Some Wagga Wagga GPs say a conservative religious culture is forcing them to prescribe medical abortions "in secret", with a number of women missing out because of a "culture of silence" in the southern New South Wales area.
"I've had women call 15-plus phone numbers trying to find a service that offers medical termination before they find us," GP Trudi Beck said.
Medical terminations involve the prescription of two pills, Mifepristone and Misoprostol, which can only be administered in the first nine weeks of pregnancy.
Dr Beck did not advertise that she was qualified to prescribe medical abortions for fear of backlash, and asked for the name of her clinic not to be published.
Since the decriminalisation of abortion in NSW in 2019, the number of GP prescribers in Wagga Wagga had grown to 16 per cent, compared with about 11 per cent of GPs nationally in 2022.
Dr Beck said the culture had improved over the past three years, but she and other GPs remained nervous to advertise because of a history of protests south of Wagga Wagga at an Albury abortion service, which eventually shut down in 2018.
"To my knowledge, there are no publicly advertised services in Wagga, or surrounding towns, and the ability for women to access them would be on a word-of-mouth basis," Dr Beck said.
Dr Beck said abortion needed to be at the forefront of conversations.
"It is the women with domestic violence backgrounds or a history of sexual assault that are most likely to find themselves with an unplanned and unwanted pregnancy," she said.
An 'underground network'
Another GP, who asked to remain anonymous for fear of professional and personal backlash, said a conservative undercurrent in the medical community had forced an "underground network" of prescribers in the city.
"All of us who support reproductive rights in Wagga know that we must do it in secret because there's a really negative impact. You could be vilified," said Dr Amanda (not her real name).
"There are a number of people in the medical community who are Catholic and who wield quite a bit of power in the medical system here."
Fear of repercussions was something Jamal Hakim also noticed when he ran training workshops in the region five years ago.
As the director of MSI Australia — the country's main supplier of medical abortion pills — he said it "was an issue many doctors spoke … about in Wagga".
"Many doctors feared they'd be removed from their [practice] rentals," Mr Hakim said.
Census 2021 data showed more than 46 per cent of people in Wagga Wagga identified as Christian — 10 per cent above the NSW average — and 27 per cent as Catholic — compared with 20 per cent nationwide.
Doctors must refer to services
State Wagga Wagga MP Joseph McGirr is a Catholic medical doctor who voted against the decriminalisation of abortion in NSW in 2019.
He said it was "well known" that there was a high population of long-standing Catholic doctors in the area, as well as overseas-trained GPs from backgrounds of various faiths.
"I suspect that is a component in the way services are provided here," Dr McGirr said, adding that the number of Catholic doctors was diminishing.
Dr McGirr said it was important, and a legal requirement, that women seeking termination were referred to the relevant information by medical professionals who did not prescribe.
He said he had not been made aware of any GPs facing backlash for prescribing medical abortions, and it "wouldn't be acceptable" if it occurred.
Doctors urged to speak out
Not all doctors are fearful.
GP Jane Goddard visits Wagga Wagga for one week every month and has spoken publicly about her willingness to prescribe medical abortions — even before it was decriminalised.
While acknowledging she never worked as a junior doctor in the town, she said her fear of professional fallout had not transpired.
"I think it might be an imagined fear," Dr Goddard said.
"I completely understand what those people are saying, but things don't change if you don't speak out and hold people accountable."
Women missing care
Dr Beck said the lack of publicity for abortions meant some women missed the nine-week window because most only discovered they were pregnant in the first four to six weeks after their period was due.
"Pretty quickly, three-plus weeks can pass and a woman who may have found out soon after her period [was due] is now significantly more pregnant and may not be able to have the procedure prescribed," she said.
Dr Amanda said she recently had to send a 15-year-old girl out of the region to access surgical abortion because she had missed the deadline, and had treated a 14-year-old patient who was "right on the line".
Riverina patients in need of surgical termination must travel to capital city providers, with the closest being MSI Canberra.
Mr Hakim confirmed most of MSI Canberra clinic's regional patients had travelled from the Riverina.
Royal Australian College of GPs president Nicole Higgins said she had also been told women from the region were travelling for healthcare.
"I have spoken to GP prescribers and, anecdotally, women are seeking help and support outside of the Murrumbidgee area, including services in Melbourne and Sydney," Dr Higgins said.
Public service 'quietly opened'
The Murrumbidgee Local Health District (MLHD) said in a statement it had launched a public medical abortion service in June 2022 through the Wagga Women's Health Service, which serviced 26 communities across the region.
MLHD said it was part of efforts to improve timely and affordable access within the region.
Jan Roberts, a member of the working party that set up the new service and long-time campaigner for reproductive rights, said MLHD was facing criticism over the "quiet opening".
She said "health services should be publicised".
"It signals that there is still stigma and shame around talking about this area," Ms Roberts said.
Dr Beck said she had no idea the service was up and running, but welcomed it as an "amazing" step for healthcare in the region.
"Given the time-sensitive nature of the procedure, it's really important women are made aware this service is available," she said.
Dr Amanda said the public remained largely unaware.
"There has not been sufficient advertisement of it, not at all," she said.
"There needs to be more of an effort to make people aware of this."
Information about the service is available on the Women's Health Service website and through Health Pathways for GPs, but Dr McGirr said finding the information was "not intuitive".
The MLHD did not respond directly to questions about why the service had not been publicly announced but said patients' privacy and safety was of the utmost concern.
