Demand for abortions has increased by 45 per cent at an Illawarra centre during lockdown, with vulnerable women at increased risk of sexual assault and reproductive coercion within their own homes.
Illawarra Women's Health Centre general manager Sally Stevenson said the pandemic had increased the risk of domestic and family violence in already violent homes - as well as homes where violence did not exist previously.
"Evidence shows domestic and family violence (DFV) increases during time of economic and social distress," she said. "Sexual assault and reproductive coercion are forms of DFV and therefore logically, some women will be experiencing these.
"Sexual assault can lead to unwanted pregnancies and reproductive coercion can lead to pressure to abort or keep a baby - we have had both circumstances in the last seven weeks.
"We know of perpetrators who have sought to control women who are pregnant by preventing them from leaving the house to have an abortion, and that there's a lack of privacy at home in seeking out services; there's control over finances and there has been additional childcare responsibilities during school closures."
Ms Stevenson said the pandemic had highlighted the barriers women already faced over access to surgical and medical termination of pregnancy (MTOP) - especially in regional and rural areas.
A shortage of staff and resources, and the high cost of terminations for those under increased financial strain, meant unwanted pregnancies could rise in these uncertain times.
"In our centre we have had an increase over the last month of 45 per cent for women attending medical abortion appointments," she said.
"This comes off a small base as we are only able to offer MTOP one day a week due to limitations of doctors. In the past year we have had between 14 to 20 clients every quarter. In the past seven weeks we have seen 14 clients.
"As the procedure is time sensitive, and our appointments are full, we have also referred many women on to local GPs who perform MTOPs.
"One thing we think is a factor in our increases is that we bulk bill and in this time of financial distress cost of abortion becomes even more prohibitive."
Average out-of-pocket costs for medical abortion (which involves taking two medications 24-48 hours apart and is available up to nine weeks gestation) is $555, Ms Stevenson said. Surgical abortions range from $495 to $1000 up to 13 weeks gestation, and upwards to $4000 for late term.
Ms Stevenson said there was also a lack of information available for women on what services were open for abortion, and whether it was lawful to access these services.
In September 2019, NSW parliament finally passed laws decriminalising abortion, more than a century after it was included in the state's criminal code.
"The lack of information caused a lot of distress for women who have unwanted pregnancies. Abortion itself is considered an essential service, but a lot of women did not know this," she said.
"Also a lot of women were not aware that the 'morning after' pill does not require a prescription, or that they were legally allowed to visit a pharmacist during shutdown to access the medication."
Distance from services was also an issue, Ms Stevenson said, with reports that some women have to travel 250km to get a termination.
"If you are far away from services then the regional travel restrictions can create perceived and real obstacles. It hasn't been made clear that you are exempt from such restrictions if seeking an abortion," she said.
"And if you do travel, and you get pulled over by police, then you have to explain why - so issues around privacy and confidentiality come into play."
Ms Stevenson welcomed Tuesday's announcement by NSW Attorney General and Minister for the Prevention of Domestic Violence Mark Speakman that the NSW and Federal Governments would invest more than $21 million to boost frontline services and other supports.
However she said there were significant gaps in where the funds were going.
"For example, face to face counselling and casework is vital in this environment, where we know many women are very unsafe if they try to access support via phone or internet," she said.
"Similarly, special client groups have also been neglected, most noticeably is the ongoing lack of support and compassion for women on temporary visas, who remain in highly vulnerable and dangerous situations.
"Women's health centres across the state have not received any additional funds during COVID-19, including from this tranche."
She said the pandemic highlighted the need for "free, safe and confidential access to abortion" in public hospitals. Currently NSW public hospitals do not provide abortions.
"We know women have had to go to extraordinary lengths to access an abortion during this time - but in many ways this is as it has always been - and this pre, during or post COVID is unacceptable."