The COVID-19 crisis has clearly exposed the uneven and precarious supply of abortion in Australia, exacerbating existing inequalities in access.
What was already an expensive procedure may be even less feasible for many women facing financial hardship during the pandemic.
it’s already expensive
Even before COVID-19, one on three women wishing to have an abortion found it “difficult” or “very difficult” to finance the procedure. Many have failed to pay bills or borrowed money so that they can access health care quickly.
Costs vary depending on where you live, the method of abortion and the gestational age of the pregnancy. A study published in 2017 reported after Medicare reimbursement, a first trimester abortion costs on average:
A $ 560 for one medical abortion, which involves taking two drugs 24 to 48 hours apart (currently available up to nine weeks gestation)
A $ 470 for one surgical abortion.
Even where they do, demand far exceeds supply, meaning public hospitals routinely refer patients to private clinics.
The costs of abortion would currently be magnified for those who are newly unemployed and for temporary visa holders and international students excluded from government payments.
During the coronavirus pandemic, abortion referral services reported an increase in calls from migrant women who are concerned about their ability to pay for abortions. Meanwhile, services that offer financial assistance for abortion fear they will not be able to meet the growing demand for assistance.
A lack of resources
In April, canceled suppliers orders of personal protective equipment (PPE) from abortion clinics on the grounds that these supplies were reserved for “health professionals”.
Providers could be forgiven for assuming that medical procedures relegated to the private sector are optional. Indeed, the idea that abortion is a non-essential procedure is a anti-abortion trope.
While the federal government confirmed that abortion was “essential”When the elective procedures were stopped, they did not support much. Instead, they told clinics to source PPE from Chemist Warehouse.
Although the provision of PPE to abortion clinics is is no longer threatened immediately, the industry continues to face resource constraints.
This includes a shortage of suppliers.
Lack of access in regional and rural areas
But abortion care is not integrated into medical education or training. the shortage of health professionals trained and willing to perform surgical abortion, and the failure of governments to demand public hospitals taking responsibility for local procurement means that abortion is practically inaccessible in much of rural and regional Australia.
The few clinics that offer surgical abortions outside urban centers often rely on fly-in-fly-out workers, who depend on domestic air transport to provide abortion care.
With domestic travel dramatically reduced during COVID-19, some private clinics have started using private charter flights to ensure that women in rural and regional Australia still have access to abortion. But the cost of this is not sustainable.
Likewise, a clinic in the eastern suburbs of Melbourne, one of the largest providers of abortion after 20 weeks gestation in Australia, relies on interstate doctors. The clinic had to limit this service, which has led some women to continue pregnancies that they would otherwise have terminated.
Women may need an abortion after 20 weeks for a range of reasons, including maternal health, fetal abnormalities and late diagnosis of pregnancy.
It can be assumed that many of these women are also affected by travel restrictions.
We could do more with telehealth
Early medical abortion can be performed via telehealth. In this scenario, the drugs are sent to the patient after some local testing and a remote consultation with a doctor by phone or video call. This method is particularly appropriate now that we continue to practice social distancing.
Marie Stopes Australia, a major provider of family planning and abortion, said demand for the service was increased by 25% during the pandemic.
the Royal Australian and New Zealand College of Obstetricians and Gynecologists has argued the importance of this option as we navigate COVID-19.
Notably, the abortion law in South Australia prevents early medical abortion through telehealth.
COVID-19 highlights bigger issues
Governments should act to ensure that people in need of abortions can access them during the current crisis, including by scaling up the provision of early medical abortion as widely as possible through telehealth.
Yet the COVID-19 crisis has revealed that we need longer-term investments to ensure that women can access this essential and urgent procedure.