Jessica R. Botfield

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.

Objectives: Amid the unmet need for contraception and safe abortion care globally, harnessing the capabilities of primary care nurses and midwives is vital for facilitating equitable access to these critical healthcare services. We aimed to evaluate the impact of interventions delivered by primary care nurses and/or midwives on facilitating access to contraception and abortion care. Study design: We conducted a systematic review in accordance with PRISMA guidelines and searched five electronic databases in September 2023. A narrative synthesis was conducted with analysis informed by the Levesque et al framework for access to healthcare. Results: Twenty-three articles met the inclusion criteria; 20 related to contraception and three to abortion care. Access to contraception and abortion care was predominantly focused on addressing consumer-related factors such as perception of healthcare needs and support to engage with services. Findings suggested home visiting, telehealth and reproductive counselling interventions by primary care nurses and midwives can be effective at increasing women’s access to contraception. There was some evidence these clinicians could be acceptable providers of medical abortion; however, there were no articles on procedural abortion. Conclusions: Primary care nurses and midwives have the potential to improve women’s access to contraception care, particularly through the use of home visiting or telehealth strategies. However, evidence on how nurses and midwives can support access to abortion care is scarce and more research is needed, particularly for procedural abortion. Further research should also target under-studied access factors, including the acceptability of nurses and midwives providing contraception and abortion care and consumers' ability to reach and pay for this healthcare.

Reproductive coercion (RC) broadly encompasses behaviors that interfere with a person’s reproductive choices, including control over contraception, pregnancy, and pregnancy outcomes, and can pose considerable health risks. However, its full impact on health remains insufficiently understood. This scoping review systematically examined empirical literature on the health consequences of RC published between 2010 and 2024. Following JBI methodology and Preferred Reporting Items of Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines, we searched five databases (MEDLINE, CINAHL, Embase, PsycINFO, and Scopus) for peer-reviewed studies reporting on RC and associated health outcomes. Sixty-two studies across 18 countries met inclusion criteria, the majority from high-income settings, revealing adverse effects on reproductive, sexual, and mental health. Most studies focused on pregnancy coercion and contraceptive sabotage perpetrated by male partners. RC was consistently associated with adverse mental health outcomes, including post-traumatic stress disorder, anxiety, and depression. Studies associated RC with an increased risk of unintended pregnancy and sexually transmitted infections. Contraceptive use patterns varied: some studies reported reduced uptake among those experiencing RC, while others described increased use of covert long-acting methods and emergency contraception as protective strategies. Few studies examined physical health outcomes or healthcare utilization following RC. Evidence gaps remain regarding the health consequences of other RC behaviors, including coerced continuation or termination of pregnancy and forced contraception, as well as from low- and middle-income contexts. Clarifying the health consequences linked to current or past experiences of different RC behaviors may support healthcare providers in recognizing and responding to RC, to promote reproductive autonomy and improve health outcomes for RC victim-survivors.

Background: There is limited understanding of the pain experiences of young nulliparous people undergoing intrauterine device (IUD) insertion without sedation and how this influences the acceptability of the procedure. Although quantitative studies have measured pain intensity during insertion, little research has explored how young people perceive, experience, and contextualise this. We therefore conducted a mixed-methods study to better understand pain experiences and how this affects acceptability. Methods: Patients aged 16–30 years getting an IUD at a family planning clinic were recruited. They completed pre- and post-insertion surveys to rate anticipated and actual pain associated with the insertion. Interviews were conducted post-insertion to discuss expectations, pain, and acceptability. We used a convergent mixed-methods design with merged integration of qualitative and quantitative data for analysis. Results: Altogether, 30 young people participated. Most used simple oral analgesia and local anaesthetic spray to the cervix. On average, participants rated anticipated pain as 6.63/10 and actual pain as 5.88/10. Despite describing the procedure as very painful, most felt the pain was short-lived and therefore tolerable, and that their analgesia was sufficient. Overall, participants reported the procedure as acceptable. Higher acceptability was significantly associated with feeling that their pain relief was sufficient, that the insertion went as they expected, and that they perceived the benefits of the IUD outweighed the discomfort. Conclusions: Although the IUD insertion was very painful for young nulliparous patients, it was not the only determinant of insertion acceptability. Findings emphasise the importance of clinicians providing sufficient education and information about IUD insertions to support preparation and manage expectations, in addition to providing effective pain management.

