Australia Women in regional NSW finding access to abortion tougher during coronavirus pandemic

18:46  19 september  2020
18:46  19 september  2020 Source:   abc.net.au

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Women 's health workers say the legislation has done very little to improve access to abortion in regional NSW , a problem only made worse by Manager of the Shoalhaven Women 's Health Centre Tracy Lumb also said access to surgical abortion in her region was no better since decriminalisation.

As the coronavirus pandemic sweeps the globe, women 's access to abortion has become one of many healthcare provisions thrown into jeopardy. One abortion provider operating in 37 countries has warned of far-reaching impacts worldwide.

a person in a dark room: A Bill passed in NSW Parliament last year decriminalising abortion. (ABC RN: Fiona Pepper) © Provided by ABC Health A Bill passed in NSW Parliament last year decriminalising abortion. (ABC RN: Fiona Pepper)

When 23-year-old Hayley* had an unplanned pregnancy last year, she discovered just how difficult it can be for women in regional NSW to get an abortion.

The tertiary student lives in Wagga Wagga and the nearest doctor who could terminate the pregnancy was across the border in Victoria, a 90-minute drive away.

Hayley says the trip is known among local women wanting an abortion as "Going to Wodonga".

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Coronavirus is threatening abortion access , particularly in states that already have aggressive limitations, by preventing doctors from traveling and, in Dr. Khattar pointed out that the pandemic is spotlighting the fragility of abortion access for women in states with significant abortion restrictions

The coronavirus pandemic is showing up the cracks in Australia's patchwork abortion access laws, under which women often have to travel long distances to Women Wanting An Abortion Face Two Major Barriers In Australia. Now There's A Third: The Coronavirus . The coronavirus pandemic is

On September 25 last year, the NSW Parliament passed a Bill decriminalising abortion.

Women's health workers say the legislation has done very little to improve access to abortion in regional NSW, a problem only made worse by the coronavirus pandemic.

Hayley went to Gateway Health, a not-for-profit health service that bulk-bills the cost of an abortion to Medicare.

She was to have a medical termination of pregnancy, but hit a snag.

Patients having a medical abortion need to fill a prescription for two medications that induce a miscarriage, have a blood test, and an ultrasound.

When Hayley got to Wodonga for her appointment, the blood test results had not come through and the appointment had to be cancelled.

"It was pretty gut-wrenching because we'd gone all the way out there and when they told me they could not do anything for me that day, I was thinking, 'Damn, what am I going to do?'" she said.

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Gateway Health explained that because they were managing so many patients, the next available appointment Hayley could get was a surgical abortion at around 10 weeks.

Medical abortion medications are only licenced for use up to nine weeks of pregnancy.

That meant being an in-patient at Wodonga hospital and she was not hopeful her then-employer would give her time off work.

"I did not feel great about needing to be pregnant for longer than I wanted to be, I would have been approaching the second trimester by the time I could do anything about it," she said, and so she cancelled the appointment.

There is another option — if you can afford it

With a Medicare-funded medical abortion off the cards, Hayley took the only other option available to her.

She found almost $400 for a telehealth medical abortion with the not-for-profit Marie Stopes Australia, plus about $200 for a six-week dating ultrasound.

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Jamal Hakim, the managing director of Marie Stopes Australia said it aimed to just to break even on medical telehealth services, keeping costs about $300.

"We have that as a priority access model, we are keen to have medical abortion available for communities that have no access," he said.

Marie Stopes allocated $561,000 in financial bursaries to women who could not afford abortions in 2019, and 64 per cent of that money went to women in NSW.

Mr Hakim said other private operators had stopped providing telehealth medical abortions because they had not been able to sustain the business model without a Medicare rebate.

Things changed during the pandemic, when the Federal Government introduced telehealth Medicare items in late March.

It meant doctors were able to provide medical abortions to patients remotely.

But in July, telehealth items were restricted to regular patients who had seen their doctor in the last 12 months, putting them out of reach for most abortion providers.

Pandemic exposed holes in regional abortion services

Amanda Cohn, a GP at Gateway Health in Wodonga where Hayley had planned to have her abortion, said her service was providing medical abortions for women in the "border bubble" Albury-Wodonga Health catchment area.

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Abortion providers say they’re seeing heightened demand for telemedicine abortions during the coronavirus pandemic These clinics are looking to video call apps like Facetime and AI-powered chatbots to make prescribing abortion medication almost entirely virtual during the pandemic .

