Sexual and reproductive health
Program Lead: Associate Professor Kristina Edvardsson
Sexual and reproductive health is a human right and planned parenthood confers significant health benefits for women and their families. This program of work addresses sexual and reproductive health and the desire by women and pregnancy-capable people, and their families to effectively control their fertility and maximise their opportunities for a planned and wanted pregnancy and birth.
We use both epidemiological and ethnographic methods to investigate the prevalence of, attitudes to, and use of contraception, emergency contraception, the measurement of and extent of reproductive coercion and safe and unsafe pregnancy termination in Australia and other countries (e.g. Timor Leste and Ghana). We aim to improve the access, equity, effectiveness, quality and affordability of sexual and reproductive health services.
The prevalence and variations in unintended pregnancy by sociodemographic and health-related factors in a population-based cohort of young Australian women
A research study aimed at estimating the prevalence of unintended pregnancy and associated sociodemographic and health-related factors among a national cohort of young Australian women
Unintended pregnancy is an important population-level indicator of access to essential sexual and reproductive health services. Examining which population sub-groups have higher exposure to unintended pregnancies and understanding why that is the case is critical to guide equity-focused public health responses to close gaps in service delivery and access. We also examine pregnancy outcomes among women with a history of unintended pregnancy by urban and rural residence, and factors associated with recent experience of unintended pregnancy in the previous year. We utilise data from three waves (2013-2015) of the Australian Longitudinal Study on Women’s Health (ALSWH) new young cohort. More information about ALSWH can be found here: https://alswh.org.au/
Research team: Angela Taft, Kristina Edvardsson, Leesa Hooker; in collaboration with Mridula Shankar, University of Melbourne; Wendy V Norman, University of British Columbia, Canada
Funding: NHMRC SPHERE CRE (seed funding)
Findings presented at the Children by Choice Abortion and Reproductive Rights Conference, Brisbane, August 4-5, 2022 (A Taft)
Global variations in the underreporting of induced abortion: A systematic review
A research study to explore the worldwide variation in the underreporting of induced abortions by individuals
An important consideration when using abortion data to estimate prevalence and incidence is the extent of completeness of data. Data on induced abortions are susceptible to underreporting due to stigma and social disapproval of the procedure. We will also investigate if and how underreporting of induced abortions changes over time and by age cohort, vary by survey methodology or design, country or regional context, or sociodemographic characteristics. A total of 6810 records across five databases have been identified for initial screening, and 167 full text papers assessed for eligibility.
Research team: Kristina Edvardsson, Leesa Hooker, Felicity Young, Angela Taft; in collaboration with Mridula Shankar, University of Melbourne; Kirsten Black, Deborah Bateson, University of Sydney; Melissa Harris, University of Newcastle; Wendy V Norman, University of British Columbia, Canada
Funding: N/A
Status: systematic review protocol registered (Prospero); review ongoing
Testing a methodological approach for measuring agreement across data sources and trends in the incidence and methods of induced abortion by characteristics of young women in Australia using self-report and linked administrative health data
A research study to develop a method (algorithm) to identify abortion events using self-report surveys and three administrative datasets
Induced abortion is a common reproductive experience for women in Australia and is recognised as an essential service. Presently abortion data for public health planning and assessment is limited, and there is no national routine data collection on abortions. The algorithm will form a key to several sub-studies undertaken by the team and collaborators. We utilise self-reported abortion data from six waves of the ALSWH’s new young cohort (2013-2019) and its linkages with the Medicare Benefits Schedule, Pharmaceutical Benefits Scheme and the National Morbidity Hospital Database to: (1) evaluate levels of agreement between self-report and administrative data, and (2) test a measurement approach for ascertainment of abortion method, time trends in method distribution and characteristics associated with method type among this sample of young women.
Research team: Kristina Edvardsson, Leesa Hooker, Angela Taft; in collaboration with Mridula Shankar, University of Melbourne, Kirsten Black and Deborah Bateson, University of Sydney; Wendy V Norman, University of British Columbia, Canada; Katrina Moss, University of Queensland; Melissa Harris, Nick Egan, Peta Forder, University of Newcastle
Funding: La Trobe University, ABC grant
Status: approval for use of linked data obtained from ALSWH and state/territory ethics and data custodians
Trends and factors associated with prior abortion at time of childbirth among childbearing women in Victoria, Australia, 2010-2019
A research study to fill an important data gap by examining the prevalence of a history of induced abortion among individuals giving birth in Victoria, and changes in prevalence by time and sociodemographic characteristics
Nearly half of all pregnancies worldwide are unintended, and many of these unintended pregnancies end in induced abortion. Robust data on abortions are needed for tailored public health responses that include equitable access to contraception and abortion care. We analysed population-based perinatal data obtained from the Victorian Perinatal Data Collection. The dataset included a total population sample of women experiencing a childbirth in Victoria, Australia years 2010 to 2019 (n=767 055).
Research team: Kristina Edvardsson, Leesa Hooker, Xia Li, Angela Taft; in collaboration with Mridula Shankar, University of Melbourne; Kirsten Black, Deborah Bateson, University of Sydney; Wendy V Norman, University of British Columbia, Canada
Funding: N/A
Status: preliminary findings presented, Children by Choice Abortion and Reproductive Rights Conference, Brisbane, Australia, August 4-5, 2022 (K Edvardsson); paper submitted.
