Original research article| Volume 100, ISSUE 5, P380-385, November 2019

Expert consensus on a nurse-led model of medication abortion provision in regional and rural Victoria, Australia: a Delphi study



      To develop a nurse-led model of medication abortion provision for the primary health care setting of regional and rural Victoria, where, despite decriminalization, access to abortion services is restricted.

      Study design

      This study used a three-round Delphi process to explore consensus about a nurse-led medication abortion model. We recruited a panel consisting of physicians, nurses and other experts involved with or interested in medication abortion provision. The research team thematically analyzed the responses to the seven open-ended questions of the first questionnaire. In subsequent rounds, panelists rated the 83 generated statements for agreement, using feedback and statistical summaries.


      A total of 24 panelists participated; 17 completed all three rounds. Through the iterative process, the panel reached consensus (at least 75% agreement level) on 69 statements, relating to model construction and the barriers to model implementation and their solutions. Due to current health care system restrictions we not only developed a ‘fully autonomous’ nurse-led model, but also a ‘legally feasible’ model. For nurses working in primary health settings that lack GP support we additionally constructed an ‘absence of a (medication abortion supportive) general practitioner’ model.


      Nurse-led medication abortion provision is a recognized strategy to improve access to equitable, affordable and safe abortion services for women residing in underserved areas. The constructed models and recommendations for practice and policy can serve as a guide to expand the role of primary health care nurses in the provision of medication abortion in Victoria and beyond.


      The findings of this study indicate that a nurse-led model of medication abortion provision is feasible in service poor areas of Victoria and that model implementation has the potential to improve abortion access. The models are adaptable for use in other settings.


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        • Baird B.
        Medical abortion in Australia: a short history.
        Reprod Health Matters. 2015; 23: 169-176
      1. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. The use of mifepristone for medical abortion. C-Gyn 21. East Melbourne: RANZCOG; 2019.

      2. Regional Development Victoria. Victoria's Regions. Melbourne: Victoria State Government; 2018.

        • Australian Bureau of Statistics
        Australian demographic statistics, Sep 2018.
        ABS, Canberra2019
      3. Abortion Law Reform Act 2008 (Vic).

        • de Moel-Mandel C.
        • Shelley J.M.
        The legal and non-legal barriers to abortion access in Australia: a review of the evidence.
        Eur J Contracept Reprod Health Care. 2017; 22: 114-122
        • Australian Institute of Health and Welfare
        Rural, regional and remote health: A guide to remoteness classifications AIHW cat no PHE 53.
        AIHW, Canberra2004
        • Dawson A.J.
        • Nicolls R.
        • Bateson D.
        • Doab A.
        • Estoesta J.
        • Brassil A.
        • et al.
        Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study.
        Reproductive health. 2017; 14: 39
        • World Health Organization
        Health worker roles in providing safe abortion care and post abortion contraception.
        World Health Organization, Geneva2015
      4. Barnard S, Kim C, Park MH, Ngo TD. Doctors or mid-level providers for abortion. Cochrane Database of Systematic Reviews, Issue 7; 2015.

        • Tomnay J.E.
        • Coelli L.
        • Davidson A.
        • Hulme-Chambers A.
        • Orr C.
        • Hocking J.S.
        Providing accessible medical abortion services in a Victorian rural community: a description and audit of service delivery and contraception follow up.
        Sex Reprod Healthc. 2018; 16: 175-180
      5. Australian Nursing and Midwifery Federation. National practice standards for nurses in general practice. Melbourne: Australian Nursing and Midwifery Federation; 2014.

      6. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. The use of mifepristone for medical termination of pregnancy. C-Gyn 21. East Melbourne: RANZCOG; 2016.

      7. Belton S. Models of telehealth abortion: what works in regional, rural and remote Australia? Sexual health symposium: abortion: 2017 and beyond. Canberrra2017.

        • Aiken A.R.
        • Broussard K.
        • Johnson D.M.
        • Padron E.
        Motivations and experiences of people seeking medication abortion online in the United States.
        Perspect Sex Reprod Health. 2018; 50: 157-163
        • Hsu C.-C.
        • Sandford B.A.
        The Delphi technique: making sense of consensus.
        Pract Assess Res Eval. 2007; 12: 1-8
        • Keeney S.
        • Hasson F.
        • McKenna H.
        Consulting the oracle: ten lessons from using the Delphi technique in nursing research.
        J Adv Nurs. 2006; 53: 205-212
      8. Qualtrics. Qualtrics. May 2017 ed. Provo, Utah, USA2015.

        • Skulmoski G.
        • Hartman F.
        • Krahn J.
        The Delphi method for graduate research.
        Journal of Information Technology Education: Research. 2007; 6: 1-21
        • QSR International
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qual Res Psychol. 2006; 3: 77-101
      9. The Royal College of Obstetricians and Gynaecologists. Abortion care: Our responsibility. O&G Magazine. Spring ed. London: The Royal College of Obstetricians and Gynaecologists 2017.

        • Corp I.B.M.
        IBM SPSS statistics for windows.
        22 ed. Armonk, NY, IBM Corp2013
        • Department of Health
        The September 2017 Medicare benefits schedule.
        Australian Government Department of Health, Canberra2017
      10. Therapeutic Goods Administration. Registration of medicines for the medical termination of early pregnancy. Canberra: Australian Government Department of Health; 2012.

      11. Nursing and Midwifery Board of Australia. Registered nurse and midwife prescribing – Discussion paper. Melbourne: NMBA; 2017.

        • Department of Health
        Abortion statistics, England and Wales: 2016.
        UK Department of Health and Social Care, London2017
        • Department of Health and Human Services
        Women's sexual and reproductive health - key priorities 2017–2020.
        Victoria Department of Health and Human Services, Melbourne2017
        • Ganatra B.
        • Guest P.
        • Berer M.
        Expanding access to medical abortion: challenges and opportunities.
        Reprod Health Matters. 2015; : 1-3
        • Levandowski B.A.
        • Kalilani-Phiri L.
        • Kachale F.
        • Awah P.
        • Kangaude G.
        • Mhango C.
        Investigating social consequences of unwanted pregnancy and unsafe abortion in Malawi: the role of stigma.
        Int J Gynecol Obstet. 2012; 118
        • Lipp A.
        Stigma in abortion care: application to a grounded theory study.
        Contemp Nurse. 2011; 37: 115-123
        • Lokeland M.
        • Iversen O.E.
        • Engeland A.
        • Okland I.
        • Bjorge L.
        Medical abortion with mifepristone and home administration of misoprostol up to 63 days' gestation.
        Acta Obstet Gynecol Scand. 2014; 93: 647-653
        • Kapp N.
        • Grossman D.
        • Jackson E.
        • Castleman L.
        • Brahmi D.
        A research agenda for moving early medical pregnancy termination over the counter.
        BJOG. 2017; 124: 1646-1652
        • Costescu D.
        • Guilbert E.R.
        • Bernardin J.
        • Black A.
        • Dunn S.
        • Fitzsimmons B.
        • et al.
        Medical abortion.
        J Obstet Gynaecol Can. 2016; 38: 366-389
        • World Health Organization
        Safe abortion: Technical and policy guidance for health systems.
        2th ed. World Health Organization, Geneva2012