How and why abortion access is limited

August 15, 2001
Issue 

Picture

BY KAMALA EMANUEL

Tasmanian abortion services may be set to improve, with health minister Judy Jackson offering to investigate the possibility of public funding for the establishment of a new abortion clinic. This is a significant victory for Tasmanian women who, like many women around Australia, face numerous hurdles in accessing abortion services.

Not all the hurdles result directly from the presence of abortion on the criminal code but all have been exacerbated by it. The Tasmanian experience highlights the need both for abortion laws to be abolished and for increased recognition that reproductive choice is a woman's right.

In March, Tasmania's only free-standing abortion clinic closed. Since then the public hospital system has struggled to manage the increased demand for abortion services and more Tasmanian women have been forced to travel interstate to access a confidential, timely and non-judgmental service.

Launceston General Hospital has continued to perform a fixed number of abortions. However, at the Royal Hobart Hospital, while the number of women seeking access to abortion has increased, the loss of a staff member in late August is expected to result in a decline in the number of abortions performed.

In the 1970s, women couldn't obtain abortions in Tasmania. Feminist activists ran a support network, enabling women to fly to Melbourne on student concession fares and obtain abortions at the Fertility Control Clinic where lower costs for Tasmanian women had been negotiated. In the 1990s the Women's Health Foundation (WHF) abortion clinic was established near Hobart.

Isolated by Tasmanian medical personnel the clinic was forced to fly in interstate doctors. The clinic's poor relationship with the specialist community, combined with uncertainty about the legal status of abortion, also meant that it required a much greater degree of experience for all its proceduralists than other medical services and interstate clinics.

This resulted in high fees for the clients — in the vicinity of $250-380 — and financial uncertainty for the clinic. According to the 1996 National Health and Medical Research Council's draft report on abortion in Australia (since pulped by a hostile federal government) Medicare rebates for abortion are not as high as for comparable procedures.

Non-surgical abortion

For a brief time medical abortion — non-surgical abortion induced by drugs under medical supervision — was available in Hobart. This gave women another (cheaper) option.

Methotrexate and misoprostol have been successfully tested for use in medical abortion (provided surgical abortion is available for back-up). But they are not licensed for this use. The manufacturer of one has tried to stop it from being used for abortion, and the manufacturer of the other will not seek to extend its licence to include abortion. So, despite being easily prescribed in Australia (unlike the banned but even more reliable mifepristone RU486), they are not in widespread use.

Multiple impediments exist for doctors wishing to prescribe medical abortion. Many anti-choice doctors refuse to prescribe it, and other doctors are unaware of this use for the drugs. Those who are, and do not have "moral" objections, then have to face high insurance premiums.

At least one medical insurance provider currently refuses to indemnify doctors who prescribe the drugs for abortion, on the grounds that it would be "off-label" prescribing. But it is not illegal to prescribe medications outside the manufacturers' recommendations. Doctors who use methotrexate to treat ectopic pregnancy (pregnancy outside the uterus) are insured even though this is also against the manufacturer's guidelines.

Another insurance provider covers medical abortion under the costly rate associated with surgical "procedures", despite the fact that it doesn't involve the use of any surgical instruments.

It is hard to escape the conclusion that these insurance providers are more worried about litigation resulting from the quasi-legal status of abortion than about safe medical practice. This makes it much harder for women to find doctors to perform the procedure, and pushes the costs up when they do.

The availability of medical abortion in Hobart, although briefly opening up more opportunities for women, contributed to a decline in women attending the WHF clinic. Financial pressure soon forced the clinic's closure, and at around the same time access to medical abortion was severely reduced.

Previously employed at the clinic, since its closure I have been involved in searching for ways to maintain Tasmanian women's access to abortion. In the process I have become convinced that mainstream acceptance of anti-choice ideas and the crimes act provisions prohibiting abortion are the two biggest intertwined factors undermining women's access to abortion services.

