Decriminalisation was meant to give women access to safe, affordable abortions as a form of health care. Five years on, the ABC can reveal glaring examples of the system failing people in rural and regional areas at almost every step.
Abortion is legal in Australia, but doctors say an 'unspoken ban' is robbing women in regional and rural areas of the right to chooseAbortion is legal in Australia, but doctors say an 'unspoken ban' is robbing women in regional and rural areas of the right to chooseMelissa received a call on the day she was booked in for an abortion at Queanbeyan hospital, to inform her the termination could no longer go ahead.
The ABC has been told how patients are being denied equitable access due to ideological position, unclear guidelines, chronic staff shortages, overstretched resources and lack of government funding. Surgical terminations are generally available further into the pregnancy and are administered through a procedure known as a dilation and curettage , where the pregnancy is removed from the uterus, under anaesthetic.
Dr Robertson referred her to Queanbeyan District Hospital, a regional service outside Canberra, having transferred patients with malformations there before. Terminations at later gestations can require sophisticated equipment and resources, which not all hospitals have. It did not respond to direct questions about Melissa's case, or about why Queanbeyan hospital had stopped providing surgical terminations.Dr Robertson, the sonologist, wrote to the LHD's executive management the day after Melissa was turned away, requesting a formal apology on behalf of her patient.Her Moruya-based GP, Lisa Hyde, asked the LHD to provide clear guidelines for terminations on medical grounds, to avoid a repeat of what happened to Melissa.
She is concerned that Melissa's case has been shrouded in secrecy, with no feedback or communication from the LHD executive. "If there are people in positions of power who are uncomfortable with abortion services or don't believe they should be provided … they can obstruct the provision of services," she said.
During that appointment, the woman again requested a termination. Only then was she supported to have one. But by that stage she was 22 weeks pregnant. A highly anticipated inquiry into reproductive health care has recommended significant changes to Australia's health system to make contraception, abortion and pregnancy care more accessible.
Patients seek abortions for all sorts of reasons — for many, going through with a pregnancy may present real and lasting harm. Some factors include poverty, domestic violence, existing carers' responsibilities, and trauma from rape or sexual assault. In many cases, it's simply not the right time to be a parent.
Mr Donato said he could not be clear on where the directive came from, but he has been led to believe it was from "high in the health bureaucracy", such as the hospital executive or the Western NSW LHD. The spokesperson said the LHD is currently reviewing abortion access across public health facilities in the region, "including service provision and referral pathways at Orange Hospital".
"Historically, the public health system was designed to respond to emergencies. Terminations, I guess, have been viewed as an elective procedure, meaning they won't be prioritised as an area of service delivery," she said. Given the patient had missed the nine-week deadline to take MS-2 Step for a medical termination, the only option was surgical. The nearest public hospital that might provide that service was Wollongong or Sydney — hours away and too far to travel.
Even for women who have the time, money, and resources to access the care that they need, the reality of navigating the system is exhausting. "I lived in the United States for a long time, and I'm just gobsmacked at where they are now," Dr Hyde said.
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