Unprofessional abortion referrals harming patients

Despite existing guidelines and codes of conduct, many practitioners are failing to refer patients for abortion in a professional manner.

A perspective published in the Medical Journal of Australia examines how unprofessional abortion referral practices are a threat to person-centred abortion care in Australia.

Access to safe abortion care is essential health care and a human right, and practitioners who refuse to participate in abortion care are expected to refer patients on to a willing provider.

Medical guidelines, such as the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Clinical guideline for abortion care advise practitioners that referrals for abortion “must not impose delay, distress or health consequences on a woman seeking an abortion.”

However, unprofessional abortion referral practices continue to occur, causing harm and distress to abortion seekers through misinformation, judgement and delays to care.

“There is ample evidence of a disconnect between real-world abortion referral practices and the principles outlined in professional codes of conduct and clinical guidelines,” Dr Shelly Makleff and co-authors wrote.

“Strategies are urgently needed to ensure that practitioners refer patients for abortion in a professional manner.”

A spectrum of practices

The perspective authors identified a spectrum of professionalism when it comes to referral practices.

Refusal to refer: This may be due to conscientious objection, discomfort, stigma or fear of repercussions. Refusal to refer violates a range of professional codes of conduct, and in many jurisdictions it violates legal obligations.

Unprofessional referral: This includes rude, unfriendly and judgemental communication with the patient, delaying access to care through unnecessary tests, or referral to services that will not provide an abortion.

Minimum professional standards: At a minimum, an abortion referral should be timely, communicated in a non-judgemental manner, and made to a high quality and willing provider. To support professional referrals, pathways for abortion care should be systemised with clear and accessible information for health practitioners looking to refer abortion care.

Person-centred referral: Going beyond minimal professional standards, this would centre the needs and preferences of the abortion-seeker rather than the health practitioner, and support the patient’s right to dignity and autonomy in a friendly and empathetic way.

Moving towards person-centred care

The perspective authors believe a person-centred approach to abortion referrals can be reinforced at various levels of the health system.

“Professional bodies have a critical role in articulating and enforcing professional standards and codes of conduct — with a focus on regulating medical professionalism rather than over-regulating abortion,” the authors wrote.

“Government regulators, such as the Australian Health Practitioner Regulation Agency (Ahpra), have a responsibility to develop effective reporting and enforcement mechanisms for individuals who avoid their professional obligations for abortion referral.”

“Health service policies and management can ensure that all staff are aware of their professional and legal obligations to refer respectfully for abortion.”

At an individual level, the authors encourage practitioners to reflect on whether they are referring in a way that reflects person-centred care principles, either intentionally or unintentionally.

“In this perspective article, we have argued the importance of encouraging all health practitioners, regardless of objector status, to move along the spectrum towards person-centred referral.”

Read the perspective in the Medical Journal of Australia.

Annika Howells is the sub-editor of the MJA’s InSight+.

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