Experiences and Lessons Learned Implementing Abortion Services at an Australian Sexual and Reproductive Health Service: A Mixed-Methods Study Using Normalisation Process Theory.

IntroductionAbortion has been decriminalised in New South Wales, Australia since 2019. Post-decriminalisation, non-government organisation Family Planning Australia commenced abortion services. This study used Normalisation Process Theory (NPT) to examine the implementation of abortion services at five clinic sites.MethodsA convergent mixed methods study was conducted with >50% of staff and 43 clients during the implementation period. Quantitative data was described using descriptive statistics. Qualitative data were analysed deductively using NPT constructs, with data within each domain examined to identify patterns, similarities and differences across participants. Data were integrated and synthesised narratively to align with NPT.ResultsAbortion care was conceptualised by staff as an important service addition. More than a third of staff surveyed increased in that belief post-implementation, some staff also reported a diminished scope of practice. 92% of clients rated their care as very good or excellent. Staff reported challenges implementing the service, which occurred during the COVID-19 pandemic. Time and logistical constraints negatively impacted the implementation. Staff debriefing opportunities and client access to social workers had a positive influence.ConclusionsKey drivers of implementation were identified as shared staff values regarding abortion, and high client satisfaction. We make recommendations for new implementation or ongoing improvement of abortion services delivered in primary care contexts.