Geography hurts women’s choices

Pregnancy termination processes are legal across Australia and appear to be staying that way, but there is still a large disparity between regional accessibility versus metropolitan.

Dr Margreet Stegeman of Shepparton Women’s Health Centre has seen first-hand the challenges women living regionally face when accessing an abortion.

But one major challenge isn’t initially what comes to mind.

“The first barrier there is, and a lot of people seem to forget this, the thoughts within the woman herself and then perceived reactions of the immediate family and support persons,” Margreet said.

“Women do not take the decision to have a termination lightly, they always have very good reasons why they come to the conclusion that this is the only solution, the only way out for them.

“That is the first and hardest barrier to overcome.

“Once they have made this decision it should be smooth sailing, but unfortunately that is not the case, even in Australia.”

Though it’s not a new problem by any means, with further strained services due to COVID-19 paired with the lack of health professionals in rural areas, more people seeking a termination are facing explicit accessibility issues.

Financially, geographically and time — it can be a race against the clock.

While Greater Shepparton is among three regional areas that will receive a sexual and reproductive health hub over the next four years, current resources are lacking.

Margreet said while there are some options in Shepparton, there are not enough — especially in the public health system.

“In general, it would be good if more nurses in the town were trained in the medical termination option — other towns have done this,” she said.

“More public options for women would be ideal, with easier and quicker access, especially with a view to the medical option.”

A 2021 report showed an estimated 2850 of the 41,000 GPs in Australia are registered to prescribe for medical abortions.

Margreet said local hospital facilities have also struggled to maintain services largely due to the pandemic causing staff shortages, but also due to other factors.

“There are opportunities for GPs to be trained in medical termination services, and some are trained, but not enough are taking this up,” she said.

“But the medical option only works for women comfortable or eligible for this.

“If they want to or have to go with surgical termination — for instance, if they are over nine weeks which is the cut-off for medical terminations — then we need operating facilities and they are scarce at the moment.”

A medical termination is a two-stage process, which includes ingesting medication 24 to 48 hours apart and can be given up to 63 days gestation, though the process may not be suitable for all within that time frame.

Costs of a medical abortion in Victoria can vary from $100 to $600 in the public system.

A surgical termination is generally performed as a day procedure under general anaesthetic, with costs ranging from $200 to more than $1000.

At Shepparton Women’s Health Centre, a referral from a patient’s regular GP is necessary, together with a blood type report and an ultrasound report to confirm the number of weeks of pregnancy.

“We try to see women certainly before their options are limited, so if they are referred we will try to see them within one to two weeks so the medical termination is still an option,” Margreet said.

One in four women will undergo an induced abortion throughout their reproductive lives.

But despite the prevalence, Margreet said there was still stigma attached.

“I don’t think you ever hear anyone say at a dinner party they had an abortion,” she said.

“It is usually ‘confessed’ to in hushed tones amongst women when they know they are in equally thinking company.

“It can be a hard decision to make for women, some will feel guilty about the decision they have or had to make and then to be criticised is the last thing you need, even if this criticism comes 10 years after the fact.”