Most health professionals working in sexual and reproductive health care perceive that nurse-led models of care are viable and acceptable, although doctors feel there are additional benefits to the current doctor-led model, and self-administered abortion is overwhelmingly perceived as unsafe.
Key Findings
Results
Attitudes towards both doctor-led and nurse-led models of abortion care were overwhelmingly positive among health professionals working in sexual and reproductive health.
Survey included doctors, nurses/midwives, and administrative staff working in primary care in Australia
ANOVAs were used to compare favourability ratings and attitude strength across professional groups
Qualitative data was thematically analysed using Leximancer software
Results
Doctors perceived doctor-led care more favourably than other health professionals did.
Doctors felt doctor-led care provides a more holistic and safer experience compared to other models
Doctors believed doctor-led care opportunistically facilitated discussions about other sexual and reproductive health matters
Differences in favourability ratings across professional groups were compared using ANOVAs
This difference in perception represents a potential attitudinal barrier to transitioning to alternate models of care
Results
Self-administered abortion care was perceived unfavourably by approximately 60% of participants and was associated with significant safety concerns.
Approximately 60% of participants perceived self-administered care unfavourably
Self-administered care was associated with 'significant safety concerns' across participant groups
The paper describes self-administered abortion as being 'overwhelmingly perceived as unsafe'
This was the most negatively received of the three models assessed
Conclusions
Nurse-led models of abortion care were considered viable and acceptable by most health professionals in sexual and reproductive health.
The acceptability of nurse-led care was broadly supported across professional groups
Nurse-led care models were identified as potentially able to increase access to safe abortion in Australia
The study explored three distinct models: doctor-led, nurse-led, and self-administered care
Alternate models including nurse-led care are 'increasingly seen as viable alternatives' to doctor-led abortion care
Background
Attitudes of health professionals towards the leadership of different abortion care models can serve as a barrier to changing current models of care.
The study was motivated by recognition that attitudinal barriers among health professionals can impede adoption of alternate care models
Abortion care in Australia is typically undertaken by doctors, with nurse-led care representing an alternate model
Professional group differences in attitudes (particularly doctors rating doctor-led care more favourably) highlight this barrier
The mixed methods survey was designed specifically to explore these attitudinal differences across professional roles
What This Means
This research suggests that most health professionals working in sexual and reproductive health in Australia view nurse-led abortion care as a safe and acceptable alternative to the current standard of doctor-led care. Using a survey that combined numerical ratings and open-ended responses, the researchers found broad support for both doctor-led and nurse-led models among doctors, nurses/midwives, and administrative staff. However, doctors tended to rate doctor-led care more favorably than other staff did, believing it offers a more thorough and holistic experience and provides natural opportunities to discuss other reproductive health topics.
The study also found that self-administered abortion care — where a patient manages the process largely on their own — was viewed negatively by about 60% of participants, with widespread concerns raised about safety. This suggests that while health professionals are open to expanding who delivers abortion care, they remain cautious about models that reduce clinical oversight entirely.
This research matters because access to abortion services in Australia can be limited by workforce shortages and geography. If nurse-led models are acceptable to health professionals, expanding these models could help more people access safe abortion care, particularly in areas with fewer doctors. The finding that doctors still prefer the current model suggests that any transition to nurse-led care may require engagement with the medical profession to address their specific concerns about holistic care and safety.
Sheeran N, Jones L, Corbin B, Melville C. (2024). Attitudes towards models of abortion care in sexual and reproductive health: perspectives of Australian health professionals.. Australian journal of primary health. https://doi.org/10.1071/PY24100