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Choice terminated in the bush

Kim Powell reports on the difficulties rural Australian women face when seeking reproductive health services, especially termination. Those who are most socially disadvantaged have little to no choice at all due to both social and geographical isolation.

Mar-May 2007

Unplanned pregnancy is a reality for many women. No contraceptive method is 100 per cent effective, and sometimes things just happen. For women living outside metropolitan areas, the decision to terminate a pregnancy is made even harder.

Women in rural and remote Queensland have to travel thousands of kilometres to access abortion services. There is a clinic in Cairns, one in Rockhampton, and the rest are in the south-east corner of the state. A woman in Mt Isa seeking an abortion has to travel over a thousand kilometres to get to Townsville, and it is the same distance again to get from Charleville to Brisbane.

On top of having to travel long distances and arrange overnight accommodation, the services in these regional clinics are at least $100 more expensive than they are in Brisbane and there’s no reduced price for healthcare card holders.

Children by Choice is an organisation offering referrals for abortion, adoption and parenting in Queensland. Cait Calcutt, Coordinator of the organisation, says a number of the women who contact Children by Choice are single parents who feel they have completed their family. Many of them are on a low fixed income where it’s hard enough to find an extra $50 out of the fortnightly payment, let alone $500 for an abortion plus travel and accommodation expenses. Often, the termination is delayed as they try to find the money.

“Now, of course, the provision of welfare and a lot of the emergency relief is provided by church-based agencies, some who aren’t willing to provide money for the termination of a pregnancy because they have a moral objection. So that makes it doubly hard for women,” says Calcutt.

“It’s not necessarily the fault of the providers in those areas. At least women north of Brisbane have access to abortion services. It is the failure of governments through the health system to address the needs of women’s reproductive health.”

In most states and territories in Australia, abortion services are generally only provided by private clinics, partly because these clinics opened in the 1970s when abortion was legalised. But the other part is political.

“Governments generally have been shying away from the issue of abortion for a long time,” Calcutt says. “They refuse to see it as a public health issue and a vital service in terms of women’s health.”

No one really knows how many abortions are performed in Australia each year because only South Australia, Western Australia and the Northern Territory collect accurate statistics. The Health Insurance Commission collects figures for which the Medicare rebate has been claimed, but not those of public patients in public hospitals.

To confuse things further, the Medicare item numbers used for terminations in each trimester also refer to different procedures, such as Dilation & Curettage after miscarriage. Despite this, it is generally agreed that the figure is around 70,000-80,000.

Women’s Health Victoria, an independent health promotion organisation run by women for women, believes this number could be significantly reduced if governments made a greater investment in reproductive health promotion.

Marilyn Beaumont, the Executive Director, says termination services are “very patchy” outside of Melbourne, and in many regional areas when the hospital administrator has decided against performing abortions, there is no local obstetrician, gynaecologist or skilled GP to do it either.

“Confidentiality and anonymity are also quite difficult. Some women are not prepared to ask locally where to go for a certain service. The whole way that small communities operate, in that everyone knows everyone’s business, makes it difficult to access services in a timely way,” says Beaumont.

Beaumont wants the Victorian Government to develop a comprehensive state-wide sexual health and reproduction policy to get information to women and men about taking responsibility for contraception and about risk-taking behaviour in sexual activity.

“It’s also dealing with the knowledge that most teenagers have sex for the first time when they are under the influence of alcohol or drugs, that they’re not making the decision in an informed, caring way,” she says.

She says the development of skills across the state is critical, as well as removing abortion from the criminal code. While the legislation varies across states and territories, abortion is only considered legal if it’s to protect the mother’s mental or physical health. It does not allow the decision to terminate a pregnancy as a matter for individual conscience.

Advocacy groups like Women’s Health Victoria want abortion to be regulated in the same way as other medical services, under the health care and medical practice legislation.

“Some doctors are not prepared to work in an area that can lead to public vilification, their home being vandalised and being driven out of town,” says Beaumont.

“Abortion needs to be decriminalised and regulated as a health service, and planned as a health service and conducted more openly, so it’s more in line with how the majority of Australians think. That is, that abortion is open and easily accessible if you need it.”

According to the 2003 Australian Survey of Social Attitudes, 81.2 per cent of Australians agree that women should have the right to choose an abortion.

Dr Ross Maxwell, president of the Rural Doctors Association of Australia, says that while women do travel for terminations “if they’re really very motivated,” the women who suffer are those in isolated areas.

“For a young indigenous woman in a remote community, the concept of going somewhere to have a termination just won’t be on your radar. So the more disadvantaged you are, the more remote you are, then the less likely you are going to be able to have a choice,” he says.

Unfortunately for most of these young women, having the child can become “part of a cycle of poverty” because the mother is then out of education and work.

“It is a very difficult decision for any woman to make to have a termination, but one of the downsides of choosing to keep the baby is you have to give up your education and your work, which puts you at a disadvantage when you’re trying to make your way in the world,” Maxwell says.

The use of abortion drugs, such as RU486, is one way to increase the availability of services, but it isn’t as simple as it sounds.

“To use RU486 safely you’ve got to have access to anaesthetist and a specialist obstetrician gynaecologist or general practitioner who has trained in that area,” says Maxwell. “And you need special care afterwards.”

Cait Calcutt is only slightly more optimistic. “There is a hope that RU486 may eventually make access to early termination of pregnancy a little bit easier for women in regional areas, but that’s a long way away.”