Since Australian women rallied for “free, safe, accessible abortion on demand” 40 years ago, much has been achieved.
Legal reform of some kind has taken place in most states and territories. There is Medicare funding for pregnancy termination, mifepristone is available on the Pharmaceutical Benefits Scheme (PBS) and women no longer suffer the complications from illegal “backyard” operations.
Yet there are still obstacles for women to access affordable pregnancy termination services in a timely manner.
A 1998 Western Australia law reform, while decriminalising most abortion, imposed the obligation for an extra doctor’s visit – with counselling from a doctor uninvolved with the procedure. This gatekeeper role of GPs, including those personally opposed to abortion, means for some women, obstruction, delays, and extra expense and risk.
Last year’s closure of one of Perth’s privately run women’s health clinics has put pressure on the remaining services. Public hospital service provision is patchy, depending on a coincidence of willing clinicians and acquiescent administrations. This spells an end to the provision of public pregnancy terminations.
Full or part-privatisation (such as public-private partnerships) also threatens provision, especially where the private provider objects to pregnancy termination.
Privately, abortion is expensive and can put the procedure out of reach for many women. Many GPs are unaware that the public hospitals that don’t provide abortion may be able to fund its private provision.
Abortion data for WA is available only up to 2012, so it is too early to know what impact last year’s PBS listing of mifepristone and misoprostol (termination up to seven weeks’ gestation), is having on abortion accessibility. It certainly has the potential for improving access, especially for women in regional or remote areas.
However, the need for the prescriber to undergo (admittedly straightforward) online training, to arrange a designated pharmacy to dispense the drugs, to ensure management pathways for the expected cases of ongoing pregnancy or complications, institutional resistance, and the assumption that abortion is something for someone else to provide, may all deter the uptake of prescriber status by medical practitioners.
And then there are the difficulties for marginalised groups — those unable to access Medicare; young women, homeless women, Aboriginal women — with barriers additional to expense, making their needed abortions delayed or simply unattainable.
So, what needs to be done?
The barriers to self-referral, including younger women and women with later gestation pregnancies, should be removed. Legal protection for clinicians to avoid involvement in abortion should not be used by institutions to decline abortion provision.
The public should be able to expect public hospitals to provide the full range of essential surgical and medical procedures, and abortion should be no exception. Retaining public hospital services in public hands, with full accountability to the community’s expectations, would also help ensure the services are provided.
Creating a new generation of abortion providers, to remove the sense that it’s someone else’s responsibility, would help. As well as increasing Medicare rebates to cover the costs.
Despite remaining stigma, the ideal service is much like many sexual health services associated with public hospitals – co-located to manage complications, confidential and separate patient files, a dedicated staff that respect patients’ wellbeing, autonomy and privacy, publicly funded and with the option of self-referral.
[Kamala Emanuel is a clinician at Family Planning Association of Western Australia’s Sexual Health Service. This article was first published at Medical Forum WA.]