{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:31:13Z","timestamp":1782282673821,"version":"3.54.5"},"reference-count":73,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Journal of Australia"],"published-print":{"date-parts":[[2025,7,21]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To synthesise primary research findings about factors that affect medical abortion provision by general practitioners, nurses, midwives, and pharmacists in Australia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>Mixed methods systematic review of peer\u2010reviewed primary publications of qualitative, quantitative, and mixed methods studies of the provision of medical abortion in Australian primary care, 1 January 2013 \u2013 18 January 2025.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data sources<\/jats:title><jats:p>MEDLINE, Scopus, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature).<\/jats:p><\/jats:sec><jats:sec><jats:title>Data synthesis<\/jats:title><jats:p>Twenty\u2010three publications satisfied our inclusion criteria. We undertook a thematic synthesis of the qualitative study findings to identify barriers and facilitators of medical abortion provision, and assessed the confidence of each review finding using the GRADE\u2010CERQual approach; we also compared the qualitative synthesis with quantitative study findings. We developed ten review findings grouped under three themes: moral, legal, and regulatory influences on abortion care (three review findings; very low to moderate confidence); the absence of a systems\u2010based approach to abortion provision (six review findings; moderate to high confidence); and early medical abortion belongs in primary care (one review finding; high confidence). Barriers to providing medical abortion include the absence of a supportive service delivery strategy, insufficient Medicare remuneration, geographic isolation, limited access to training, and colleagues who conscientiously object to abortion. Facilitators of its provision include clinician support networks and personal motivation to improve access to reproductive health care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A range of individual, service level, and system factors exacerbate the effects of geographic location and financial considerations on the provision of medical abortion in Australian primary care. Our findings indicate that financial and structural support is needed for the geographic decentralisation of medical abortion training and services, the establishment of nurse\u2010led models of care, and the integration of abortion care into primary care.<\/jats:p><\/jats:sec>","DOI":"10.5694\/mja2.52707","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T03:00:30Z","timestamp":1750215630000},"page":"101-110","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Factors that affect the provision of medical abortion services in Australian primary care: a mixed methods systematic review"],"prefix":"10.5694","volume":"223","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2985-3515","authenticated-orcid":false,"given":"Greta","family":"Skahill","sequence":"first","affiliation":[{"name":"The University of Melbourne  Melbourne VIC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mridula","family":"Shankar","sequence":"additional","affiliation":[{"name":"Nossal Institute for Global Health, the University of Melbourne  Melbourne VIC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"key":"e_1_2_8_1_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30293-9"},{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2024.117098"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.52194"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rhm.2015.10.002"},{"key":"e_1_2_8_5_1","unstructured":"Royal Australian and New Zealand College of Obstetricians and Gynaecologists.Clinical guideline for abortion care. An evidence\u2010based guideline on abortion care in Australia and Aotearoa New Zealand. Updated Sept2024.https:\/\/ranzcog.edu.au\/wp\u2010content\/uploads\/Clinical\u2010Guideline\u2010Abortion\u2010Care.pdf(viewed Oct 2024)."},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.51217"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.51275"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.18773\/austprescr.2021.050"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.13846"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50782"},{"key":"e_1_2_8_11_1","unstructured":"Australian Department of Health and Aged Care.Reforming the health system to improve sexual and reproductive care [media release]. 31 May2024.https:\/\/www.health.gov.au\/ministers\/the\u2010hon\u2010ged\u2010kearney\u2010mp\/media\/reforming\u2010the\u2010health\u2010system\u2010to\u2010improve\u2010sexual\u2010and\u2010reproductive\u2010care(viewed Oct 2024)."},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.13716"},{"key":"e_1_2_8_13_1","article-title":"Realising access: abortion and contraception inequities and enablers in Victoria (Women's health Victoria knowledge paper 6). Women's Health","author":"Sarder M","year":"2024","journal-title":"Victoria"},{"key":"e_1_2_8_14_1","unstructured":"Senate Community Affairs References Committee.Ending the postcode lottery: addressing barriers to sexual maternity and reproductive healthcare in Australia. May2023.https:\/\/parlinfo.aph.gov.au\/parlInfo\/download\/committees\/reportsen\/RB000075\/toc_pdf\/EndingthepostcodelotteryAddressingbarrierstosexual maternityandreproductivehealthcareinAustralia.pdf(viewed Oct 2024)."},{"key":"e_1_2_8_15_1","volume-title":"Abortion care is health care","author":"Baird B.","year":"2023"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.51979"},{"key":"e_1_2_8_17_1","volume-title":"Abortion care guideline","author":"World Health Organization","year":"2022"},{"key":"e_1_2_8_18_1","unstructured":"Therapeutic Goods Administration (Australian Department of Health and Aged Care).Amendments to restrictions for prescribing of MS\u20102 Step (mifepristone and misoprostol) [media release]. 11 July2023.https:\/\/www.tga.gov.au\/news\/media\u2010releases\/amendments\u2010restrictions\u2010prescribing\u2010ms\u20102\u2010step\u2010mifepristone\u2010and\u2010misoprostol(viewed Oct 2024)."},{"key":"e_1_2_8_19_1","volume-title":"MS health: June 2023 update","author":"Marie Stopes Health","year":"2023"},{"key":"e_1_2_8_20_1","unstructured":"Australian Department of Health and Aged Care.Summary statistics allied health all professions [dataset]. Updated 22 Oct2024.https:\/\/hwd.health.gov.au\/resources\/data\/summary\u2010all.html(viewed Oct 2024)."