Kirsten Isla Black

Background: Although closely spaced and unintended pregnancies can occur among all women, women from migrant and refugee backgrounds may experience these at higher rates. Access to high-quality, culturally responsive information regarding fertility return and postpartum contraception is essential for supporting informed decision-making. However, limited research has examined the related information needs of migrant and refugee women. Methods: We undertook an exploratory qualitative study with 17 English-speaking postpartum migrant and refugee women to better understand their experiences of and preferences for receiving postpartum contraception information. As part of their interview, participants were shown two educational contraception videos. Reflexive thematic analysis was used to construct themes. Results: No participant currently wanted to be pregnant; however, most were using condoms or no contraception. Knowledge of postpartum fertility return and contraception options was limited. Although desired, antenatal and postpartum education on fertility return and contraception had been provided to few of the women. Participants found the videos to be informative, culturally appropriate and visually engaging. Content considered important related to cost, effectiveness, side effects, where and how to access, and what is involved. Viewing short videos, along with provision of additional fertility and contraception information, was seen as especially valuable during pregnancy to support postpartum planning. Conclusions: Limited resources and inconsistent postpartum contraception discussions with maternity providers can hinder contraceptive choice and decision making for migrant and refugee women. Our study underscores the need for accessible, culturally responsive, plain English and in-language resources on fertility return and postpartum contraception, supported by routine discussions and timely access to contraception methods.

Background: Persistent oncogenic HPV infection can cause cervical epithelial changes leading to premalignant lesions such as CIN2. Active surveillance, a conservative option, reduces exposure to excisional risks while allowing timely treatment when needed. However, little is known about clinicians' perspectives, acceptability, and experience of offering active surveillance in the Australian healthcare context. Aims: To explore gynaecologists' perspectives, acceptability, and experiences in providing active surveillance to women diagnosed with CIN2. Materials and Methods: Individual semi‐structured interviews were conducted with obstetrics and gynaecology specialists and trainees in secondary and tertiary healthcare settings across Australia. Data were analysed using inductive thematic analysis. Results: Twenty‐five in‐depth interviews were conducted. Participants expressed positive views about active surveillance, regarding it as a safe option that does not increase long‐term cancer risk. When formulating management recommendations for CIN2, participants considered various interrelated diagnostic, patient, clinician, and policy‐level factors. To support shared decision‐making, participants used several communication strategies such as anatomical models and visual images to help address patient knowledge gaps and they provided patients with time and space to reflect on their preferred management plan. Participants identified strategies that could support offering active surveillance and patients' adherence to this, including enhanced clinician education and training, increased resourcing, and improved use of information technology to support follow‐up tests for active surveillance. Conclusions: A deeper understanding of multi‐level factors influencing clinicians' recommendations and implementation of active surveillance for CIN2 may inform the development of targeted interventions to address barriers and strengthen enablers, ultimately supporting wider offering of active surveillance.

Objectives: To examine longitudinal trends in the provision of medication abortion (MA) in Australian general practice. Study design: Retrospective study of Australian females aged 14–49 years attending Australian general practices between 2014 and 2021. Data were sourced from the national general practice dataset, MedicineInsight. We calculated rates of MA provision and reported characteristics of those receiving and providing MA services. Results: We identified 4306 instances of MA provision to 3980 unique individuals. The rate of MA provision increased from 0.11 per 1000 females in 2014/15 to 2.10 per 1000 females in 2020/21. A greater absolute increase in the rate of MA was evident among those aged 25–29 years, those residing in regional areas or those in areas of lower socioeconomic status. The proportion of general practices providing MA increased from 4.4% in 2014 to 22.7% in 2021. The proportion of general practices providing MA was higher among those located outside of major cities and in higher socioeconomic status areas. Conclusions: Despite modest increases in the rates of MA provision in general practice over time, less than one third of general practices provide MA. Significant geographical variation in MA provision is also evident according to remoteness, socioeconomic status and state/territory. The findings emphasise the need for additional initiatives to ensure equitable access to abortion care within the general practice setting, and future research should examine the underlying reasons for differences in MA uptake by patient characteristics and geographical location, informing targeted interventions and service planning.

