CHILDREN BY CHOICE ASSOCIATION INCORPORATED

Access to Abortion Services

Unplanned pregnancy remains a key health issue for Australian women. Approximately, 50% of all pregnancies are unexpected. These pregnancies often arise due to contraceptive failure, or where contraception is not readily available to women. The experience of an unplanned pregnancy can be difficult for many women when the pregnancy is unwanted. Many women and their families make the decision to terminate an unwanted pregnancy when they feel they are unable to parent a child at that time. People already parenting would understand the tremendous dedication and responsibility required of parents to raise their children in a loving and supported environment. 

There are many issues which can negatively impact on women's access to abortion services in Queensland. 

Medicare and financial disadvantage

Children by Choice is very concerned about the widening gap between the cost of a termination and the value of the Medicare rebate for this vital service. Over the past four years, Children by Choice has received increasing numbers of requests for financial assistance from Queensland women who are experiencing unplanned or unwanted pregnancy and are seeking a termination of pregnancy.  The Women's Access Fund is a project of Children by Choice, a donation fund existing to help financially-disadvantaged women pay for the cost of a termination procedure.  Demands on WAF continue to rise consistently and the fund is under increasing pressure due to the high rate of requests for assistance.  To make a tax deductible donation to the Women's Access Fund through the National Foundation for Australian Women, please click here. 

Services are only available in private medical clinics and day surgeries in Queensland. Private medical clinics offering pregnancy termination services charge clients and patients a ‘theatre fee’, as the Medicare Benefit scheduled fee does not adequately cover the real cost of service provision (particularly following the large increases in medical insurance following the collapse of HIH and the hardening of the global insurance market).

The current ‘out of pocket’ expense for a first trimester termination range from $370 to $1100 for services in Queensland. Rural and regional women are particularly disadvantaged as any services north of the Sunshine Coast start from $550.

The situation in Queensland is mirrored in other Australian states where termination of pregnancy services are generally unavailable within the public health system. The reduction in the relative value of the Medicare rebate means that women from lower socio-economic parts of society are impacted greatly when trying to access termination services.

Children by Choice is currently undertaking research into the declining value of the Medicare rebate for termination of pregnancy and it’s impact on women. We have also made Budget submissions to the federal government for an increase to the Medicare rebate and also for increased funding to sexual and reproductive health organisations to improve access to sexual health services and education in rural, regional and remote areas.

The lack of Medicare funding for abortion procedures is also of concern given the recent attacks on funding by Tasmanian senator Guy Barnett.  Senator Barnett has targeted the Medicare item number relating to second trimester abortions in the cases of fetal abnormality, fetal death or life-threatening maternal illness, which was investigated by a Senate Estimates committee.  The Committee made no recommendation for or against the withdrawal of funding and Barnett's senate motion was withdrawn. 

Geographic Isolation

One of the major factors that influence access to abortion services for Queensland women is geography.  The sheer size and remote nature of some health districts across regional Queensland mean many women have little or no access to local medical services, and may have to travel vast distances simply to see a GP.  With surgical terminations only available in larger regional centres (Rockhampton, Townsville and Cairns are the only towns outside the southeast corner where procedures are available), the cost and inconvenience of travel adds to the often high cost of the procedure itself.  In many cases it is not financially viable for two people to travel from a remote town to a larger centre in order for a woman to access an abortion, but Queensland Health policy states that anybody receiving surgery under anaesthetic must be picked up by a support person and is under no circumstances to drive themselves.  However, no financial assistance is provided to support people for travel expenses, often leaving the woman to travel alone.  Providers have spoken of driving women home personally after giving them a termination, putting themselves and their staff members at risk of prosecution for doing so.

Stigma

Women in small or Indigenous communities also face problems with privacy, which can prevent them seeking to access a termination.  Stigmatisation of abortion is still a very real issue for many women, in metropolitan or remote areas of Queensland, resulting in many women desiring to keep the procedure a secret.  This desire for privacy is leading more and more women, particularly those in remote areas, to seek out medical abortion rather than opt for the surgical procedure. 

Succession planning and workforce retention

Succession planning conitnues to be among the biggest concerns raised by providers of abortion in Queensland.  There are several overlapping causes of this, including the unclear legal status of abortion, surgical as well as medical, throughout Queensland.  Issues with legality as well as the continued stigmatisation of abortion make it difficult to attract new doctors to the profession, and all providers emphasised the need for an industry-based training system for new graduates.  The difficulty of classifying abortion provision under one of the larger umbrellas of medical practice, such as general practice, or obstetrics and gynaecology, creates a lack of educational pathways for graduates as well as problems in recruiting. 

Providers also stated that official medical bodies, as well as more conservative individual members of the profession, will continue to distance themselves from the abortion issue until it is decriminalised, due to fear of litigation. 

Licensing restrictions

All abortion providers in this state who provide surgical abortions must be licensed by Queensland Health, a necessity for safe service provision but one which is adding an increased cost burden to the sector.  Licensing is becoming an increasingly difficult area to negotiate, with providers commenting on the growing number of restrictions being applied to new agencies applying for operating licences.  Licensing restrictions have also prevented Queensland providers from performing post-20 week terminations, meaning women seeking those procedures have to go through the public system or travel to Victoria.  The licensing restrictions require a large operating theatre and equipment which ensures patient safety but also results in increased costs, with one provider estimating the price of a termination had risen 30% in recent years. 

These issues were discussed in depth by providers and others in the health and medical sector at the Abortion in Queensland conference, held at the UQ Medical School in October 2008.  For a copy of the full conference report, please contact us, or alternatively download the report here. 

If you are interested in this issue, or would like to know more, contact the Coordinator.