Table 1

Major categories, key concerns and participant quotes from discussion forum posts relating to long-acting reversible contraception and early medical abortion

Category and key concernsSupporting participant quotes from posts
1. Clinical knowledge
  1. EMA side effects and complications

  2. Decision-making around contraceptive choice

  3. LARC duration of use

  4. Precautions and contraindications to LARC

  5. Strategies for LARC insertion/removal

  6. LARC risks and side effects

“I am looking for some latest evidence behind giving Anti D [after EMA] for Rh neg blood group, there seems to be mixed medical opinions.” [Nurse, provides EMA]
“Any tips for inserting IUDs in nulliparous young women? Last fortnight I had two consecutive young women in whom I was unable to insert a [hormonal] IUD due to not being able to get the sound through a tight cervix. … is [there] anything else I could try?” [GP, inserts IUDs]
2. Training and upskilling
  1. EMA training courses

  2. Gaining formal qualifications in sexual health

  3. Training in point-of-care ultrasound

  4. LARC insertion training

  5. Maintaining competency in IUD insertion

“Has anyone done a GP early pregnancy ultrasound course? My clinic has an ultrasound machine so I'd love to do a course to provide dating/location scan for EMA provision.” [GP, does not provide EMA]
“I am looking for guidance about how many IUDs a GP is required to insert per year to maintain competence? … I work only part time and feel that losing my competency is likely as I may only do a handful per year.” [GP, does not insert IUDs]
3. Tools for practice
  1. Clinical guidelines

  2. List of local providers/dispensers of EMA

  3. Medical software templates

  4. Patient educational resources

  5. Instruments for IUD insertion/removal

“I cannot find the … guidelines for RPOC [retained products of conception], can you point me in the right direction?” [GP, does not provide EMA]
“Hi all, I wondered whether or not any of you have any experience in using any handy tools to help retrieve strings that are curled up within the cervical canal in a GP setting? I have tried the [endocervical sampling brush] but find I only have occasional success with it!” [GP, inserts IUDs]
4. Service implementation
  1. Establishing relationships with EMA providers

  2. Funding and fee structure for LARC and EMA

  3. Models of care for LARC and EMA services

  4. Task-sharing in LARC and EMA services

“I am a nurse that provides [EMA] counselling. A consult can be anywhere from 10 min to ~30 min … This is all before they see the GP! I discuss consult costs and routine follow-up … and send reminders.” [Nurse, provides EMA]
“I am wondering what most people do when following up a patient post-IUD insertion. Do you do a string check after 4–6 weeks or a formal ultrasound by Radiology to check IUD placement?” [GP, inserts IUDs]
5. Ethical issues
  1. Managing patient and clinician stigma

  2. LARC and EMA care for vulnerable groups

  3. LARC insertion in adolescent patients

  4. Reproductive coercion

  5. Patient autonomy around contraceptive choice

“I remind myself it isn’t my place to judge whether they have one abortion or ten, and whether they will accept contraception or not … we need to concentrate on providing safe medical service not MORAL services.” [GP, provides EMA]
“We began screening for both intimate partner violence [IPV] and reproductive coercion [RC] … we can offer hidden options for contraception if that’s wanted…” [Nurse, inserts contraceptive implants and IUDs]
6. Health system and regulatory issues
  1. Abortion referral pathways

  2. Conscientious objection to abortion

  3. Patient cost for abortion care

  4. Legislative changes impacting abortion access

  5. Reporting to child protection services

  6. Contraceptive availability/shortage

“Can I ask if the pharmacy then just charges the PBS [Pharmaceutical Benefits Scheme] price for dispensing [EMA] or are there any other charges for the patient? I assume that only approved prescribers can obtain an authority script and you wouldn't ever see it prescribed privately, is that right? [Pharmacist, does not dispense EMA]
“For those interested, the ACT [Australian Capital Territory] Legislative Assembly have published their findings and recommendations for the inquiry into abortion and reproductive choice…” [GP, provides EMA]
  • EMA, early medical abortion; GP, general practitioner; IUD, intrauterine device; LARC, long-acting reversible contraception.