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To assess the prevalence of a history of induced abortion among women who gave birth in Victoria during 2010–2019; to assess the association of socio‐demographic factors with a history of induced abortion. Retrospective cohort study; analysis of cross‐sectional perinatal data in the Victorian Perinatal Data Collection (VPDC). All women who gave birth (live or stillborn) in Victoria, 1 January 2010 – 31 December 2019. Self‐reported induced abortions prior to the index birth; outcome of the most recent pregnancy preceding the index pregnancy. Of the 766 488 women who gave birth during 2010–2019, 93 251 reported induced abortions (12.2%), including 36 938 of 338 547 nulliparous women (10.9%). Women living in inner regional (adjusted odds ratio [aOR], 0.94; 95% confidence interval [CI], 0.93–0.96) or outer regional/remote/very remote areas (aOR, 0.86; 95% CI, 0.83–0.89) were less likely than women in major cities to report induced abortions. The likelihood increased steadily with age at the index birth and with parity, and was also higher for women without partners at the index birth (aOR, 2.20; 95% CI, 2.16–2.25) and Aboriginal and Torres Strait Islander women (aOR, 1.32; 95% CI, 1.25–1.40). The likelihood was lower for women born in most areas outside Australia than for those born in Australia. The likelihood of a history of induced abortion declined across the study period overall (2019 v2010: 0.93; 95% CI, 0.90–0.96) and for women in major cities (0.88; 95% CI, 0.84–0.91); rises in inner regional and outer regional/remote/very remote areas were not statistically significant. Access to abortion care in Victoria improved during 2010–2019, but the complex interplay between contraceptive use, unintended pregnancy, and induced abortion requires further exploration by remoteness of residence. Robust information about numbers of unintended pregnancies and access to reproductive health services are needed to guide national sexual and reproductive health policy and practice.

BackgroundDocumenting medical and lifestyle preconception health risk factors in electronic medical records (EMRs) could assist general practitioners (GPs) to identify those reproductive-aged women who could most benefit from preconception care (PCC). However, it is unclear to what extent PCC risk factors are identifiable in general practice records. This study aimed to determine the extent to which medical and lifestyle preconception health risk factors are documented in general practice EMRs.MethodsWe conducted an audit of the documentation of medical and lifestyle preconception risk factors in 10 general practice EMRs in Melbourne, Australia. We retrospectively analysed the EMRs of 100 consecutive women aged 18–44 years who visited each practice between January and September 2022. Using a template informed by PCC guidelines, we extracted data from structured fields in the EMR and conducted a descriptive analysis.ResultsAmong the data extracted, the more commonly documented medical and lifestyle preconception health risk factors in the EMRs included smoking (79%), blood pressure (74%), alcohol consumption (63%) and body mass index (57%). Among the women audited, 14% were smokers, 24% were obese, 7% had high blood pressure, 5% had diabetes, 28% had a mental health condition, 13% had asthma, 6% had thyroid disease and 17% had been prescribed and could be using a potentially teratogenic medication.ConclusionsBetter documentation of medical and lifestyle preconception health risk factors in structured fields in EMRs may potentially assist primary care providers including GPs in identifying and providing PCC to women who could most benefit from it.

BackgroundShort birth intervals and unintended pregnancy are associated with poorer maternal and infant outcomes. There is a risk of pregnancy during the immediate postpartum period unless contraception is initiated. This retrospective cohort study aimed to capture the current patterns of hormonal contraceptive provision within 12 months postpartum in a high-income country.MethodsWe used a linked administrative dataset comprising all women who gave birth in Queensland, Australia between 1 July 2012 and 30 June 2018 (n=339 265 pregnancies). We described our cohort by whether they were provided with government-subsidised hormonal contraception within 12 months postpartum. The associations between hormonal postpartum contraceptive provision and demographic and clinical characteristics were examined using univariate and multivariate logistic regression and presented in terms of crude and adjusted odds ratios with 95% confidence intervals.ResultsA majority of women (60.2%) were not provided with government-subsidised hormonal postpartum contraception within 12 months postpartum. Women who were younger (<25 years), were overweight or obese, smoked, were born in Australia, were non-Indigenous, gave birth in a public hospital, or were in the lowest socioeconomic status group were more likely to be provided with postpartum contraception after adjusting for other covariates, compared with their counterparts.ConclusionsStrategies to increase the provision and uptake of contraception in the immediate postpartum period are needed to prevent short birth intervals and unintended pregnancy and ensure women’s fertility intentions are enacted. Ongoing research is needed to examine the factors influencing women’s access to contraceptive services and, further, the types of contraception provided.

