Abortion patients trapped in limbo as country doctors put moral objections first, obstetrician says

Women in many areas remain cut off from abortion care, one SA doctor says, as a South East woman tells of her excruciating efforts to access the service.

Gabrielle* remembers sitting with friends as they enjoyed a Sunday roast, while she was in excruciating pain pretending like nothing was wrong.

Hours earlier the Mount Gambier woman made the 200km round-trip to Naracoorte for a GP to prescribe her medication to cause a miscarriage.

“When I took them, it was the most horrific experience I’ve ever had,” Gabrielle says.

“It went for 24 hours, I was at home and I had to act normal with my friends.

“I remember having a Sunday roast and trying to sit there, it was horrific.”

Five years ago, Gabrielle was in her 20s and single when she fell pregnant – she instantly knew she wasn’t ready to welcome a baby into the world.

And despite living in the state’s second largest city of Mount Gambier with a population of 27,846 residents, she said her termination options were limited.

“You go to the doctor and you’re told the options are either going to Adelaide, or paying privately and going to Warrnambool where you’ll get in quicker,” she says.

Adelaide is a 900km round-trip, while Warrnambool is 180km away in Victoria.

At six weeks gestation, Gabrielle managed to find a Naracoorte doctor who would prescribe her tablets for a medical abortion, which causes cramping and bleeding.

Dr Anna Kearney said there were multiple regions in country SA where objections from scarce local doctors limited access.

The next time she needed the service, she had to take time off work and travel to Adelaide where a scan would later show the baby had no heartbeat.

She had to undergo a scraping of the uterus.

“I’m upset about the lack of services at the Mount Gambier hospital,” she says.

“It’s so emotional to go through this without the extra judgement and not being able to go back to your own home.

“If it (termination) was offered, people still might decide to go to Adelaide because they don’t want people to know, but as a level 4 hospital it should be provided.

“It just makes me angry.”

GP and obstetrician Dr Anna Kearney, who advocates for greater access to termination services, said she was aware of regional areas in South Australia where abortion access was limited because of objections from local doctors.

Dr Kearney said of the 50 regional hospitals she knows of, only three offer surgical abortions and 10 offer medical terminations.

“I’ve provided rural abortion services since 2017 when I started a service out of Port Lincoln. Prior to that there wasn’t a service on the Eyre Peninsula so all women had to travel to Adelaide,” she says.

“It was very disheartening that women were making huge changes to their lives just to get to Adelaide for something we could have prescribed.

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“I’m also aware of one rural GP on the Eyre Peninsula who refused to prescribe contraception to women because they had a conscientious objection.

“It wasn’t that long ago and it’s terrifying that some doctors can use archaic model of care where they know best.”

She said she was aware of a situation in one South Australian regional community where a doctor’s personal opinion was affecting abortion access across the community.

“The person has been very vocal over a long time period and they’ve definitely made it worrisome for some GPs in the community to prescribe medication,” Dr Kearney said.

The Limestone Coast Local Health Network told The Advertiser medical termination services were provided at the Mount Gambier Hospital.

The Mount Gambier Hospital. Picture: Jessica Ball

In SA, there were 4906 pregnancy terminations last year and of the 744 regional residents, only 19 per cent accessed termination services in country areas.

The Pregnancy Advisory Centre, on Port Rd in Woodville Park, conducted 65 per cent of all terminations last year, followed by Flinders Medical Centre with 10 per cent.

The remaining terminations were at Noarlunga Health Services, GP rooms, Lyell McEwin and Women’s and Children’s hospitals and other public hospitals.

Dr Kearney says the state government must put more resources into training practitioners, much like the resources it committed when voluntary assisted dying laws passed.

“When we had the change to abortion laws in 2022, we heard nothing and I think it’s a true reflection to how society views women’s rights and healthcare – and abortion is healthcare,” she said.

“If the government wanted to make sure we had equality for women’s healthcare they would put greater funding and education models in place so women had access in all areas.”

Greens MLC Tammy Franks also highlighted the lack of access during a passionate debate on late-term abortion reforms in the upper house last week.

“I have had so many people contact me from Mount Gambier and raise their concerns about the lack of access to terminations in Mount Gambier … not only early medical abortion but also surgical abortion,” she told parliament.

It is understood a complaint has been made to the Health and Community Services Complaints Commissioner about the lack of services at the hospital.

Under the Act, the commissioner was prevented from disclosing whether specific complaints have been made to the office.

Limestone Coast Local Health Network chief executive Emma Poland said medical terminations were available across the region, including at the Mount Gambier and District Health Service.

“Like many other regional and rural health services across Australia, we are not able to routinely offer surgical termination of pregnancy services,” Ms Poland said.

“Like any procedure we are unable to perform locally, our doctors refer patients to appropriate alternative services.”

Ms Poland said over the past four years they were not aware of any complaints related to the termination of pregnancy services.

Mount Gambier resident and Liberal MLC Ben Hood introduced a termination of pregnancy bill that was dramatically defeated 10-9 last Wednesday night.

It would have required mothers seeking abortions after 28 weeks to be induced to deliver their babies alive.

Under SA legislation passed in 2021, late-term abortions after 22 weeks and six days are allowed if two medical practitioners agreed it medically appropriate.

This included it being necessary to save the life of the pregnant person or another foetus, or if there is a significant risk of injury to physical or mental health.

South Australian Abortion Reporting Committee data showed of the 47 late-term abortions last year, 78.7 per cent were for the physical or mental health of the parent and 21.3 per cent were for suspected serious foetal anomalies.

*Gabrielle is not her real name

Originally published as Abortion patients trapped in limbo as country doctors put moral objections first, obstetrician says