Women seeking abortions are being turned away from public hospitals three years after NSW decriminalised the procedure, leaving many no option but to travel hundreds of kilometres and pay more than $600 at private services.
Just two hospitals in NSW – John Hunter Hospital in Newcastle and Wagga Wagga Base Hospital in the Murrumbidgee Local Health District – run abortion services, forcing women and their GPs to make dozens of calls to private providers to find appointments.
Jess Scott Hayes had to travel almost two hours to the Gold Coast and pay $700 for a surgical abortion. Credit: Wolter Peeters
Professor of sexual and reproductive health at the University of Sydney Kirsten Black said the only way a woman could get a surgical abortion at any other public hospital – including major tertiary Sydney institutions – was if she suffered a medical complication or needed a late-term termination.
Even then, she could be turned away, Black said.
Many women in regional and rural areas have to travel for hours to get to their nearest private sexual health clinic, incurring additional travel and accommodation costs.
“This is baffling,” Black said. “We have had decriminalisation [of abortion], but women still face serious hurdles to exercising their reproductive rights.”
Black recently took a call from a GP “completely distressed” because she had rung 20 abortion providers, including public hospitals, trying to get a surgical abortion for her 19-year-old patient who was 20 weeks pregnant.
Another woman was recently turned away from a hospital emergency department despite bleeding heavily from complications of an incomplete medical abortion because the hospital did not perform abortions, Black said.
“These are the types of cases we confront every day,” she said. “Women in rural and regional areas are especially disadvantaged.”
Jess Scott Hayes discovered she was pregnant two weeks after she reported her abusive partner to police.
“Being tied to someone like that for the rest of my life was never an option,” she said.
The then-22-year-old was eight weeks pregnant when it was confirmed by a blood test.
With no public abortion service in her area, it was another three weeks before she secured an appointment with a private abortion provider on the Gold Coast, an almost two-hour drive north from her home.
She paid $700 for her surgical abortion and to get a Mirena intrauterine contraceptive device inserted.
“I’m so grateful that I could get that done and I was in a fortunate position that I could afford it, but a lot of people can’t,” she said. “It should be free and safe for everyone, no matter where you live.”
About 60 per cent of abortions in NSW are surgical (performed in an operating theatre) rather than medical (taking medication to induce a miscarriage).
Yet only 0.7 per cent were performed in public hospitals in 2020 after decriminalisation, the most recent available data from NSW Health shows.
The Abortion Law Reform Act 2019 removed abortion from the Crimes Act and allowed for pregnancy terminations at up to 22 weeks, and beyond 22 weeks if two medical practitioners agreed.
Supporters of the change in law on both sides of the NSW parliament hoped decriminalising abortion would remove the legal barriers that prevented healthcare services from performing terminations and would give access to any woman who wanted it.
Black said hospitals had not taken on the responsibility of setting up abortion services, even though the clinical skills required to perform a surgical abortion under 12 weeks’ gestation, which account for 82 per cent of abortions in NSW, were almost identical to managing miscarriage.
“We provide free antenatal care and care for women experiencing miscarriage, but there is no regular care for women seeking a surgical abortion, with those two exceptions [the public hospitals in NSW that run abortion services],” she said.
Advocacy group Australian Clinicians for Choice, co-founded by Black, commissioned a survey of 650 NSW residents in January and February that found two-thirds (68 per cent) believed that every public hospital delivering women’s health services should also provide abortions.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists has developed a pathway for training in abortion and contraception, but the pathway can be run in only two hospitals in Australia – John Hunter Hospital and the Royal Women’s Hospital in Melbourne – because the services to train clinicians don’t exist anywhere else, Black said.
“The training for the actual procedure, counselling patients about their options, post-abortion care and contraception … these are skills that our trainees in obstetrics and gynaecology are just not getting because the services don’t exist,” Black said.
A spokesman for NSW Health said local health districts that did not provide abortions were required to develop local referral pathways to ensure that women had timely access to abortion services and was supporting a pilot by Family Planning Australia called SEARCH to improve access.
NSW Health also supports the NSW Pregnancy Choices Helpline (1800 008 463) to help women find abortion service providers as well as information on pregnancy options counselling, the spokesman said.
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