Background: Medical student electives play an important role in both personal and professional development. The need for medical students to have early exposure to teacher training skills has also been recognised. The Sydney Medical School elective in medical education was designed and implemented in 2021 in response to growing student interest in acquiring professional skills in teaching, as well as the global mobility restrictions at the time. We sought to explore students' perception of their experience. Approach: The 4‐week elective was designed based on the successful ‘Peer Teacher Training’ programme for health professional students. Delivered online to 49/250 (20%) final year medical students, the programme consisted of 13 e‐learning modules with required asynchronous and synchronous activities and formative assessment. Evaluation: We collected qualitative data from 34 participants (69%) using a postcourse questionnaire. Students valued learning about educational theory with opportunities to practice teaching and feedback with their peers. The elective was found to enhance participants' confidence in teaching. Although students valued the flexibility afforded by online delivery, some expressed a preference for the inclusion of in‐person learning activities. Implications: The medical education elective provided students with dedicated time to develop knowledge and skills in clinical teaching and fostered engagement and interest in teaching activities. Such electives present a valuable alternative for students and may offer an initial entry point into the clinician educator pipeline.

Updates have been made to conditions with increased risk of thrombosis and use of depot medroxyprogesterone acetate (DMPA). Four medical categories—multiple risk factors for venous thromboembolism (VTE), multiple sclerosis (MS), chronic kidney disease (CKD) and sickle cell trait (SCT)—have also been added. Guidance on levonorgestrel intrauterine device (LNG-IUD) use and the risk of stroke, and consideration regarding anxiety and mood disorders and hormonal contraception (HC), feature in the 2025 UKMEC.

Background: There is a lack of evidence regarding the impact of body weight on the safety of surgical abortion. Study Design: We performed a systematic review and meta‐analysis of observational studies reporting the effects of obesity on perioperative anaesthetic and surgical outcomes during surgical abortion. Analytical observational studies examining individuals undergoing surgical abortion up to 28 weeks gestation were eligible for inclusion if they reported perioperative anaesthetic or surgical outcomes in participants with body mass index (BMI) in two groups: BMI < 30 kg/m ² and BMI ≥ 30 kg/m ² . Sub‐analyses were performed comparing outcomes in those with BMI < 30 kg/m ² and ≥ 40 kg/m ² . Results: Eight retrospective cohort studies were included, comprising 9912 obese and 31 672 non‐obese participants. 1770 participants had BMI ≥ 40 kg/m ² and only 71 had BMI ≥ 50 kg/m ² . BMI ≥ 30 kg/m ² was not associated with an increase in major surgical adverse outcomes (RR [95% CIs] 1.16 [0.83–1.62]) compared to BMI < 30 kg/m ² . BMI ≥ 40 kg/m ² was associated with increased risk of major complications (RR [95% CIs] 2.60 [1.28–5.28]) based on low‐quality evidence from two studies on second‐trimester surgical abortion. Anaesthetic adverse outcomes were rare and not increased by BMI ≥ 30 kg/m ² (RR [95% CIs] 1.02 [0.50–2.06]) or BMI ≥ 40 kg/m ² (RR [95% CIs] 2.0 [0.55–7.24]). Conclusions: Anaesthetic and surgical risks are not increased by BMI ≥ 30 kg/m ² . Individuals with BMI ≥ 40 kg/m ² may have increased risk of major surgical complications. The lack of sufficient data on those in the BMI ≥ 40 kg/m ² and BMI ≥ 50 kg/m ² categories underscores the need for further research to ensure high‐quality abortion care for this population.

