This week at Parliament House in Canberra, we join decision-makers from across Australia who are gathering for the RANZCOG Women’s Health Summit. The theme of this year’s Summit is ‘Time to Act’.
This moment in time is significant. For the first time in over 100 years, any woman or pregnant person in Australia can access abortion without the threat of being criminalised.
In Australia abortion is a common women’s health procedure; almost 1 in 4 women in Australia have had an abortion. Abortion is Category 1 essential healthcare. Yet abortion remains one of the least accessible or equitable healthcare services in the country. Here we table some solutions — because right now is the time for action.
Abortion stigma permeates — we need to smash abortion stigma
This year marks 20 years since the last person was shot at an abortion clinic in Australia. Health professionals continue to avoid training in or working in abortion care due to fear for personal safety and societal stigma. Patients continue to experience shame for accessing abortion care — in Western Australia patients must confront picketers in order to access healthcare. As a surgical abortion provider, we regularly face procurement challenges including inflated prices for goods or services.
Abortion is healthcare. Smashing abortion stigma requires whole of community approaches. We need to be talking about bodies, personal safety, consent and relationships throughout the lifespan, with age-appropriate and culturally responsive relationships and sexuality education embedded in school curricula. A sexual health check with a GP should be as common as getting a flu vaccine, or any other regular health appointment.
Workforce is at crisis point — we need to prioritise abortion care education
We are facing a global health worker shortage. By 2030 we will have a global shortage of 18 million healthcare workers. We need to boost abortion training across the country and also incentivise healthcare graduates to practice in Australia. Available training in abortion care is limited with only a handful of specialist abortion care courses across Australia. Gaining practical training experience is incredibly challenging. The number of experienced surgical abortion providers is dwindling into the double digits. Our abortion care workforce is at crisis point.
Future proof the abortion care workforce by mainstreaming sexual and reproductive health in all health and allied health curricula. Support experienced surgical abortion providers to share knowledge through educational development, delivery and practical placements. Increase capacity for medical abortion care alongside contraceptive care, as well as STI and reproductive coercion prevention by incentivising GP education and SRH-specific training. Nurse-led abortion care is on the horizon, so consider how nurses, nurse practitioners, midwives and Aboriginal and Torres Strait Islander health workers can upskill alongside medical practitioners.
Abortion access is a postcode lottery — we need to invest in abortion provision
It is not financially viable to provide abortion care. Lack of funds for service provision means that it’s not viable for new clinics to open or existing clinics to expand their models of care. At Marie Stopes Australia our business model has only been feasible because we have subsidised the cost of abortion care through other health services. It is not viable for us to continue filling gaps in essential healthcare provision.
Australia needs funded pathways to support access to both surgical and medical abortion. Medical abortion access has been temporarily increased with intermittent and short-term Medicare Benefits Schedule (MBS) item numbers for telehealth care. Throughout the pandemic, we have heard calls from healthcare professionals to make these MBS item numbers permanent. Investing in MBS item numbers for medical abortion via telehealth is an inevitable and essential step towards improving access.
Abortion equity is dire — we need to respond to financial hardship
In the past two years, the Choice Fund has funded in excess of $850,000 worth of contraception and abortion services for patients experiencing financial hardship. During the pandemic, the number of regular Choice Fund donors, philanthropists, and the size of their donations has dramatically reduced. For the first time in many years, we have had to turn away women and pregnant people experiencing financial hardship who cannot afford to access their choice of healthcare.
The Choice Fund requires regular donations, with every dollar going toward healthcare for pregnant people experiencing hardship. If not the Choice Fund, then State and Territory Governments need to establish their own version of a bursary program to subsidise the cost of abortion care. We need to support healthcare for all people experiencing financial hardship, including migrant and refugee women and women on temporary visas.
Abortion legislation is inconsistent — we need to harmonise abortion law
Australia may have decriminalised a patient’s access to abortion care, but still has a patchwork of legislation that maintains barriers to abortion care. Until abortion law is harmonised, patients will continue to be forced to travel between jurisdictions in order to access healthcare.
As a Committee on the Elimination of Discrimination against Women (CEDAW) signatory, Australia has agreed to respect, protect and fulfil sexual and reproductive health and rights. The United Nations observations on Australia’s eighth periodic CEDAW report recommended that Australia harmonise abortion-related legislation across Australian jurisdictions to increase health access and equity.
Women’s health strategy is stalling — we need to implement, monitor and evaluate
The Australian Government National Women’s Health Strategy was published 2 years ago. Sexual and reproductive health is the very first priority area. It promises equitable access to abortion care in Australia. Related funding has been fractional and inadequate. Without a National Sexual and Reproductive Health Strategy, this is all we have.
The SPHERE coalition published a consensus statement on the implementation and monitoring of the National Women’s Health Strategy. We need greater transparency with this strategy. We need to undertake baseline evaluation, and measurement and reporting of progress. Action needs to be taken immediately across the health sector to implement and evaluate the entirety of the Strategy, including abortion care.
Following sweeping Federal Budget statements about investments in women’s health, this week we visit Australian Parliament, to yet again discuss women’s health. While we do so, our colleagues continue to deliver the news to women across Australia that they may not be able to access their choice of healthcare.
Barriers may be complex, but the solutions are here — and they are clear. Abortion is healthcare.
Dr Catriona Melville is the Deputy Medical Director at Marie Stopes Australia. She is a specialist in sexual and reproductive health and has been providing client-centred reproductive health services for over 20 years. Catriona has spent much of her life working in the NHS in Scotland, pioneering integrated sexual and reproductive healthcare before relocating to Queensland in 2016. She has participated in writing SRH guidance and has been published widely; including Sexual & Reproductive Health at a Glance. You can follow Catriona on Twitter.
Swathy Santhakumar is a 2021 graduate from Monash University with a Bachelor of Science — Global Challenges. In 2020, Swathy conducted research on abortion care education within primary medical degrees in collaboration with Marie Stopes Australia as part of her honors research. She is currently working at Marie Stopes Australia as part of the organisation’s graduate program. Follow Swathy on Twitter.
Bonney Corbin is the Head of Policy at Marie Stopes Australia where she collaborates with doctors, nurses, midwives and counsellors to advocate for sexual and reproductive health, rights and justice. She is also Chair of the Australian Women’s Health Network and Vice Chair of Violence Prevention Australia. Bonney is BRCA1 positive and is a consumer advisor with RANZCOG. You can follow Bonney on Twitter.