Abortion is one of the most common medical procedures Australian women may experience in their lives, yet barriers around cost and access to the procedure remain.
An estimated one in three women choose to terminate a pregnancy, yet the procedure is a criminal act in two states, and difficult, particularly for regional, rural and remote women to access.
Inside this edition of the Shepparton News, an anonymous woman has spoken about the barriers country women face in terms of cost, accessibility and discrimination when trying to access the procedure, and a Shepparton sexual health nurse has highlighted the issues and attitudes around the issue.
Earlier this year, politician Tanya Plibersek addressed a large crowd in Canberra, pointing out that, for many Australian women, abortion is unaffordable and unattainable.
Ms Plibersek said outdated laws were a serious barrier to the provision of healthcare.
‘‘Access to safe, legal and affordable abortion is absolutely not the beginning and end of the fight for reproductive rights in Australia,’’ she said.
‘‘Real reproductive freedoms mean the freedom to say yes or no to sex, access to appropriate contraception, and also to have children without experiencing discrimination.’’
Tough road to termination
Shepparton woman Jenny (not her real name) was 24, and in a stable career and relationship when she discovered she was seven weeks pregnant.
Unsure about her relationship and not wanting to put her life on hold, the woman, who lived in Benalla at the time, made a choice to terminate the pregnancy.
After trawling through mass amounts of information online about the procedure, some which harboured scaremongering and inaccuracies, the young woman found a clinic in Albury, two hours away.
‘‘My doctor was shocked when he found out about my decision,’’ the woman said.
‘‘He was a young male doctor and I felt he was uncomfortable talking about what I wanted to talk about and later on with the check-ups afterward, he didn’t make me feel comfortable.
‘‘My partner was pretty bad, too, in dealing with it afterward. He was a very blokey country guy and didn’t want to talk about it.’’
After the procedure, the woman buried her secret, unable to talk about it with friends, family and even her own boyfriend.
‘‘I went along quite a few months without telling anyone, so that’s when I struggled with it the most,’’ she said.
‘‘That was the only time I’d ever felt I’d had some mental health problems. I wasn’t offered counselling and I couldn’t talk to anyone else about it.’’
She is one of the thousands of Australian women who unexpectedly fall pregnant each year and one of one in three who makes the decision to terminate a pregnancy.
Depending on where a woman lives, rules and regulations around pregnancy termination vary from state to state — From facing imprisonment to inducing a miscarriage with RU486 at home or having to seek approval from two doctors, before finally approaching a clinic.
The procedure is illegal in three of the eight Australian states and territories and access is often expensive and difficult to access for those who have to travel interstate or from rural and regional areas.
While the young woman was mature, supported and financially capable enough to be able to go through with the procedure, she said a woman who was younger, in an isolated rural or regional area and had little support would face difficulty.
She said limited or strained access to the procedure was something which needed to be addressed, given the number of women who sought to terminate pregnancies.
‘‘I think the stigma is still there, but obviously it’s something that people don’t feel confident talking about, so they do it anonymously, and that says something about it,’’ she said.
‘‘Speaking from experience, I think there needs to be more education around this topic for medical professionals, who should be better trained to talk about it and offer counselling, or at least better hiding of their beliefs.
‘‘I think you’re well within your own right to choose not to go through with a pregnancy, because bringing children into the world is something that shouldn’t be taken lightly.’’
Australian politician and deputy Opposition leader Tanya Plibersek has been outspoken about the issue, lobbying for the medical abortion pill RU486 to be added to the Pharmaceutical Benefits Scheme in 2013.
But Ms Plibersek said the reality for many women who sought an abortion remained unaffordable and unattainable, despite it being one of the most common medical procedures.
Ms Plibersek said since RU486 was added to the PBS, the medicine costs $6 with a health care card, but the average price many women paid for a medical termination was $560.
‘‘Even in states where abortion is legal, there is a huge gap between the law and the reality on the ground and the legal right to access a termination isn’t much use to a homeless teenager when the upfront cost of an abortion is more than $500,’’ she said.
‘‘It’s a ridiculous situation to be put in when you consider the longer term cost of raising a child.
‘‘It still seems tragic to me that a woman would have a child for no reason other than that she couldn’t afford an abortion.’’
Ms Plibersek said the current situation was a serious restriction on women’s reproductive freedom and was a terrible start for children born in those circumstances.
‘‘The reality of the situation is that if you’re a middle-class woman from a relatively privileged background living in a capital city, maybe you’ll agonise over the decision, there will be barriers and stigma around you getting an abortion, but you’ll probably be able to get one if you need to,’’ she said.
‘‘But if you live in a rural or remote area, if you’re experiencing poverty, if you don’t speak much English, if you’re young ... it’s going to be a whole lot harder, if it’s possible at all.
‘‘When it comes to something as important as carrying and raising a child, we deserve as much say as possible, as much choice as possible.’’
Limited services on ending pregnancy
Clinical services giving women the chance to terminate a pregnancy are available locally, but services are limited and the organisations which provide them are not widely publicised.
Rural sexual health nurse Suzanne Wallis at Shepparton’s Community Health said at a local level there were a number of public and private services for medical termination up to nine weeks and surgical termination for up to 12 was provided.
