Negotiating public access in Queensland
In April 2013 Queensland Health released the Maternity and Neonatal Clinical Guideline on Therapeutic Termination of Pregnancy [pdf], around the provision of abortion within public hospitals in Queensland. Until this point there had been no statewide guidance for hospitals and staff on when termination may be provided in a public hospital. As many health professionals consider Queensland abortion law to be unclear, the result of this lack of guidance was an adhoc approach to public provision that meant only a small proportion - Queensland Health estimates around 1% - of the state's abortions are performed in public hospitals, many of these for fetal anomaly reasons.
It was hoped the release of the Therapeutic Termination of Pregnancy Guideline in 2013 would result in more uniform and open access to terminations in public hospitals for women with exacerbating circumstances - those experiencing domestic or sexual violence, homelessness, or physical or mental health problems. While some hospitals have implemented the guideline, there is no monitoring of this process and no funding allocated for implementation, so provision remains fragmented across the state and can still be extremely difficult to negotiate at some hospitals.
The guideline is available online [pdf] and stipulates that:
- pregnancy termination can be lawfully performed by medical practitioners in Queensland, if there is a serious risk of harm posed by pregnancy, to a woman’s life, physical or mental health;
- women presenting at a public hospital requesting a termination of pregnancy should be assessed by a practitioner who does not hold a conscientious objection to abortion, as to whether they are eligible;
- when assessing the risk of harm, a medical practitioner should consider the social, medical and economic factors impacting on the woman’s life and health. In addition, risks that may not be present at the time of assessment by the doctor but that could arise during the pregnancy or following the birth of a child can be considered.
According to the guideline, all Hospital and Health Services (HHS) should provide access to therapeutic termination of pregnancy services to women living within their region. Where service level capabilities are insufficient to provide pregnancy termination services, timely referral and transfer procedures to a hospital service with the requisite capabilities should be established. However, the impact of the guideline will depend on how rigorously and consistently it is implemented.
For more information on using the guideline to assist a patient to access a public procedure, please contact our counselling team online or via 07 3357 5570 (in Brisbane) or freecall 1800 177 725 (outside Brisbane). Children by Choice has had some success for complex cases (serious danger to the woman’s physical or mental health from the continuance of the pregnancy); however this has been limited and different hospitals/staff have different criteria for eligibility.
Issues to be aware of:
- Circumstances which may create a case for public access include sexual assault, severe health problems caused or exacerbated by the pregnancy, and significant drug and alcohol problems. However, not all cases with these factors are approved for a public procedure and eligibility may be interpreted differently by individual hospitals and decision-makers.
- Patients need to present to the hospital with a GP referral letter (or have a GP fax a referral to the hospital), with a strong case for public provision. Support workers can also offer a short letter of support that offers information on social, emotional and economic circumstances that compound the woman’s risks. If you'd like some support around writing a referral letter, please contact our counselling team.
- Your client’s mental health is something to take into account when considering pursuing a public procedure, as approval processes can be lengthy and may require her to speak to several different medical staff and repeat her reasons for requesting termination to each. Emergency department staff may also ‘gatekeep’ on behalf of doctors, so persistence and assertiveness are often critical. These processes can be too onerous or difficult for some women.
- The gestational limit at which services are available to and the methods used to provide these services vary from hospital to hospital depending on the experience of the practitioners in each facility. It is important to be aware that in many hospitals, women presenting for termination later in pregnancy may only be given the option of a medication-induced labour on the maternity ward. This can be distressing and may not be appropriate for all women, especially those with histories involving sexual violence or trauma.
- Developing a relationship with the hospital (O & G, social work staff) can create good pathways for access. Social workers in particular can be valuable supports for women through the different stages of assessment.
- Supporting women to make a formal complaint when turned away with little or no assessment may seem extreme, but can help to put pressure on the system to change. Doctors can also complain and act as an advocate for the woman.