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Terminating choice: Pro-choice pregnancy counselling service hangs in the balance

Lauren Farrow looks at the future of pro-choice counselling services in Australia, which are struggling to survive under the burden of disappearing budgets.

December 2006

Leonardo Da Vinci image altered by Deborah Kelly

In a little house nestled within jacaranda trees in Auburn sits the Bessie Smyth Foundation. Inside it feels like the home of a grandparent with crocheted pillows, a blue kitchen and tapestries on the wall. Look a little closer, though, and you will see that the tapestry depicts the trials of childbirth and the fight for abortion rights. 

The Foundation, established by the women’s movement as a pro-choice abortion clinic and counselling service, has a history of providing services for the disadvantaged. From the time it started in 1977 to the closure of their clinical service in 2002, Bessie Smyth had seen over 42,000 women.

Running on the feminist principle of ‘no woman would be turned away if she didn’t have the money’, often meant the provider was owed ‘in theory’ around $10,000 by women per year.

Initially the Bessie Smyth Foundation had about 13 counselling staff and six doctors, says counsellor and former board member, Margaret Kirkby. Now it is just Margaret and a casual counsellor. In 2005 they provided services to only 358 women.

The downsizing is the consequence of increasingly limited funding, and the Foundation is set to shut its doors in December if the State Government decides to cease funding completely.

When the Bessie Smyth abortion clinic was running counselling services, a standard session lasted around 45 minutes to an hour. If women decided to go ahead with a termination of pregnancy they would agree to pay whatever they could afford. “Sometimes it would be 200 dollars, sometimes it would only be 50,” says Margaret.

The not-for-profit organisation ran ‘on a shoestring’ for 25 years, following the principle of ‘pay what you can’. But the collapse of the insurance company HIH and the consequent hike in their insurance premium from $17,000 a year to $30,000 meant the Bessie Smyth Foundation had to choose between retaining its counselling service and closing its abortion clinic.

“We could have kept going,” says Margaret. “We could have continued running a termination service if we had decided to cut counsellors but we were not prepared to do that. That is not high quality. That is not what women need. Women need support and counselling.”

Margaret worked at Bessie Smyth on and off from 1986 and was the last manager of the clinic. She believes the closure of the termination services affected women on low incomes the greatest, with access to abortion becoming increasingly difficult across Australia.

With bulk-billing becoming something of a distant medical memory, women are forced to pay the whole cost of abortions up front. And while Medicare continues to offer rebates, the problem for women on low incomes is increasing the lump sum needed for a termination, says Margaret.

“We had heaps of women come to us, during the time we ran the termination services, who couldn’t raise the $160. So how are they going to raise $540 for a termination?”

This is a problem which is also happening in Queensland, says Children by Choice’s Cait Calcutt.

“There are significant cost barriers for women who have decided that they are going to terminate an unplanned pregnancy,” says Cait. This has particularly affected women living in regional and rural areas and those on low incomes and Centrelink benefits.

Children by Choice is a non-directive counselling service in Queensland. The organisation is pretty unique, explains Cait. They are the only dedicated, unplanned pregnancy service that is funded by a government body. The success of Children by Choice is what Bessie Smyth hopes to achieve in NSW. A state-funded, pro-choice service that seeks to allow women to make up their own mind.

Both Bessie Smyth and Children by Choice list out-of-pocket costs and the lack of public hospitals providing termination services as the biggest financial challenges facing woman on low incomes.

“There are hardly any abortions being done in the public hospital system. Blacktown hospital does about 3 a week and there is a gynaecologist who does some terminations at Camden and Campletown hospitals, but there is always a waiting list,” argues Margaret. 

“The other problem is that public hospitals only go up to 12 weeks of pregnancy and that’s a real problem because a lot of women don’t twig that they might be pregnant until a second period has been missed. So [even if they] know about the few public hospitals that do abortions they are faced with 3 or 4 week waiting lists, so they are going to be over the limit anyway.”

Doctor Geoff Brodie runs two clinics in NSW and is the current president of the Abortion Providers Federation of Australasia. He has performed abortions since 1978.

His clinics do provide a system called Plan B for women on low incomes. “They pay $275,” explains Geoff. “Then we send their claim off to Medicare, who then process the cheque of the patient, who then forwards it to us.”