To determine the completion rate for the London Measure of Unplanned Pregnancy (LMUP), a psychometrically validated measure of a woman's intention with regard to a current or recent pregnancy, during booking visits at two metropolitan antenatal care clinics; to identify socio‐demographic characteristics associated with unplanned pregnancy. Retrospective cohort study; analysis of LMUP data for women attending antenatal care booking consultations as public patients in the Sydney Local Health District, 31 December 2019 – 30 November 2020. Proportions of women with LMUP scores indicating unplanned (0–9) or planned pregnancies (10–12); associations between planned pregnancy and socio‐demographic characteristics, crude and adjusted for age, parity, and socio‐economic status (Index of Relative Socioeconomic Disadvantage). Of 4993 women with antenatal care bookings, the LMUP was completed by 2385 (47.8%; 1142 of 3564 women at the tertiary referral hospital [32.0%], 1118 of 1160 at the secondary hospital [96.3%]). Planned pregnancies were indicated by the total LMUP scores of 1684 women (70.6%); 1290 women (59.1%) reported no health actions in preparation for pregnancy. In multivariable analyses, planned pregnancies were more likely in all age groups than for women aged 24 years or younger (30–34 years: adjusted odds ratio [aOR], 2.54; 95% confidence interval [CI], 1.76–3.66; 35–39 years: aOR, 2.91; 95% CI, 1.95–4.33). The likelihood of planned pregnancy declined with increasing parity (vno previous births: three previous births: aOR, 0.25; 95% CI, 0.16–0.40; four or more previous births: aOR, 0.10; 95% CI, 0.05–0.19). Seven in ten women who completed the LMUP had planned their pregnancies, but fewer than half had undertaken health‐related actions prior to conceiving. Higher parity was associated with unplanned pregnancy, indicating the importance of postpartum contraception advice. Overcoming barriers to implementing the LMUP more widely would enhance preconception health monitoring.

BackgroundWe are in the process of developing a new non-hormonal long-acting reversible method of contraception (LARC) in recognition of the fact that a significant minority of users are unhappy with their current method. Our method has a novel (post-fertilisation) mechanism of action (MOA), but little is known about the value users place on this.MethodsUsing in-depth interviews, we explored 30 Australian end-users’ experiences of contraception, recruited via social media. A thematic approach was taken to examine the influence the MOA has on choice and factors affecting willingness to try current methods and a novel non-hormonal LARC with a post-fertilisation effect.ResultsWe identified two themes that were the most salient across all interviews: that contraceptive decision-making involves a trade-off of priorities, influenced by contraceptive properties (including MOA) and the context in which contraception is used; and views on novel methods of contraception were influenced by willingness to trial new products and interest in non-hormonal options. Side effects, efficacy, and the financial burden of contraceptives were all considered more important than MOA during decision-making. Participants were willing to try a new method if endorsed by trusted sources, including friends and medical practitioners, and were enthusiastic to try a novel LARC with no hormones.ConclusionThis study found that the MOA had minimal impact on participants’ choice of contraception. Rather, avoidance of hormones and side effects influenced willingness to try a novel method over any unacceptable aspects of a post-fertilisation MOA.

