"My heart sank," Amanda Kelly said.
The chief executive of Women's Health Goulburn North East was aimlessly scrolling on her phone when she read the news.
Roe versus Wade, the landmark ruling which in 1973 granted Americans the constitutional right to an abortion, was set to be overturned by the US Supreme court, a leaked document had revealed.
In response, Women's Health Goulburn North East (WHGNE) — based in north-east Victoria's Wangaratta — is one of four Victorian women's health services calling on Australia's state and federal governments to prioritise women's sexual and reproductive health.
WHGNE joined Women’s Health in the South East, GenWest and Women’s Health Loddon Mallee.
Accessing abortion involved extra hurdles in regional areas, she said. Fewer providers and smaller communities could complicate the decision-making process and add to the cost.
"You can't have access to every health service in every single town," Ms Kelly acknowledged, but she said travel and other costs needed to be better catered for.
Board director of the Rural Doctors Association of Victoria and chair of the rural maternity services working group, Louise Manning, said abortion access was "definitely not equitable" across the state.
"As someone who is a termination provider in a regional context currently, I've got patients who are needing to travel up to 2 or 3 hours from different areas in the state to be able to access services," the Bendigo-based doctor said.
Dr Manning said there were not enough providers in the regions, and GPs who were conscientious objectors of abortion potentially caused "further delays".
"The western region of Victoria is quite notorious for this," Dr Manning said.
Cost barriers
Mifepristone and misoprostol, the medication used for medical abortion, usually cost around $40, Dr Manning said.
But she said many people in regional, rural and remote Australia also had to pay travel costs and out-of-pocket gap costs associated with a GP consult, ultrasound and a blood test.
Surgical abortion services might be at your local hospital "if you're lucky", but you would still need a referral from a doctor, and going to a private provider could cost "hundreds of dollars", she said.
Ultrasound access was also a big problem.
"People are waiting over 6 weeks to get an ultrasound," Dr Manning said.
Dr Manning said she had resorted to doing some bedside scans herself. Wait times for a "formal ultrasound" were just "too long", she said, especially for patients who were already six to seven weeks pregnant when they first came in.
This also had implications for medical terminations prescribed via telehealth, she said, with many providers still requiring an ultrasound to rule out ectopic pregnancy.
Contraception training gaps
Dr Manning said there were also not enough regional women's health professional's "adequately trained" and confident in inserting reversible forms of long-acting contraception, including intrauterine devices (IUDs).
Dr Manning said she had also heard stories from colleagues of "patients who have had to go through abortion services because they didn't have access to a person who could put an IUD in".
Doctors needed extra training to insert an IUD, she said, and access to training needed to be "easy" and GPs adequately renumerated.
Call for Medicare change
Dr Erica Millar, a research fellow at La Trobe University, has studied the cultural and social contexts of abortion.
She said the impacts of what academics called "abortion exceptionalism" – the idea that women need to be protected and abortion is more dangerous than it actually is – had resulted in over regulation and "completely unnecessarily" hurdles for doctors and patients.
The Therapeutic Goods Administration (TGA) currently requires doctors to complete an instruction module and register to prescribe the medication for a medical abortion.
"We need more nurse-led provision and then the TGA needs to get rid of its special laws regulating medical abortions," Dr Millar said, adding that doctors needed to be "properly compensated for their time".
Dr Millar said the absence of a Medicare item number for medical abortion meant there was currently no way for doctors to bill appropriately for much longer appointments.
Countries 'chalk and cheese'
Amanda Kelly was concerned about "cultural seepage" from the US when it came to progress on abortion access in regional Australia.
But Dr Erica Millar said she was comforted by the differences between the US and Australia. When it came to abortion, the countries were "chalk and cheese", she said.
She was hopeful "horror stories" out of the US would "galvanise the pro-choice community more than energise the anti-abortion community".
"But maybe I'm just optimistic," Dr Millar said.
