Note: For the purposes of this article I refer to women seeking abortions, however I would like to acknowledge that other people who do not identify as women can also experience pregnancy and abortion.
Yesterday marked 45 years since the United States Supreme Court handed down it’s landmark decision in Roe v Wade. It is a great time to reflect on the reproductive rights of women here in Australia, and to critically consider what exactly decriminalising abortion achieves. There is a widespread assumption that law has a direct and causal relationship to health outcomes. However, this has not been proven to a sufficient level in the states and territories that have legalised abortion in Australia. That is not to say that decriminalising abortion is unimportant or that those that fought for legalised abortion in the other four states do not deserve our utmost respect and gratitude. As shown by the situation in New South Wales, South Australia and Queensland; in jurisdictions where abortion is criminalised, other protective measures remain out of reach. Decriminalisation is a precondition for the improvement of access to abortion services, and it is only when public health departments take responsibility that equitable access will be delivered. If our goal is to advance the access to safe, legal, and affordable abortion services for all who need them, we need to push further than just decriminalisation. As it stands, abortion is provided liberally in Australia, but mostly by private providers. This means that well-informed women in metropolitan centres with reasonable economic means seeking first trimester abortions are adequately served. To all those who exist outside of that characterisation, the same cannot be said.
The United Nations Council for Economic Social Cultural Rights explicitly acknowledges the right to elective abortion as essential to reproductive health rights, included in the broader right to health. This represents a gradual willingness to acknowledge the importance of securing a woman’s access to safe and legal abortion services as central to the right to the highest attainable standard of health. The provision of access to services and the removal of impediments are necessary to securing the protection of women’s rights. Barriers to access in addition to legality include financial affordability, geographical distance, privacy concerns, and workforce capability. These can be understood in terms of affordability, accessibility, and acceptability.
The supply of elective abortion procedures offered by public health clinics and hospitals does not meet the demand. This demand is instead met by private clinics. Fee-free treatment under Medicare only applies for procedures undertaken in public hospitals, and only around 50% of the population has some form of private hospital insurance cover. The majority of abortions are performed in the private sector for profit. Private clinics charge fees that significantly exceed the universal insurance rebate. Prices generally range from $800 to $4400 for a first trimester surgical termination, increasing remarkably for procedures needed in later stages of gestation. The situation is no better for medical abortion, where the cost to receive the necessary drugs can cost between the $500 to $1000. The drug itself costs slightly less than $40, as the drug is a part of the Pharmaceutical Benefits Scheme, however the other services required to attain an abortion (ultrasounds, doctors appointments, counselling, etc.) increase the cost of the procedure considerably. The private clinics which provide services operate with little competition, allowing them to charge whatever they choose. This results in costs in the hundreds of dollars, even with private health insurance and Medicare rebates. For those who cannot afford to purchase private health cover, getting an abortion can be financially unviable. There is a notable socio-economic gradient of access to reproductive health services. Cost poses a significant barrier to the most vulnerable women. There are limits to what the private sector can deliver. Health is a public good, and as such market principles do not work as desired. If public hospitals were to provide abortion services, this barrier would not be as pertinent. Government support for abortion services would also lead to some price regularity, with there being no consistent or standard rate for the procedure throughout the country. As with many other hurdles, affordability is intersectional; the affordability of the procedure is compounded for rural women living in remote locations, who may have to pay to travel to a metropolitan area for the procedure.
Geographical distance is a major impediment to women having access to abortion. 30% of Australians live in rural or remote locations with limited access and options when it comes to health care. In the rural and remote areas of Australia, particularly in Queensland, the Northern Territory and Western Australia, abortion provision is sparse and limited to private clinics in major cities. Most of the impediments to accessing abortions in Australia are amplified for women who live rurally. Many studies have highlighted distance to services, capacity of doctors, access to medical abortion, privacy issues, access to unbiased counselling, doctors with contentious objections, cost, and waiting times as significant obstacles to access for rural women. A study focused on Melbourne abortion clinics found that 10% of women seeking the procedure had travelled between 50km to 100km, and an additional 9% travelled more than 100km. This creates additional transport and accomodation costs. 20% of the women who contacted Victoria’s largest telephonic service were faced with a lack of transport or childcare, making travelling from their remote location to receive support impossible. This lack of access is unacceptable, with women in rural NSW reporting attempts to self-abort given the inability to attain professional assistance.
It is impossible to overlook the moral tactics that cloud and block women’s access to abortion services. These have influenced legislation, safe access, and factual knowledge related to abortions. Health practitioners have the right to refuse to participate in the termination of a pregnancy at any stage if they are religiously or morally opposed. More over, 75 Australian hospitals, seven teaching and 21 taxpayer funded, are administered by Catholic Health Australia, and consequently do not provide abortion services.
The Australian Capital Territory, Victoria, and Tasmania all have legislated safe access zones surrounding clinics that provide abortion services. The recent legislation relating to terminating pregnancy in the Northern Territory also includes provisions relating to privacy. These provisions guard against intimidation, harassment and intrusion of privacy that may result in harm. Safe access zones play an integral role in protecting women’s right to privacy, and access to health services. Facilities which provide terminations in Melbourne and Canberra have consistently reported protest activity at their premises, which has resulted in psychological distress for their staff, patients, and passersby.
Those who are against the legal provision of abortion services often disseminate false and inaccurate information regard health risks. This is an attempt to influence women to reconsider their termination and to advocate politically for stronger abortion regulations. Strategies of influence can be feral-centred or women-centred. Fetal-centred strategies have been used since the 1970s, and try to frame foetuses as babies. This is intended to guilt pregnant women. Strategies that are women-centred focus on the increased susceptibility of women who have had an abortion to experience health problems such as breast cancer, depression, and infertility. There is no evidence which supports these suggested links. They are not recognised scientifically or medically, and there is not a single international or national health organisation which agree with these claims. These are intended to incite fear in women, and falsely attribute contestation to abortion as concern for women's health.
As demonstrated by the exploration of existing barriers above, decriminalising abortion must be seen as a first step, not an ultimate goal. For all women to have fair and equal access to abortion services, there is still a long way to go. One thing that would improve our ability to progress more quickly would be a systematic collection of data relating to abortion on a federal level. There is no Australia wide data collection or policy directive in relation to pregnancy termination similar to other health procedures, such as cervical pap screening. As a result there is no national level policy directive to implement at state level. These vacuums in data and policy allow for conservative bodies to push morally based viewpoints. Many politicians have previously suggested that there are ‘too many abortions of convenience’, which has in turn pushed the trope of the selfish and irresponsible women. Without accurate data, it is difficult to rebut these arguments. Most numbers are inferred through complex guess work, and this is simply insufficient. There are many different initiatives which could significantly improve the current state of abortion access in Australia. I would love to hear what you think are the next steps in making reproductive health services accessible to all.
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