“I’m sorry, it looks like we can’t get you in for another four weeks.” The tears brimming over Sarah’s* eyelashes spill, and she starts to sob. I offer her a tissue from the box perched ready on the desk. “I can’t wait another four weeks for the abortion. I can’t keep any food down, I’m so weak, and I just need to get back to work,” she says.
Working in general practice in the Northern Territory, this is a conversation that I have with women all too often. Despite widely available contraception and good uptake, unplanned pregnancies occur, as they do all over the world. Some women choose to abort these pregnancies. They are allowed to do so; abortion in the Northern Territory is legal. But our laws make accessing abortions difficult, and women have to endure long waits.
A bill to reform abortion law that will be debated in Northern Territory Parliament tomorrow aims to change this.
Unfortunately, it doesn’t go far enough.
The law that currently regulates abortion in the territory is restrictive and outdated. It permits a woman to abort a pregnancy under 14 weeks, but only if she sees two doctors who agree, one of whom must be a specialist gynaecologist.
The abortion must be performed in a hospital. If she is under 16, her parents or guardians must also consent. If a doctor does not believe in abortion, there is no obligation to refer a woman on to someone who will offer this option. In practice, this means that women can only access surgical abortions at Royal Darwin and Alice Springs hospitals.
Surgical abortions require an operating theatre, staff and a general anaesthetic. These clinics are only held once a week and sometimes there is a waiting list. To accommodate everyone, women like Sarah, who are in earlier stages of pregnancy — say, six weeks along — are deemed less urgent than women whose pregnancies are 13 weeks and approaching the legal cutoff. So they have to wait.
If Sarah and I were down south, there would be a much simpler solution that would mean she could avoid surgery altogether and get back to work within just a few days. Sarah could get RU486, a medical abortion. Instead of handing her a tissue, I could print a request for an ultrasound and take a blood test.
The results would take a couple of days. If Sarah still wanted to go ahead with the abortion, she could come back and see me, without needing to repeat her story to another doctor. Sarah would take one round pill in my office and take a purple packet home with her. Thirty-six hours later, she would put four hexagonal tablets between her cheek and her gum, letting them dissolve. Shortly afterwards, she would have a miscarriage, in the privacy of her own home.
Since it was approved in 2006, RU486 has been safely prescribed by general practitioners in all jurisdictions in Australia except the NT. In 2013, it was added to the Pharmaceutical Benefits Scheme without fuss or fanfare. For pregnancies under seven weeks, the drug is 96% effective and serious side effects occur in less than 0.5% of cases. Ninety-two per cent of Australian women who have taken RU486 say they would recommend the method to a friend.
Access to RU486 for Territorians is the aim of the bill introduced last November by Kezia Purick, the independent member for Goyder. The Medical Services Amendment Bill will allow RU486 to be prescribed by GPs who have done additional training, bypassing the need for specialist gynaecologist involvement. It is a good start. (See earlier posts on this subject here and here.)
But to truly improve access to abortion for NT women, we need the bill to go further. The requirement for two doctors to agree needs to go (as it has done in all states except South Australia). Women do not have to explain themselves to two doctors for any other medical procedure, including life-threatening ones.
We need legislation that provides safe access zones, to prevent protesting at abortion sites and allow women to access health care without being harassed (like that recently passed in Victoria, ACT and Tasmania). We need legislation that requires doctors who object to abortions to refer women requesting referrals to someone who can help them. And we need to affirm, in the law, that women who have abortions are not guilty of a crime.
Our MLAs have the ability to make amendments to the Purick’s bill to strengthen the legislation. But they will only do it if we ask them to — abortion law reform is a risky issue for politicians.
But for Sarah’s sake, and the sake of all Northern Territory women, I urge you to contact your MLA.
Let them know you want them to vote for Purick’s bill. And let them know you want them to make it even stronger.
*Names have been changed