharmacy workers in Senegal: a cross sectional study","volume":"17","author":"Reiss","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025090221350962000_47.1.9.28","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1111\/1467-9566.12479","article-title":"The changing body work of abortion: a qualitative study of the experiences of health professionals","volume":"39","author":"Purcell","year":"2017","journal-title":"Sociol Health Illn"},{"key":"2025090221350962000_47.1.9.29","first-page":"91","article-title":"Induced abortion in rural Bangladesh: mortality levels and physicians' attitudes","volume":"8","author":"Obiadullah","year":"1981","journal-title":"Rural Demogr"},{"key":"2025090221350962000_47.1.9.30","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12506"},{"key":"2025090221350962000_47.1.9.31","doi-asserted-by":"crossref","first-page":"e117","DOI":"10.1016\/j.whi.2012.12.002","article-title":"Women's and providers' experiences with medical abortion provided through telemedicine: a qualitative study","volume":"23","author":"Grindlay","year":"2013","journal-title":"Womens Health Issues"},{"key":"2025090221350962000_47.1.9.32","doi-asserted-by":"publisher","DOI":"10.1111\/j.1931-2393.2005.tb00221.x"},{"key":"2025090221350962000_47.1.9.33","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1111\/ajr.12510","article-title":"Snapshot of medication abortion provision in the primary health care setting of regional and rural Victoria","volume":"22","author":"Moel\u2010Mandel","year":"2019","journal-title":"Aust J Rural Health"},{"key":"2025090221350962000_47.1.9.34","unstructured":"World Health Organization (WHO) . Who recommendations: optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting. Geneva, Switzerland: WHO, 2012."},{"key":"2025090221350962000_47.1.9.35","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-015-1502-2","article-title":"Health care providers\u2019 perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia: a systematic literature review of qualitative and quantitative data","volume":"15","author":"Rehnstr\u00f6m Loi","year":"2015","journal-title":"BMC Public Health"}],"container-title":["BMJ Sexual &amp; Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsrh-2019-200487","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T04:35:25Z","timestamp":1756874125000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/bmjsrh-2019-200487"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,30]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,12]]},"published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1136\/bmjsrh-2019-200487"],"URL":"https:\/\/doi.org\/10.1136\/bmjsrh-2019-200487","relation":{},"ISSN":["2515-1991","2515-2009"],"issn-type":[{"value":"2515-1991","type":"print"},{"value":"2515-2009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12,30]]}}}