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  • Limited abortion access in regional Australia

    Author: Rahima Saikal

Although abortion is legal across Australia, women in rural and regional areas are increasingly finding themselves denied access to essential reproductive healthcare. Doctors and advocates are now warning of an "unspoken ban" that leaves women stranded, unable to exercise their right to choose, especially in remote parts of New South Wales.

Melissa (not her real name), a mother of two, found herself among the many women affected by this silent barrier when she travelled to Queanbeyan District Hospital for a scheduled surgical termination at 14 weeks. Diagnosed with a pregnancy that had severe life-limiting malformations, she was referred to the hospital by her doctor. But when she arrived, the procedure was suddenly cancelled.

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"I could tell he was baffled by the whole situation," Melissa said, recalling the bewildering phone call from the obstetrician. "It should have been straightforward. He'd done it before” she told ABC News.

After a long day of confusion, she received a second call, clarifying that the hospital staff had mistakenly thought she was 20 weeks pregnant. While they suggested the procedure might go ahead, the situation remained unresolved, leaving her and her husband in limbo.
Even after this unsettling experience, the hospital ceased providing surgical terminations altogether. Queanbeyan District Hospital, part of the Southern NSW Local Health District (LHD), had been a referral point for fetal anomaly terminations but stopped offering the service shortly after Melissa's case. Her healthcare team is still seeking answers, but the Southern NSW LHD has not responded to direct inquiries about the decision.

For Canberra-based GP and reproductive rights advocate Jess Tidemann, this marks an alarming trend across rural health services.

"It's an unspoken ban," she said. "A decision for public health services or districts not to offer surgical abortion services is an unspoken ban."

In NSW, only two public hospitals, the Royal Hospital for Women in Sydney and John Hunter Hospital in Newcastle, provide formal abortion services. Elsewhere, access to both medical and surgical terminations is either ad-hoc or completely absent, leaving women to navigate a fragmented and often inaccessible system.

Chronic staff shortages, overstretched resources, and a lack of clear guidelines for health professionals compound the situation. Reports from multiple inquiries into reproductive health services have yielded little improvement, leaving clinicians like Dr Tidemann frustrated with the lack of action from government authorities.

One key issue is the influence of conscientious objection, where healthcare professionals refuse to provide abortion services based on personal beliefs. While the law allows for conscientious objection, doctors must refer patients to another practitioner who can provide the care they need. But, according to Dr Vijay Roach, former president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, this practice contributes to an uneven distribution of services.

"Why don't they provide this essential health service? I think it can only be due to people within the system who object to abortion," he said. "There is no moral, legal or ethical right to impede access. Abortion is an integral part of women's healthcare."

In rural NSW, where options for medical termination are already scarce, delays and refusals can lead to life-altering consequences. One case on the Mid-North Coast saw a woman delayed in accessing a termination due to a GP's conscientious objection. By the time she received care, she was 22 weeks pregnant and had to deliver a stillborn child.

For many women, particularly those from vulnerable groups, the challenges are even more dire. Dr Lisa Hyde, a GP in the coastal town of Moruya, works with women facing a range of barriers, from homelessness to severe mental health issues. One of her patients, a woman with poor health literacy, sought a medical termination at just over nine weeks. However, due to delays and a lack of accessible services, the patient was unable to access the care she needed. Dr. Hyde has since lost contact with her patient, leaving her with a heavy sense of failure.
The financial burden of private clinics also prevents many women from accessing timely care. In some cases, surgical terminations can cost hundreds of dollars, making them out of reach for those in financial distress.

Despite these significant challenges, there are some glimmers of hope. Doctors like Trudi Beck, who runs a private clinic in Wagga Wagga, continue to provide terminations despite the underfunded and overstretched public health system. However, Dr Beck acknowledges that the systemic issues will not change until there is clear direction from the state government to ensure formal termination services are available in every public hospital.

"The reality is, nothing will change until there's a directive from the state government or NSW Health to make formal termination services available in every public hospital across the state," Dr Beck said.

As public health systems in rural and regional areas continue to struggle, advocates fear that the situation could worsen.

"If we don’t lock away safe, secure, accessible terminations for women, that's something that could very quickly be taken away," Dr Hyde warned, drawing comparisons to the erosion of abortion rights seen in the United States after the overturning of Roe v. Wade.

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Rahima Saikal

Rahima Saikal is a freelance journalist and content creator and has been working in the media industry for 10+ years all around the world.

Rahima enjoys writing about healthcare, wellness, travel and social change movements, particularly animal rights.

Having written numerous articles for both print and online publications, Rahima is well versed in what makes a good story.

Rahima lives between Bali and Australia with her family and 3 Bali dogs.