Women shouldn't have to travel interstate for abortions, doctor says

Women who need surgical abortions between nine and 14 weeks of pregnancy will be left in the lurch throughout Australia unless state and territory governments learn from Tasmania and start preparing for the closure of private abortion providers, gynaecologist Dr Paul Hyland says.

Hyland has been Tasmania’s primary surgical abortion provider for 17 years, but was recently forced to close his Hobart clinic, the only provider of surgical abortions to women in the state. While public hospitals also carry out surgical abortions, these are not routine, and are usually reserved for women in later stages of pregnancy who are experiencing life-threatening and emergency complications.

There has been a rapid uptake of the pill RU486 since it was registered by the Therapeutic Goods Administration in 2012. The pill brings on a miscarriage, known as a medical abortion, and it has caused the demand for surgical abortions to decline rapidly in countries where it has been introduced. Hyland said this was one of the reasons it became financially unsustainable to keep his surgical abortion clinic open.

He said the closure of his clinic was a good thing, because it meant women had more choices regarding abortion and no longer had to attend a clinic or undergo a surgical procedure. However, he is angered by the failure of the Tasmanian government to fill the gap that the closure of his clinic will leave for women who are too advanced in their pregnancy to take RU486, but who are also not suffering a medical emergency or foetal abnormality and so will not be able to undergo an abortion in the state’s public hospital system.

These women have been forced to travel to Victoria to get the surgical procedure, leaving their families and taking time off education or work, a situation Hyland described as unacceptable. A spokeswoman for Michael Ferguson, the Tasmania health minister, told Guardian Australia he was still awaiting the outcome of an investigation by the Department of Health and Human Services that was exploring other options.

“We made the department of health aware of this issue before our other clinic closed in Launceston in 2016, and that is the point he should have been working hard to make abortion services available in the public system,” Hyland said.

Types of abortion

Surgical - can be performed up to between 20 to 24 weeks gestation, depending on legislation

Medical – can be administered up to nine weeks gestation and can be done at home except in South Australia and the Australian Capital Territory

Legislation

Abortion laws vary between states and territories.

It has been effectively decriminalised in Victoria, the Australian Capital Territory, Tasmania, South Australia, Western Australia and the Northern Territory.

It remains in the criminal code in Queensland and New South Wales, but can be performed in these states under certain circumstances.

Costs

Costs vary, depending on geography and gestation. In urban areas and when they are performed by private providers, a first trimester surgical or medical abortion usually costs between $250-$400. This is what most women would pay in Brisbane, Sydney, Perth and Melbourne. Outside of major population areas, for example Tasmania and North Queensland, or regional areas, abortions of both kind can cost much more. In Rockhampton for example, a medical abortion costs above $700. In places where they can be provided publicly, like South Australia and the Northern Territory, they are free.

Late term abortions can be especially hard to access and women may be flown interstate to get them.

How often do they happen?

There is no specific Medicare number for abortions – they are lumped in with other gynaecological procedures including treatment of miscarriage. Because of this it is difficult to accurately measure the number that occur each year.

According to Children by Choice, a Queensland-based counselling service: "The lack of accurate information about abortion rates makes it difficult to plan for service delivery and to monitor whether public health interventions are successful in reducing the unplanned pregnancy and abortion rate, at both state and national levels."

Ferguson said he had extended the patient travel assistance scheme for women who were referred by their GP to go to Melbourne for the procedures so they would not be out of pocket. He had opposed the introduction of RU486, and has joined in protests against changes to make abortion access easier.

Hyland said other states would face similar problems if they did not start making abortions more readily available through the public system. Medical terminations using RU486 were first approved in France in 1988, followed by the UK in 1991. According to Scotland’s National Statistics office, in 1992, one year after RU486 was licensed in the UK, 16.4% of terminations were performed medically. Within five years, that number rose to more than one-third, and by 2016 it was 82.9%.

“Eventually public hospitals will have to provide abortion,” Hyland said. “Tasmania, because of its small population size, has been the experiment. And it should be the trigger for other states realising they have to bite the bullet and provide it in public hospitals.”

The head of the Australian Medical Association, Dr Michael Gannon, who is an obstetrician, agreed that the situation in Tasmania was unacceptable. He said the personal ideologies of people in government should not get in the way of providing legal medical services to women.

“I have a lot of experience with the great trauma and sadness that has for generations now seen Irish women having to travel to terminate a pregnancy,” he said.

“And to think Tasmania has women crossing the Bass Strait to access something which is a legal and legitimate form of healthcare, and the fact that they have to make excuses to be absent from school or work or university to obtain what is their right, is very simply not good enough.

Asked what should be done to address the problem, he said the Tasmanian and other governments were “duty-bound” to provide abortion services.

The deputy leader of the Tasmanian opposition, Michelle O’Byrne, was behind the successful amendment that led to abortion being removed as a criminal offence when her party was in government. She said that when the Liberal government was elected in 2014, she had done all she could to make abortion access easier and safer for women.

Now, when women seek information about health and abortion services on the Tasmanian government’s website, they get a message: “page not found”.

“I am devastated by what is happening,” O’Byrne told Guardian Australia.

“We were so careful to make sure no one would be disadvantaged when it came to abortion. And while medical abortions are often better than surgical abortions for women, they will never and should never replace surgical abortions altogether.

“It’s heartbreaking we are back here again and horrifying that in 2018 we are still trying to get women access to abortion in a state where it is legal.”