What women want from local primary care services for unintended pregnancy in rural Australia: a qualitative study from rural New South Wales

Abstract

Background. Under the generalist model of health care in rural Australia, general practitioners (GPs) are often the first point of contact for women seeking health services for unintended pregnancy, including pregnancy decision-making support and options advice, antenatal or abortion care. Rural women are more likely to experience unintended pregnancy in Australia, yet little is known about how well local rural primary healthcare services currently meet their needs. Methods. To address this gap, this qualitative study explores through in-depth semistructured interviews, the experiences of 20 rural women managing an unintended pregnancy, and their expectations of, and satisfaction with, the quality of care they received. The Framework Method was used to organise data and conduct an inductive thematic analysis. Results. Three themes related to management of unintended pregnancy in a rural primary care setting were identified: (1) women expect informed and efficient care once services are reached;(2) women desire greater choice and aftercare; and (3) comprehensive reproductive health should be part of rural primary care. Participants indicated an awareness of the limitations of the rural health system, yet a firm expectation that despite access delays, all of their reproductive health needs would be met. Choice, time efficiency, and aftercare were identified as gaps in the current primary care service experience. A desire for greater attention to rural reproductive health, including improved contraception, was also emphasised. Conclusions. Rural women with unintended pregnancy experienced gaps in service quality and described a lack of womancentred care in their local rural health setting. This study offers insight into how rural primary care providers can better support women to make decisions about and reach their preferred services for unintended pregnancy.

The role of primary care in optimising women’s sexual and reproductive health

“…Given the central role of primary care to women's health and wellbeing, we put together this special issue to explore the ways in which primary care settings and practitioners can optimise women's sexual and reproductive health. The papers in this special issue explore a range of issues and opportunities across the spectrum of sexual and reproductive health, including in relation to contraception access (Dev et al 2023;Li et al 2023;Mazza et al 2023); support for unintended pregnancies (Noonan et al 2023); abortion care (Haas et al 2023;Srinivasan et al 2023); preconception, pregnancy, postpartum and interconception care (Fitch et al 2023, Li et al 2023Simhi and Yoselis 2023;Withanage et al 2023;Thomas et al 2023;Yussf et al 2023); and issues relating to informed consent (Power et al 2023). The special issue takes a reproductive life course perspective through consideration of both pregnancy prevention and pregnancy preparation (Hall et al 2023).…”

“…A high proportion of women experience an unintended pregnancy in Australia, with rates even higher in non-urban areas. Deciding how to manage an unintended pregnancy commonly involves consideration of two possible outcomes and associated reproductive healthcare pathways: continuing the pregnancy and receiving antenatal care, or not continuing the pregnancy and receiving abortion care (Noonan et al 2023). However, rural women with an unintended pregnancy commonly experience gaps in quality of reproductive health services and delays in access and require better access to care and support to make decisions about and reach their preferred services for unintended pregnancy (Noonan et al 2023).…”