BackgroundUnhealthy lifestyle is responsible for many chronic conditions, and antenatal engagement with women about lifestyle behaviours can be too late to prevent some adverse pregnancy outcomes and subsequent childhood risks. To reduce the risk of future adverse outcomes, the interconception period is an opportunity to implement positive health changes. The aim of this scoping review was to explore women’s needs for lifestyle risk reduction engagement during the interconception period.MethodsThe JBI methodology guided our scoping review. Six databases were searched for peer-reviewed, English-language research papers published between 2010 and 2021 on topics including perceptions, attitudes, lifestyle, postpartum, preconception and interconception. Title-abstract and full text screening was independently undertaken by two authors. Included papers’ reference lists were searched to find additional papers. The main concepts were then identified using a descriptive and tabular approach.ResultsA total of 1734 papers were screened and 33 met our inclusion criteria. Most included papers (82%, n=27) reported on nutrition and/or physical activity. Papers identified interconception through postpartum and/or preconception. Women’s self-management needs for lifestyle risk reduction engagement during interconception included: informational needs, managing competing priorities, physical and mental health, self-perception and motivation, access to services and professional support, and family and peer networks.ConclusionsThere is a range of challenges for women to engage in lifestyle risk reduction during interconception. To enable women’s preferences for how lifestyle risk reduction activities can be enacted, issues including childcare, ongoing and tailored health professional support, domestic support, cost and health literacy need to be addressed.

BackgroundSelf-managed medical abortions are generally safe; however, pharmacy provision of abortion pills is against the Ghanaian abortion law. Nevertheless, evidence shows increasing numbers of women use it. An understanding of the influence of the law on pharmacies dispensing abortifacients and women who needed hospital care after using these pills is lacking. This study aimed to address this gap.MethodsWe conducted 26 interviews with eight pharmacy workers and 18 women who sought hospital care after using abortion pills. Study participants were recruited from private pharmacies and hospitals within the Ashanti Region of Ghana between June 2017 and March 2018. We employed phenomenology in analysing the data.ResultsResults show that criminalising medical abortion care from pharmacies does not stop abortions but rather drives it to be provided without oversight. It also denied pharmacy workers formal training in medical abortion care, resulting in situations where they failed to provide correct dosage information, used their discretion in determining the price of abortifacients and to whom they would dispense the pills. For women, it contributed to limited interaction with providers and an inability to insist on their rights even in instances where the pills were sold at exorbitant prices.ConclusionsDue to the increasing numbers of Ghanaian women using medical abortion pills from pharmacies, although it is illegal, the ideal would be for medical abortion pills to be made legally available through pharmacies. Given that this may not occur in the short term, an immediate solution would be to upskill pharmacy workers.

BackgroundNearly half of women experience unintended pregnancies. These are associated with increased risk of poor maternal physical and psychosocial health outcomes. Many pregnancies in the first year postpartum are unintended, further increasing risks of poor outcomes and complications. We undertook a qualitative evidence synthesis to evaluate qualitative research on women’s views and preferences for accessing postpartum contraception, and identify evidence gaps and opportunities for postpartum contraception provision.MethodsFive databases were searched to identify relevant qualitative studies. Included studies focused on views of, and preferences for, accessing postpartum contraception for women of reproductive age in high-income countries.ResultsOf 1854 studies identified, 28 full texts were assessed and 19 studies included. These were critically appraised using Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) and analysed using thematic synthesis. Included studies indicated the majority of women desire postpartum contraception, but face a range of financial, health system and personal barriers. Women felt unclear about the ideal interpregnancy interval (IPI) and the rationale for this. Women preferred contraceptive counselling at varying times both antenatally and postnatally, and commonly preferred to receive contraception in the immediate postpartum period before hospital discharge. Women commonly saw their obstetrician or general practitioner for contraceptive counselling, but welcomed midwifery involvement.ConclusionsMost women were interested in postpartum contraception and pregnancy spacing, but felt unclear about the optimal IPI, highlighting the need for further education and support around this issue. Contraceptive counselling was viewed as valuable antenatally and postnatally, and by varying maternal health providers, as was the provision of immediate postpartum contraception.

