Termination of pregnancy in Queensland post-decriminalisation: a content analysis of client records from an all-options pregnancy counselling organisation

Abstract

Background Termination of pregnancy (ToP) was decriminalised in Queensland, Australia, in December 2018. Although approximately 14 000 terminations are performed in Queensland annually, decriminalisation had addressed a known barrier to ToP access by supporting the legal right to access and enabling safe and regulated public pathways to ToP care. The post-decriminalised ToP experience in Queensland is unknown. Therefore, this study explored the reported reasons clients access information and support from an all-options pregnancy counselling service in Queensland with the aim of identifying the facilitators and barriers accessing ToP that remain post-decriminalisation in Queensland. Methods A two-part qualitative conventional and directed content analysis approach guided by the Socioecological Model was used to examine counsellor notes on interactions with clients (n = 1933) between December 2018 and June 2020 at an all-options pregnancy counselling service in Queensland. Findings Key reasons for contacting the service were for financial assistance, ToP information, and support for decision making. Facilitators and barriers affecting ToP access interconnected across the Socioecological Model levels highlighting affordability, violence, stigma, knowledge, and information as key factors influencing ToP access post-decriminalisation in Queensland. Conclusions Inclusive multisectoral action to support reproductive autonomy is needed in Queensland. Following decriminalisation, cost, stigma, and intimate partner violence continue to impede access to safe, compassionate, and timely abortion care. Future models of care must eliminate these barriers by developing public models of service provision, investing in workforce development, fully utilising the capacity of that workforce, and creating stronger connections between sexual and reproductive health and intimate partner violence services.