Intention to claim a Medicare rebate among women receiving private Victorian pregnancy termination service

Objectives: To determine the proportion of women who have pregnancy terminations as private patients in Victoria who do not intend to claim a procedure fee rebate from Medicare, to compare characteristics of women who intend to submit a Medicare claim with those who do not and to compare the findings to the results from a similar study conducted in NSW in 1992.

Design, setting and participants: This was a cross-sectional observational study over a 12-week period. Women having a pregnancy termination service in eight large Victorian private clinics were invited to complete a brief written questionnaire.

Outcome measurer: The proportion of women who did not have a Medicare card or who had a Medicare card but did not intend to use it to claim from Medicare.

Results: Of the 1,329 women who responded, 13.1% either did not have a Medicare card or did not intend to use their card to claim a Medicare rebate. A further 20.7% of respondents were not sure about whether they would submit a claim. Women who intended to claim a Medicare rebate were different from women who did not according to age, language spoken at home, residency, citizenship and distance travelled to the service. These results are very similar to the findings from the 1992 NSW study.

Conclusion: Between 13.1% and 33.8% of private Victorian pregnancy terminations were estimated to not be recorded at the Health Insurance Commission. Health Insurance Commission records of Medicare rebate claims for pregnancy terminations are an incomplete and somewhat biased record of the services that are provided and are likely to have been so for some time.

Travel undertaken by women accessing private Victorian pregnancy termination services

Objective: To investigate the extent and cost of travel undertaken by women accessing Victorian termination of pregnancy services.

Design, setting and participants: This was a multi-centre, cross-sectional observational study of women receiving privately funded pregnancy termination services, conducted between November 2002 and June 2003 at eight major pregnancy termination service providers in Victoria.

Main outcome measures: Distance travelled, money and time expended undertaking travel, and reasons women chose particular clinics.

Results: Of the 1,244 Australian resident respondents who resided in Victoria, 9.3% travelled more than 100 km to access services. Teenagers were 2.5 times more likely than other respondents to travel further than 100 kilometres (km) (18.2% compared with 7.8%, OR=2.5, 95% CI 1.5-4.2, p<0.001). Women originated from all Australian States and Territories except South Australia and 13.7% were from Statistical Divisions other than Melbourne. More than one-third of respondents (41.3%) chose their clinic because they were referred by a doctor or general practitioner.

Conclusion: Many pregnancy termination patients face substantial and immediate costs beyond the service fee, as well as the diffculties associated with poor continuity of care and signifcant time away from home. Patients and service providers should be consulted further to determine appropriate clinical services, support services and subsidy schemes for the sizeable proportion of patients who undertake long-distance travel to access pregnancy termination services.

Factors influencing the planning undertaken by women during pregnancy for their return to work after maternity leave

The planning women (N = 199) do during pregnancy for their return to work post birth and the factors that influence employment planning during late pregnancy were investigated in this study. The findings revealed three components of planning: Planning for Childcare, Planning with Partner, and Planning with Employer. Several factors emerged as consistent cross-sectional predictors of these components (work satisfaction, hours worked before commencing maternity leave, anticipated weeks of maternity leave and anticipated hours per week on the return to work). Anticipated support from family and friends, and from the workplace also predicted Planning with Partner and Planning with Employer, respectively. The theoretical and practical implications of these findings are discussed.

Depression and anxiety through pregnancy and the early postpartum : an examination of prospective relationships

Background: The aim of this study was to explore the prospective relationship between depressive symptoms and anxiety across pregnancy and the early postpartum.
Methods: Participants (N=207) completed the State–Trait Anxiety Inventory Trait subscale, Beck Depression Inventory, and social support and sleep quality measures at two time points during pregnancy and once in the early postpartum period.
Results: After accounting for the relative stability of anxiety and depression over time, depressive symptoms earlier in pregnancy predicted higher levels of anxiety in late pregnancy and anxiety in late pregnancy predicted higher depressive symptomatology in the early postpartum. A bi-directional model of depression and anxiety in pregnancy was supported.
Limitations: Data were based on self-reports and participating women were predominantly tertiary educated with high family incomes.
Conclusion: Our findings suggest that depressive symptoms precede the development of higher levels of anxiety and that anxiety, even at non-clinical levels, can predict higher depressive symptoms. Clinicians are advised to screen for anxiety and depression concurrently during pregnancy.

Developmental outcomes of children exposed to antidepressants in pregnancy

Objective: To examine the developmental outcomes in children exposed to antidepressants in utero and compare those to children not exposed to these medications
Method: A prospective case-controlled study of children exposed to antidepressants in pregnancy assessed 22 exposed and 19 not exposed children using the Bayley Scales of Infant Development, third edition. The control group was measured at a mean age of 23.09 (SD 3.82) months and the medicated group at 28.53 months (SD 6.22). Maternal variables were assessed using a purpose-designed questionnaire and the Beck Depression Inventory (II) in pregnancy and at three assessments in the postpartum.
Results: Children exposed to antidepressant medication in pregnancy scored lower on motor subscales in particular on fine motor scores than non-exposed children with a moderate effect size of Cohen ’ s d = 0.47 fi ne motor and Cohen ’ s d = 0.43 for gross motor. Due to lack of power these findings did not reach conventional criteria for statistical significance. There was no association found between maternal depression and neurodevelopment.
Conclusions: This finding of a possible effect from antidepressant exposure in pregnancy on children ’ s motor development is similar to the findings from a previous study. Future research is needed which assesses children at an older age using specific assessments of motor development.

Men’s emotional responses to their partner’s pregnancy and their views on support and information received

The main aim of this study was to extend previous research of men’s experiences of pregnancy; 48 Australian men and their pregnant partners took part. Most men reported feeling positive about the pregnancy, emotionally well supported and well informed. Men reported receiving more valuable information from their partner than from doctors/obstetricians, family or the internet and were accurate observers of women’s depression levels.