Abortion Access in Rural NSW: Overcoming the Barriers

Women in regional and rural NSW face unique challenges when it comes to accessing abortion services. While there are significant barriers to abortion access in regional Australia, there are ways for women to get the essential healthcare they need, including improved access to local abortion services, telehealth abortions, and regionally-located private abortion providers like Gynaecology Centres Australia.

KEY TAKEAWAYS

• Abortion is basic healthcare; it is legal in NSW.
• Many abortion service providers are concentrated in capital cities, presenting challenges for women located in regional and rural areas.
• Accessing abortion in rural NSW is difficult for many women, for whom the closest abortion service provider may be over 160km away.
• Despite the World Health Organisation recommending that pregnancy termination be available in all public hospitals, only 3 of 220 NSW public hospitals currently provide surgical abortion services. Access to these public hospital services is, however, compromised by long waiting lists.
• The NSW government must commit to improving abortion access for women in regional NSW, including improved access to local services and telehealth abortion services for medical abortions for women at fewer than 63 days gestation.
• Gynaecology Centres Australia operates several clinics in regional and semi-rural NSW locations, improving access to surgical abortions (in the first trimester) for women outside Sydney.

Barriers to Abortion Access in Regional Areas

Women who live in rural and remote areas of Australia can face significant barriers to accessing the targeted healthcare they need, and this is particularly the case when it comes to abortion services, especially for surgical abortions. With only three out of more than two hundred public hospitals in NSW providing surgical abortion procedures (The Royal Women’s Hospital in Sydney, John Hunter Hospital in Newcastle, and Broken Hill Hospital), women without close access to a private provider (and the financial and practical means to avail of their services) are left at a major disadvantage.

These barriers include:

• Extended waiting periods to secure a GP appointment – abortion is extremely time-sensitive
• Limited access to bulk-billed medical care
• Access to GPs who are highly experienced in reproductive health care
• Access to GPs who do not have a conscientious objection to providing abortion services
• Extremely limited access to surgical abortion services, which is exacerbated by the closure of several private abortion clinics in regional areas due to financial pressures

In NSW, the problem is underpinned further by a lack of transparency in terms of providing complete, directory-based information on where reproductive healthcare (including abortion and long-term contraception) providers are located throughout the state.

Travel, Cost, and Availability

Abortion Deserts are vast areas of NSW where, to have an abortion, women must:

1. Have access to a private form of transport
2. Travel a minimum of four hours round-trip by car
3. Potentially require overnight accommodation
4. Absorb additional costs of travel on top of the cost of the abortion itself

All of this is also based on the assumption that the woman can:

1. Travel
2. Take time away from carer responsibilities and/or work
3. Have a support person travel with them (one can’t drive within 24 hours of a surgical abortion; medical abortion, by its nature, can also be prohibitive for driving while it is taking place)

As a result of the abovementioned barriers, many rural or remotely-based women find the travel, cost, and availability of the healthcare they require to be out of reach.

Travel: In most cases, women located in rural or remote areas of NSW must travel, in some cases hundreds of kilometres, to access abortion services. Depending on individual circumstances, this can prove to be impossible.

The real life scenarios that play out in such a way are diverse: for example, the teenager who does not have parental support; the single mother who can’t leave home/children to travel for an abortion; the unemployed woman who can not afford to pay for a private abortion; the woman in an abusive relationship who can’t leave the home.

Cost: There is a fee payable for a private surgical abortion; this incorporates consultation, ultrasound, sedation, and procedure fees, and it can be prohibitive for many women. Add to this the costs of travel, accommodation, and the associated financial outlay to go away from home for an abortion, and it becomes out of reach for many.

Availability: For women whose pregnancy is past the 63 day mark (and for whom a medical abortion is unsuitable and prohibited) or who, for whatever reason, prefer or need location-based care or a surgical abortion, there are very few locatable abortion providers in regional NSW (most being on the coast) and almost none in rural areas (including country towns).

There are very limited public hospital abortion services (and those who do offer them tend to be compromised by, among other things, long waiting lists, conscientious objection by some doctors, and a potential lack of experience among some doctors performing the procedure).

Despite these challenges, rural women do have options.

Women’s Health Services That Can Help

Telehealth and Local Clinics

Telehealth abortions: Appropriately trained GPs can provide medical abortions via telehealth.

Medical abortion (“early medical abortion” or EMA) is suitable for many women whose gestation is fewer than 63 days (9 weeks). It involves taking pill-based medications and can be prescribed by a trained doctor via a telehealth consult. The cost of these oral medications is covered by the PBS (Pharmaceutical Benefits Scheme) but there will be a cost for the consultation and follow up.

This is a valid option for many women who are unable to travel for a surgical abortion and for whom a medical abortion is a suitable alternative. This service is more readily available than surgical abortion in the community via some general practitioners and women’s health/family planning clinics.

Local clinics: Private abortion providers like Gynaecology Centres Australia offer surgical abortions (which are statistically more effective and more complete than medical abortion) for women at any point during the first trimester.

Gynaecology Centres Australia has a clinic situated in the Greater Sydney region, as well as four clinics located in regional NSW:

• Newcastle
• Gosford
• Wollongong

Providing local services in these regional hubs offers women a more convenient option than having to travel to Sydney for an abortion. Not only does this enable women to see an experienced surgical abortion proceduralist closer to home, but these locations tend to have more affordable accommodation and travel options than the capital city does, which is another benefit for women.

Support and Advocacy

Pressure is mounting on NSW Health to improve abortion access for women statewide. It is now five years since abortion was decriminalised in NSW, and fair and equitable access to these services must be provided for all women in the state. The urgency of this is supported by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) The solution to this issue lies in changes to healthcare policy and improving the willingness of doctors and nurses to provide abortion care.

Contact Gynaecology Centres Australia (GCA)

GCA is a leading provider of safe, legal, and compassionate surgical abortion and women’s health services, including IUD insertion under sedation. We also perform vasectomies for men. At our Wollongong centre

Contact us online or call to book a consult:

Gosford 02 4324 5176

Newcastle 02 4962 4999

Wollongong 02 4227 4100

Sydney 02 9158 0678

Please note that surgical abortions at GCA are partially covered by the Medicare Rebate. There is still an out-of-pocket private fee payable on the day of the procedure that is not rebatable.

To discuss the cost of abortion or if you have any questions, please call us on (02) 95859599