There’s an assumption that it’s relatively easy to access an abortion in Australia, but the truth is that it really depends on where you live.
Marie Stopes managing director Jamal Hakim says flying-in staff willing to work in the clinics has become more costly
Dr Andrew Crossman says he once had to send a patient 800 kilometres away to access appropriate abortion services
- Mr Hakim argues governments have a responsibility to provide reproductive healthcare to women
There is still a struggle to provide access in many parts of the country, according to Jamal Hakim, the managing director of an NGO that provides reproductive health services in both metropolitan and regional areas.
“Everywhere in Australia, access to abortion and contraception care is very much a postcode lottery,” he said.
“It gets even more difficult when it comes to rural and remote Australia.”
Marie Stopes Australia, the NGO Mr Hakim leads, runs four clinics in regional Australia — Rockhampton, Townsville and Southport in Queensland and Newcastle in New South Wales.
The organisation announced last month that all those clinics will close their doors in August, because of rising costs.
“It’s been one of the hardest decisions I’ve had to make,” said Mr Hakim.
“With all four clinics, we see about 6000 people,” he said, though not all of them come seeking an abortion.
A Marie Stopes reproductive health clinic, which is not one of the ones set to close in August.(
Supplied: Marie Stopes
Marie Stopes Australia estimates the closures mean that the pathway to safe abortion care would be compromised for about 500 people, but it would still try to help them find an alternative path.
How stigma is limiting access
The closure of the Marie Stopes clinics is just a symptom of a bigger problem.
There is a range of barriers to safe abortion access outside of major cities, and negative attitudes towards abortion can underpin all of them in one way or another, according to Mr Hakim.
Australia’s abortion postcode lottery
There’s an assumption that it’s relatively easy to access abortion care in Australia, but the truth is that it really depends on where you live. So why is it such a lottery still?
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When it comes to the closure of regional clinics, he lays the blame squarely on stigma and its flow-on effects on staffing.
“In our regional areas … we can’t always get qualified and specialist staff to work in our clinics.
“We have a number of vacancies always, so we fly-in nurses and doctors to continue services.”
As flights have become more expensive and scarce throughout the pandemic, that cost has only risen further.
Local doctors are often unwilling to help as well.
Sophie, whose name has been changed to protect her identity, recently sought an abortion in a small town which she has chosen not to name.
“It was probably the worst decision I’ve ever had to make in my life,” she says.
“But really I was looking at being a single mum or not being a single mum.
“I just didn’t think I could do it on my own, basically.”
Having made the difficult choice, there were still more hurdles to clear.
“I initially went to a GP and he refused to help me with that process, based on religious reasons, which I understand is his right to do.”
She found out about a local women’s health clinic by word of mouth, which ultimately helped her access a medical abortion.
Fewer and narrower paths
There are two types of termination — medical abortion and surgical termination.
Medical abortion is only available for the first 8 or 9 weeks of pregnancy. A pill is taken, often at home, under the advice of a doctor.
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Surgical abortion on the other hand takes place under general anaesthetic, under direct medical supervision.
It is available later in the pregnancy and can be a necessary next step if a medical abortion goes wrong.
Surgical abortions are hardest to access and that means women are often rushed into a choice because of the looming time limit that applies for medical abortions.
“When you find out you’re pregnant, you’re already quite close to eight or nine weeks, you really don’t have much time to work it out,” said Sophie.
“Healthcare appointments are quite hard to lock down in smaller areas, there was this real urgency that came about that was really panicking.”
Dr Andrew Crossman, while practicing as a GP in Broken Hill, once had to send a patient 800 kilometres to access the appropriate services.(
ABC News: Declan Gooch
In a different town with similar problems, Broken Hill in far-west NSW, Dr Andrew Crossman was the only local GP providing abortion access for eight years, until he left town two years ago.
“When I left, there was no one there actually doing it anymore.
“There were times when we had a failed medical termination for example, and we had fly-in, fly-out doctors who were conscientious objectors.
“We ended up having to send people hundreds of kilometres away, one particular case we had to send 800km away.”
He’s been told that another local doctor has since begun providing abortions, but only since his departure.
“I knew other doctors who were actually trained in the areas but didn’t really take it up for some reason.
“I think there’s a perception that it might be a bit harder than it is.”
He said pulling together multiple elements, from a willing pharmacist through to pathology and counselling, can also be challenging.
“At every one of these steps, particularly where health infrastructure is struggling, you can have a delay there.”
He said he wants to see hospitals make it a priority
“I see it as bread and butter healthcare, we’re talking about just general healthcare for women and it isn’t really rocket science.”
‘We need to talk about it more’
In recent decades, abortion was technically illegal in most jurisdictions.
“Up until this year, abortion care was in the criminal code in some places in the country”, says Jamal Hakim.
“Decriminalisation means that this now is no longer a criminal issue, this is a health issue and governments do have a part to play, and some have done that better than others.”
Jamal Hakim argues state and territory governments need to fund services and the federal government needs to provide more funding for the procedure itself via Medicare.
The harder thing to shift though is that sense of stigma, which kept Sophie from talking about what was happening to her, even with family and close friends.
“It’s the judgement,” she said.
“I just felt so fragile that any amount of judgement or hatred or anything, I really wouldn’t have been able to cope with it, and I probably still couldn’t.
“There are so many women who have been in this position and I don’t know why we don’t talk about it.
“I think we need to talk about it more.”