Professor Kirsten Black Academic gynaecologist at the University of Sydney , NSW .

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This information was correct at the time of publication : 6 December 2024

EPIDEMIOLOGY OF UNPLANNED PREGNANCY AND ABORTION

IT is estimated that about two-fifths of

all pregnancies in Australia are unintended . 1 Younger women , those in rural areas and those experiencing socioeconomic disadvantage are at greater risk . 1 , 2 However , rates of unintended pregnancy and abortion are not routinely or systematically collected or counted in Australia at a national level , and only some states record abortion data . 3

For the period 2015-19 in Australia , the abortion rate was about 15 abortions per 1000 women of reproductive age ; this has steadily been decreasing over the past 10 years , from 20 abortions per 1,000 in 2005-09 . 4 These figures include a small proportion of planned pregnancies that result in abortion because of fetal or maternal medical reasons . 5

There are two types of abortion methods available in Australia . These are medical abortion , also called medical termination of pregnancy , and

surgical abortion , also called surgical termination of pregnancy . In 2012 , Australia became one of the last high-income countries in the world to approve the use of mifepristone for medical abortion . 6 Since 2012 , while the overall abortion rate appears to be declining , the proportion of surgical procedures has been falling , while the proportion of medical abortions has risen , as has occurred in other settings . 7 , 8

This How to Treat covers abortion in the first trimester and aims to ensure GPs understand the key issues around surgical and medical abortion counselling and provision .

UNINTENDED PREGNANCY

UNINTENDED pregnancy is not synonymous

with unwanted pregnancy . More than half of women with unintended pregnancy carry the fetus to term and raise the child . 9 It is therefore important not to make assumptions about the woman ’ s intentions and to approach counselling with a supportive , non-judgemental tone ,

and with the understanding that for many the situation may be causing stress and anxiety .

Opening with a neutral question like “ How do you feel about the pregnancy ?” provides the space for a woman to express her feelings .

Exploring her thinking with “ Do you know what your options are ?” or “ What are your thoughts about parenting / adoption / abortion ?” can help the clinician further assess the situation and often leads the woman to identify a personal option early . 10

Some women will benefit from referral to a counsellor to clarify their decision .

Enquiring about a woman ’ s social supports , including asking her who she has told about the pregnancy and what reactions she has received , may help identify those in need of additional resources and those at risk of reproductive coercion . Screening for domestic violence is important , using tools such as the NSW Health questions ( see box 1 ). Exploring risk of abuse with questions about the woman ’ s feelings for the partner with whom she conceived

Box 1 . Screening for domestic violence

1 . Within the past year have you been hit , slapped or hurt in other ways by your partner or ex-partner ?

2 . Are you frightened of your partner or ex-partner ? If YES to either 1 or 2 : 3 . Are you safe to go home when you leave here ? 4 . Would you like some assistance with this ? Source : Safer Families 2023 11

the pregnancy , and the age of the partner , can help to identify those at risk .

It is critical that the woman understands that the choice regarding the management of an unintended pregnancy is hers to make . Although others may be affected , she should not be forced into any decision . Understanding whether adolescents are receiving support from their parents and , if they are under 16 , whether they are ‘ Gillick competent ’ ( that is , mature enough