But the sexual health nurse, who works extensively across women’s sexual health and education, said providers were afforded anonymity so services were not lost.
Within the public health system, healthcare card holders can access a medical termination and a bulk-billed option is also available via referral.
‘‘It is not readily public knowledge, but for young women there are two pregnancy termination options, as well as counsellors who will make themselves available,’’ Ms Wallis said.
‘‘If a woman contacts a clinic within our local area, they will be given my number to contact me so I can help to facilitate that locally, rather than them having to travel away from the area for the procedure.
‘‘On average, we would see a couple of women seeking support around unplanned pregnancies every week, so there’s certainly a need to invest further in these services.’’
Despite the medical abortion drug RU486 being available on the PBS, many women are still paying upwards of $500, and sometimes closer to $1000, for the entire medical abortion process, which can include doctor’s consultations, ultrasounds, counselling, aftercare and the drug itself. A surgical abortion, which needs to be performed with a nurse and anaesthesiologist in a day surgery, can cost upwards of $600, not including the cost of travel for those in rural areas or from states such as NSW and Queensland where the procedure is illegal.
But Tabbot Foundation director Paul Hyland said there were safe, accessible options for those who struggled to access the procedure.
Although access to the drug is still costly.
The Tabbot Foundation offers medical abortions as a non-surgical alternative to those who are at a less than nine weeks’ gestation and who live within two hours driving time of a medical facility.
‘‘The barriers here are that women don’t realise that there are no barriers, because they’re unaware that medical abortion is available,’’ Dr Hyland said.
‘‘Especially for women in remote areas, you don’t need a centre of excellence, the important thing is that they need to present early.
‘‘We have women around the country presenting to their local hospitals, to their GPs and being intimidated by staff who have different values, and this service avoids that.’’
As part of her role, Ms Wallis is involved in sexual education across a number of rural Victorian schools and she believed attitudes towards sexual health make a significant contribution towards unplanned pregnancy.
Ms Wallis said a range of issues contributed to an unplanned pregnancy, including a widespread lack of knowledge among young women and men around sexual health, as well as a strained ability across some towns to access contraception and emergency contraception.
‘‘I would like to think it would be up to both our education systems and families at home to contribute to an individual’s awareness around sexual health, and I think it will take time for women to be fully educated,’’ Ms Wallis said.
‘‘If you don’t have relatively good sexual health early on, it undermines your choices and often your self-esteem, and if you don’t have good self-worth, you won’t make good choices for your future,’’ Ms Wallis said.
Women need better support
When Pat Moran sits down with a woman contemplating their unplanned pregnancy, she asks them to imagine themselves in five years’ time.
As part of her volunteer role with the Goulburn Valley Pregnancy and Family Support Service, her aim is to encourage women to have their baby and let them know there is support for those at a disadvantage.
While the service does not refer pregnancy terminations, Ms Moran said the organisation supported whatever choice a woman made and women could return to talk through the issue whatever path they decided to take.
Ms Moran said there were many women, particularly young, who fell pregnant and were either unprepared, unsupported or not ready for the reality of bringing new life into the world.
A branch of the Caroline Chisholm Society, the organisation provides a range of services to pregnant women and their families.
Relying on the help of volunteers and minimal government funding, the organisation offers support to those who are pregnant, provides new and preloved maternity goods and has the ability to refer women and their families to suitable support organisations locally.
In her time with the organisation, Ms Moran has experienced the societal changes and controversy brought about by the introduction of the pill and the RU486 abortion drug.
‘‘Often they will go away with some idea about the medical side of things, where to go pre-birth and post-birth, and also what they require for their baby,’’ Ms Moran said.
‘‘We have a wonderful volunteer base here who do a great job and, although we’ve had our highs and lows with funding, we’ve always managed to keep our head above water.’’
Ms Moran said stress related to pregnancy often came down to not having the support of a partner or family or not having the financial means to support a child.
And although there was significant material and social support for new parents, which included local services The Bridge and Family Care, among others, what often got left by the wayside was mental health.
Ms Moran said there was particularly a high rate of young women locally who had no family support.
‘‘I would say financial issues are the main stressors, we’ve got a lot of disadvantaged families around Shepparton, and that’s the main issue we and so many other community organisations target,’’ Ms Moran said.
‘‘Pre- and post-natal depression is a very real worry and I definitely think we need more support here in Shepparton for that,’’ she said.
‘‘Mental health is a big factor. Some find the process of pregnancy and after very difficult, and if they haven’t got that support, it can become a very tough life for them and their families.’’
‘‘Another concern is the lack of education within the schools about the impact of early pregnancy and counselling support for those students, both male and female who are experiencing this.’’
Ms Moran, who formally became involved with the organisation in 1996, said it was her interest in social issues which pushed her to take up the challenge in her early 50s.
‘‘I’ve worked with families since 1979 and I just want to say that women are so special,’’ she said.
‘‘I feel privileged to have worked with families, and I found each mother had some hidden talent that they didn’t realise, and you’d try to bring it out.
‘‘And that’s the reason why I continued with pregnancy support, because once you get hooked you’re there forever and you can’t help but hope for a better future for the mothers out there.’’