Hunter women waiting longer, paying more for safe terminations

Despite changes to the law, there has been next to no funding or support, making abortions increasingly difficult to access, according to Dr Kate Haggar, who specialises in sexual and reproductive health.

Put simply, the system was failing, she said.

"Sexual health services in general are limited in the Hunter region, with just one non-gynaecologist based service offering IUD insertions under sedation, and Family Planning NSW the only other stand-alone clinic offering specialised sexual health care, particularly medical termination options," Dr Haggar said.

The closure of the Marie Stopes Australia clinic in Newcastle in 2021, which was conducting about 100 terminations per week and was the only non-government service to offer abortions, has left a hole in the availability of safe, affordable options, she said.

Increasing private fees, inadequate Medicare rebates, cost of living increases, long waitlists and general oversaturation of an exhausted healthcare system meant women in the Hunter were having to wait longer, travel further and pay more, she said.

"This contributes to reduced patient autonomy, less patient choice, increased social and economic vulnerability, worse outcomes, later gestation abortions, increased risks, dissatisfaction, and trauma experiences," Dr Haggar said.

Abortion has been decriminalised nationally since South Australia made the change, the last state to do so, in 2021, not far behind NSW where the law was changed in 2019.

"The first step of decriminalising abortion was critical, and the NSW government mandated that the public health care system needs to provide access to reproductive healthcare choices," Dr Haggar said.

"However so far there has been limited funding to support the establishment and provision of terminations, particularly in more regional areas."

A $1.3 million grant (over three years, for all of NSW) has been put towards Family Planning NSW's SEARCH project, which aims to train and upskill GPs to provide long-acting reversible contraception options and medical terminations.

It was a wonderful endeavour, Dr Haggar said, but did nothing to address the gap in public hospital funding and service provision that was needed to make access to termination care equitable.

"In Newcastle, there is only GCA (GynaeCare Australia) providing private sector surgical terminations," she said.

"This is limited to 12 weeks gestation. They also have a clinic in Gosford which goes up to 14 weeks gestation. Between them they see about 30 patients a week, and their waitlist can be more than four weeks.

"So you need to know that you are pregnant, have decided that you want a termination, know where to get it, be able to afford it, and get on that list by about eight weeks. It's a lot."

Dr Haggar said there was not enough clinicians supporting patients in the region.

"There are so few doctors doing this service, that if a proceduralist, or the sedationist calls in sick, then there is no clinic. That might be the only clinic list that week, and patients still have to be seen, and now there is even less time and availability," she said.

"Both the federal and state government need to support GPs to upskill into this, and provide termination services at a hospital-level, publicly funded, just like they do for all other parts of pregnancy, including ectopic pregnancies, miscarriages and antenatal care."

The stigma attached to the procedure remains a significant stumbling block, says Dr Milton Sales, who heads up Brunker Road Medical Practice where Dr Haggar works part time.

"I think it's so important for people to understand, it's not a situation that's taken on lightly by anybody who needs to have an abortion," Dr Sales said. "I think we need to provide a safe and available method of dealing with the issue."

Looking at the mental health of women after pregnancy, lots of psychological surveys of women at different stages, post abortion and post pregnancy, showed the rates of depression and anxiety were higher among women who delivered an unwanted baby compared to those who had a termination, Dr Sales said.

Dr Phoebe Walsh, medical lead on the SEARCH project, agreed there was still sometimes a reticence among GPs, particularly in regional remote areas, to be known as "the abortion doctor". That can really affect how they are perceived in a community and can be isolating, she said.

"As of June (2022), just under 3500 medical officers were registered to prescribe MS2Step (medication for a medical termination) across the country, of more than 100,000 AHPRA registered medical practitioners," Dr Walsh said.

In the Hunter New England region, which covers close to one million people, only about 12 GPs had done the training, Dr Haggar said, and at last count only six offered the service within a GP clinic.

"I know quite a few doctors who've done the medical termination training, but not felt comfortable to actually prescribe it to patients," Dr Haggar said.

"That may be because they feel like they need systems in place, or don't feel comfortable advertising the service. I have been told that people would even throw eggs at this doctor's home. It sounds archaic, but this is the stuff that was going on. In some cases, it still is going on."

The issues are now being canvassed nationally, with a senate inquiry into universal access to reproductive healthcare (initiated by the Greens in 2022) looking closely at the priorities set out in the National Women's Health Strategy.

There have been almost 300 submissions to the inquiry, including from the Australian Catholic Bishops Conference, which said the bishops and the Catholic community recognised that many women have been affected by abortion, whether their own or one experienced by a friend or family member.

"To those women, we wish to affirm that nothing said in this submission is meant to make you or others feel unwelcome or unloved." But, they go on to say, the inquiry risks "moving to pre-determined solutions" rather than taking the opportunity for a broader investigation of issues, including "how we might address the reasons that a woman might feel compelled to have an abortion"

"These reasons reflect deeper problems in the community that we can all help to resolve" and the church remains opposed to abortion "because of our respect for the human dignity of both mother and unborn child".

The Right to Life Australia Incorporated goes further to say the inquiry purports to be related to improving healthcare for women, but is instead about "increasing the marketing, availability, rate and gestational age limits of abortion".

Another submission, from Hunter-based generalist GP Bob Vickers, who has sub-specialty training in obstetrics and gynaecology and was employed as a proceduralist at Marie Stopes before it closed, suggests broadening the scope of who can prescribe abortion-related medications, creating a Medicare number for surgical abortion, and adding all contraception medications to the PBS.

He also calls for conscientious objectors to have to identify themselves on a public, easily accessible register for patients.

"Most women want to have a medical termination, at home, at a time that suits them," Dr Haggar said. "And if they can do it through their GP, it's a lot less expensive, and traumatic."

It's not a perfect solution, she said, because GPs have their own supply and demand issues. Dr Haggar is now running two clinics, Pregnancy Care within Brunker Road Medical Centre, Adamstown, and a new joint venture with Dr Phoebe Walsh, Brightwell Health, co-located within Appletree Family Practice in Charlestown.

Most of the women Dr Haggar sees are not the "young teenagers" some might expect, she said, but the 30- to 40-something-year-olds who already have a family of two or more kids.

"An unplanned pregnancy can change everything for that family ... sometimes they are just surviving with the family they already have. Another child would break them.

"No one wants to have to make a choice to have an abortion. But if that is what they decide is best for them, and their family, and their life, we should respect that."