},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.31128\/AJGP-02-20-5223"},{"key":"e_1_2_8_22_1","volume-title":"Nurse\u2010led medical termination of pregnancy in Australia: legislative scan","author":"Marie Stopes Australia","year":"2022"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-12-181"},{"key":"e_1_2_8_25_1","unstructured":"HongQN PluyeP F\u00e0breguesS et\u00a0al.Mixed methods appraisal tool (MMAT) version 2018. User guide. 1 Aug2018.http:\/\/mixedmethodsappraisaltoolpublic.pbworks.com\/w\/file\/fetch\/127916259\/MMAT_2018_criteria\u2010manual_2018\u201008\u201001_ENG.pdf(viewed Oct 2024)."},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.7275\/pdz9\u2010th90"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269216317690685"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-8-45"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0689-2"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0690-9"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0691-8"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0693-6"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0692-7"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2014.08.003"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12507"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1136\/jfprhc-2016-101541"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-017-0303-8"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-018-0888-8"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajr.12510"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2019.07.004"},{"key":"e_1_2_8_41_1","first-page":"5156","article-title":"General practitioner knowledge and practice in relation to unintended pregnancy in the Grampians region of Victoria, Australia","volume":"19","author":"Keogh L","year":"2019","journal-title":"Rural Remote Health"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-019-0346-1"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.31128\/AJGP-01-20-5198"},{"key":"e_1_2_8_44_1","first-page":"18","article-title":"Identifying barriers and facilitators of full service nurse\u2010led early medication abortion provision: qualitative findings from a Delphi study","volume":"38","author":"De Moel\u2010Mandel C","year":"2020","journal-title":"Aust J Adv Nurs"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1071\/PY20288"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1071\/PY20297"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.13489"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1080\/13691058.2021.1880640"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1071\/PY22130"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.15226"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.31128\/AJGP-07-22-6485"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.31128\/AJGP-04-23-6799"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1071\/PY24100"},{"key":"e_1_2_8_54_1","first-page":"9229","article-title":"\u201cImagine if we had an actual service \u2026\u201d: a qualitative exploration of abortion access challenges in Australian rural primary care","volume":"24","author":"Noonan A","year":"2024","journal-title":"Rural Remote Health"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.16299"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2024-202330"},{"key":"e_1_2_8_57_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2023-012906"},{"key":"e_1_2_8_58_1","article-title":"Health providers\u2019 reasons for participating in abortion care: a scoping review","volume":"20","author":"Merner B","year":"2024","journal-title":"Womens Health (Lond)"},{"key":"e_1_2_8_59_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1206253"},{"key":"e_1_2_8_60_1","volume-title":"Abortion in Australia: what does the overturning of Roe v Wade have to do with it? [podcast]","author":"Williams J","year":"2022"},{"key":"e_1_2_8_61_1","volume-title":"Abortion attitude transformation: a values clarification toolkit for global audiences","author":"Turner KL","year":"2008"},{"key":"e_1_2_8_62_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-018-0480-0"},{"key":"e_1_2_8_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.conx.2021.100054"},{"key":"e_1_2_8_64_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40592-024-00215-0"},{"key":"e_1_2_8_65_1","volume-title":"Health specialists say biased Medicare rebates are costing women more [online]","author":"Long C.","year":"2024"},{"key":"e_1_2_8_66_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.13368"},{"key":"e_1_2_8_67_1","doi-asserted-by":"publisher","DOI":"10.1080\/14461242.2023.2184272"},{"key":"e_1_2_8_68_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2024-202330"},{"key":"e_1_2_8_69_1","unstructured":"QueenslandHealth.Termination of pregnancy: action plan 2032. Mar2024.https:\/\/www.health.qld.gov.au\/__data\/assets\/pdf_file\/0028\/1316467\/Termination\u2010of\u2010Pregnancy\u2010Plan_Digital.pdf(viewed Oct 2024)."},{"key":"e_1_2_8_70_1","unstructured":"Australian Capital Territory (Legislative Assembly).Health (Improved Abortion Access) Amendment Bill 2024.https:\/\/classic.austlii.edu.au\/au\/legis\/act\/bill\/haaab2024383(viewed June2025)."},{"key":"e_1_2_8_71_1","unstructured":"Parliament of Western Australia.Abortion Legislation Reform Act 2023.https:\/\/www.legislation.wa.gov.au\/legislation\/statutes.nsf\/law_a147399.html(viewed June2025)."},{"key":"e_1_2_8_72_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-065137"},{"key":"e_1_2_8_73_1","unstructured":"Australia Department of Health.National women's health strategy 2020\u20132030. Updated 31 Oct2023.https:\/\/www.health.gov.au\/sites\/default\/files\/documents\/2021\/05\/national\u2010women\u2010s\u2010health\u2010strategy\u20102020\u20102030_0.pdf(viewed Oct 2024)."}],"container-title":["Medical Journal of Australia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.5694\/mja2.52707","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,20]],"date-time":"2025-07-20T14:10:18Z","timestamp":1753020618000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.5694\/mja2.52707"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,18]]},"references-count":73,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,7,21]]}},"alternative-id":["10.5694\/mja2.52707"],"URL":"https:\/\/doi.org\/10.5694\/mja2.52707","archive":["Portico"],"relation":{},"ISSN":["0025-729X","1326-5377"],"issn-type":[{"value":"0025-729X","type":"print"},{"value":"1326-5377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,18]]},"assertion":[{"value":"2024-10-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}