In October 2018 Queensland’s parliament passed a bill decriminalising abortion, finally bringing the state’s reproductive laws into the 21st century.
It was a grossly overdue step towards giving women their basic bodily rights, but it was not enough. With New South Wales now on the verge of decriminalisation, it is important to acknowledge that the broader battle for women’s reproductive rights lies not only in decriminalisation but in accessibility.
Legalising abortion is a crucial start, but it doesn’t do much to assist people who can’t get to a clinic or can’t afford to pay for treatment. Australia’s abortion laws vary wildly across the country but access is universally poor, with state governments often failing to make progress in accessibility following decriminalisation. Public hospitals and general practitioners across Australia are under no obligation to provide abortions as it is not tied to federal funding. This leaves most with the options of visiting a clinic or using a telehealth service, which puts rural women at a severe disadvantage.
Holly Brennan, manager of Queensland-based reproductive advice and referral service Children By Choice, says that “a large number of people who contact us for help, around 80%, are facing geographical or financial limitations”.
“Though access has dramatically improved for some women since the recent legislation, a significant number of women still don’t have public services available to them,” she says.
As one of Australia’s largest states, options for Queensland’s rural and regionally-based women are limited. The majority of clinics are located in the Brisbane and Gold Coast areas; others are limited to larger regional cities of Townsville, Cairns and Rockhampton. According to Children By Choice, some healthcare providers have an option to carry out the procedure at home, with a consultation from a doctor via Skype for those who are not able to travel to a clinic in person.
However, these appointments come at an out-of-pocket cost starting at $300 and must be conducted in the first nine weeks of pregnancy. Other GPs stipulate that patients must live less than an hour away from a hospital to access an at-home medical abortion. Further, most GPs across Queensland and other states only offer medical abortions and do not offer a remote procedure, leaving some women with one expensive option: travelling to a clinic.
Financial accessibility is poor across Australia. It is difficult to access fully rebatable abortions under Medicare, meaning an abortion anywhere can incur an out-of-pocket cost, which is usually higher in rural areas. In regional areas such as Rockhampton and Townsville, a medical abortion has an upfront cost of $790, whereas the same procedure in inner-city Melbourne, can cost as little as $250. Women based in rural areas are penalised further with telehealth procedures costing up to $676. Children by Choice estimates that some private procedures, for those who cannot access a public service, can cost up to $4000.
So what happens when someone can’t access a termination? Children By Choice offers support, information and referrals for women seeking abortions, and urges women to contact them if they are unable to access the procedure for any reason. They vehemently advise against women taking their pregnancy into their own hands. There is good reason for this: over 22,000 women die each year around the globe from unsafe abortion, and there are other all too common dangers faced by those unable to access abortion easily.
According to a 2010 study, women in violent relationships are more likely to have an unplanned pregnancy and experience reproductive coercion. Accessing abortion, especially a surgical abortion, is extremely difficult in a coercive relationship due to financial monitoring and surveillance by an abusive partner and can lead to physical violence, as reported by 74% of those suffering reproductive coercion. Addressing reproductive coercion must be a vital part of domestic violence policy and, by extension, abortion access as well. Women in abusive relationships are suffering under this approach to reproductive rights and will continue to do so without a major expansion of the services currently available.
Indigenous women are also heavily affected by the lack of access to reproductive healthcare, according to Children By Choice. They are more likely to live in a rural area and suffer from domestic violence. A 2016 study indicated that both pregnancy and birth rates for teenagers are higher in Indigenous communities due to a lack of access to terminations and a lack of access to long acting contraceptives. It found that Indigenous women may also face a higher number of doctors and other medical staff who are conscientious objectors to termination procedures.
The historical colonial control of the reproductive choices of Indigenous women has led to dysfunctional and ineffective public sexual health services, which can alienate Indigenous communities and create distrust. Research shows that Aboriginal Community Controlled Health Services are highly effective at reducing the health gap between Indigenous and non-Indigenous peoples and the federal government needs to strongly support these initiatives in order to provide appropriate reproductive care.
The women of Australia don’t just need legal abortions, they need properly funded access. All states must commit to federal Labor’s proposed policy of public hospitals providing abortions in order to access federal funding as well as committing to public funding for procedures for rural and Indigenous women.
Countries like Sweden, Canada and England have universally provided low cost, safe and legal abortions for decades and Australia must follow their example by fixing its fractured and flawed approach to reproductive care. The state has a responsibility to these women. Leaving them with this shell of a system is a violation of the rights of any pregnant person.