Background and Objective:
Universal access to safe abortion is key to upholding sexual and reproductive health and rights. However, abortions at 20 weeks and over for psychosocial reasons are highly stigmatised and particularly difficult to access. The Abortion and Contraception Service (ACS) at the Royal Women’s Hospital is the only service in Victoria, Australia that provides these abortions, and little is known about healthcare providers’ experiences in providing this care. This study aimed to examine healthcare provider perspectives and experiences in providing abortion care at 20 weeks and over, and how the quality of care might be improved.

Methods:
An exploratory qualitative study was conducted. Healthcare providers of abortion at 20 weeks and over for psychosocial reasons were recruited from the ACS, Royal Women’s Hospital. In-depth, semi-structured interviews were conducted with participants from May to June 2022 by researchers experienced in trauma-informed care. Data were analysed by reflexive thematic analysis using NVivo software.

Results:
Participants included 13 healthcare providers from medicine, nursing, midwifery, social work and Aboriginal clinical health backgrounds. Four themes were identified: ‘Delivering quality care’, ‘Strengthening the service’, ‘Being an abortion provider is challenging’, and ‘Navigating a complex environment’. Participants perceived the care provided as patient-centred and timely, but noted barriers to care including understaffing, difficulty maintaining a sustainable workforce, and the absence of similar services state-wide. Personal challenges faced by participants included the emotional toll and ethical considerations of their work, but they felt well-supported by the wider team.

Conclusion:
Further research exploring the care experiences of providers and service users of abortion at 20 weeks and over for psychosocial reasons is required to support these findings. There is an urgent need for supportive policies and frameworks to expand provision of affordable, acceptable and accessible abortions at 20 weeks and over in Victoria, and Australia more widely.