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Women’s health centres are for women only (Broom, 1998). Needless to say, this is an important factor for most women attending the centres (Broom, p. 12). Women who experience domestic or sexual violence, and/or are victims of other abuse (e.g., financial, mental), the safe environment offered by an all women venue is of utmost importance (Broom). Women who attend the centres for other reasons (e.g., Pap [Papanicola] smears, workshops) also enjoy a safe environment (Broom). The safe environment of women’s health centres is but one of many significant factors of why they are so popular (Broom). According to Broom, women’s health centres are popular due to several factors: (a) compassionate counselling, (b) longer counselling time frames, (c) opportunity to socialise with other women, (d) health information, (e) involvement in health development, (f) empowerment through group activities, and (g) best practice (p. 5).
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In south east Queensland, the Wide Bay Women’s Health Centre (WBWHC) is a service established “for women, by women” (WBWHC, n.d., as cited in WBWHC Policy Manual, November 4, 2009). As a women’s community health service, the WBWHC has implemented the best practice and principles represented in the Australian National Women’s Health Policy (1989), the World Health Organisation (WHO) Alma-Ata Declaration on Primary Health Care (1978) and, the WHO Ottawa Charter for Health Promotion (1986) (WBWHC, n.d.; as cited in WBWHC Employee/Policy Manual, November 4, 2009, pp. 13-14).
In Russia, during the late seventies, the Alma-Ata Declaration on Primary Health Care (1978) was the first document accepted by “all WHO member countries” (Hall & Taylor, 2003, p. 18), for its principles for primary health care which are a “fundamental human right” (Hall & Taylor, p. 17). The Ottawa Charter for Health Promotion (1986) is an extension of the Alma-Ata Declaration on Primary Health Care (1978) (WHO 1986; Victorian Curriculum and Assessment Authority, 2007). They both identify and promote primary health care, whereas, the National Women’s Health Policy (1989) promotes a social health approach which encompasses “the interaction between social and economic factors and health or illness. This perspective is particularly important in considering women’s health issues.” (National Women’s Health Policy, 1989, as cited in Women’s Health Goulburn North East, 2006, p. 8)
A prominent feature of women’s health centres is their “holistic approach” (Brown, 1998, p. 14; WBWHC, n.d., as cited in WBWHC Policy Manual, November 4, 2009). Women are not only concerned about their general wellbeing but often “identify financial, child care and legal issues as ‘health’ concerns” (Brown & Doran, 1996; Redman, Hennrikus, Bowman, & Sanson-Fisher, 1988; as cited in Brown, 1998, p. 14), which are “all elements that can be encompassed within a broad social model of health.” (Brown, p. 14)
As such, the WBWHC utilises the social model of health. According to the Victorian Healthcare Association, (2009) the social model of health:
[R]ecognises the effect of social, economic, cultural and political factors and conditions on health and wellbeing. It is a conceptual framework for improving health outcomes, aimed at preventing and reducing illness and addressing inequalities and disadvantage that exist within the community. (Â¶ 1)
However, women residing in rural, remote, and regional areas of Queensland are somewhat disadvantaged compared to women who live in major metropolitan centres and cities, especially “when confronted with the crisis of an unplanned or unwanted pregnancy.” (Australian Reproductive Health Alliance and Reproductive Choice Australia, n.d., p. 16)
“One of the major factors that influence access to abortion services for Queensland women is geography.” (Children by Choice Association, n.d., Â¶ 9 [p. 2] Geographic isolation; Russell et al., 2008, p. 53) The only centres that provide surgical abortions in regional Queensland are Cairns, Townsville and Rockhampton (Children by Choice Association; Russell et al.). Surgical terminations are also available in southeast Queensland (e.g., Sunshine Coast, Caboolture, Brisbane, and Gold Coast) (Children by Choice Association; Russell et al.). Medical terminations using the controversial RU 486 – Abortion Pill (Mifepristone) are only available in south east Queensland (e.g., Brisbane) (Calcutt, 2007), due to ongoing legal issues (de Costa & Carrette, n.d.). Therefore, for women living in rural and remote regions in Queensland, “the cost and inconvenience of travel adds to the often high cost of the procedure itself.” (Children by Choice, n.d., Â¶ 9 [p. 2] Geographic isolation; Russell et al., p. 53). As pointed out by de Crespigny and Savulescu (2004, p. 202), “it is unreasonable that Australian women’s access to abortion depends on where they live, unless they have the resources to travel.”
According to Singer (2004, p. 235), “an unplanned pregnancy is a crisis in a woman’s life.” For some women the choice between adoption, abortion, or parenthood, is a relatively “straightforward” choice; for others it is an emotional rollercoaster ride (Reproductive Choice Australia, n.d., p.5). For a woman who is undecided, options counselling can offer “the support and information she needs to explore her alternatives and clarify her values and feelings.” (Singer, p. 235) In this regard, “options counseling is a form of crisis intervention that usually takes place during one … interaction. As such, it is short term, addresses an immediate problem, and involves a major life crisis with a time-limited decision.” (Baker, 1995, as cited in Simmonds & Likis, 2005, p. 377) Although, options counselling is considered to be a fundamental feature in women’s health, there is a shortage of research in this particular area (O’Reilly, 2009; Simmonds & Likis; Singer).
According to O’Reilly, (2009, p. 598) “a literature search conducted in CINAHL, Medline, Psych Info [sic] and Sociological Abstracts of pregnancy options counseling, unwanted, unintended, and unplanned pregnancies between January 1997 and December 2008, provided no research studies and two commentaries by APNs [Advanced Practice Nurses].” In this regard, Singer (2004) suggests that there are some useful handbooks and brochures written by professional counsellors. However, these “may not be representative of the entire population of women with unplanned pregnancies.” (p. 235) Simmonds and Likis (2005, p. 379) also acknowledge the lack of research in this area.
