Abortion’s postcode lottery: Where women are being denied essential care

Last Friday, amid the backwash of Donald Trump’s re-election, Orange Hospital made national headlines for banning abortion – an executive decision made earlier this year that blindsided the community and clinicians, sparking instant criticism and public outrage.

By the same afternoon, NSW Health Minister Ryan Park had publicly instructed the hospital to reinstate the service immediately. Now, it has been revealed that Queanbeyan Hospital has also implemented a formal abortion ban. If you are wondering how this could happen when abortion has been fully decriminalised in NSW since 2019, you are not alone. New polling shows most people in Australia support pro-abortion law.

Women have campaigned for abortion rights for decades but still they are denied access to safe terminations, especially in country towns. Credit: The Age

There is an erroneous belief that abortion is routinely provided in NSW’s public health system. Yet, to date, only two public hospitals offer a formal abortion service for pregnancies beyond nine weeks gestation. Both are in metropolitan centres.

As a sexual and reproductive rights researcher in western NSW, I work with people seeking abortion and rural healthcare workers who try to support them. My research has found that paths to abortion care in our region are so narrow that providers are hard to find, and the system is even harder to navigate. For many rural residents, the only way to receive abortion care is to travel hundreds of kilometres by car to a city-based clinic at significant personal cost and far from the comforts of home. Not everybody has the resources to make the journey.

Abortion seekers and healthcare workers say obstructions to abortion are too often the result of disinterest, discouragement and, inexplicably, refusal to provide abortion care within the health system. Abortion care is not routinely taught in the Australian medical curriculum. In NSW, legislation prevents anyone but doctors from prescribing abortion pills despite the World Health Organisation recommending that nurses, midwives and other healthcare workers are equipped to do so.

The few abortion providers in western NSW have told me that their willingness to provide abortion care is kept secret for fear of reprisal and reputational damage, and to avoid other practitioners sending every person seeking abortion their way. Many GPs have said they would gladly prescribe abortion pills if only they were confident that hospitals would also ensure easy access to follow-up care if required.

Since the United States Supreme Court overturned Roe v Wade in 2022, total or near-total bans on abortion care have been enacted across almost half of America. Yet the Guttmacher Institute, which tracks US abortions, reported that more than 1 million abortions took place in the formal health system in 2023. Health workers, activists and feminist networks have mobilised in what the institute has described as “a monumental effort” to help people in “ban states” access abortion. Organisations such as Hey Jane, Plan C and Women on Web have ensured abortion pills remain in circulation, and funds and support are provided for people who need to cross state lines for care. Shout Your Abortion proudly states: “We are doing it anyway”, sharing online abortion pill resources far and wide.

So why is access an issue in Australia where, unlike in the US, there are no legal obstructions? Because, unlike in the US, where voices are loud, our public discourse on the responsibility of the health system to provide abortion care has mostly been whisper-quiet.

In 2019, the federal Labor opposition promised free public abortion if elected. Now in government, it has remained silent on recommendations last year from a Senate inquiry into universal access to reproductive healthcare, the report of which was titled Ending the Postcode Lottery.

As Ryan Park told state parliament, the current NSW Health policy on abortion “does not make it mandatory” for the department to provide abortion services. Why not? Why is it appropriate for NSW public hospitals to turn people away? An NGO-funded hotline number pointing you to a far-away clinic is not a sufficient referral.

News in small towns spreads quickly. When Orange Hospital announced its ban, a local friend texted me from the sidelines of a school sports day. She said women, for the first time, were openly furious. Her text read: “No quiet niceties, no behind-hand comments, loud rage.” Loud rage might just be what we need. No more quiet niceties, no more erroneous beliefs.

In Orange and Queanbeyan, abortion access is now a community responsibility. The community’s rage will not subside until we are all convinced that the pathway to public abortion is cleared permanently, free of all obstruction.

Dr Anna Noonan researches sexual and reproductive health – and rights in rural abortion access – at the University of Sydney’s School of Rural Health.

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