AUSTRALIA – Women’s access to abortion is a postcode lottery. Here’s what needs to change

The inquiry — Ending the postcode lottery: Addressing barriers to sexual, maternity and reproductive healthcare in Australia – has concluded and the report has been published by the Commonwealth of Australia in May 2023. A key recommendation is that “All public hospitals within Australia […] provide surgical pregnancy terminations, or timely and affordable pathways to other local providers.” This article discusses why this recommendation is necessary when abortion is legal in Australia and nearly one in five Australian women who have ever been pregnant will have an abortion by the age of 45.

It’s important for women to have a choice about the type of abortion they have, as medical abortion is only available up to nine weeks, yet access is patchy. Yet many hospitals, particularly those outside major metropolitan areas, don’t currently provide any abortions, let alone surgical ones. Many hospitals discourage referrals from general practitioners. There have also been reports of hospitals turning away women who need care in the uncommon event of complications following a medical abortion.

Abortion remains very stigmatised in our community. Few gynaecologists want to perform the procedure. Training on how to provide abortion has not been a routine part of gynaecology or GP training and there is a shortage of trained providers, particularly for complex cases. Hospitals haven’t felt obligated to provide abortions. To date, no one has held them accountable for providing this essential service. There has also not been any regional-level planning to ensure services are locally available. Some health professionals are also conscientious objectors who believe they should not be forced to provide abortions.

Many private clinics have closed in recent years and more are open for very limited hours or staffed by fly-in-fly-out teams, which means they can be very difficult to access. Women may need to travel long distances to get a surgical abortion.

The inquiry’s key recommendation seeks to ensure all public hospitals provide surgical abortions – and if not, at least ensure women in their catchment can access timely and affordable care via other local providers. The inquiry also recommends that contraception and abortion access (particularly for rural and regional women) is made available via publicly funded community and hospital-based services, with regional-level planning, training and accountability. To make this a reality, there has to be consequences if it doesn’t happen. Funding should be tied to provision. For full transparency, hospitals should also be made to issue public reports that spell out how many and what type of abortions they provide each year.

Funding also needs to be offered to train health professionals to deliver the services to ensure that now and into the future, we have a health workforce capable of delivering the services needed. GPs need to know that if they provide a medical abortion, their local public hospital will provide support and see patients if and when needed. GPs also need to have clear referral pathways so women can get into surgical abortion services in a streamlined and timely way.

Finally, women need assistance to navigate to abortion services when they need to. The inquiry recommends governments develop coordinated campaigns and education materials to improve women’s knowledge of their rights and options for accessing effective contraception and abortion care. It also recommends establishing a national information services like the Victorian 1800myoptions hotline.

While the recommendations are a step in the right direction, action is needed to translate these recommendations into actual services on the ground. The government’s response is eagerly awaited.

SOURCE: The Conversation, by Danielle Mazza, 30 May 2023