do women in Tasmania have access to safe abortions?

People are absolutely appalled that in one of our states women are not getting access to safe terminations, and what I know is that in any decent society we ensure that all women have access to those choices and right now people in Tasmania are being deprived of that.

– Australian Greens leader Richard Di Natale, speaking at the Tasmanian Greens election launch in Hobart, February 21, 2018

Access to elective abortions has become a key point of policy difference between the Tasmanian Liberal and Labor parties in the state election to be held this Saturday.

Abortion was decriminalised in Tasmania in 2013, but elective surgical and medical abortions remain unavailable through the state’s public health system, and Tasmania’s last dedicated surgical abortion clinic recently closed.

The incumbent Tasmanian Liberal government is offering financial assistance to women who travel to the mainland to have a surgical abortion, but has ruled out funding elective abortions through the public system.

The opposition Labor party has pledged to make surgical abortions available through Tasmania’s public health system, if elected.

At the launch of the Tasmanian Greens state election campaign in Hobart, Australian Greens leader Richard Di Natale said that “in one of our states women are not getting access to safe terminations”.

Was Di Natale correct?

Checking the source

The Conversation contacted Richard Di Natale’s office to request sources, but a spokesperson for the Australian Greens leader declined to comment.

Verdict

At the launch of the Tasmanian Greens state election campaign in Hobart, Australian Greens leader Richard Di Natale said that “in one of our states women are not getting access to safe terminations”. With reference to Tasmania, this statement is incorrect.

However, Di Natale added that “in any decent society we ensure that all women have access to those choices, and right now people in Tasmania are being deprived of that”. This is a fair statement.

Elective medical and surgical abortions are legal and available in Tasmania.

However, not all women may be able to access these services.

Abortions are only provided in the Tasmanian public health system in extraordinary circumstances – for example, in cases of foetal abnormality or to save the life of a pregnant woman or to prevent her serious physical injury.

Otherwise, women must access these services through the private sector. There are very few health professionals providing these services in Tasmania. Women may face challenges in locating, travelling to and paying for abortion services.

Young women, those living in rural areas and women of low socioeconomic status may be most disadvantaged.

Access to safe abortions in Tasmania

There are two safe ways for a woman to terminate a pregnancy – by surgical abortion, or by medical abortion. Both surgical and medical abortions are available and legal in Tasmania.

However, abortions by request are only offered in the private sector, and for a fee.

Tasmania’s public health system does not accept referrals for abortion by request. In the public system, abortions can be provided in cases of foetal abnormality or to save the life of a pregnant woman or to prevent her serious physical injury.

Accessing surgical abortions in Tasmania

In Tasmania, surgical abortions can be provided up to 16 weeks gestation.

A surgical abortion involves the use of a local or general anaesthetic, and is performed by a medical practitioner, such as a gynaecologist or surgeon, in a day clinic or a hospital theatre in line with National Safety and Quality Health Service Standards, which are set by the Australian Commission on Safety and Quality in Health Care .

The woman must find a private gynaecologist willing to perform the procedure.

There are 39 gynaecologists accredited by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Fellows in Tasmania. But the not-for-profit organisation Family Planning Tasmania told The Conversation they were aware of only two accredited gynaecologists who offer surgical abortion services.

These services come at a cost. Family Planning Tasmania told The Conversation that one surgical abortion health professional in the south of the state offers elective surgical abortions at a cost of A$2,500 per procedure.

Medicare will cover some of the costs of the procedure, including the cost of the anaesthetic and the clinician fees. However, women will have out of pocket costs.

For example, a clinic in Sydney has a fee of A$750 for a surgical abortion, with the Medicare rebate covering A$400 of this.

Given that there appears to be only two providers offering elective surgical terminations in Tasmania, some women may need to travel within the state, or to other states, to access a surgical abortion. This could incur additional travel and accommodation costs.

If a woman suffers complications after the procedure, she would need to return to the private clinic (which may incur additional costs) or go to her local emergency department.

To access an elective surgical abortion beyond 16 weeks gestation in Tasmania two medical practitioners must be involved – at least one of whom needs to be a specialist in obstetrics or gynaecology. They must both agree that the continuation of the pregnancy would involve greater risk of injury to the physical or mental health of the pregnant woman, than if the pregnancy were terminated.

Accessing medical abortions in Tasmania

For medical abortions in Australia, the registered medication MS-2 Step is recommended for use up to nine weeks gestation.

A medical abortion involves the use of two oral medications: mifepristone linepharma (also known as RU 486) and misoprostol (also known as GyMiso).

