Accessing abortion
While it may be legal, it's not easy
by Saffire Penn
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The United States Supreme Court ruled there was no constitutional right to abortion on the 24th of June, 2022.
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Ever since, our international headlines have highlighted their issues of access. However, we have our own difficulties with accessing women's reproductive rights.
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In Australia, abortion has been decriminalised in all states. Abortion is treated as a healthcare matter, and not a crime.
In 1988, Western Australia was the first to decriminalise abortion and just this year, South Australia was the last state to decriminalised abortion.
In 2019, New South Wales decriminalised abortion with the Abortion Law Reform Act overturning the 119-year-old law of abortion being a crime.
The bill passed the upper house with 26 votes to 14 after nearly 40 hours of debate. It is currently the third longest debate in the history of the Senate.
Image: NSW Legislation
Image: NSW Legislation
Dr Frida Carswell is a gynecologist and obstetrician at the Merewether Specialist Centre.
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She addresses that many women who make the decision to have a termination procedure feel anxious, and therefore seek private clinics.
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“Most people who fall pregnant want to go to private clinics, but there is only one place to go in Newcastle,” explains Carswell. “That’s why so many people go to Sydney to access abortions.”
The Gynecology Centres Australia (GCA) is the one place where a person can access a private abortion clinic in Newcastle.
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It is located on 9/24 Brown Rd, Broadmeadow NSW 2292.
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The GCA provides first trimester pregnancy termination services of medical and surgical abortions.
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Their policy is to provide comprehensive, concise and unbiased information, with each patient being individually assessed and counselled prior to her procedure.
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Through their website, a consultation can be arranged.
The Marie Stopes Australia, a nationally credited private abortion centre, used to operate a Newcastle clinic. However it closed during August, 2021.
The decision to close, according to their statement, was due to financial loss from the COVID-19 pandemic.
In NSW, the only Marie Stopes clinics are now located in the Sydney CBD, Westmead and Penrith.
A study conducted by James Cook University found that those living in rural areas experience the greatest issues regarding access to reproductive services.
Women living in rural areas lack effective transportation and have greater distances to travel to these services. Additionally, they experience greater financial barriers due to generally having lower incomes and bearing higher costs to primary healthcare.
Dr Carswell explains that prior to decriminalising abortion, it could only be accessed by women in the private healthcare system who could afford these private clinics. It required a psychiatric test, to which a doctor would need to find an honest and reasonable belief that an abortion was required to avoid 'serious danger to the pregnant woman's life or to her physical or mental health.'
The interview recording further explains how abortions were gained prior to its decriminalisation.
In 1975, abortion was listed as a rebatable item in the medicare system. The rebate would assist with half the cost of a first-trimester procedure. However, a survey conducted by the Preterm Foundation in 1976 found that 2 in 10 women had attempted an abortion before presenting at the clinic, due to the still high cost, averaging around $630.
Since abortion was decriminalised in NSW, with the passage of the Abortion Law Reform Act 2019, it was introduced into the public healthcare system, under the Pharmaceutical Benefits Scheme.
This legislation has enabled for further facilities and an extension of power to General Practioners (GP) to prescribe and perform abortions. The Pharmaceutical Benefits Scheme has allowed for the average cost of an abortion to decrease. However, it is still expensive, according to Marie Claire which found the out of pocket expenses varies form $465 - $560.
On a positive, from mid-next year, ACT residents will have access to free medical and surgical abortions up to 16 weeks of gestation. The other states are yet to make a decision that allows abortions to be affordable.
Image: City of Philadelphia
Image: City of Philadelphia
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General practitioners are able to perform the two types of abortion; medical and surgical. Additionally, you also don’t require a reason or referral to undertake either abortion procedure.
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GPs can prescribe the medication that would induce an abortion. This is a safe and effective method of terminating a pregnancy up to 9 weeks gestation.
An early medication abortion can occur by using two medications, mifepristone and misoprostol to cause the pregnancy to miscarry. This broader scope for GPs is across all states and territories, except South Australia, which requires the medication to be served on hospital grounds.
Additionally, a GP or gynacologist can perform a surgical abortion. This is commonly performed from 12 weeks to 16 weeks gestation.
