Decriminalising Abortion Doesn't Go Far Enough
In case you hadn’t noticed, a debate is raging about the decriminalisation of abortion in New South Wales.
A bill co-sponsored by 15 cross-party MPs seeking to remove abortion from the Crimes Act passed the NSW Legislative Assembly in August. A debate in the upper house has been delayed by conservative MPs who are unhappy with the proposed reforms.
There is no doubt that legal reform is essential. Although abortions happen every day in NSW, as the law currently stands, medical practitioners and patients are at risk of prosecution for “unlawfully” attempting to procure an abortion.
Since 1994, 12 people have been prosecuted under the 119-year-old law. In 2017, a court found a woman guilty for self-administering the abortion drug misoprostol in her last-ditch effort to terminate her pregnancy at 26 weeks gestation.
NSW is one of the last states to decriminalise abortion, a move supported by both the Australian Medical Association the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).
But legal reform doesn’t always mean equitable access to abortion for women who need it. Even in states that have removed abortion from the criminal code, such as Queensland or Victoria, if you live in a regional or remote area, the chances are that you have to travel to a regional centre or a city to access an abortion.
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What should be a simple procedure suddenly becomes a logistical nightmare. You have to organise travel, which means either finding a support person willing to drive you or travelling via public transport, which is invariably expensive and slow. You’ll probably have to pay for overnight accommodation. If you have children, you have to find someone to care for them. You have to take extra time off work.
It’s why RANZCOG argues that not only should abortion be “regulated as a health procedure and not by the criminal law”, but that “access to lawful abortion should be on the basis of health care need and should not be limited by age, socioeconomic disadvantage, practitioner-preference or geographic isolation.
"Equitable access to services should be overseen and supported by health departments in each jurisdiction in the same way it is for other health services."
RANZCOG is right -- where abortion is a legal health procedure, it should be provided by the public health service. In practice, however, that rarely happens.
Tasmania’s only surgical abortion provider closed in December 2017, almost five years after abortion was made legal. It meant that women seeking an abortion after nine weeks gestation had to travel interstate to access the procedure, a journey that is costly, time-consuming, and both physically and emotionally draining.
Victoria decriminalised abortion in 2008, yet abortion access remains problematic, particularly for women in regional areas. Medical abortion, suitable up until nine weeks, is becoming more commonly prescribed by GPs and family planning clinics throughout the state. Surgical abortion, however, is mostly confined to private clinics in metropolitan areas.
“Ideally, women would be able to choose between medical and surgical abortion," said Dr Philip Goldstone, Medical Director at Marie Stopes Australia, "because, although they’re both safe, they’re both effective, they are very different, and women do tend to have a preference for one method over the other,” he said.
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Dr Goldstone said the situation is better in Queensland, where abortion was decriminalised in December 2017.
Perhaps they learnt the lesson of Victoria that law reform on its own isn’t enough, and that you do need to put in policy and systemic changes in the public health system to improve access.
But even in Queensland, access to abortion is “a postcode lottery”, says Holly Brennan, manager of Children by Choice, a Queensland-based pregnancy counselling service. “For some women and pregnant people in Queensland, there is not a service that is accessible or close to them or affordable.”
It’s a similar situation in NSW, where abortion access has never been a problem -- if you’re a woman living in the city who can afford to pay for the procedure in a private clinic.
For everyone else, abortion is not easily accessible -- and unfortunately, legal reform on its own won’t change that.