Nurse and midwife interventions to improve access to contraception and abortion in primary care: a systematic review

Clinical Snapshot

Key Findings

• Effect Size: Not quantified - narrative synthesis only

• Primary Outcome: Access to contraception and abortion care through nurse/midwife interventions

• Nnt Or Sensitivity: Not calculated - qualitative synthesis of intervention effectiveness

Clinical Application

High feasibility in Australian primary care given established nurse practitioner and midwife roles Highly relevant to Australian primary care with established nurse practitioner prescribing rights, Medicare Benefits Schedule support for nurse consultations, and RACGP guidelines supporting multidisciplinary reproductive health care Women of reproductive age accessing primary care services

Abstract

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.

References

1. 1.Wong, J., Arefadib, N., Botfield, J. R., Rilloraza, M., & Mazza, D. (2026). Nurse and midwife interventions to improve access to contraception and abortion in primary care: a systematic review. BMJ Sexual & Reproductive Health. https://doi.org/10.1136/bmjsrh-2025-202716