But with 40 per cent of the patients involved in Plan B not forwarding the cheque, the system is not reliable. “That may be because they’ve changed address. That may be because they gave us a fake address or that may be because they have lost the envelope,” he says

Plans such as these are notoriously difficult for clinics to maintain if they are seeking to cover costs and make a profit.

“That is why we charge more money for Plan B: because we have a number of claims that we never get payment on and we also wait up to 5 months for a payment,” Geoff says.

At present the Bessie Smyth Foundation operates under an instalment plan, whereby women can borrow from an access fund, which is then paid back through deductions of Centrelink benefits. “We accept as low as $10 a fortnight and no interest is charged,” says Margaret.

But Margaret’s concerns over the closure of the Bessie Smyth Foundation do not only encompass finance but also the level of counselling which will be provided once Bessie is gone.

In Australia the abortion debate was reignited recently due to prescription drug RU486, Tony Abbott and to a lesser extent, the Senate Enquiry of 2005 into the Transparent Advertising and Notification of Pregnancy Counselling Bill.

The Bill, pushed by Democrat Senator Natasha Stott Despoja, aimed at ensuring organisations clearly stated their stance on abortion. It was basically trying to assure that pro-life counselling services state they are anti-abortion on their websites and advertisements so women’s decision making isn’t compromised.

Both Children by Choice and the Bessie Smyth Foundation claim that many pro-life counselling services around Australia feed women misinformation about the risks of abortion and pressure women into retaining the pregnancy.

“Reports from clients who’ve contacted us is that they haven’t been able to identify the fact that the service has a bias against abortion and then they end up calling us in distress, having been told a whole lot of misinformation about how they won’t be able to get pregnant again, the risk of breast cancer and those sorts of things,” says Cait.

“Often women are being told that abortion is equivalent to child abuse.”

Helen Dennis from the anti-choice, Pregnancy Counselling Australia does not agree. “We don’t use the words ‘kill’, ‘murder’ or ‘going to hell,’ anything that is so judgemental that it is just going to aggravate and upset somebody,” she says.

However, the ABC reported earlier this year that the PCA helpline told the father of a rape victim who wished to find out information on abortion that he was ‘nothing but a bloody murderer'.

The parent body of Pregnancy Counselling Australia (PCA) is Right to Life. According to Helen the service provided by PCA is clear and open and she says they do not receive any government funding, only private donations.

 “We make it clear for callers that we don’t recommend any procedure that may cause physical or psychological harm, so we don’t refer for abortion,” she says.

The PCA website lists ‘side effects’ from abortion such as, seizures, tremors, eating disorders, suicidal thoughts, personality disorders, sterility, coma, menstrual disturbances and loss of organs. These claims have been widely disputed by medical professionals, and the World Health Organisation has dismissed any link between abortion and breast cancer, a claim commonly made by anti-choice organisations. The PCA was an organisation of interest in Democrats Senator, Natasha Stott-Despoja’s private member’s Bill, the Transparent Advertising and Notification of Pregnancy Counselling Bill 2005 due to the use of misleading advertising and information.

Unlike agencies like the Bessie Smyth Foundation and Children by Choice, those volunteering at PCA have no formal training in psychology, social services or counselling. PCA will only continue helping a woman if she decides to go ahead with the pregnancy.

But Margaret Kirkby feels Bessie Smyth is a valuable and necessary service, which allows women to explore for themselves the issues surrounding the pregnancy.

“If a woman rings up and is worried about her pregnancy but says abortion is definitely not on the agenda, explaining ‘I’ve grown up believing it’s wrong and I just cannot go there,’ I wouldn’t insult her intelligence and talk about the option of abortion - you are going to work through what are her concerns about how she’s going to support herself and so forth. And vice versa.”

As for allegations of bias surrounding the Bessie Smyth Foundation’s history as a termination clinic, Margaret only sees it as a positive. “Having been a provider we can explain how the actual procedure is done.”

“We can explain it in a very comprehensive way - that’s a huge bonus for women, because having accurate information only helps people feel stronger in their decision- whatever that decision is.”

Wo! Magazine contacted the NSW State Government for comment. However a spokesperson said they were unable to discuss any issue relating to the Bessie Smyth Foundation as their appeal for funding was still under consideration.

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