Gynaecologist Paul Hyland, medical director of the Tabbot Foundation, readily admits he is helping to put his own separate abortion clinic out of business. Since the launch of the Tabbot Foundation in September 2105, a telemedicine service providing medical abortions, he has been forced to closed his Launceston abortion clinic. But there are other reasons too.Dr Hyland says that changed laws around the licensing of day surgeries combined with additional costs of insurance, accreditation and compliance have pushed the cost of a surgical abortion to AUS $500 – double what the fee was just three years ago. Thus, he says, establishing the telemedicine service was a matter of necessity.The Tabbot Foundation was first launched in Tasmania and is now moving to become a registered charity to ensure the service is sustained into the future. The Foundation’s website averages 120 hits a day, sometimes generates up to 90 calls a day and consults with between 30 and 40 patients each week. The average age of those accessing the service is 30.Differing legislation between states and territories initially has made it difficult to provide an equal service across the nation. Abortion medications cannot be delivered to women in every region – those in the Australian Capital Territory, for example, must travel to New South Wales to collect the pills.One surgical termination provider complained the service may undercut their profits so severely it would even affect their charity work overseas. Another also said it was ruining his clinic business.Australian law states that drugs cannot be advertised and a traditionally conservative medical culture has made it difficult for word of the Tabbot online service to spread. “It makes it very difficult to educate the population that medical abortion is an alternative, and indeed preferable to surgical abortion,” Dr Hyland said. “This culture of obstruction exists in all levels of society – medical, nursing, politics, religious, business – and we are trying to break down barriers every day. You can put a billboard on the road saying ‘Don’t have an abortion, you’ll go to hell’, but you can’t have a billboard saying ‘If your pregnancy is unwanted, here are your options’.”For former state Health Minister Michelle O’Byrne, the woman behind the decriminalisation of abortion in Tasmania in 2013, changing the law was a matter of equality. Her nation-leading legislation aimed to clear up the language around abortion, remove it from the criminal code, improve access to termination and ensure those who did undergo the procedure were free from harassment.“…Women aren’t incubators. There’s no point where the rights or needs of the women shouldn’t be paramount.If you fundamentally believe women have equality, then everything you do must demonstrate that equality,” she said.Some of Ms O’Byrne’s staff took stress leave after the legislation passed. Her office was bombarded with fake fetuses and e-mailed “appallingly graphic” pictures throughout the lengthy debate.Women’s Legal Service chief executive Susan Fahey spoke strongly against suggestions Tasmanian laws impinged on freedom of speech because it created a harassment-free zone around clinics:”Where the access zone is concerned, anyone who suggests it’s an assault on free speech is speaking absolute rubbish. They can protest outside Parliament, they can protest anywhere, just not outside a clinic. [Protesting outside a clinic is] not a protest against the law, it’s a protest against the person, and it’s done to make that person change their mind.”But, Ms Fahey said, it seemed access to surgical abortion had decreased since the 2013 laws passed. “Access has actually gotten worse because a couple of the clinics have now closed down and the fact we have the Tabbot Foundation tells us access is not as it should be,” she said.“There are some doctors who say they won’t refer and that is a concern. If that happens the person needs to report it to the Australian Health Practitioner Regulation Agency.”Women’s Health Tasmania executive officer Glynis Flower agreed access to surgical abortion had not improved in the past three years. “The legislation is somewhat clearer, and clearing that is a big thing, but the problem is there is almost no option for a service within the government sector,” she said.SOURCES:The Examiner, by Emily Baker, 8 July 2016 ; The Examiner, by Emily Baker, 10 May 2016PHOTO: Tabbot FoundationSEE ALSO: Tabbot Foundation offers a telephone abortion service, 1 July 2016