Choice under COVID-19

Issues of accessibility persist after the decriminisation of abortion

This year, International Day of the Unborn Child, a Catholic pro-life event, was cancelled in Sydney due to the COVID-19 pandemic that is bearing down on the world. These crisis conditions have made the priorities and flaws of our government clearer than ever, and it has also pronounced the long-standing inaccessibility of abortion. With the Australian healthcare system now exceeding capacity, the recent decision made by the National Cabinet to suspend non-urgent elective surgeries seemed to leave surgical abortions up in the air. The suspension of all Category 3 and some Category 2 surgeries was announced last Wednesday, and it was originally unclear whether surgical abortions would be included within these austerity measures. This lack of clarity is nothing new; rather, it points to a much deeper problem of inaccessibility, and how the powers that be have time and time again failed women.

Abortion accessibility is limited today due to cost, lack of information, and social stigma; reasons that have persisted even after decriminalisation. Before decriminalisation, medical professionals and public hospitals offering the surgery were few, far between, and shockingly expensive on the rare occasion they were available. The decriminalisation of abortion in NSW last year came at no small cost and was rightfully heralded as a huge victory for the pro-choice movement. However, as the dust settles, it becomes clear that the lack of abortion accessibility will prove to be an enduring issue.

Different methods of abortion present their own challenges, but one that is particularly interesting is that of medical abortions by phone. These services, also known as teleabortions, provide access to an abortion without having to visit a clinic. This is appealing in the face of overt social stigma against abortion and even more so given the social isolation measures that have been implemented in the time of the COVID-19 pandemic. A statement released by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) tells us that “Greater use of remote consultations, and early medical abortion at home, may be necessary to ensure women have access to timely and safe abortion care.” When procuring a medical abortion by phone, one is able to consult with a medical specialist and be talked through the process of performing an abortion remotely. Pain, nausea, and abortion medication is couriered to the patient within 1-3 days of their consultation, and they are provided with free access to aftercare nursing.

Though serious side effects are uncommon, medical abortions still carry slightly more risk than surgical ones. Moreover, they cannot be performed after eight weeks of pregnancy and cannot be performed on patients who live more than two hours away from emergency medical services. They are the cheapest form of termination, costing a minimum of $290 for merely a consultation without the medication. Medicare only partially covers the cost of abortions – whether they be surgical or medical – if at all. This means that those in low socioeconomic status brackets are often unable to access essential and life-saving healthcare.

The reproductive healthcare system is flawed as it is, so it comes as no surprise that the outbreak of COVID-19 has only exacerbated the difficulty of obtaining surgeries like abortions. Surgical abortions are nowhere to be found on the National Elective Surgery Urgency Categorisation, established in 2015, when abortions were still considered a crime. Additionally, states and territories have individual elective surgery policies, which impacts the way that surgeries are prioritised in hospitals.

The general lack of information around the classification of surgical abortions and lack of timely responses from health departments led to widespread confusion as almost 80 women on surgical abortion lists around Australia were left vulnerable. Last week, Buzzfeed News reported that Marie Stopes Australia (MSA)—one of Australia’s largest abortion providers—was forced to call the COVID-19 hotline to demand a concrete picture of what surgical abortions would look like under the new restrictions on surgeries. It came as no small relief when MSA received confirmation from Western Australia, the Australian Capital Territory and Queensland that abortion providers would be treated as essential health workers during this pandemic. It is unclear whether other states would be taking the same approach.

“We clearly classify abortion care as a Category 1 procedure because it is so timely and sensitive and it has been really heartening to have that confirmed by some governments,” said MSA managing director Jamal Hakim. Nevertheless, the fact that abortion providers have been left to define for themselves whether abortions are a necessary procedure speaks volumes about the ineptitude and apathy of the government and their priorities in times of crisis.

Beyond the deficit of information available to confirm whether surgical abortions can continue under austerity measures, the pandemic has also over-looked the effects on abortion access and aftercare. For example, the panic buying of pain medication makes it difficult for patients recovering from abortion to access material relief. Moreover, fly-in abortion providers to rural areas are now limited in their ability to provide services due to interstate travel restrictions that mandate 14 day self-isolation for those travelling into different states or designated remote communities. But these crisis conditions have only highlighted pre-existing constraints that rural women face, as it remains extremely difficult for people who do not live near metropolises to access safe abortions and aftercare.

If there is one thing that has been made unmistakably clear in the turmoil of COVID-19, it is that the dilemma of reproductive health inaccessibility has persisted even after the historic decriminalisation of abortion in New South Wales. Abortion remains expensive and largely exclusive to metropolitan areas. It is unacceptable that these shortcomings are only becoming more obvious and dire now, as the country heads towards an indefinite period of social isolation. For many, being unable to access an abortion is not a side effect of disrupted healthcare amidst a worldwide pandemic, but a lived reality. It is plain that the government doesn’t prioritise abortion as necessary healthcare, despite it being an essential and life-saving medical procedure.

The fight for reproductive rights needs to continue. Though we demanded free, safe and legal, we have only really won one of these demands.

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