Early medical abortion with mifepristone and misoprostol is highly effective and safe and can be safely used in a woman’s own home.

Specifically trained medical practitioners, including general practitioners (GPs), can prescribe these medications to women during a face-to-face appointment, or over the phone.

Face-to-face appointments

A woman must find a GP or private gynaecologist who has undergone the accredited training required to prescribe the medications. Family Planning Tasmania told The Conversation that while 43 GPs are trained to offer medical abortion services, they are only aware of three who currently offer the service.

These services also come at a cost. A consultation for medical abortion may be covered by Medicare, but some GPs or gynaecologists may charge a gap payment, requiring women to pay the difference as an out-of-pocket expense.

Women seeking these services are required to have an ultrasound to confirm the pregnancy is less than nine weeks gestation, and have a blood test. This may incur additional out-of-pocket costs associated with ultrasounds and other tests where Medicare does not cover the providers’ fees. Women from rural areas where ultrasound services may not be available may need to travel to access these services.

The medical provider must also locate a hospital willing to provide specialist support in the case of complications. This can be difficult.

GPs in New South Wales have reported that health professionals in public hospitals are often reluctant or unwilling to be involved in providing care associated with abortions.

The medical abortion drugs are listed on the Pharmaceutical Benefits Scheme and cost approximately A$39.50, or less if women have a health card. Most women will have their prescription for medical abortion drugs filled by a pharmacist registered with MS Health.

However, according to Dr Betty Chaar at the University of Sydney, pharmacists registered with MSHealth may, in special circumstances and in consultation with the doctor, send medications via post or courier.

Telephone prescriptions

Tasmanian women can also request medical abortion medication over the telephone from two private providers: the Tabott Foundation and Marie Stopes Australia.

Women must call one of the private service providers to have a consultation with a doctor over the phone. They will also be required to have an ultrasound to confirm the pregnancy is less than nine weeks gestation, and have a blood test.

Again, this may incur additional out-of-pocket costs, and present challenges for women from rural areas in particular.

Where appropriate, the providers will mail or courier the medication to the women. Women receive over the phone 24-hour nurse aftercare following their abortion.

Women who suffer complications must travel to their nearest emergency department.

The Tabbot Foundation offers this service for A$250 to women with a valid Medicare card, and A$600 to those without. However, this does not include the cost of additional services, including the necessary ultrasound and blood test, or any costs associated with complications.

Tabott Foundation medical director Dr Paul Hyland told me that since February 2017, 313 women had been prescribed medical abortion medication via the Tabbot tele-medicine service.

The reproductive health company Marie Stopes Australia has no clinics in Tasmania, but does offer home abortion by phone. This service starts from a cost of A$290, though this varies depending on Medicare card availability and excludes the cost of the medication, the required medical tests and emergency care.

It’s worth restating that medical abortions are only available to women up to nine weeks gestation. After nine weeks gestation, a woman would need to seek a surgical abortion. As outlined above, there are very few medical professionals who provide this service in Tasmania.

Finding information about abortion services in Tasmania isn’t always easy

Women in Tasmania can find information about terminations from not-for-profit organisations like Family Planning Tasmania or other community health services.

However, this information is generally not publicly available.

This lack of information, as well as the costs that women must incur, constitute significant barriers to accessing abortion in Tasmania.

Tasmanian women may face further barriers to abortion, as noted in other Australian research. This can include conscientious objection from health professionals, unwanted counselling, harassment from protesters and gestational limits requiring the approval of more than one health provider.

International research has found that places where abortion is difficult to access are associated with higher maternal mortality and unsafe abortion rates.

Barriers to abortion access in Australia particularly affect young women, those in rural areas and women of low socioeconomic status. – Angela Dawson

Blind review

This article presents a comprehensive overview of the availability of abortion services in Tasmania.

It’s worth clarifying that children under the age of 16 have access to abortion in Tasmania, but they need to be deemed capable of consenting to the procedure.

This decision is made by a GP and is based on several factors, such as the age and maturity of the individual. People under the age of 16 need not obtain parental consent to have an abortion.

Another area of relevance is the issue of conscientious objection. Doctors and nurses have the right to conscientiously object to participation in terminations under the Tasmanian Reproductive Health (Access to Terminations) Act 2013. The only exception to the rule is when a woman is at risk of death or serious injury.

Doctors, however, are required to provide women with a full list of prescribed health services if they become “aware that the woman is seeking a termination or advice regarding the full range of pregnancy options”. They have an obligation to refer patients to abortion services where this is requested. – Xavier Symons

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