Objective: To determine associations between gestational diabetes mellitus (GDM) and body mass index (BMI) change between consecutive pregnancies, and hospital length of stay (LOS) and hospital costs. Design: Retrospective cohort study. Setting: Two maternity hospitals, New South Wales, Australia. Population: Women with two most recent singleton births between September 2011 and April 2019. Methods: Multivariable generalised linear models assessed association between GDM status (none, first only, second only, or both pregnancies) and BMI change (loss: < −1 kg/m ² ; stable: −1 to < 1; small gain: 1 to < 2; medium gain: 2 to < 4; or large gain: ≥ 4) in relation to second‐birth LOS and hospital birthing costs. Costs were calculated using DRG codes and valued in 2024 AUD. Main Outcome Measures: Hospital LOS and hospital costs for the second birth. Results: Of 11 157 women, 5% had GDM only in the first pregnancy, 9% only in the second and 8% in both. For the second birth, women with GDM in both pregnancies stayed 0.91 days longer (3.71 vs. 2.79 days) and incurred AU$1960 higher costs (AU$14680 vs. AU$12720) than those without GDM in either pregnancy. Adjusted models indicated GDM in both pregnancies was associated with a 21% longer LOS (95% CI: 16%–26%, p < 0.001) and 9% higher costs (7%–11%, p < 0.001). Large BMI gain (≥ 4 kg/m ² ) was associated with a 9% longer LOS (4%–14%, p < 0.001). Women with both GDM (both pregnancies) and large BMI gain had a 23% longer LOS (12%–36%, p < 0.001) and 9% higher costs (4%–15%, p < 0.001). Conclusion: GDM and interpregnancy BMI gain were associated with increased hospital stay and higher birthing‐related hospital costs for the second birth. These findings underscore the importance of preventive strategies and supportive public health policies to reduce the burden of GDM and high BMI gain. Approaches such as nutritional counselling, lifestyle modification and physical activity programs are likely to support women planning a subsequent pregnancy after their index birth (first pregnancy or first pregnancy with GDM diagnosis).

Introduction: Community pharmacists can play a key role in the prevention and management of unintended pregnancy, including in the provision of counselling and by dispensing contraception, and for medication abortion (MA). However, Australian pharmacists’ practice and knowledge of effective contraceptive methods, including long-acting reversible contraception (LARC), is unknown, and few were registered to dispense MA at the time of the study. Aim: Our aim was to understand the knowledge, attitudes and practices of Australian community pharmacists in LARC and MA care. Method: We conducted a cross-sectional national online survey of community pharmacists from July until October 2021. Participants were recruited through convenience sampling via mail and partner organisations’ emails, newsletters, and mailing lists. We used descriptive statistical analysis, including counts, proportions, Pearson’s chi-squared tests and Poisson regression for data analysis. Our descriptive survey forms part of the Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS) mixed-methods project (ACTRN12622000655741). Results: There were 533 eligible responses; 72% (n = 385) self-identified as women, and 71% (n = 378) were from metropolitan areas. Respondents' correct LARC knowledge varied, with 88% understanding LARC effectiveness, 67.7% understanding return to fertility, and 65.9% understanding LARC suitability for nulliparous women. Most pharmacists were registered to dispense MA (70%; n = 373), although fewer than half discussed LARC at the time of dispensing MA. Those working outside metropolitan areas were more likely to be registered to dispense MA and feel that they had the knowledge and confidence to dispense MA. Conclusion: With community pharmacists increasing scope of service in relation to contraception and MA, ongoing education and support will ensure they have accurate information for the provision of LARC and MA.

Background: Preconception care (PCC) aims to optimise health before pregnancy by addressing risk factors. This improves conception rates, pregnancy outcomes, and the health of future generations. Despite its benefits, preconception care in Australia is underutilised due to the rate of unplanned pregnancies and inadequate care before pregnancy. Evidence is lacking on consumer preferences for PCC services. Methods: A discrete choice experiment was designed to investigate preferences of Australian adults for the delivery of PCC services in primary care. An online survey including 12 choice tasks describing alternate PCC service configurations was completed by a sample of the general population. Data were analysed using mixed logit and latent class models to identify key attributes influencing decision‐making and explore preference heterogeneity. Results: A total of 485 respondents of a generally representative sample of Australian adults completed the online survey. Most respondents (67%) indicated that they had either not heard of PCC or were unsure if they had. Choice modelling results indicated strong preferences for PCC services delivered face‐to‐face, particularly by specialist obstetricians. Lower out‐of‐pocket costs and the inclusion of incentives were also important drivers of preferences. Conclusions: Increasing awareness of PCC and its importance to the health of parents and babies is essential to improve uptake. Reducing costs and offering incentives may further encourage engagement with PCC services. The results highlight the lack of knowledge concerning the skills of nurse practitioners and pharmacists who are well placed to contribute to PCC delivery in primary care.