After a 34-month stretch of dry conditions, rain began falling in south-eastern Australia in early 2020, ending an extended period of drought for many rural people. Around that time, approximately 40,000 city folk packed up and moved to rural Australia in one record-breaking tree change. While the brochures speak of fresh air and less traffic, they do not mention the ongoing struggles faced by the rural health system to build and retain its workforce, especially in primary care. Rural people experience long wait times to secure an appointment with any rural general practitioner (GP), let alone one that bulk bills, is female, or specialises in reproductive health care, including abortion.
Early medical abortion (EMA) can be prescribed by a trained doctor via telehealth for a pregnancy of up to 63-days’ gestation. However, for rural women* in New South Wales (NSW) who prefer or need surgical abortions or prefer place-based care, the handful of locatable abortion services (that is, those that advertise their services) have all but evaporated. Those that remain simply cannot meet demand.
In August 2021, leading abortion provider MSI Australia (formerly Marie Stopes Australia) closed four of its regional services due to financial pressures. As options shrank, demand also increased, with MSI Australia reporting a 189 per cent increase in EMA requests alone from women living in remote areas of Australia. Similar demand has been seen in other states like Victoria where approximately 85 per cent of the 315 calls per month to the 1800 My Options sexual and reproductive healthcare service hotline relate to abortion provision. That’s around 10 calls a day.
A Queensland-based map of abortion and contraception providers was launched by Children by Choice in October 2021. In NSW, however, there is no such directory. Unless you are lucky enough to know a local abortion provider, or hear of one by word of mouth, finding local abortion services is like sourcing water in a drought.
Alongside telehealth services, rural GPs are able to offer EMA, provided they have completed the required training through MS Health. A local, trained pharmacist is also needed to dispense MS-2 Step, the required medication approved by the Therapeutic Goods Administration about a decade ago. Yet rural providers are reluctant to advertise these services for fear of stigma, professional concerns or being unable to manage service demand. Options for surgical abortion are usually far from home and require long-distance or interstate travel (assuming possession of a car and licence or the ability to pay for transport) – an almost impossible task during the COVID-19 pandemic.
Researchers in the United States refer to this situation as an ‘abortion desert’; when the nearest available service is over 100 miles (160 kilometres) away. A recent research study, conducted by Mazza et al (2021), reported at least 30 per cent of Australian women aged 15–45 years live in areas where there were no medical abortion services, increasing to 50 per cent in remote areas. Perhaps in the Australian context we could consider this experience as an ‘abortion drought’ – a drought that can and must be broken.
And the first glimpses of hope are emerging. In 2020, abortion was fully decriminalised across Australia, removing longstanding legal barriers to service provision. In August 2022, the Australian Capital Territory Government announced that all of its abortion services – both medical and surgical – would be made safe and accessible and be publicly funded, including for those without a Medicare card. This is an encouraging step that all states and territories should follow.
In the meantime, a national and freely available abortion service directory is needed to assist all women – especially rural women – in locating the services best suited to their needs, no matter where they live.
*This article uses the word ‘women’ but the author wishes to acknowledge that people who do not identify as women also experience pregnancy and may also need abortion services.