Background: Reproductive coercion (RC) is a form of gender-based violence that interferes with reproductive autonomy. General practice is a key primary care setting where individuals, particularly women, access support for sexual and reproductive health (SRH). However, limited research explores how general practice clinicians recognise and respond to RC. We aimed to explore how general practitioners (GPs) and practice nurses (PNs) recognise and respond to RC in Australian general practice. Methods: A qualitative descriptive study was conducted using semi-structured interviews with 10 GPs and 6 PNs. Interviews were conducted via Zoom, transcribed verbatim and analysed using inductive content analysis. Results: Participants identified consultation-based ‘red flags’, including partner dominating the consult, patient discomfort, and disruptions in appointment or contraception use, that prompted RC inquiry. Participants proactively asked about RC in SRH consultations, tailoring questions to the context of contraception, pregnancy, or abortion care. Balancing safety, autonomy, and support was described as challenging, especially in cases involving adolescents or women with disabilities where carers or parents influenced patient consent. Participants described practical and patient-centred strategies, such as using telehealth consultations, discreet signals, covert care planning, and whole-of-practice team-based vigilance, to support women experiencing RC in general practice. Conclusions: Findings highlight how general practice clinicians in Australia recognise and respond to RC and can inform the development of clinical guidelines and practice approaches to strengthen recognition and response to RC in general practice.

Reproductive coercion (RC) refers to behaviours that interfere with an individual’s autonomy over their reproductive health and decision-making. While traditionally attributed to partners or families, emerging research has highlighted the potential role healthcare providers may play in perpetrating and perpetuating RC. This study aims to explore the perspectives of Australian healthcare providers who deliver reproductive healthcare, focusing on their understanding of provider bias and coercion in the context of reproductive decision-making, both within their own practice and among their peers. This qualitative study used semi-structured interviews to gather insights from 18 healthcare providers, including general practitioners, nurses, and obstetricians/gynaecologists who deliver reproductive healthcare services in Australia. Participants were purposively sampled to capture a range of perspectives, selecting individuals from different healthcare roles with experience in reproductive healthcare provision. Interviews were analysed using reflexive thematic analysis and themes were constructed through an inductive approach. Three key themes were identified: (1) Explicit refusals and their impact on reproductive autonomy, where participants described how refusal to provide or refer for services like abortion, sterilisation or long-acting contraception undermined patients’ reproductive choices; (2) Implicit bias shaping reproductive decision-making, with participants reflecting on how unconscious biases influenced contraceptive counselling and other reproductive health decisions, often leading to coercive practices; and (3) Oversight and misinformation enabling coercion, where participants noted that a lack of awareness or incorrect assumptions about patient needs could unintentionally collude with coercive dynamics. This research highlights the complex ways healthcare providers may, often unintentionally, undermine reproductive autonomy through biased guidance, non-referral, or restrictive practices. Addressing both explicit and implicit provider biases is essential for fostering person-centred, non-coercive reproductive healthcare. Our findings underscore the need for healthcare systems to prioritise bias and reflective practice training, along with corresponding clinical guidance for providers. This must be supported by institutional safeguards, such as enforceable referral mechanisms and bias-aware education to ensure reproductive decisions are respected and supported in practice. By actively dismantling coercive practices, healthcare providers can ensure that the care they provide respects and upholds patients’ reproductive intentions and autonomy.

Aim: To address the gap in existing postpartum care literature by gaining an in‐depth understanding of Australian child and family health nurses' experiences of providing postpartum contraceptive care. Design: A qualitative exploratory study design, using semi‐structured interviews. Methods: Convenience and snowballing sampling methods were employed to recruit child and family health nurses currently practising in Australia. Semi‐structured interviews were conducted with 15 nurses in July 2023, and data were analysed using reflexive thematic analysis as outlined by Braun and Clarke. The consolidated criteria for Reporting Qualitative research checklist were used to support the research process. Results: Despite their frequent contact with postpartum women and acknowledging the importance of postpartum contraceptive care, most participants did not commonly discuss contraception or family planning with mothers and did not feel it was part of their role to do so. Participants cited role ambiguity, limited knowledge of postpartum contraception, lack of clinical practice guidance, time constraints, and competing priorities as contributing to inconsistencies in postpartum contraceptive care provision. Conclusion: This study highlights critical gaps in the provision of postpartum contraceptive care by child and family health nurses in Australia and underscores the need for systemic changes to promote postpartum contraceptive care as a key component of routine maternal health services. Implications for the Profession and Patient Care: This study provides actionable evidence for improving the delivery of postpartum contraceptive care, ensuring women are provided with accurate information about their options, and supporting contraceptive uptake to reduce the incidence of short interpregnancy intervals. Impact: Our findings provide practical guidance relevant for healthcare policy and practice, emphasising the need to enhance child and family health nurses training in reproductive health, develop clear clinical practice guidelines, and address systemic barriers such as time constraints to improve the provision of postpartum contraceptive care and support women's reproductive health needs. Reporting Method: Standards for reporting qualitative research (SRQR). Patient or Public Contribution: No patient or public contribution.