At least eight states have attempted to temporarily ban abortion , including the procedure in directives halting "non-essential" procedures to preserve

But the service helps all women, including those from the Riverina region, which is proving challenging at the moment.

"For those women around Wagga and Narrandera, if they were to come and see us in Wodonga, they would need to self-isolate for 14 days when they return to NSW," she said.

Then there's the time it takes for those women to organise a permit to re-enter NSW, pushing them closer to the nine week cut-off that would require a surgical abortion.

All of the regional women's health services the ABC spoke to said there had been a spike in requests for abortions since the pandemic started, which they put down mainly to an increase in domestic violence.

GPs reluctant to prescribe abortions

Medical abortion medications were licenced by the TGA in 2014 and can be prescribed by GPs after they have completed an online training program.

Data given to the ABC by Marie Stopes Australia, the sponsors of the drugs, shows only 7 per cent (2,462) of the 37,000 GPs are certified, and not all of those are actually prescribing.

NSW has one of the lowest per capita rates of GPs who can do medical abortions, and most of those are concentrated around Sydney and Newcastle.

[Insert chart].

Danielle Mazza, professor of general practice at Monash University said lack of knowledge and support was stopping GPs providing abortion services.

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"There's also a lot of fear that in small communities, if GPs become know as abortion providers, they will receive a backlash, they will be threatened and they are concerned about that."

Julie Mecham, crisis and support worker at the Wagga Wagga Women's Health Centre, said in the conservative atmosphere of the town, GPs who were conscientious objectors of abortion also contributed to the problem.

"We hear some horror stories [of] GPs who claim they don't know where to refer to, ultrasounds having the volume turned up to hear the foetal heartbeat, having the visual, even when women have requested not to see it," she said.

Under the new law, healthcare practitioners with a conscientious objection to abortion have a duty to refer their patient to another doctor.

Ms Mecham knows of one GP in Wagga Wagga whom she can refer women to for a medical abortion, and understands there are now seven GPs providing this service in the city of 60,000.

But she said there was still nowhere in Wagga Wagga to get a surgical termination.

Surgical abortion still difficult to access

Professor Mazza said women should be able to access both medical and surgical abortions, particularly when a medical abortion was not appropriate.

This included for women with no support at home, or those experiencing family violence.

A spokeswoman for Albury-Wodonga Health told the ABC it provided surgical abortions only for women within the catchment area, though some women outside the catchment had accessed the service in the past.

Ms Mecham said women in Wagga Wagga had to travel to Queanbeyan in the ACT for a surgical abortion, a round trip of about 500 kilometres.

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"Access is absolutely critical, otherwise it [decriminalisation] is completely useless," Ms Mecham said.

"As a regional community, it is not as simple as going to the next suburb or catching public transport and accessing procedures."

Manager of the Shoalhaven Women's Health Centre Tracy Lumb also said access to surgical abortion in her region was no better since decriminalisation.

The local hospitals do not do surgical abortions and she has had to send patients to Wollongong or Sydney.

That creates delays, pushing women into a late-term abortion and she has had to organise external funding from other organisations to help women pay for it.

"When you're talking late-term, it is about $1,500, it's a two-day procedure, and also overnight accommodation in Sydney," she said.

Little support from NSW Government

Mr Hakim said the Queensland Government did a lot to ensure that abortion services were provided to priority groups following decriminalisation in 2018, setting up engagement with stakeholders to ensure immediate access.

"In NSW it has been very much decriminalisation is done, now walk away."

Mr Hakim said organisations like Marie Stopes Australia were subsidising public health provision for priority groups and would like other state governments to "step up to the plate".

"We've been providing this service for a long time and it's unsustainable," he said,

A NSW Health spokesperson said following the change in law last year, it launched a pregnancy options helpline, wrote to all health districts and GPs to inform them of the provisions in the law, and to support access to pregnancy termination.

Hayley is just glad she could get the right outcome.

"I'm English-speaking, I'm health literate, I'm educated, I have money, I can travel," she said.

"But if you don't have those things, that access is just gone for you."

*Name has been changed

COVID-19 takes a toll on public transport, speed camera revenue in Qld .
The lockdown in March dragged annual revenue down as people stayed home and avoided public transport.Queensland's public transport network recorded a drop in patronage of almost 20 per cent over the past year, costing more than $71 million in fare revenue.

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