After the overturning of Roe v Wade in the United States cast a spotlight on reproductive rights in Australia, the Northern Territory has emerged as a leader in safe abortion access .
While a similar court ruling could never happen here, existing barriers to abortion and differing legislation among the states and territories have meant it wasn't always easy to terminate a pregnancy.
So what makes abortion care so successful in the Northern Territory?
How the territory compares
Despite its large and hard-to-reach remote population, the Northern Territory offers women easier access to abortions than most Australian states and territories, according to MSI Australia's latest abortion access scorecard.
MSI Australia's managing director, Jamal Hakim, said: "The good story here is the Northern Territory is doing really well."
"[Remote living] is certainly one of the major challenges in the Northern Territory, and in healthcare generally.
"But we’re seeing medical abortions via telehealth, for example, as a really critical way of enabling that access."
Over the border, Western Australia's abortion laws are among the most restrictive in the country, and still fall under the state's criminal code.
What are the abortion laws in the territory?
In November last year, the Northern Territory government passed legislation making it easier for women, girls and gender-diverse people to terminate a pregnancy in their second trimester.
The changes mean:
- pregnant women can get an abortion between 14 and 24 weeks, in consultation with one doctor
- pregnant women can legally get an abortion after 24 weeks for medical reasons, with support from two doctors.
Previously, it was illegal to terminate a pregnancy after 23 weeks in the Northern Territory unless it was ruled necessary to save a pregnant woman's life.
Support offered to remote women
Family Planning NT chief executive Robin Wardle said "the Northern Territory is really a gold standard".
She said that women in remote communities could access abortion services by visiting their local clinic, where they would be referred to a city centre, such as Darwin, Katherine, Alice Springs or Nhulunbuy, for the procedure.
In the territory, the cost of a medical abortion is free if you hold an Australian Medicare Card.
And, in some cases, the Northern Territory government will also help cover travel costs, such as when a pregnant woman or girl needs to be air-lifted to the nearest abortion clinic hundreds of kilometres away.
Ms Wardle said the territory's system was so successful that Family Planning NT typically received "hundreds of calls every week" from women all over Australia seeking an abortion.
"We get calls about our termination services from Tasmania, Broome, everywhere," she said.
Unplanned pregnancies happen
Medical anthropologist — and associate professor at the Menzies school of health research — Suzanne Belton said many women seeking abortions already had children.
"In all of the data I’ve ever seen, more than half of women going for abortions are already mothers, which means they’ve already completed their family," Dr Belton said.
"Women don’t always want to be mothers, or they'd like to be mothers to only a small number of children and offer those children optimal opportunities."
In Australia, more than a quarter of pregnancies are unplanned, and almost one third of those pregnancies end in abortion, according to a 2018 study conducted by Melbourne researchers.
"There's no such thing as perfect contraception," Dr Belton said.
"You have to be well organised, you have to have money — because you have to pay for contraception, it's not free — and you have to be able to tolerate it in your body as well."
Trends in the territory
About 60 per cent of women seeking abortions at the Northern Territory's Family Planning clinics in Coconut Grove or Palmerston are at the six- or seven-week gestation mark, Ms Wardle said.
Up until nine weeks' gestation, women in Australia typically have the option of taking medication to end a pregnancy instead of undergoing surgery.
Ms Wardle estimated that about 1,000 abortions were performed territory-wide each year.
About 75 per cent of pregnancy terminations in the NT were early medical terminations before nine weeks gestation, a NT Health spokesperson said in a statement.
"Less than one per cent of pregnancy terminations in the NT occur after 23 weeks gestation," the spokesperson said.
In the less-common cases of later-term surgical abortions, Dr Belton said, some women simply didn't realise they were pregnant or needed more time to decide.
Dr Belton said others were dealt the heartbreaking news that their baby had developed serious birth defects after seeing the results of genetic testing, which usually happens at 18 weeks.
Sometimes, abortion is the only way for a pregnant person to survive.
Women with kidney problems or rheumatic heart disease can suffer serious health complications, while others can die from an ectopic pregnancy or miscarriage if left untreated.
Areas of improvement
Mr Hakim said the Northern Territory could improve its abortion access even further by allowing nurses, midwives and Aboriginal health workers — not just doctors — to provide medical abortions.
That would remove a significant barrier facing remote Territorians, who need to travel long distances to terminate a pregnancy, he said.
"The Northern Territory is relying heavily on individual surgical abortion providers and health workers in the Royal Darwin Hospital to fill those gaps," Mr Hakim said.
"But there’s so much more to do across the health system."
