Public hospitals should not be able to “opt out of” providing abortions, according to the Greens MP Dr Amanda Cohn, who said despite abortion being decriminalised in New South Wales five years ago “far too little has changed”.
Her comments came in response to data published by Guardian Australia on Tuesday that shows just three public hospitals in the state provide surgical abortion outside of emergencies. The majority of the state’s cities and towns are “abortion deserts”, meaning the nearest service is more than 160km away, obfuscated, and often costly.
“Abortion is healthcare – it’s not something hospitals with public funding and the capability to provide abortion should be able to opt out of,” Cohn said.
“We would never accept a public hospital turning away all patients with diabetes or all patients who needed a knee replacement.”
Cohn, who was a provider of medical abortion before entering politics, acknowledged the “excellent clinicians in our public hospitals doing their best to provide abortion care”.
But when Guardian Australia asked 15 local health districts which of their public hospitals provide abortion, and under what circumstances, none responded. They did not respond to questions around what happens to a woman denied an abortion.
The NSW health minister, Ryan Park, would also not provide these specific details, nor would the health department.
Cohn said when services are “ad hoc or not publicly communicated, it adds to patients’ distress and delays what is a time sensitive procedure”.
“Decriminalising abortion in NSW five years ago was a critical first step but since then far too little has changed,” she said. “When abortion was still in the Crimes Act in NSW, people travelled from across western NSW to Wodonga [in Victoria] to access care, where I was working as an abortion provider.
“This is still happening.”
Cohn has given notice of a bill that would allow nurse practitioners and midwives with appropriate training to prescribe medical abortion.
“I’ve also called on the NSW government to fund abortion care in all public hospitals that provide reproductive health services.”
The NSW premier, Chris Minns, did not respond to questions about funding of abortion care and the lack of information provided by health districts. He referred the questions back to the health minister.
In November, Minns said he recognised the importance of the public hospital network in the provision of abortion. “That will be fully funded, and the services will be available,” he told parliament at the time.
Dr Madeleine Belfrage, from the University of Sydney’s Social Sciences and Humanities Advanced Research Centre, was among the researchers to map the NSW abortion deserts highlighted by Guardian Australia.
She said while decriminalisation was an important step, “it is only part of the solution”.
“We are yet to see the necessary changes in the health system to ensure that abortion is provided as routine healthcare,” she said.
A co-author of the research, Dr Anna Noonan, said; “That politicians and health leaders are unwilling to respond to simple queries implies two things.
“First, the health system and its decision-makers are actively contributing to the inaccessibility of abortion care for many people, and two, how can clinical staff and constituents navigate referral pathways when those in power cannot even answer where services are?”
Asked about the lack of information at a press conference on Tuesday, the NSW treasurer, Daniel Mookhey, said: “Of course the health minister has been dealing with that issue and we did intervene to ensure that abortion services are available in certain regional hospitals when they were going to be withdrawn.”
Pushed by Guardian Australia on whether the level of access revealed by the Guardian today was acceptable, Mookhey said: “Again look, I make the point again, our expectation’s pretty clear that people have access to abortion services when they need it. Of course the operational details of that are under the health minister.”
The chief executive of Family Planning Australia, Sue Shilbury, said NSW “does lag behind other states in providing access to abortion services in the public health setting”.
Shilbury said NSW Health needs to publish the data it collects annually around abortion services, which would lead to greater transparency around demand for and provision of those services. She also said legislation needs to change to allow for nurse prescribing of medical abortion, and services needed to be expanded beyond just hospital settings.
For example, John Hunter hospital in Newcastle on the north coast and the Royal Women’s hospital in Sydney provide surgical abortion, but only for women in their local catchment area.
“I think it’s important that there be greater clarity about the role that regional-based hospitals play in providing access to abortion services, and pathways for women need to be more clearly delineated,” Shilbury said.
“It should be easy for women to know exactly what and where their options are at nine weeks, versus 10 weeks or 15 weeks or more gestation.”
