This month marked a major win for reproductive healthcare in Australia. The Therapeutic Goods Administration finally made it easier to access abortion pills by following expert advice and allowing doctors and pharmacists without specialist certification to prescribe MS-2 Step, also known as RU486.
It has been a long, slow road to get here.
Mifepristone (MS-2 Step), which is most commonly used in conjunction with misoprostol for early medical abortion, was put on the Pharmaceutical Benefits Scheme in 2013 for less than $40 but has been prohibitively expensive and difficult to access for too many patients for the past decade.
As some of Australia’s leading voices on sexual and reproductive health wrote in 2019: “There is no good reason why mifepristone, which has minimal side effects and is supplied uniquely as a single tablet, needs to remain indefinitely as a special drug.”
In the hundreds of articles I have written over the past seven years about the dire state of abortion access in Australia, many barriers have slowly broken down. Women are now protected from religious picketers, abortion has been moved from criminal codes to health legislation in all jurisdictions, and as of this month medical abortion access has been improved so many people won’t have to spend hundreds, sometimes thousands of dollars organising childcare, travelling interstate and overpaying on medical fees to take two pills.
But Labor can no longer hide from the biggest remaining fight. The recent recommendations from the Senate inquiry into sexual, maternity and reproductive healthcare echo what experts have said for years: public hospitals should be equipped to provide surgical terminations (“or timely and affordable pathways to other local providers”). In 2019, then-opposition spokesperson for women Tanya Plibersek said a federal Labor government would require public hospitals to offer termination services as part of their Commonwealth funding arrangement. But the policy was swiftly withdrawn and wasn’t taken to the last election.
Nearly one in five Australian women who have been pregnant will have an abortion by age 45 and yet the service is still predominantly provided by the private sector. In a country so proud of its universal healthcare, what other common medical procedure would we expect people to pay for? Why are women’s organisations still fundraising to subsidise abortions for unhoused pregnant people or those experiencing violence? Why can patients in South Australia and the Northern Territory access abortion for free in public hospitals and yet everywhere else people spend hundreds or thousands of dollars on private providers? Why are we comfortable with hospitals that receive federal funding turning women away?
“Should abortions be funded by public hospitals?” a reporter asked then-prime minister Malcolm Turnbull in 2018 after Tasmania’s main surgical abortion clinic closed, forcing people to go interstate at huge expense. “I’ll leave this issue,” he said and palmed it off to the state government.
In July, in the wake of the US Supreme Court’s devastating decision on Roe v Wade, Prime Minister Anthony Albanese said it was a “good thing” that abortion rights were not a “matter for partisan political debate”. But when asked if he would require public hospitals to offer abortion, he said “No” and, like Turnbull, palmed it off as a “state matter”.
He is well aware of the federal levers that can be pulled to improve healthcare for the most disadvantaged — again, Labor promised to do just that by holding public hospitals to Commonwealth funding requirements in 2019.
The right to accessible, legal and affordable abortion has long come second to the self-interest of politicians in this country. Premiers and prime ministers from across the political spectrum have dragged their feet or been entirely out of step with experts, patients and the public for decades.
Abortion is common as far as medical procedures go and yet has been treated as a fringe issue, a political hot potato, always coming second, even to the partial privatisation of Telstra. (In 1996, anti-abortion independent Brian Harradine, who held the balance of power in the Senate, agreed to support John Howard’s one-third float of the telecommunications company if the government tweaked legislation to grant the health minister veto to prohibit the import, manufacture or use of abortion drug RU486.)
Politicians from the major parties have kicked abortion decriminalisation down the road — relying on independents or the Greens to spearhead legislation, they have hidden behind fearmongering by religious lobbyists. Most importantly, they have acted out of line with most of the people who elected them.
In March 2019, while giving reporters a tour of offshore detention facilities on Christmas Island, then-Prime Minister Scott Morrison said he was disappointed abortion was being raised on the eve of an election in a “very politically charged context”.
“I don’t find that debate one that tends to unite Australians,” Morrison told reporters at his press conference The Sydney Morning Herald estimated cost taxpayers $2000 a minute.
In fact, Australians are pretty united on this. Poll after poll after poll after poll after poll after poll suggests they overwhelmingly support safe and legal abortion, making plain what has been known for a long time: the make-up of views on abortion in our state and federal parliaments do not proportionately reflect those of the electorates.
Abortion is not as divisive here as it is in the US. The Australian Abortion Stigma Study from the College of Medicine and Public Health at Flinders University found most people support access to abortion care without restrictions. When the survey was weighted to reflect the whole population, 97% of non-religious participants and 87% of people who were religious but rarely attended religious services supported abortion.
There used to be a postal abortion service that was a lifeline for women in regional and rural areas who couldn’t afford to travel for MS-2 Step. Sometimes with medical abortions, the first pill (mifepristone) ends the pregnancy but the second pill (misoprostol) fails to expel it, so the patient needs a D and C (dilation and curettage), an operation that every obstetric and gynaecological ward around the world performs every day, for both spontaneous or induced miscarriage.
The head doctor for the postal abortion service called me multiple times about patients who had turned up at hospitals seeking a D and C and were turned away. I asked the hospitals why they weren’t accepting the women. They either ignored me or quietly accepted the patients.
“Whose values and morals does this woman have to abide by?” the doctor said of one patient, who as we spoke was driving six hours to seek medical care at the only hospital that would accept her.
As Australia’s long-acting reversible contraception uptake increases and MS-2 Step becomes more readily accessible, the number of surgical terminations is likely to continue to decline, but there will always be some demand. There will always be people who had barriers in receiving medical care in time or received devastating foetal anomaly diagnoses long after the nine-week eligibility period for RU486.
