Nearly 20 years ago when Anna was 21 she had an unplanned pregnancy, at the time she was living in far north Queensland and abortion was still under the criminal code.
“First, I had to get a GP to certify that it would be damaging to me to go ahead, and then I was able to find a service that would provide it,” she said.
“At that point there were no clinics or hospitals that provided abortion services nearby. I had to travel several hundred kilometres to access one.”
Anna is not her real name. Despite the fact one in four women of reproductive age will have an abortion, it is still taboo and few women speak publicly about it.
“I’m pleased that there is less social stigma around abortion than there was when I had one, but I still think there’s a way to go because it’s still difficult to talk about openly,” she said.
When Anna asked for time off work, she tried to be as honest as possible, telling her boss that she had to travel to Townsville for a medical procedure.
“My colleague guessed what I was doing because Townsville was the only place where you could get an abortion, and so at a very vulnerable time I was outed in the workplace,” she said.
“I was very sad about having the abortion, and while I came to terms with it I had a very deep need for privacy which was ultimately blown by my situation of being in a rural area.”
Rise of tele-abortions
For women in regional and rural areas of Australia, access to abortion has drastically improved with the availability of medical abortions.
A medical abortion is when a woman takes the abortion drug Mifepristone, better known as RU486, usually in her own home before nine weeks gestation.
But heavy restrictions still limit accessibility and many women are turning to tele-abortions as an alternative.
Nurse Kyna Reddan works at a Melbourne call centre where she talks patients through medical abortions.
Using this service, women have several consultations with a nurse and doctor before being sent out the abortion drug RU486 in the mail.
Ms Reddan has worked as a nurse for family planning organisation, Marie Stopes Australia, for five years and said the service was vitally important.
“Before this, people in rural areas just did not have an option if they wanted a termination. They had to travel hours, sometimes even days, to even access a termination service,” she said.
“Whereas now they can do it in their own home, which is just amazing for accessibility.”
Anna said it was a shame she could not access this service, but was glad that it has become easier for women with unwanted pregnancies in isolated areas to access abortions.
“It’s not just sending a pill out in the mail — it’s all of the counselling and consultation that comes with that,” she said.
But the service is not available to all.
In South Australia and the Australian Capital Territory women have to travel to a government-recognised provider to access an abortion, with smaller hospitals and health centres not usually recognised.
Restrictions on medical abortions
Tele-abortions have filled a much-needed gap in regional and rural areas because of the lack of general practitioners able to prescribe the drug.
GPs have to undergo a specific training course to prescribe it and pharmacies also have to register to administer it.
Figures from Marie Stopes Australia show that just 0.2 per cent of regional GPs, or five per cent of regional and urban GPs combined, are trained to administer RU486.
Caroline De Costa was the first GP in Australia to prescribe RU486 and has spent the last decade researching abortion service provision and law reform in Australia.
More than 100,000 women have now used RU486 in Australia and Professor De Costa said the drug was safe and effective.
“It needs to be taken out of this special category because especially GPs — they’re busy, they’re concerned about the fact there’s something different about this drug,” she said.
“No other drug requires this kind of scrutiny, so it just needs to be removed from the special status and just marketed like any other drug.”
Barriers to access
In Australia the process of decriminalising abortion has been a long one and New South Wales is the last state that considers abortion to be a criminal offence.
In Queensland abortion was decriminalised late last year, which was a long-time coming for Cairns-based GP Heather McNamee.
Dr McNamee said the law change has made an enormous difference to abortion access but has also helped in reducing the stigma.
“I’m no longer asked ‘is this illegal?’, and I used to be asked that at least once a week prior to the law change,” she said.
“That was just an added layer of stigma, shame and fear for women accessing a service which the World Health Organisation says is a basic human right.”
But living in a small or conservative town can still be a barrier to woman wanting to access abortion services according.
“If she either knows the GP’s attitudes or it’s such a small town that you know she mixes socially with the GP, then she may not even want to approach the GP with the fact she has an unplanned pregnancy,” Dr McNamee said.
On top of that, some GPs remain conscientious objectors or simply are not aware of the services like tele-abortions that are available.
“The internet has thankfully made an enormous difference to the ability to access,” Dr McNamee said.
Calls for publicly-funded abortions
On top of distance and a lack of GPs, the cost of an abortion still makes it inaccessible for many women.
Dr McNamee also provides tele-abortion and said despite trying to make the cost as reasonable as possible, they still had to charge women hundreds of dollars.
“Your postcode and your income very much dictate your ability to access abortion,” she said.
“The biggest obstacle to changing that and making it more accessible to women, is the fact that there is no Medicare item number relating to medical abortion currently available in Australia.”
Earlier this year the main provider of tele-abortions, the Tabbot Foundation closed down due to financial reasons, after four years of operation during which they provided 6,000 medical abortions.
The Labor party has committed to tying federal funding for public hospitals for the provision of abortion services in the public sector if it wins the May 18 election.
While this has been welcomed by many health professionals, Professor De Costa said access to medical abortions needed to be included in any policy reform.
“There clearly is a need for tele-medicine providing abortion for Australian women in rural and remote areas, so I think this will be an expanding area and I would like to see it supported as part of the public system,” she said.
“So that women in rural and remote areas do not have to travel too far away from home in order to access an early abortion.”