BackgroundPregnancy planning and preconception care benefit women, their children, and future generations. The London Measure of Unplanned Pregnancy (LMUP) is a tool that can be used in antenatal care to identify women with unintended pregnancies who require improved access to such services. This tool was recently implemented into routine antenatal care in two maternity centres in New South Wales, Australia. This study explores midwives’ attitudes to the LMUP 12 months after it was introduced into the booking visit and their understanding of its application to their scope of practice.MethodsThis is a qualitative study using in-depth semi-structured interviews with midwives from two maternity care centres in Australia. All midwives performing antenatal booking visits were eligible to take part. Interviews were transcribed, analysed, and coded to define key themes. Recruitment ceased when thematic saturation was reached.ResultsTen midwives from two maternity centres were interviewed. Midwives support the inclusion of the LMUP into the booking visit and felt it was in their scope of practice to be using the tool. Time constraints, the impact of COVID-19 and the lack of structured referral pathways were identified as barriers to the implementation of the LMUP in routine care.ConclusionsMidwives support the inclusion of the LMUP into the antenatal booking visit and see that it falls within their scope of practice. Service barriers were identified at the individual, organisational and external context levels. These need to be addressed to enhance the potential of this tool.

Objective: Most Australian women access contraception through general practitioners (GPs) but choose oral methods rather than long‐acting reversible contraceptives (LARCS). The Australian Contraceptive ChOice pRoject (ACCORd) successfully tested a complex intervention for LARC uptake. We aimed to explore the critical elements of this intervention to increase LARC uptake. Design: ACCORd was a cluster randomised control trial conducted in 57 GP clinics in Melbourne, Australia. To explore intervention impact, fidelity checks (n=21 GPs) and interviews with 37 GPs and 40 patients were undertaken 12 months after initial consultations. Data were inductively coded, thematically analysed and mapped to Normalization Process Theory constructs. Results: Doctors understood the importance of effectiveness‐based contraceptive counselling (EBCC). GPs demonstrated cognitive engagement in the promotion of LARC and some appreciated the rapid referral pathways. GPs and women valued the effectiveness approach. GPs held varying views about having a rapid referral pathway, with many already having established pathways in place. Some GPs viewed intrauterine device insertion costs or insertion training as barriers to ongoing practice. Most GPs and women saw the ACCORD model as effective and sustainable. Conclusions: GP training in EBCC and the use of rapid referral pathways were critical features of an effective sustainable model for successful uptake of LARCs in primary care. Implications for public health: Improving Australian women's access to and use of LARCs is sustainable with EBCC training and support for general practitioners.

Most Australian women access contraception through general practitioners (GPs) but choose oral methods rather than long‐acting reversible contraceptives (LARCS). The Australian Contraceptive ChOice pRoject (ACCORd) successfully tested a complex intervention for LARC uptake. We aimed to explore the critical elements of this intervention to increase LARC uptake.

IntroductionDespite the knowledge of pregnancy risks attributable to inadequate birth spacing, over one-third of pregnancies occur within 18 months of a preceding birth. In this qualitative study we sought to interview women with a short interpregnancy interval (sIPI) to explore their knowledge of contraception and birth spacing and their experience of counselling on these themes.MethodsWe conducted in-depth interviews with women with a sIPI (live-birth less than 18 months prior to conception of current pregnancy) at Royal Prince Alfred Hospital and Canterbury Hospital in Sydney, Australia. Women were recruited at the second antenatal visit or day 3 postpartum. Interviews were recorded and transcribed. The six-phase thematic analysis framework described by Braun and Clarke was used to perform qualitative data analysis.ResultsTwenty women were interviewed (IPI range: 3–18 months). The three central themes that arose were that perceptions of IPIs are shaped by individual circumstances, a lack of information from healthcare providers (HCPs) on IPI and contraception limited women’s ability to make informed decisions, and that reproductive life planning is an important element of pregnancy care.ConclusionsIn this study, women with a sIPI did not feel informed about birth spacing, had poor knowledge of reliable contraceptives, and remained at risk of further closely spaced pregnancies. There was a desire among women with a sIPI to receive clear and consistent education on these topics. HCPs need to do more to educate women in the antenatal and postnatal period to help them space their pregnancies appropriately.

