Rural sexual and reproductive health and rights: An exploration of the experiences of consumers and providers navigating a rural health system for unintended pregnancy and abortion care in Australia

Abstract

Background

Access to safe abortion and pregnancy planning are indicates of sexual and reproductive health and rights (SRHR) Despite Australia’s sophisticated public health system, equitable access to reproductive health services including abortion care remains a significant challenge for rural populations.

Methods

This PhD uses multiple methods to explore the complexities of health service access for unintended pregnancy and abortion care in rural Australia. A quantitative study uses the London Measure of Unplanned Pregnancy (LMUP) tool and online surveys to estimate the prevalence of unintended pregnancy and abortion consideration among antenatal care recipients in rural NSW. Two parallel qualitative studies explore the experiences of rural consumers and primary care providers in negotiating the local health system for early pregnancy and abortion care, employing semi-structured interviews and inductive thematic analysis to identify themes.

Results

The quantitative study findings indicate 32% of all antenatal care participants had an unintended pregnancy, and statistically significant association between unintended pregnancy and abortion consideration. The consumer-focused qualitative study describes complex, compounding and uniquely rural challenges to accessing abortion care, and strong consumer expectations about SRHR. The third study highlights the structural and professional obstructions within the health system that either inhibit or diminish the provision of abortion care in rural Australia.

Conclusion

This thesis demonstrate equivalent prevalence of unintended pregnancy compared to other Australian settings, yet a far more complex and fragmented health service environment where rural abortion care is both hard to find and hard to provide. Findings demonstrate how abortion access in rural Australia is entangled by two sets of intersecting challenges: abortion exceptionalism in mainstream health services and a severely under-resourced rural health system.