specialty focus
Equal access
The case for nurses to be more involved in providing abortion care .
Lydia Mainey interviewed by Elise Hartevelt
An expert says Australian abortion legislation is hindering people seeking access to those services , and suggests nurses and midwives should be more involved .
CQUniversity academic Lydia Mainey , who specialises in abortion care and gender-based violence , says a change in abortion laws is needed to enable nurses and midwives to perform procedures as well .
Currently , most states mandate the approval of two GPs and the procedure can only be performed by a medical practitioner .
“ If you ’ ve only got one GP in the community who ’ s pro-choice and everybody else is anti-abortion , it ’ s a huge stumbling block for access to abortion ,” she says .
During her PhD research , she found that nurses and midwives sometimes pretended to be a medical provider to sign the referral so people could have the procedure .
Nursing Review had a conversation with Lydia about what needs to change to improve access to abortion services .
16 | nursingreview . com . au
NR : Why are you calling for a rethink on abortion services offered in Australia ? LM : Abortions are probably the most commonly performed gynaecological procedure in Australia . One in four pregnancy-capable people will have an abortion in their lifetime in this country . So it ’ s very , very common , but unfortunately access to abortion care is a bit of a rigmarole at the moment .
People disadvantaged by socioeconomic status , because they live in regional or remote areas , or even if they live in metropolitan areas but find it difficult navigating transport systems , etc , have real access barriers to abortion care .
The only people who can provide abortions in Australia in most states are medical practitioners , ie doctors . This would be greatly relieved if nurses and midwives , with the appropriate amount of training and credentials , could also provide abortion care .
It will particularly open it up to the regions because there are far more nurses and midwives there than doctors . In the regions doctors tend to rotate in and out , whereas nurses , generally speaking , tend to come from the communities , so it ’ s a more stable workforce . If you get a nurse or midwife in the community who can provide medical or surgical abortions , then it ’ s likely to be a service that can be provided long term .
“ We ’ re putting nurses and midwives in really precarious situations .
I ’ ve done a scoping review of the global literature on the nurse and midwives ’ scope of practice in abortion care , and Australia has a very conservative scope of practice .
In developing countries surgical abortion is performed by trained auxiliaries : they don ’ t have as high education levels as nurses and midwives , and these are safe and effective .
Surgical termination or abortion performed by nurses and midwives who are appropriately trained has been studied extensively . The findings are that it is at least as safe and effective as surgical abortions performed by medical staff .
If nurses and midwives can do a pap smear , if they can insert an intrauterine device , they ’ ve already got most of the skills that they need to be able to perform an abortion .
They need upskilling certainly , and they need somebody to train and preceptor them , absolutely . But there is potential for them to be providers of surgical abortion . Nurses and midwives are as safe and effective at providing medical abortion as a medical provider .