BackgroundUnsafe abortion is an important public health problem in Ghana, making significant contributions to the morbidity and mortality of reproductive-aged women. Although mostly used in explaining mortality associated with perinatal care, recent calls for research on induced abortion in Africa suggest that the Three Delays Model could be used to enhance understanding of women’s experiences and access to induced abortion care.MethodsWe conducted 47 face-to-face interviews with women who had experienced unsafe abortions, with formal abortion providers (abortion providers in hospitals) and with informal and non-legal abortion providers (pharmacy workers and herb sellers). Study participants were recruited from selected hospitals, community pharmacies and markets within the Ashanti region of Ghana. We drew on phenomenology to analyse the data.FindingsThe first delay (in seeking care) occurred because of women’s poor knowledge of pregnancy, the influence of religion, and as a result of women underestimating the seriousness of abortion complications. Factors including cost, provider attitudes, stigma, and the proximity of pharmacies to women’s homes delayed their access to safe abortion and resulted in their experience of the second delay (in reaching a healthcare facility). The third delay (in receiving appropriate care) was a result of hospitals’ non-prioritisation of abortion complications and a shortage of equipment, resulting in long hospital waiting times before treatment.ConclusionThis study has shown the value of the Three Delays Model in illustrating women’s experiences of unsafe abortions and ways of preventing the first, second and third delays in their access to care.

•Nepali women appear to have variations in pelvic floor muscle function.•Weaker and thinner pelvic floor muscles are not always associated with a greater stage of prolapse.•A larger hiatal area is associated with a greater stage of prolapse.

BackgroundMaternal mortality in Myanmar is one of the highest in the WHO South-East Asian region. Additionally, the country has a high unmet need for contraception and low rates of uptake of long-acting reversible contraceptive methods (LARCs) including intrauterine devices (IUDs) and implants. Engagement with health professionals around the time of a birth is an ideal opportunity for women to access contraception but immediate postpartum provision is not widely offered in Myanmar.MethodsWe undertook a cross-sectional survey of women immediately postpartum at two hospitals in Yangon to investigate their knowledge, and past use of, contraceptive methods and their plans for postpartum contraception including perceptions of implants and IUDs. Four trained obstetrics staff collected data using electronic tablets between January 2017 and January 2018.ResultsOf the 1755 participants, 55.1% had used pills and 42.2% injectables. In contrast, only 0.5% had used an IUD and 0.3% an implant. Few women (4.4%) anticipated starting contraception immediately postpartum and only a minority would consider future use of an implant (36.9%) or an IUD (13.0%). Fear of side effects was the major barrier to future implant and IUD uptake, reported by 64.5% and 62.5%, respectively.ConclusionsWomen in maternity care in Yangon have some awareness of IUDs and implants but many hold misconceptions about their side effects leading to reluctance to use. Reducing the unmet need for contraception and improving maternal outcomes in Myanmar could be achieved by improving education, policy and practice around immediate postpartum contraception provision, with a particular focus on LARC methods.

To report results of a community survey of NSW residents’ knowledge of current abortion law and views on abortion law reform.

Objective:To report results of a community survey of NSW residents’ knowledge of current abortion law and views on abortion law reform. Methods:A total of 1,015 men and women participated. Recruitment and questionnaires were completed anonymously online using survey panel sampling. Results:Seventy‐six per cent of respondents were unaware that abortion remains a criminal offence in the Crimes Act 1900(NSW) and 73% thought it should be decriminalised and regulated as a healthcare service. Support for decriminalisation was consistent across genders, age groups, residents of metropolitan/regional and rural areas and levels of education. Support was strong for women seeking abortion to be protected from harassment (89%) and for protester exclusion zones around clinics (81%), with support for these measures significantly stronger among regional/rural residents than Sydney‐based respondents. Conclusions:Abortion law in NSW is out of step with contemporary community views. Residents are largely unaware that it remains a criminal offence and, when informed, support decriminalisation. There is strong support for legal changes to protect women from harassment and to provide protester exclusion zones around abortion clinics. Implications for public health:Abortion law reform would reduce current inequities of access, be democratic and support women's autonomy and reproductive rights.