Boycott

Even many of those who pay lip service to access to abortion being a woman's right do not acknowledge that this means there is a duty on the part of health services to provide it. Currently, staff can boycott the procedure.

For years abortion hasn't been available in northwestern Tasmania because the anaesthetists at the local public hospital refuse to be involved. New gynaecology staff who will be taking up positions in the Royal Hobart Hospital have indicated that they refuse to perform abortion. The hospitals haven't been obliged to try to recruit staff who will.

Staff do not even have to be trained to do the procedure. Despite the fact that abortion is one of the 10 most performed surgical procedures, medical training does not routinely include it. Worse, it may not even be available as an option.

When I was a student in NSW, abortion wasn't carried out in the hospital where I was attached for gynaecology; as an intern and resident, I was unable to be trained in the teaching hospital where I worked. When I finally trained at an abortion clinic, I was still unable to work in a teaching hospital under gynaecologist supervision to up-grade my skills or achieve some kind of accreditation to work alone.

In the last few months I have held a series of meetings with service providers, referral agencies and the health department. While hospital management has ensured the short-term continued provision of abortion, its repeated message is that this is "not sustainable", and that an out-of-hospital "solution" must be found.

Surgical abortion is a relatively simple procedure. For the majority of women requiring it, it can be safely performed in a consulting room or outpatient department facility.

The advantages of a free-standing clinic are that abortion can be provided in a private, non-bureaucratic and non-judgmental environment by specifically recruited staff. The advantages of hospital provision are the presence of back-up facilities in case of a medical emergency and the relative protection from anti-choice attacks that a mainstream public institution can provide.

The recent murder of Steve Rogers, a security guard at Melbourne's Fertility Control Clinic, has shown how vulnerable free-standing clinics can be to anti-choice activity. Protests, anti-choice hate mail, harassment of clients and staff, and violence all hinder women from accessing abortion services and even information and referral services.

The presence of abortion on the criminal codes of most states adds legitimacy to the calls to close down services, to prevent them receiving government funding (through Medicare or grants), and to suppress information about abortion availability.

Only a large, visible public campaign supporting women's right to decide can strengthen access to abortion. We need to abolish the laws that currently prohibit women from inducing abortion, and assisting others to do so and we need to get rid of all practical barriers to the provision of abortion.

The struggle for reproductive rights is broader than just abortion provision. It includes strengthening contraceptive and fertility services (including conception assistance to lesbian and single women), pregnancy care (including midwife care) and child care. But securing the option to terminate a pregnancy remains a touchstone for feminist campaigning.

There is an opening now for women to run such a campaign. We should continue the struggle that women started in the '70s, to make abortion free, legal, safe and available on demand. And I would add, provided in non-judgmental, geographically accessible facilities.

There has been little public discussion in Tasmania of abortion services since the clinic's closure. There is a danger in the lack of public input that other health services may be traded off or cut. State government figures released on August 3 show a budget surplus of $3.5 million, up from an expected $2.6 million. The money exists to adequately fund all health services, but for it to be allocated will require a united public political campaign.

The Denison branch of the Socialist Alliance has produced a petition calling for repeal of all abortion laws in the criminal code. This will be presented to the state attorney general in late August. The socialist youth organisation Resistance will be holding a public meeting about the abortion rights campaign on August 18 [see pages 30-31 for details].

[Dr Kamala Emanuel is the convenor of the Denison Socialist Alliance branch and a member of the Democratic Socialist Party.]

You need 91×ÔÅÄÂÛ̳, and we need you!

91×ÔÅÄÂÛ̳ is funded by contributions from readers and supporters. Help us reach our funding target.

Make a One-off Donation or choose from one of our Monthly Donation options.

Become a supporter to get the digital edition for $5 per month or the print edition for $10 per month. One-time payment options are available.

You can also call 1800 634 206 to make a donation or to become a supporter. Thank you.