"Almost like it was really underground": a qualitative study of women's experiences locating services for unintended pregnancy in a rural Australian health system.

Rural women in Australia are more likely than urban women to experience unintended pregnancy, yet little is known about how this issue is managed in a rural health setting. To address this gap, we conducted in-depth interviews with 20 women from rural New South Wales (NSW) about their unintended pregnancy. Participants were asked about accessing healthcare services and what was uniquely rural about their experience. The framework method was used to conduct an inductive thematic analysis. Four themes emerged from the data: (1) fragmented and opaque healthcare pathways, (2) a limited number of willing rural practitioners, (3) small town culture and community ties and (4) interrelated challenges of distance, travel and money. Our findings highlight how pervasive structural issues related to accessibility of health services intersect with small-town culture to create compounding obstacles for rural women, especially those seeking an abortion. This study is relevant to other countries with similar geographies and models of rural healthcare. Our findings point to the necessity for comprehensive reproductive health services including abortion to be an essential - not optional - part of healthcare in rural Australia.

What women want from local primary care services for unintended pregnancy in rural Australia: a qualitative study from rural New South Wales.

BACKGROUND: Under the generalist model of health care in rural Australia, general practitioners (GPs) are often the first point of contact for women seeking health services for unintended pregnancy, including pregnancy decision-making support and options advice, antenatal or abortion care. Rural women are more likely to experience unintended pregnancy in Australia, yet little is known about how well local rural primary healthcare services currently meet their needs. METHODS: To address this gap, this qualitative study explores through in-depth semi-structured interviews, the experiences of 20 rural women managing an unintended pregnancy, and their expectations of, and satisfaction with, the quality of care they received. The Framework Method was used to organise data and conduct an inductive thematic analysis. RESULTS: Three themes related to management of unintended pregnancy in a rural primary care setting were identified: (1) women expect informed and efficient care once services are reached; (2) women desire greater choice and aftercare; and (3) comprehensive reproductive health should be part of rural primary care. Participants indicated an awareness of the limitations of the rural health system, yet a firm expectation that despite access delays, all of their reproductive health needs would be met. Choice, time efficiency, and aftercare were identified as gaps in the current primary care service experience. A desire for greater attention to rural reproductive health, including improved contraception, was also emphasised. CONCLUSIONS: Rural women with unintended pregnancy experienced gaps in service quality and described a lack of woman-centred care in their local rural health setting. This study offers insight into how rural primary care providers can better support women to make decisions about and reach their preferred services for unintended pregnancy.