Clinician views and experiences with reproductive coercion screening in a family planning service.

BACKGROUND: Reproductive coercion refers to behaviour that interferes with a person's reproductive autonomy, such as contraceptive sabotage, pregnancy coercion, controlling a pregnancy outcome or forced sterilisation. Routine screening for reproductive coercion, together with clinician education, was implemented at a family planning service in New South Wales, Australia, in December 2018. A study was undertaken to explore the views and experiences of clinicians in undertaking reproductive coercion screening at this service. METHODS: Clinicians were invited to complete an online survey and interview to discuss their understanding of reproductive coercion and their views and experiences of undertaking reproductive coercion screening. Descriptive and thematic content analysis was conducted. RESULTS: Clinicians deemed reproductive coercion screening to be relevant and important in family planning services. Key barriers to reproductive coercion screening and responding to disclosures included time constraints and limited appropriate referral pathways. Ongoing education and training with resources such as a decision-support tool on reproductive coercion screening and management, as well as effective multi-disciplinary collaboration, were identified as strategies to improve the screening program. CONCLUSIONS: Findings from our study highlight that clinicians' perceived reproductive coercion screening as a relevant and important component of sexual and reproductive healthcare. Ongoing reproductive coercion education, training and support would ensure the competency and confidence of clinicians undertaking screening. Identifying appropriate referral pathways with multi-disciplinary collaboration (involving clinicians, social workers, support workers and psychologists) would support clinicians in undertaking screening and responding to disclosures of reproductive coercion in Australian health care settings which provide family planning and sexual and reproductive health services.

Impact of policy changes of Medicare-rebated telehealth services on medical abortions provided at a family planning service during the coronavirus (COVID-19) pandemic.

This study reviewed data on the mode of delivery of medical abortion care (via face-to-face or telehealth) at a Family Planning service during the coronavirus (COVID-19) pandemic; April 2020 to March 2022. This was considered over time, in the context of changing eligibility criteria for Medicare-rebated telehealth services as well as patient demographic data. The study demonstrated that when Medicare rebates for telehealth are available for all those requiring abortion care, telehealth contributes to care provision alongside face-to-face services, and is more likely to be utilised by people living in regional and remote areas.

Outcomes of routine screening for reproductive coercion in a family planning service.

Background Reproductive coercion (RC) occurs when a person's autonomous decision-making regarding reproductive health is compromised by another. RC screening, that is, the use of routine, non-invasive screening questions asked of service users/clients, is one strategy that can be used to assess for RC. Routine screening for RC was implemented within Family Planning NSW clinical consultations in December 2018. A cross-sectional study was undertaken to review the outcomes of screening to better understand the situation of RC among women accessing family planning services. Methods A retrospective review of clinical consultation data of eligible women attending Family Planning NSW clinics in 2019 was undertaken. Descriptive analysis was conducted and modified Poisson regression was used to estimate prevalence ratios and assess associations between binary outcomes and client characteristics. Results Of 7943 women eligible for RC screening, 5497 were screened (69%) and 127 women (2.3%) disclosed RC. RC was more likely to be disclosed among clients who were unemployed, had a disability or had more than one visit within 1 year. Conclusions Sexual and reproductive health clinicians, in particular, are well placed to conduct RC screening. However, they must have adequate training and access to resources to implement screening and respond to women who disclose RC.

Use of Royal Darwin Hospital emergency department by immigration detainees in 2011.

OBJECTIVE: To describe the number and nature of emergency department (ED) attendances by immigration detainees in Darwin, in the Northern Territory, over a 12-month period. DESIGN AND SETTING: Retrospective observational study of immigration detainees attending the Royal Darwin Hospital ED during the 2011 calendar year. MAIN OUTCOME MEASURES: Number of ED attendances and primary diagnoses. RESULTS: In 2011, there were 770 ED attendances by 518 individual detainees at Royal Darwin Hospital. Those who attended the ED had a mean (SD) age of 27.6 (12.2) years, and 112 of them (21.6%) were children. Most (413, 79.7%) were male, and Iran and Afghanistan were the two most common countries of birth. We estimate that 50.1% (95% CI, 47.0%-53.2%) of immigration detainees in Darwin (mean, 776 per month; total, 1034), attended the Royal Darwin Hospital ED at least once in 2011. The most common primary diagnosis was psychiatric problems (187 attendances, 24.3%), including self-harm (138 attendances, 17.9%). CONCLUSION: In 2011, asylum seekers in immigration detention in Darwin had a high prevalence of unmet health needs and substantial levels of psychiatric morbidity. The primary health care provided to them was inadequate.

Long-acting reversible contraceptives: New evidence to support clinical practice.

BACKGROUND: General practice plays a key role in providing access to contraceptive options to reduce unintended pregnancies. The use of long-acting reversible contraceptives (LARCs) is increasing in Australia. OBJECTIVE: The aim of this article is to provide an update on new evidence and guidance relating to clinical practice for LARCs. DISCUSSION: A new Pharmaceutical Benefits Scheme-listed hormonal intrauterine device (IUD), as well as updated guidelines for LARC provision and use, are reviewed. The 19.5 mg levonorgestrel IUD provides a smaller, lower-dose hormonal IUD. This article compares IUDs now available in Australia to support informed patient choice. Updated guidance for IUD users in perimenopause, as well as those using menstrual cups, is outlined. The contraceptive hormonal implant has updated product information, which includes new insertion site and arm positioning for procedures.

Medical Abortion before Confirmed Intrauterine Pregnancy: A Systematic Review.

"Very early medical abortion" (VEMA) refers to medical abortion (with mifepristone and misoprostol) before intrauterine pregnancy is visualized on ultrasound. Our aim is to present the current evidence on efficacy, safety (focused on ectopic pregnancies), and how to assess treatment success of VEMA. We conducted a systematic review of studies reporting outcomes of VEMA. The field is small and so our objective was to map all relevant literature, without conducting meta-analysis. We searched PubMed, Medline, and Embase on April 19, 2022. We conducted a narrative synthesis of the evidence. A total of 373 articles were identified. Six articles (representing four observational and one pilot trial) were included in the final review. Across all included studies, treatment efficacy ranged between 91 and 100%. Prevalence of ectopic pregnancy was low and very few cases (n = 2) of ruptures were reported. Most studies used serial serum human chorionic gonadotrophin (s-hCG) levels to determine success of abortion; one study used low sensitivity urine hCG. From the available evidence, VEMA appears to be efficacious and does not appear to cause harm to ectopic pregnancies. Treatment can be assessed with pre- and postabortion s-hCG. Good quality, randomized controlled trial evidence is needed to best inform practice.