More than three years after abortion was decriminalised, some Illawarra women are still being told by health workers that the procedure is illegal, reproductive health advocates say.
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Through her community liaison role at the Illawarra Women's Health Centre, Miranda Batchelor sees around five women a day - up from an average of just three a week last year - who need help accessing an abortion.
Some are facing poverty, immigration issues, domestic violence, financial abuse or reproductive coercion, while others simply cannot work out how navigate the long list of barriers for those who want to terminate a pregnancy.
Ms Batchelor says the GP shortage and rising cost of living are exacerbating to these issues, and that women also face judgement or shaming from some of the health professionals they turn to when seeking the procedure.
"I was on the phone with a woman and we rang her GP together so she could discuss her options for an abortion. I heard her on the phone with her GP, and this doctor told her that abortion is illegal in Australia," she said.
"You could see this woman's shoulder slump, and of course I jumped in straight away and called him out on lying. But the shame women are still carrying with this medical procedure - which one in four women have in their lifetime - it's outrageous."
"I've also helped some women get into a GP appointment and they have had to wait two or three weeks for that, and then when they finally get there it turns out that GP is a conscientious objector, so we have to start the whole process all over again.
"Legally [the GP] is supposed to refer these women to a GP who is not a conscientious objector, and that's not happening."
According to NSW Health, a registered health practitioner may object to performing, assisting in or advising on an abortion it conflicts with their own personal beliefs, values or moral concerns, but they are required to inform patients of their objection in "a timely manner".
They must also either provide information on how to locate or contact a medical practitioner who does not conscientiously object or transfer the patient to someone who will help them.
Ms Batchelor also said many pregnant women who did not want a child remained unaware of how to access an abortion, as there remains no simple pathway to do so.
"A lot of women are aware that in 2019 it was decriminalised, so there's a fair assumption that you can just go to any GP and ask for script for the two abortion pills you can take if you're under nine weeks," she said.
"But the problem is that only a handful of GPs in the Illawarra are actually able to write this script."
While there are moved to expand access so more GPs can prescribe the drugs that bring on a miscarriage, the Illawarra Women's Health Centre currently only lists eight practices in the Illawarra which have a doctor who can prescribe the medication.
With most women not finding out that they are pregnant until they are six to seven weeks along, any delay in being able to see one of these doctors means they could miss the deadline for a medical abortion.
"Even when they get in to the GP, they have to get a referral for a blood test and an ultrasound, then they have to go and get those, then come back for a second appointment and see if they qualify for the pills," Ms Batchelor said.
"If you've got a woman who finds out she is pregnant at seven weeks and can't get in to the GP for two weeks, because of the GP shortage, then the GP says 'sorry, you've just missed the mark'."
For people more than nine weeks pregnant, a surgical termination is needed, and Ms Batchelor said there was only one private provider in the Illawarra - Gynaecology Centres Australia on Keira Street - which is often also booked out two to three weeks in advance.
"They only do surgical terminations up to 12 weeks, so then these women might have just missed the mark again - so now they have to go up to Sydney," she said.
"It's a really long, drawn out and frustrating process. If a woman is in domestic violence, financial hardship, is a single mother or doesn't have access to transportation for all these bad and forth appointments - it's very difficult."
With these delays, she says costs can also increase, with surgical terminations running anywhere from about $600 to $1200 depending on how far along a patient is and where they can get an appointment.
As part of a federal Senate inquiry, the Illawarra Women's Health Centre made submission calling for all GPs to be able to write the script for a medical abortion, and for the government to establish a publicly funded clinic for abortions.
Access to abortions limited in public health system
Currently there are some free abortions provided by the Illawarra Shoalhaven Local Health District, however there is no transparent access to this service.
The district will not disclose the number of abortions it performs.
A spokesperson said Wollongong and Shoalhaven hospitals would only provide abortions to "women with more complex health needs or those requiring a termination beyond 22 weeks".
There are also non-admitted services provided by the Local Health District with priority given to patients from socially disadvantaged and vulnerable communities with limited access to other options, the spokesperson said.
Ms Batchelor said many of the women she sees qualify for the public service, but still faced significant access barriers.
"It's things like being in domestic or family violence, being homeless, in financial hardship, being a young person under a certain age, identifying as a being Aboriginal or Torres Strait Islander, or having mental health issues," she said.
"The hospital is inundated, we know the doctors and nurses at the hospital are operating over capacity and I have enormous respect for the work they do. But they're not properly resourced and equipped for this service.
"From what I understand, they are not able to meet the demand, so they have to triage it. If a woman is pushing 20 to 22 weeks they will get them seen as soon as possible... so you have other women who are going to have to wait a little bit before they can be seen."
On Monday, the NSW Greens said they would push for abortion to be provided at every public hospital in NSW, and introduce a statewide directory service of contraception and abortion providers if they party hold the balance of power after the March 25 election.
Launching the policy, Federal Greens Senator Mehreen Faruqi said it was "still unacceptably difficult and expensive for people to access abortions"
"Access to abortion is a geographic, class and racial lottery," she said.
"A vast majority of people in NSW support abortion being provided in all public hospitals, just like they supported the decriminalisation of abortion.
"Governments must listen to the community and treat abortion services like other healthcare - provided through our public hospitals, fee-free and covered by Medicare."
Labor's health spokesman Ryan Park said his party would make sure women seeking a termination have safe access to abortion.
"Women have a legal right to safe and accessible terminations in NSW and the government has failed to make sure that we have in place at our public hospitals a clear and transparent pathway available for women," Mr Park said.
In a statement, the local health district said NSW Health has introduced initiatives to continue to improve equitable access to information and services for reproductive health in NSW, including pregnancy options support, and access to long-acting reversible contraception.
"NSW Health is supporting Family Planning Australia (formerly Family Planning NSW) to lead the pilot of a new service model, the SEARCH project, to improve access to affordable abortion (medical and surgical) and long acting reversible contraception services for women who experience barriers to affordable services in regional and rural NSW," the statement said.
"This service model will build local service provider capacity and includes a strong focus on working with local Aboriginal Community Controlled Health Services.
"NSW Health also supports the NSW Pregnancy Choices Helpline to assist NSW residents to find out about abortion service providers that meet their specific needs, as well as information on pregnancy options counselling."
The NSW Pregnancy Choices Helpline 1800 008 463, which provides free, unbiased and confidential information, is available 8am - 8pm Monday to Friday, or via the Pregnancy Choices Helpline website and Live Chat at www.pregnancychoices.org.au.
Kate McIlwain
For more than a decade, I've helped the Illawarra Mercury set the news agenda across the region. Currently I'm the paper's health reporter - covering the stories of Illawarra workers and residents in the wake of a global pandemic and at a time where our health systems are stretched to the limit.
For more than a decade, I've helped the Illawarra Mercury set the news agenda across the region. Currently I'm the paper's health reporter - covering the stories of Illawarra workers and residents in the wake of a global pandemic and at a time where our health systems are stretched to the limit.