Although there is little evidenced based research into options counselling, pregnancies, both intended and unwanted, are a frequent occurrence around the world (O’Reilly, 2009, p. 599). Consequently, supporting and counselling are significant features of women’s health issues, and are major factors in many women’s health centres, not only in Australia, but worldwide (O’Reilly). Therefore, “the quality and availability of options counseling may be suboptimal for precisely that reason – it is so habitual that evidence based improvements are rarely even considered a possibility.” (O’Reilly, p. 599)
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Today, access to primary health care is a basic human right (Hall & Taylor, 2003, p. 17), but so too is freedom of choice (United Nations, 1948). For that reason, a woman should be free to make decisions regarding her future, especially when it involves the termination of an unwanted or unintended pregnancy (Reproductive Choice Australia, n.d., p.5). Most woman’s circumstances, and reasons for termination will be different, which may impact on her decision making process (Reproductive Choice Australia, p.5). The decision to terminate could be “straightforward” or it “can become a prolonged emotional crisis.” (Reproductive Choice Australia, p.5) Research (e.g., Rowe, Kirkman, Hardiman, Mallett, & Rosenthal, 2009; see also de Crespigny & Savulescu, 2004) has shown that there are numerous reasons why women decide to terminate.
According to a recent Australian research study by Rowe, Kirkman, Hardiman, Mallett, and Rosenthal (2009), into the psychological and social circumstances of why women seek abortions, found that the main reasons given were (a) “wrong time” (54%); (b) family completed (26%); (c) “financial, relationship, or medical reasons” (19%); and (d) sexual abuse (1%) (Rowe et al., 2009, Â¶ 17 Reasons for seeking abortion). de Crespigny and Savulescu (2004, p. 202) also established that approximately 98% of terminations performed in Australia “are for social or economic reasons.” Only 2% of terminations are for “fetal abnormality” (de Crespigny & Savulescu, p. 202). However, Calcutt (2007, p. 27) also suggests that a woman’s choice for seeking an abortion is not only for one reason, but a combination of many factors.
The decision to terminate an unwanted pregnancy may affect woman differently, so the counsellor needs to be aware of the different emotions a woman can experience as she struggles with the decision making process (Reproductive Choice Australia, n.d; Simmonds & Likis, 2005; Singer, 2004). As previously mentioned, there are a number of different stages of decision making that a woman may progress through, but they are “dependent upon a number of individual variables [such as]: the level of personal emotional support, her decision-making and coping abilities, and the level of attachment she has for the pregnancy.” (Reproductive Choice Australia, n.d., p.5)
During the decision making process, the counsellor provides support, information and educational materials, and clarifies any concerns that the woman may have in choosing an option (O’Reilly, 2009; Reproductive Choice Australia, n.d.; Simmonds & Likis, 2005; Singer, 2004). The counsellor needs to respect the woman’s autonomy and her ultimate decision regarding the unintended pregnancy (Simmonds & Likis; Singer). The counsellor should not force his or her own values and beliefs onto the client (O’Reilly; Reproductive Choice Australia; Simmonds & Likis; Singer).
No matter where counselling takes place (e.g., a women’s health centre, or a doctor’s surgery) there are also ethical factors to consider (O’Reilly, 2009; Reproductive Choice Australia, n.d.; Simmonds & Likis, 2005; Singer, 2004), such as “non-biased and non-judgmental validation for the woman’s situation and her ability to make informed choices and decisions.” (Reproductive Choice Australia, n.d., p.6) In addition, up to date and accurate information, “free from the counsellor’s own value judgements and bias” should also be provided so that “an informed decision – one which she can completely own” can be made (Reproductive Choice Australia, p.6). As pointed out by Singer (2004) letting a woman know that “she is not alone can relieve many of her fears.” (p. 237)
In this regard, the Australian National Health and Medical Research Council (NH&MRC, 1995), Draft Review into Services for the Termination of Pregnancy suggest that “best practice pregnancy options counselling should be based on the respect for the woman’s autonomy to make decisions, and is designed to support the woman’s decisions, rather than influence or subvert her decision making process.” (as cited in Reproductive Choice Australia, n.d., p. 6; The Royal Australian College of General Practitioners [RACGP], n.d., p. 2) Consequently, appropriate counselling should (a) acknowledge that the woman is capable of making informed choices and decisions, (b) respect for the woman’s autonomy and values, and (c) support her ultimate decision (Reproductive Choice Australia; Simmonds & Likis, 2005; Singer, 2004).
Therefore, best practice options counselling should (a) be conducted by an appropriately qualified and competent counsellor, in a safe, supportive and non-threatening environment; (b) be non-directive; (c) respect the clients integrity, confidentiality, autonomy, and honesty; (d) provide accurate and current information; (e) be unbiased and non-judgemental; (f) acknowledge that the woman is capable of making informed choices and decisions; and (g) empower and support the woman’s ultimate decision (Reproductive Choice Australia, n.d., pp. 6-7; Simmonds & Likis, 2005; Singer, 2004).
In conclusion, women’s health centres (e.g., WBWHC) offer a safe, supportive and holistic environment that is embraced by the social model of health. Besides these qualities, they also offer compassionate counselling, longer counselling timeframes, empowerment, health information and development, and best practice. When a woman is faced with the crisis of an unintended/unwanted pregnancy she can be confident that she will receive non-directive, non-judgemental, unbiased counselling together with the most accurate up to date information to enable her to make an informed decision. However, more research needs to be done regarding options counselling as very little evidenced based research has been done in this particular field. It has been suggested that because supporting and counselling are salient features of women’s health issues, there is, perhaps, no need for evidenced based research into best practice.
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