Abortion is no longer a crime in Australia. So why is it still so hard to access?

A leak of draft court documents^[1] reveals Roe v. Wade – which has broadly guaranteed abortion rights in the United States since 1973 – may be overturned.

The US decision may influence the rhetoric and lobbying techniques^[2] of anti-abortion activists globally but it has no direct bearing on Australia.

Nevertheless, it is a chance to highlight continued obstacles to abortion access in Australia.

Read more: The end of Roe v. Wade would likely embolden global anti-abortion activists and politicians^[3]

Abortion is a common, essential health service. About 88,800 people^[4] have an abortion in Australia each year. Between one quarter and one third^[5] of women living in Australia will have an abortion in their lifetime.

The vast majority^[6] of Australians are broadly “pro-choice”^[7].

Abortion is not a crime, but legal issues remain

In 2021, South Australia became the final jurisdiction^[8] to decriminalise abortion. However, the law has not commenced^[9]. Until then, the state’s abortion providers and patients remain subject to old, criminalising legislation^[10]. So the state government must enact the new law immediately.

Western Australia^[11] became the last jurisdiction to introduce “buffer zone” legislation, which prevents the harassment of pregnant people outside places that provide abortions. In WA, criminal law continues to regulate^[12] medical doctors who provide abortions.

All jurisdictions prohibit unqualified people^[13] from performing abortions. This is unnecessary legislation that seeks to regulate “backyard abortions”, which no longer exist, and prevents the full integration of abortion into health law (which already ensures medical procedures are performed by qualified professionals).

For the most part, however, abortion in Australia is now regulated under health law rather than criminal law. While new health laws correctly frame abortion as a matter of health, these health laws continue to impede access to it.

This is due to the continued over-regulation of abortion^[14] through measures including:

• gestational limits to abortion (in all state/territories except the Australian Capital Territory)

• requirements for doctors provide patients with information about counselling services (WA, NSW, SA).

Over-regulation is a direct result of, and exacerbates, abortion stigma, which treats abortion as more risky than it is in practice.

All medical procedures are already tightly regulated^[15] by government (state and federal health law), institutions (for instance, hospital policies) and professional bodies (for instance, doctors’ codes of ethics).

Removing the stand-alone abortion legislation that exists in all states/territories would treat abortion like all other health procedures and decrease abortion stigma.

Read more: Abortion is no longer a crime in Australia. But legal hurdles to access remain^[16]

Who has access? How about the cost?

People in SA and the Northern Territory can access abortion in the public system. Vulnerable people in Victoria^[17] and Tasmania^[18] also have public access.

However, abortions are costly^[19] for others because they are largely performed in private clinics rather than in the public system.

There are few abortion providers in rural and regional Australia. Currently, only about 10% of GPs^[20] are registered to prescribe mifepristone, sometimes known as RU486, for medical abortion^[21]. This figure falls to less than 1%^[22] in some regional, remote and rural areas^[23].

Read more: Early medical abortion is legal across Australia but rural women often don't have access to it^[24]

We can learn from Tasmania

Since Tasmania’s last private abortion clinic closed in 2018^[25], abortion provision in the state has been dire^[26]. Last year, the government took action, expecting^[27] that, by October 2021, select public hospitals (together, covering the entire state) would provide abortions.

Surgical abortions are now performed at three public hospitals^[28] in the state. Vulnerable women^[29] are prioritised, indicating the service may not be universal.

Read more: Here's why there should be no gestational limits for abortion^[30]

What would improve access around Australia?

The current shortage of abortion providers^[31] could be remedied if Australia followed Sweden to make abortion provision compulsory^[32] to the training^[33] and work of midwives and obstetrician-gynaecologists^[34].

The federal government could tie funding for public hospitals to abortion provision^[35].

Primary health-care provision of abortion also needs to increase, which requires two key policy shifts.

First, the Therapeutic Goods Administration (TGA) must revise its guidelines for providers and dispensers of medical abortion. At present, doctors must complete an instruction module and register to prescribe mifepristone. Pharmacies must register to dispense the drug. No other drug is subject to such unnecessary regulation^[36].

Read more: It's time to lift the restrictions on medical abortion in Australia^[37]

Second, Medicare needs to add an item number specifically for the provision of medical abortion. Appointments take time and, to keep this service viable, GPs often charge an out-of-pocket fee to patients of A$200-$300^[38]. Providing a Medicare item number reflects the need for this service and would incentivise more GPs to become providers by ensuring adequate compensation.

References

1. ^{^} leak of draft court documents (theconversation.com)
2. ^{^} rhetoric and lobbying techniques (theconversation.com)
3. ^{^} The end of Roe v. Wade would likely embolden global anti-abortion activists and politicians (theconversation.com)
4. ^{^} 88,800 people (www.mja.com.au)
5. ^{^} one quarter and one third (www.sahealth.sa.gov.au)
6. ^{^} vast majority (onlinelibrary.wiley.com)
7. ^{^} broadly “pro-choice” (law.adelaide.edu.au)
8. ^{^} final jurisdiction (theconversation.com)
9. ^{^} law has not commenced (indaily.com.au)
10. ^{^} old, criminalising legislation (www.abc.net.au)
11. ^{^} Western Australia (www.mediastatements.wa.gov.au)
12. ^{^} criminal law continues to regulate (www.parliament.wa.gov.au)
13. ^{^} prohibit unqualified people (theconversation.com)
14. ^{^} over-regulation of abortion (theconversation.com)
15. ^{^} are already tightly regulated (journals.sagepub.com)
16. ^{^} Abortion is no longer a crime in Australia. But legal hurdles to access remain (theconversation.com)
17. ^{^} Victoria (pubgeomapping.1800myoptions.org.au)
18. ^{^} Tasmania (www.health.tas.gov.au)
19. ^{^} abortions are costly (onlinelibrary.wiley.com)
20. ^{^} about 10% of GPs (www.mshealth.com.au)
21. ^{^} medical abortion (theconversation.com)
22. ^{^} falls to less than 1% (www.mariestopes.org.au)
23. ^{^} some regional, remote and rural areas (www.mshealth.com.au)
24. ^{^} Early medical abortion is legal across Australia but rural women often don't have access to it (theconversation.com)
25. ^{^} closed in 2018 (www.abc.net.au)
26. ^{^} dire (www.google.com)
27. ^{^} expecting (www.google.com)
28. ^{^} three public hospitals (www.health.tas.gov.au)
29. ^{^} Vulnerable women (www.health.tas.gov.au)
30. ^{^} Here's why there should be no gestational limits for abortion (theconversation.com)
31. ^{^} shortage of abortion providers (www.sciencedirect.com)
32. ^{^} compulsory (www.sciencedirect.com)
33. ^{^} training (obgyn.onlinelibrary.wiley.com)
34. ^{^} obstetrician-gynaecologists (www.betterhealth.vic.gov.au)
35. ^{^} to abortion provision (www.abc.net.au)
36. ^{^} unnecessary regulation (theconversation.com)
37. ^{^} It's time to lift the restrictions on medical abortion in Australia (theconversation.com)
38. ^{^} patients of A$200-$300 (www.childrenbychoice.org.au)
39. ^{^} Shutterstock (www.shutterstock.com)
40. ^{^} affordable, local and timely (3fe3eaf7-296b-470f-809a-f8eebaec315a.filesusr.com)
41. ^{^} several shifts (www.publish.csiro.au)