A surgical abortion requires an ultrasound and a blood test prior. Most surgical abortions are done under sedation, or a light anaesthetic. The procedure takes around 15 minutes, however, you will be required to remain in the clinic for about 4 hours due to medical observation.
Image: Fine Art America
Image: Fine Art America
Image: Fine Art America
Image: Fine Art America
Image: Clearblue
Image: Clearblue
Currently, there are only two states in Australia that conduct research and publish abortion data, Western Australia (WA) and South Australia (SA). The 2018 Reported Abortions by Weeks of Gestation (WA) found that 82.1% of abortions occurred before 9 weeks. Similarly, in South Australia, 91% of all abortions were found to have occured during the first 14 weeks of pregnancy.
The UNSW Sydney states that despite difficulties in estimating the rate of abortion in NSW, we can confidently estimate that a large majority of abortions would occur during the first trimester.
“If a pregnancy is detected through an ultrasound before 9 weeks, then having a medical abortion is the best available option for you,” says Carswell.
Olivia* had an abortion. “I got my abortion during the 2020 lockdown period of the pandemic,” says Olivia.
“I was 7 weeks pregnant when I first visited a GP. She immediately discussed my options, but I was unaware she could prescribe the medication. When I realised this was an option for me, it was too late. I had waited too long and needed to get a surgical abortion.”
Dr Carswell addresses that accessing information is the most prominent barrier women are facing. It’s greater than the barrier of finance, travel and access to facilities.
In reference to the Newcastle abortion clinic, she states: “It is not general knowledge of this place in Newcastle where you can have an abortion…it’s not like it’s been advertised…even many GPs don’t know about it.”
The Australian Journal of General Practice made the observation that although there is no nationwide data, it appears that only some Australian GPs are willing to provide medical abortions and less are willing to perform surgical abortions.
Evidence suggests that lack of training, lack of support, fear of or actual stigmatisation and fear of demand are key barriers to GPs establishing and providing abortion services, both internationally and in Australia.
“GPs often don’t want to do surgical abortions,” says Carswell. “Sometimes it’s for religious reasons, but it’s mostly because people don’t like doing it.”
*Olivia now acknowledges her mental health, stating: “I spent many nights wondering if I should tell anyone about this. But I was afraid to complain because I didn’t want to feel shame for having this option in the first place.”
Dr Kcasey McLoughlin, a senior lecturer at the University of Newcastle Law School, explains the US Supreme Court decision in Roe v Wade.
“What we saw in Roe v Wade was an interpretation of the 14th amendment, that effectively read a right to privacy and a limitation on states to affecting abortion rights” says McLoughlin.
The constitutional right to abortion in America, found within the 14th amendment, protected women who lived in predominantly republican states from passing legislation to criminalise it.
However, when Donald Trump appointed three conservative republicans to the Supreme Court, inevitably, the Dobbs decision overturned Roe v Wade.
Currently, neither the US nor Australia have a constititonal right to abortion. But in Australia, we have passed legislation in each state to decriminalise abortion.
Justice Samuel Alito said that the 1973 decision “must be overruled” because the arguments were “fundamentally weak.” In his opinion, a constitutional right to privacy would be ‘far-fetched’ and would not uphold the ‘neutrality’ of the constitituonal framework.
In asking McLoughlin what she thought of Justice Samuel Alito’s comment, she explained: “The neutrality of the judiciary has always been a big fantasy. If you have nine men who all have similar backgrounds, interpreting a document that only white men were able to put together, then the idea that’s neutral is on its face.’
“Nobody talks about our access to abortion because everyone’s eyes are on America. We feel like our problems don’t matter,” says Olivia*.
A study by James Cook University found that women’s experiences with GPs varied from being easy and supported to being very challenging.
Challenges related to delays in seeing a rural GP, lack of willingness of GPs to refer, lack of information provided about the procedure or the clinic, lack of information about medical abortion and the required follow-up visit, delays caused by the need for blood tests or ultrasounds and negative GP attitudes.
Despite the legal and pharamcetuical reform in Australia, we still have great barriers to our reproductive rights, and the situation in America shouldn’t diminish it.
*Olivia’s name was changed to protect her privacy.
