Even if the New South Wales government were to order all public hospitals to fulfil their obligation to provide abortion, the state’s public health system would not be capable of doing so as too many doctors are untrained or opposed, a leading reproductive choice charity says.
The managing director of Marie Stopes International (MSI) Australia, Greg Johnson, said some abortion care could be provided by GPs and other health professionals in primary care settings, but a significant proportion was surgical and required day hospital admission.
“Currently the NSW public health system is not capable of providing surgical abortion care at every hospital,” Johnson said.
“There are simply not enough doctors and nurses trained and experienced in abortion care. Also, many doctors, nurse and health service managers do not want to participate in abortion care due to personal beliefs or stigma they will experience.
“It will be many years before sufficient doctors and nurses could be available and support much broader public hospital service provision.”
While abortion in NSW is decriminalised, just three of the state’s 220 public hospitals are providing it, despite the World Health Organization recommending all public hospitals do so.
Johnson said he believed the best approach to improve affordable access to abortion was for NSW Health to support a partnership between the public hospitals, health services and non-profit, private providers that specialise in abortion and contraception care.
“This would mean public hospitals have clear, documented and effective referral pathways to enable women who seek access at a public hospital to gain timely referral to an accredited abortion service provider,” he said.
“Financial assistance should be provided from public hospital budgets … this should include subsidised cost of the procedure and travel and related costs as required.”
As Guardian Australia previously reported, none of the 15 NSW health districts could provide details about referral pathways for abortions when women are denied one in a public hospital.
The ACT, Queensland and WA governments and health departments all provide financial support and referral pathways to MSI Australia and other abortion services. But data published by Guardian Australia on Tuesday revealed that access to abortion in NSW remains poor.
A former senior medical officer at a regional local health district, who spoke to Guardian Australian on condition of anonymity, agreed with MSI that too many doctors remain unwilling to provide abortion.
“We had an incident where a woman had a failed medical abortion, and needed a surgical abortion at 12 weeks,” he said.
“A general surgeon at the time gloated about how he and one other gynaecologist, both Catholic and strongly opposed to abortion, had effectively banned abortion in that hospital for about seven years. They had effectively bullied staff over many years, to prevent surgical abortion access at the facility.”
Even though by law conscientious objectors must provide information about how to contact or locate a different medical practitioner, the former senior medical officer said this was not happening, and the lack of providers generally made onward referral difficult.
He said he made it clear to the objectors they were breaking the law and that the woman needed care.
“But I have no idea what happened after I left the service,” he said. “Doctors have more power than most people think.
“The majority of public decisions are actually made in private outpatient clinics. It would be inconceivably difficult to change that system quickly, both practically, but also politically.”
Dr Madeleine Belfrage, from the University of Sydney’s Social Sciences and Humanities Advanced Research Centre, said it was clear “conscientious objection provisions” were being misused.
“It’s clear from this example that conscientious objection provisions, which allow individual clinicians to decline to participate in abortion procedures, are being misused by institutions and people in positions of power to obstruct access and shut down services,” she said.
“The NSW government needs to implement a state-wide policy to ensure that public hospitals fulfil their duty of care and ensure timely and quality services are available for all people who live in NSW.”
“Sending directives to individual hospitals does not go far enough to ensure that services are available across the state.”
