A significant opportunity to increase women’s access to the most effective form of contraception and abortion care is being missed in Australia, according to new research from Monash University’s SPHERE Centre of Research Excellence.
A comprehensive study, published in the Journal of Advanced Nursing, reveals practice nurses – registered or enrolled nurses working within a general practice setting – are underutilised when it comes to advice, and treatment, for patients about long-acting reversible contraceptives (LARCs).
A second study from the same research, also published in the Journal of Advanced Nursing, reveals similar results.
The online survey involved about 500 practice nurses, most of whom were women working as registered nurses in metropolitan settings.
The study’s lead author and SPHERE Research Fellow, Dr Sharon James, said Australia’s 14,500 practice nurse workforce lacks the necessary structural support to provide LARCs or medical abortion.
“We found that practice nurses whose primary workplace was general practice were less likely to provide LARC or medication abortion services than those working in other settings, such as family planning organisations or women’s health services,” Dr James said.
Dr James said not enough general practitioners and other health practitioners are providing contraception and abortion care. “Any way we can extend the number of providers increases women’s access to this care.”
In the studies, practice nurses felt their support could assist patients to make informed decisions about their contraceptive choices (90.4 per cent) and support medical abortion (71 per cent), yet structural issues such as funding, education and service normalisation impact practice.
But few respondents were currently providing insertion or removal of intrauterine devices (IUDs) (11.2 per cent) or implants (15.9 per cent), and very few were involved in abortion care (8.6 per cent).
“Supportive policy, funding and training arrangements are needed to support practice nurses to provide LARC and medical abortion services in general practice settings,” Dr James said.
“Practice nurses are highly skilled and an important workforce to help expand women’s access to LARC and medical abortion. Further education and training, health system organisation, policy and funding initiatives are needed to maximise this opportunity.”
In Australia, almost a third (30.4 per cent) of all unintended pregnancies end in abortion, with women in rural and regional areas 1.4 times more likely to experience an unintended pregnancy than women in metropolitan settings. Also, contraceptive use in Australia is skewed towards less effective forms of contraception, such as oral contraceptives (37.2 per cent) and condoms (33.9 per cent).
Dr James said strengthening practice nurse training and roles in LARC and medical abortion care aligns with national workforce and public health initiatives to support patient choice.
“The Federal Government’s budget announcement of $25 million to establish LARC training centres for health professionals, including in regional and remote areas, will assist in meeting training needs,” Dr James said. “Deregulation of medical abortion by the Therapeutic Goods Administration has supported better access, allowing prescribing by nurse practitioners and endorsed midwives.”
Dr James said that most practice nurses were open to providing abortion care, but this was limited by the knowledge and confidence to do so and compounded by concerns about the stigma surrounding abortion care.
“Normalisation of abortion care as part of nursing education and routine practice would support its provision.”
Read the full papers in the Journal of Australian Nursing: Practice Nurse Provision of Long-Acting Reversible Contraception: A Cross-Sectional Survey of Knowledge and Practices and The Knowledge, Attitudes and Practices of Practice Nurses in the Provision of Medication Abortion: A Cross-sectional Survey.
DOI: 1. https://doi.org/10.1111/jan.17020 2. https://doi.org/10.1111/jan.17051
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