General practitioner experiences in delivering early medical abortion services to women from culturally and linguistically diverse backgrounds

Problem

Women from culturally and linguistically diverse (CALD) backgrounds have higher rates of unintended pregnancy than Australian-born women but underutilise sexual and reproductive health services. Consequently, the 2020-2030 Australian National Women’s Health Strategy has identified women from CALD backgrounds as a priority group for improving access to sexual and reproductive health care, including early medical abortion (EMA). Women commonly seek the counsel of general practitioners (GPs) for sexual and reproductive health concerns, making GPs ideally placed to deliver EMA services. However, little is known about how GPs should best deliver this care to women from CALD backgrounds. Our aim was to explore GP perspectives and experiences in providing EMA services to women from CALD backgrounds and their recommendations for service improvements.

Approach

A qualitative-descriptive study design was used. Semi-structured telephone interviews were conducted with 18 GPs nationwide who provide EMA to women from CALD backgrounds in the general practice setting. GPs were purposively sampled using three strategies: email invitations to publicly listed medical abortion providers, social media posts on a special interest Facebook group, and participant referral. Following verbatim transcription, reflexive thematic analysis was used to develop themes and subthemes, categorised according to the capability, opportunity, and motivation domains of the Capability-Opportunity-Motivation-Behaviour (COM-B) model.

Findings

GPs experienced challenges in communication and cultural competency because of insufficient training, lack of multilingual resources, and organisational constraints in effectively using interpreter services. Additionally, inadequate government reimbursement for EMA consultations, which contributes to high out-of-pocket costs for women, was identified as a financial impediment to care because women from CALD backgrounds tend to be more socioeconomically disadvantaged than the general population. Despite these challenges, GPs believed they are ideally positioned to provide EMA to women from CALD backgrounds since their embeddedness within communities facilitates the building of trusting provider-patient relationships.

Consequences

Up-skilling GPs in culturally competent care and cross-cultural communication, multilingual patient education resources, and efficient systems for interpreter use can optimise EMA service provision to women from CALD backgrounds. Additionally, dedicated government funding for EMA provision will help overcome financial barriers to patients accessing care.