Reducing barriers to termination care in Queensland

Overview

Initiative type

Service Improvement

Status

Deliver

Published

June 2025

Summary

Queensland Virtual Early Medical Termination of Pregnancy Service (QVEMTOPS) was established to reduce the challenges women, girls and pregnant people encounter accessing termination.

Key dates

11 November 2024 - 8 April 2025

Implementation sites

Queensland Virtual Early Medical Termination of Pregnancy Service

Partnerships:

Multiple Qld Health organisations via Clinical Advisory Group

Aim

QVEMToPS provides individuals across Queensland rapid access to an early medical termination of pregnancy by providing the options of online self-referral and virtual care.

Outcomes

  • Project commenced 11th of November 2024 with a timeline based around first patient care being delivered by end of March 2025, under Queensland Virtual Hospital with Sunshine Coast Health as the host site.
  • During the development process three working groups were established:
    1.Clinical Advisory Group
    2.Digital Working Group
    3.Business Advisory Group
  • QVEMTOPs commenced clinical operations on the 8th of April 2025

Background

One in three Australian women will experience an unintended pregnancy in their lifetime. In 30.4% of these pregnancies, the woman/pregnant person will choose to terminate their pregnancy. However, access to termination of pregnancy care is highly uneven.
In 2023, the Australian Senate Report ‘Ending the postcode lottery: Addressing barriers to sexual, maternity and reproductive health care in Australia's highlighted the challenges and inequity women and pregnant people in Australia face accessing a termination of pregnancy.

The 'Termination of Pregnancy Action Plan 2032' was the Queensland government's commitment to address these barriers to abortion information and care in Queensland.  The concept of the Queensland Virtual Early Medical Termination of Pregnancy Service (QVEMToPS) was developed to meet this commitment and support the right to reproductive health and autonomy for Queenslanders.

QVEMTOPS was also designed with a recognition that the service needed to specifically address barriers faced by priority populations in accessing termination of pregnancy care. This includes those that identify as Aboriginal and/or Torres Strait Islander peoples, those from culturally and linguistically diverse backgrounds, transgender and gender-diverse peoples and refugees as well as people experiencing family violence, financial stress, living in rural or remote areas of Queensland, young people, Medicare-ineligible people and those seeking asylum in Australia.

Methods

The project had three main groups working together to deliver QVEMToPS as an operational service.

  1. Clinical Advisory Group
    Provided clinical advice and assurance from a system-side stakeholder perspective.  Members worked collectively to co-design the Model of Care, service eligibility criteria, evaluation plan, and self-referral content.
    Members of the clinical advisory group incorporated multiple disciplines including nursing, medical, pharmacy and social work, representing primary and hospital healthcare, disability and adolescent care, and the Aboriginal and Torres Strait Islander Network, chaired by representatives from QVH and the host service. Members worked in locations from metropolitan (the Gold Coast, Brisbane, Sunshine Coast), to regional areas (Fraser Coast, Rockhampton, Mackay, Townsville, Cairns) and rural (Proserpine and Charleville).
    Collectively they worked to define how the service could best serve people seeking to access early medical termination with a particular focus on their experiences of barriers that people faced and how QVEMToPS might be able to help overcome them. Discussions were sometimes challenging as the group worked on balancing difficult requirements such as making access easy and low cost to reduce barriers that currently exist in accessing termination care while maintaining access by not replacing current providers.
  2. Digital Working Group
    Oversaw the definition and implementation of digital solutions to underpin the QVEMToPS model of care including online referral solution (REDCap) and SharePoint site (Microsoft Power Platform) for referral management.
    A key challenge for the digital working group was implementing the model of care's requirement for self-referral from patients which did not fit inside Queensland health current systems and required a bespoke design to allow self-referral and rapid access. Additionally, they focused on digital solutions for current processes such as e-consent (still in development).
  3. Business Advisory Group
    Provided subject matter expertise in the provision of business solutions, processes and practices to support the management of referrals, care pathway planning, communications and activity reporting.

Discussion

QVEMToPS has been operational for 10 days and is transitioning to business as usual. The number of referrals is slowly growing with minimal advertising to date. Data collection is an important component of business as usual as we will assess against our goals of improving equity and access to care to Queenslanders seeking medical termination of pregnancy and specifically for priority populations.

Activity:
Challenges with predicting activity as there remain many unknowns including likely demand, and the project has balanced a complex objective of improving equity and access while designed as a ‘back-up service’ and not to replace existing public or private services. Service activity will likely increase as awareness of the service grows since a 'soft' launch on 8 April 2025.

Stakeholder engagement

  • Clinical Leads have engaged with key stakeholders across the state.
  • Project benefited from the concurrent funding and establishment of Nurse/Midwife Navigators for Termination of Pregnancy positions across the state.
  • Presentation at Queensland Women and Girls' Health Showcase (Brisbane) and poster at Queensland Women and Girls' Health Showcase (Cairns)

Evaluation of Development
QVEMToPS is a great example of an exciting project development process that was able to move quickly - within 5 months - from the project starting to service delivery, while still allowing for co-design and collaboration with a wide group of stakeholders. Digital and Business advisory teams brought their expertise to create solutions for a challenging model of care which did not follow a Queensland Health 'business as usual' approach with digital and phone self-referral.
Evaluation of QVEMToPS activity

Watch this space!
An evaluation plan was developed during the design phase to collect data on patient experience, outcomes, cost-effectiveness, health equity and clinician wellbeing. We hope to return to the clinical excellence showcase with this data in the future.

References

Commonwealth of Australia. (2023). Ending the postcode lottery: Addressing barriers to sexual, maternity and reproductive healthcare in Australia. The Senate, Community Affairs References Committee.  Ending the postcode lottery: Addressing barriers to sexual, maternity and reproductive healthcare in Australia (aph.gov.au)

Queensland Health. (2024). Termination of Pregnancy Action Plan 2032. Queensland Government. Termination-of-Pregnancy-Plan_Digital.pdf (health.qld.gov.au)

Rowe H, Holton S, Kirkman M, et al. (2016) Prevalence and distribution of unintended pregnancy: The understanding fertility management in Australia national survey. Aust N Z J Public Health; 40(2):104-9. Doi:10.111/1753-6405.12461

Taft AJ, Shankar M, Black KI, et al. (2018) Unintended and unwanted pregnancy in Australia: A cross-sectional, national random telephone survey of prevalence and outcomes. Med J Aus;209(9):407-08

Key contact

Dr Claire Fotheringham and Emma Turner

SMO Obstetrics and Gynaecology

Sunshine Coast Hospital and Health Service

Email: claire.fotheringham@health.qld.gov.au

Last updated: June 2025

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