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Source: The Conversation (Au and NZ) – By Erica Millar, Senior Research Fellow, Social Inquiry, La Trobe University

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Abortion is legal in all Australian states and territories. Women, trans men and gender diverse people with a uterus have the option of taking medication to end a pregnancy, or undergoing surgery.

It is estimated that between a quarter to one-third of people with a uterus will have an abortion in their lifetime. But the availability and cost of services depends on where you live and your pregnancy gestation.

So what do the different types of abortion involve? And how do gestation, cost and location affect access?

What is early medical abortion?

Early medication abortion involves taking two different medications 24–36 hours apart:

  • mifepristone, a progesterone blocker that stops the pregnancy

  • misoprostol, which causes the uterus to contract and expel the pregnancy.

Early medication abortion is available up to nine weeks (63 days) from a pregnant person’s last menstrual period.

People can take the medications at home, with additional medications to manage pain and nausea.

Where can you access medical terminations? And how much do they cost?

The governments of the Northern Territory, South Australia, the Australian Capital Territory and Tasmania (indirectly for eligible patients through community health organisations) fund no-cost early medical abortions at community health organisations (NT, Tasmania), private clinics (ACT), through GPs (ACT, Tasmania), or public hospitals (SA).

Elsewhere, some community health organisations and hospitals provide early medication abortions inexpensively or fully through the public health system.

An early medication abortion at a private clinic, which includes co-located ultrasound and pathology services, will cost around A$580 for people with a health-care card and $620 without.

All GPs can prescribe early medication abortion. But few do. In Victoria, for example, just 17% of GPs prescribe these medications.

In Queensland, SA, Victoria, the ACT and Western Australia, other suitably qualified health professionals, such as midwives and registered nurses, can prescribe early medication abortion. But the numbers of eligible professionals are very low. Several training and regulatory barriers also impede pathways to becoming a provider.

A minority of GPs provide bulk billing to patients, meaning there is no out-of-pocket costs.

Across the health system, out-of-pocket expenses are rising. This acutely impacts on the provision of early medication abortion, which requires long and multiple (usually two or three) consultations.

Most practitioners require blood and ultrasound tests before prescribing early medication abortion. However, these tests are no longer considered necessary in most cases. They can cause significant delay and additional costs. The ultrasound typically costs around $150.

Abortion medications cost an additional $40 for those with a Medicare card.

What about telehealth?

Telehealth abortion is available throughout Australia, including via MSI Australia, Clinic 66 and Sexual Health Victoria.

After a medical consultation, prescriptions can be filled at a local pharmacy or sent via post.

Patients must first have blood and ultrasound tests. And they must be within two hours of a hospital or emergency medical facility when taking the medications.

Telehealth abortions cost around $280 for Medicare-eligible patients, excluding the costs of blood and ultrasound tests.

What happens in a surgical abortion?

To 12 weeks’ gestation, a surgical abortion is a quick day procedure, using a suction curettage under light anaesthesia. Here, the cervix is dilated and a plastic tube inserted to empty the uterus via gentle suction.

From 12–24 weeks, surgical abortions take longer and require more specialised care.

Gestational limits to surgical abortions are set by each hospital or clinic and are largely determined by the skill set and comfort levels of the doctors who perform them. All surgical providers go to 12 weeks’ gestation, and some to 14-16 weeks.

Surgical abortions after 16 weeks’ gestation (to between 20 and 24 weeks, depending on location) are only available in public hospitals in Darwin, Melbourne and Adelaide and private clinics in Perth and Sydney. Some other public hospitals provide this service discretely to eligible patients.

Abortions after surgical gestational limits involve an induction of labour in a hospital setting.

Where can you access a surgical abortion?

Surgical abortions in NT, Tasmania and SA are performed through the public health system with no out-of-pocket costs to the patient. The hospitals that provide abortion are relatively dispersed in the NT and Tasmania but concentrated in Adelaide in SA.

The ACT government funds surgical abortion care for residents (including people without a Medicare card) through a private clinic. This serves people with no medical complexities who are under 16 weeks pregnant. Care for people outside these parameters can involve travel and cost.

Similar pathways operate in Perth for patients in the St John of God Midland Public Hospital catchment area, and to people living in some Queensland catchment areas.

Abortions aren’t available at all public hospitals.
Maria Sbytova/Shutterstock

In Queensland, NSW, Victoria and WA, most surgical abortions are performed in private clinics clustered in capital cities. These have significant out-of-pocket costs.

Some public hospitals in these states provide abortions. These services have generally developed through the advocacy of individual clinicians rather than a centralised effort to expand care.

Unlike other forms of maternity care in the public health system, triaging criteria set within individual hospitals often determine which patients can receive abortion care. Triaging criteria commonly include:

  • the reason the person is requesting an abortion
  • their catchment area
  • criteria of economic vulnerability
  • medical complexity (for example, a BMI of 40 or above)
  • social complexity (for example, homelessness or domestic violence).

What about late-term abortions?

After a particular gestation, in all jurisdictions except the ACT, a request for an abortion is subject to the approval of two doctors. Gestational limits range from 16 weeks in Tasmania to 24 weeks in Victoria.

After gestational limits, abortion is legal on grounds that are defined broadly to enable for clinical judgement and patient-centred care. They can include the health of the pregnant person or fetus, a late diagnosis of pregnancy, delays in accessing abortion care, or reproductive coercion. In practice, as a pregnancy advances, it becomes increasingly more difficult to obtain an abortion.

Some second-trimester abortions are performed via a surgical procedure. Others, and those in the third trimester, are performed via an induction. This typically occurs over two days and involves cervical preparation and the use of medicines to induce labour. A doctor may also use medicine to stop the pregnancy before the induction.

Guaranteeing access

The costs and travel required for abortion differ greatly across Australia. People in rural and regional areas experience more significant delays in accessing care because of the relative scarcity of services.

People without a Medicare card are also disadvantaged.

Early medical abortion is available via telehealth, but not for free.
Jep Gambardella/Pexels

Without access to local, affordable and timely health services, pregnant people can miss the opportunity for an early medication abortion altogether. This means they will need to travel to the nearest surgical provider, and surgical providers become more sparse as a pregnancy advances.

The governments of Australia’s least populous states and territories have made significant inroads into rolling out free medical and surgical abortion access through the public health system. It’s time other states follow their lead.

Where to go for help

For information and support, contact:

Erica Millar receives funding from the Australian Research Council. She is a member of the South Australian Abortion Action Coalition.

– ref. Who can access abortion in Australia? – https://theconversation.com/who-can-access-abortion-in-australia-243699

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