BackgroundShort interpregnancy intervals (IPIs) are associated with adverse obstetric outcomes. However, few studies have explored women’s understanding of ideal IPIs or investigated knowledge of the consequences of short IPIs.MethodsWe performed a prospective questionnaire-based study at two hospitals in Sydney, Australia. We recruited women attending antenatal clinics and collected demographic data, actual IPI, ideal IPI, contraceptive use, and education provided on birth-spacing and contraception following a previous live birth. We explored associations between an IPI <12 months and a selection of demographic and health variables.ResultsData were collected from 467 women, of whom 344 were pregnant following a live birth. Overall, 72 (20.9%) women had an IPI <12 months only 7.5% of whom believed this was ideal, and the remaining stating their ideal IPI was over 12 months (52.3%) or they had no ideal IPI (40.3%). IPI <12 months following a live birth was significantly associated with younger age (p=0.043) but not with ethnicity, relationship status, education, religion, parity nor previous mode of delivery. IPI <12 months was associated with non-use of long-acting reversible contraception (LARC) (p<0.001), breastfeeding <12 months (p=0.041) and shorter ideal IPI (p=0.03). Less than half of the women (43.3%, n=149) reported having received advice about IPI and less than half about postnatal contraception (44.2%, n=147).ConclusionsYounger age and non-use of LARC are significantly associated with IPIs <12 months. A minority of women with a short IPI perceived it to be ideal. Prevention of short IPIs could be achieved with improved access to postnatal contraception.

ABSTRACTWomen in Nepal who suffer from pelvic floor disorders often have limited access to health advice. In rural areas, auxiliary nurse midwives (ANMs) are responsible for maternal health counselling and services. We sought to investigate whether an educational workshop on pelvic floor muscle training (PFMT) for ANMs would improve their knowledge and enable them to correctly teach PFMT to community women. We invited ANMs from three rural regions in Nepal to attend 1-day training workshops. Using a structured questionnaire we assessed pre- and post-PFMT knowledge following a workshop. Subsequently, three ANMs were observed teaching PFMT to women with varied levels of supervision. A correct pelvic floor muscle (PFM) contraction was assessed with transabdominal real-time ultrasound. The Wilcoxon signed rank paired test was used to assess the change in knowledge. In total, 88 ANMs attended the three training workshops. Following the workshop, the mean change in knowledge scores increased by 18.5% (95% confidence interval (CI): 15.5–21.6%, p < 0.001). The three selected ANMs successfully taught 71%, 45% and 17% of the women to correctly contract their PFMs with greater supervision resulting in higher success. A workshop on PFMT significantly increased ANMs’ knowledge, and they were able to successfully teach PFMT when given additional one-on-one supervision. Teaching ANMs about PFMT may be a worthwhile strategy to reach women in rural settings who experience pelvic floor disorders.

Objective: To assess the feasibility and acceptability of integrating a contraception clinic within an opioid agonist treatment (OAT) service to improve access to contraception, especially long‐acting reversible methods of contraception (LARC), for women receiving OAT, who have increased risk of unplanned pregnancies and adverse pregnancy outcomes. Methods: A contraception clinic was established at a Sydney OAT service. Forty‐eight female OAT clients were surveyed regarding their contraception knowledge and needs. Interested and eligible women were referred to the contraception clinic. Results: Women were aged a median of 39 years (range 24–54 years). Most women (83%) agreed it was acceptable for their OAT clinician to discuss contraception with them. Eight women reported current LARC use and 21 reported they would consider using LARC. Twenty‐three women were eligible for contraception (sexually active, aged <50 years, not using contraception, wishing to avoid pregnancy). Six months post‐survey two women had presented to the clinic and two reported an unintended pregnancy. Conclusion: Uptake of an on‐site contraception service within OAT clinic was low, despite participants’ expressed willingness to use the service. Access is therefore not the only driver of low contraception uptake for this group. Implications for public health: Other issues besides access to contraception warrant investigation to improve contraception uptake for women receiving OAT.