Reproductive coercion: Defining the domain and developing a comprehensive and validated prevalence measure
A research study to develop a new rigorous and comprehensive reproductive coercion measure and explore the role of primary care in screening and response
Reproductive coercion, or reproductive coercion and abuse, describes controlling behaviours infringing on autonomy over reproductive health decisions about pregnancy, abortion, and/or contraceptive use. This type of abuse is a distinct form of gender-based violence, overlapping with domestic, family, and sexual violence. Public health policies and interventions to address reproductive coercion are beginning to advance to scale, yet neither an internationally accepted definition nor a comprehensive, validated measure are available. The lack of a conceptually clear and consistently used definition and measure threatens the ability to make progress in understanding and preventing reproductive coercion and its harm. To address this public health research gap, this study will develop a new rigorous and comprehensive reproductive coercion measure, with an overall goal to pilot prevalence in Australian Maternal and Child Health (MCH) and General Practice primary care settings. This research is a part of SPHERE, the NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care.
Research team: Desireé LaGrappe, Angela Taft, Leesa Hooker, Kristina Edvardsson; in collaboration with Laura Tarzia, University of Melbourne
Funding: Postgraduate Scholarship (NHMRC Project GNT2013949)
Status: ongoing; findings presented at the Australian Society for Psychosocial Obstetrics and Gynaecology Scientific Meeting and the Perinatal Society of Australia and New Zealand Congress in 2022
Collaborative Work
SPHERE – the NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care
A research program focused on three important areas of women's sexual and reproductive health: abortion, contraception, and preconception care
Australian women continue to have poor sexual and reproductive health, which impacts on them, their families and the broader community. SPHERE aims to:
- improve the delivery of preconception care to optimise pregnancy outcomes
- increase understanding, awareness and uptake of long-acting reversible contraception (LARC)
- increase access and service provision of medical termination of pregnancy.
SPHERE aims to create a paradigm shift to recognise the interconnectedness of contraception, abortion and pregnancy planning for individual women and the need to use an integrated life course approach to help women achieve their own reproductive goals.
Research team: Angela Taft; in collaboration with Danielle Mazza, Jane Fisher and Safeera Hussainy, Monash University; Kirsten Black, Jayne Lucke and Kevin McGeechan, University of Sydney; Marion Haas, UTS; Wendy Norman, University of British Columbia
This research project is a NHMRC Centre for Research Excellence.
For more information about it, see the SPHERE website [external link].
The Australian contraceptive choice project (ACCORD)
Training family physicians increases the uptake of long-active reversible contraceptives and has the potential to reduce unintended pregnancies
International evidence demonstrates that long-acting reversible contraceptives (LARCs) are the most effective method to reduce unplanned pregnancy and abortion. Despite this, in Australia rates of LARC use remain low compared with less-effective forms of contraceptives. This trial was based on the successful US Contraceptive CHOICE Project. It tested a complex intervention in general practice consisting of online training for effectiveness-based contraceptive counselling for general practitioners and access to rapid referral for LARC insertion clinics. The study resulted in a significantly higher rate of LARC insertions in the intervention group compared with the control group.
Research team: Angela Taft; in collaboration with Danielle Mazza, Monash University; Kirsten Black, Jayne Lucke and Kevin McGeechan, University of Sydney; Marion Haas, UTS; Jeff Piepert, Washington University
The study received funding from the NHMRC.
The outcomes paper was published in the American Journal of Obstetrics and Gynecology in 2019 [external link].
Previous Work
Factors associated with abortion over time
This trend analysis of associations with induced abortion showed that it remains strongly associated with partner violence and illicit drug use and other factors affecting women’s control over reproductive health.
This study examined what factors affecting women over time could be identified to help reduce unwanted pregnancies among young Australian women. It found that abortion remains strongly associated with factors affecting women’s control over reproductive health such as partner violence and illicit drug use.
Research team: Angela Taft, Rhonda Powell, Lyn Watson; in collaboration with Jayne Lucke, La Trobe University; Danielle Mazza and Kathleen McNamee, Monash University
The results were published [external link] in the Australian & New Zealand Journal of Public Health (2019; 43(2):137-42).
Migrants' reproductive health (ROAM)
Comparative work on migrant, refugee and asylum-seeking women’s reproductive health outcomes and their views of maternity care in Europe, North America and Australia
The Reproductive Outcomes and Migration (ROAM) collaboration began with an initial grant awarded from the Canadian Institutes of Health Research (CIHR) International Opportunity Development Grant Scheme to establish research links between Canada and Australia for comparing reproductive health outcomes of immigrant and refugee women. Since 2004 collaborators from over 20 countries have joined the collaborative network. In annual meetings projects are discussed and planned.
Research team: Rhonda Small, Touran Shafiei, participating members; ROAM Steering Group: Birgitta Essen, Uppsala University, Sweden; Rhonda Small, La Trobe University, Australia (until 2019); Mika Gissler, Institute of Health, Finland; Lisa Merry, McGill University, Canada; Jennifer Zeitlin, INSERM, France and EURO-PERISTAT; Marcelo Urquia, University of Winnipeg, Canada; Sarah Villedsen, University of Copenhagen, Denmark
In 2019, a project investigating the impact of integration policies on infant birthweight in migrant women was completed and published [external link].