Whose values and morals do these taxpaying patients have to abide by to receive this medical care? Not those of most Australians.
Has Labor squibbed on this? Should it get its act together? Let us know by writing to letters@crikey.com.au. Please include your full name to be considered for publication. We reserve the right to edit for length and clarity.
medical care providers cannot be allowed to use “religion” to deny access to medical procedures — if your religion doesn’t allow you to do medicine, then do something else — and stop inflicting your beliefs on other people
It’s not us mate.
A tiny fraction of terminations may not happen because of the odd religious fruitcake in our midst, but the vast majority of denials are down to political influence peddling.
Makes me and the vast majority of my colleagues furious.
it’s the institutions, not the doctors. Some areas only have faith-based publicly funded medical. services.
I agree with all the article says about abortion, but the obvious answer to the quoted question is most dental procedures. This is arguably an even more glaring omission from our supposedly universal health care.
Yeah. When Medicare was to be introduced, the only way it was going to get through parliament was if something lost out. That was dental, sadly. And now we know that’s cost the country a fortune in health problems due to inadequate or non-existent dental care for low income people. They end up in hospital with all sorts of health issues exacerbated by bad gums and teeth.
dental definitely needs to be FREE on Medicare — particularly if the links between dental hygiene and conditions like dementia are proven
Medibank, introduced by Whitlam government, intitially met a lot of resistance. AMA et al had lots of discussion with government before getting on board. The dentists never wanted to have anything to do with universal health care. Look what happened when Gillard government tried to extend medicare to dentists.
The problem of affordable universal access to surgical abortion is much more complex than access to pharmacological abortion. Tony Abbot, when Health Minister in Howard government, is responsible for limiting access to RU486. Going out on a limb here……I doubt that Abbott blocking RU486 had anything to do with him being catholic, but EVERYTHING to do with him being a very nasty piece of work. Blocking RU486, I think, was part of his long term plan to be PM……he was courting the reactionary crazies.
Sorry, seems to be an echo here ?
Not all catholics are nasty. Not all nasties are catholic.
Being TA is organic. No need for external influences.
Catholics tend to be pretty nasty when it comes to womens rights, especially around reproduction.
Even if they speak politely.
I’ve been on the inside of Catholicism. In Australia, what most “practicing” catholics do, is ignore the teaching of the church, when it suits them. Including all the women using contraception of various forms. And the men using condoms and having the snip. The joy of being catholilc, is that you can commit as many sins as you want, ask for Christ’s forgiveness, and you are forgiven.
TA represents a particularly nasty type who weaponizes whatever he can. Includes religion.
I remember Abbott all too well from when we were both at Sydney Uni and he was a student politician. This included deputising for a friend who was an SRC rep a couple of times when she couldn’t make it at the time he was SRC president.
He was then, was in his parliamentary career including being PM and now a reactionary crazy. He was also a hard-core Catholic fanatic. And a very nasty piece of work. All these things are tied in to together.
Hearing support is another common medical need that misses out.
Yep!
How is it that certain public hospitals get to receive state and federal funding, but are then allowed to say “we are a religious institution, so we don’t allow abortions”. Answer: gutless politicians.
perhaps because they aren’t Public Hospitals
They sure take a lot of public money and operate within public health system. A public ambulance can take you to St Vincent’s.
That is because St Vincent’s is contracted by various state governments to provide certain public health services. One of the problems of trying to legislate that all public funded hospitals provide surgical abortion is that private hospitals also receive government funding via private health rebate. And then there is the issue of non-religious public hospitals who also do not offer surgical abortion.
Here in WA some of our “public” hospitals are run by private operators. For example the major hospital at Joondalup is a public – private partnership with Ramsey.
Abortion isn’t the only issue. The end of life hospice for the southern suburbs is operated by St John of God and bans Voluntary Assisted Dying.
VAD is voluntary for both deliverer and recipient. No way anyone could legislate that healthcare workers must, by law, provide physician assisted dying.
Until recently Calvary in Canberra was.
Even fairly brave politicians might choose not to take on the religious establishment once they’ve seen how vicious the retaliation gets when the churches feel threatened. Australia’s political past is metaphorically littered with casualties from attempting to rein in the power and privileges of the churches. Ireland used to have the same problem with its Catholic hierarchy dictating to its government, but has made a lot of progress recently; Australia not so much.
Who are you calling “the churches”? Surely it’s a signature policy of the Catholic church only, but they can hardly go all moralistic after recent revelations. I don’t know about Pentecostalists, but are they really so influential? (Not counting some recent LNP candidates).
I am calling the ‘churches’ because my point about the religious establishment dfending itself extends well beyond the Catholics. The Catholics have some obsessions that are particularly their own, but other matters of as much or more concern for all Australians, such as the religious exemption from taxation, are defended with absolute zeal by just about all the churches of any significance, from Anglicans to Scientologists.
by far the most influential are the Sydney Dioceses – Anglican and Catholic. Catholics are terrible on reproductive rights, Sydney Anglicans atrocious on family violence
I don’t see this as an abortion issue. Rather than framing it as such, we should say women should have equitable access to health services, irrespective of where they live. Then the Nationals would have to oppose equitable health services for the regions.
Thanks Gina, all too true.
We also need better access to preventing pregnancy.
There have been great advances in contraception, especially Long Acting Reversible Contraceptive (LARC). If appropriate contraception were available and free most women wouldn’t become pregnant except by active choice.
An unwanted pregnancy is stressful. Termination isnt fun. Also, we are a culturally diverse nation and there is a large cohort who would love better contraception, but would feel distressed about termination, or feel they must continue a pregnancy.
Yes but the same people thwarting abortion in regional areas try to discourage contraception