To assess the feasibility and acceptability of integrating a contraception clinic within an opioid agonist treatment (OAT) service to improve access to contraception, especially long‐acting reversible methods of contraception (LARC), for women receiving OAT, who have increased risk of unplanned pregnancies and adverse pregnancy outcomes.

To examine access and equity to induced abortion services in Australia, including factors associated with presenting beyond nine weeks gestation.

Objectives:To examine access and equity to induced abortion services in Australia, including factors associated with presenting beyond nine weeks gestation. Methods:Cross‐sectional survey of 2,326 women aged 16+ years attending for an abortion at 14 Dr Marie clinics. Associations with later presentation assessed using multivariate logistic regression. Results:Over a third of eligible women opted for a medical abortion. More than one in 10 (11.2%) stayed overnight. The median Medicare rebated upfront cost of a medical abortion was $560, compared to $470 for a surgical abortion at ≤9 weeks. Beyond 12 weeks, costs rose considerably. More than two‐thirds (68.1%) received financial assistance from one or more sources. Women who travelled ≥4 hours (AdjOR: 3.0, 95%CI 1.2–7.3), had no prior knowledge of the medical option (AdjOR: 2.1, 95%CI 1.4–3.1), had difficulty paying (AdjOR: 1.5, 95%CI 1.2–1.9) and identified as Aboriginal and/or Torres Strait Islander (AdjOR: 2.1, 95%CI 1.2–3.4) were more likely to present ≥9 weeks. Conclusions:Abortion costs are substantial, increase at later gestations, and are a financial strain for many women. Poor knowledge, geographical and financial barriers restrict method choice. Implications for public health:Policy reform should focus on reducing costs and enhancing early access.

BackgroundContraception is a field in which good doctor–patient communication is crucial and core to shared decision making. Despite the centrality of contraception to primary health care in Australia, little is known about how doctors manage the contraceptive consultation. In particular, little is known about how doctors discuss sexual issues related to contraception.MethodsFifteen contraceptive providers participated in qualitative interviews averaging 45 min. Interviews were audio recorded, transcribed verbatim, and analysed using an inductive thematic approach.ResultsWe found doctors were aware that they had to modify their illness-based ‘scripts’ in consultations about contraception, and said it was challenging always to adhere to a shared model of decision making. Prescribing behaviour reflected personal preferences in relation to some forms of contraception, and doctors were enthusiastic about the levonorgestrel-releasing intrauterine system. Doctors identified gaps in training in relation to sexuality and reported feeling tentative in raising sexual issues, even within contraceptive consultations.ConclusionsA range of factors—including tendencies to use illness scripts, personal preferences, and discomfort with communications about sexuality—appear to influence doctors' approaches to contraceptive management. Medical training that enables doctors to move out of an illness-treating framework and to improve their understanding of and comfort in discussing sexuality issues will improve their management of healthy women seeking contraception.

ObjectiveFew studies have explored Australian women's understandings of contraception. This study examined the attitudes towards, and understandings of, the subdermal contraceptive implant expressed by women living in New South Wales (NSW), Australia.Study designAs part of a larger qualitative study using in-depth, open-ended interviews in 2012–2013 with women aged 16–49 years who had ever used contraception (n=94), 65 interviews from women who discussed or mentioned the subdermal implant, but had not previously used the device, were examined and analysed using thematic analysis.ResultsThe emergent themes were: satisfaction with current method; weak personal opinions and ambivalence; uncertainty due to specific concerns; and strong negative reactions – fear and dislike. Although there were a few positive perceptions expressed by women who had never used the subdermal implant, for the majority of women the perception was predominantly negative.Discussion and conclusionWomen tended to form negative impressions from the stories of other women about the subdermal implant. Interventions to enhance evidence-informed awareness of the relative advantages and disadvantages of the implant – for example, improved access to supportive contraceptive counselling – need investigation in the Australian context. Avenues to improve women's perceived control over the device could also be usefully investigated.