Abortion access denied

THE closure of Tasmania’s last remaining private abortion clinic marks the beginning of the end for many similar clinics around Australia, says the provider who has closed the doors at the Hobart centre.

Dr Paul Hyland, who ran the Hobart clinic, says Tasmania is leading a national trend whereby women are opting for medical terminations, or the “abortion pill”, rather than surgical terminations.

“Tasmania is the forerunner of what’s going to happen in the rest of Australia and is already happening around the world,” Dr Hyland said.

The gynaecologist, who has been providing abortions in Tasmania for more than 20 years, said there had been falling demand for surgical terminations offered at clinics since the medication RU486 became available nationally when it was listed on the Pharmaceutical Benefits Scheme in 2013.

Since then, medical termination in Tasmania through the use of the abortion pill had grown to 43 per cent of all terminations by January 2016 and has continued to grow — well ahead of the national rate of 23 per cent.

Unlike the “emergencycontraception” morning-after pill, which reduces the risk of pregnancy if taken soon after unprotected sex, the RU486 “abortion pill” can be taken for pregnancies up to nine weeks’ gestation.

The change in the way Tasmanian women are accessing abortion mirrors what has already happened in countries where the abortion pill has been available for longer, with rates of medical terminations in Sweden and Finland at more than 90 per cent.

Change, said Dr Hyland, was inevitable. But, from a business perspective, there is a downside too. And Tasmania is the nation’s case in point.

Going back only four years, there were three dedicated abortion clinics in the state, at Launceston, Moonah and Hobart.

But Tasmania entered 2018 without a single abortion centre, following the closure of the Hobart clinic on new year’s eve, the closure of the Launceston clinic in May 2016 and the closure of the Moonah clinic in June 2014.

The clinics did not disappear because demand for terminations disappeared, rather the business model behind abortion clinics is under increasing pressure — from rising costs in the face of decreasing demand for surgery.

“The costs of regulation, accreditation, staffing and providing service for a limited number of patients is just not going to work in the private sector,” said Dr Hyland, who also ran the Launceston Abortion Centre before it closed for the same reason.

Before medical termination became available, the Hobart clinic would see about 15 women a week. But last year the number had dropped to less than seven a week.

“Who is going to set up a surgical clinic and get so few patients?” said Dr Hyland.

He said Tasmania was at the forefront in the change in demand because his Tasmanian clinics were offering advice about medical terminations and making them available at a much lower price than the surgical procedure.

“A patient would ring up and we would offer medical or surgical terminations,” he said.

Dr Hyland said an increasing number of women would prefer the at-home option of a medical termination, which could be performed up to nine weeks’ gestation.

But, from a business point of view, this was effectively “shooting yourself in the foot”

as the clinics were reducing their own demand for surgery.

However, the Sydney-based Dr Hyland is also medical director of the Tabbot Foundation, which was set up in 2015 as a nationwide over-thephone abortion service — offering referral for ultrasound and blood tests but all other medical assessments carried out by phone. Women are mailed out the medications, as well as antibiotics and pain relief, and speak with doctors and nurses over the phone.

For many women the first step to a medical termination would be through their GP, but Dr Hyland said some women had no desire to discuss the issue with their family doctor — or even take a prescription for the abortion pill to the local pharmacy.

Statistically, the mean age of Dr Hyland’s patients is 30, with most women falling into the 24 to 36 age bracket. They live all over Australia, from remote areas to cities. Many are mothers, who opt for terminations for financial reasons.

While an increasing number of these women are going down the medical termination path, there will always be a group in need of surgical terminations — perhaps because medical issues prevent them from taking the abortion pill or their termination is taking place after nine weeks’ gestation.

The business case for running a private clinic for these women no longer stacks up, but Dr Hyland said they should still be offered a service through a public hospital.

He said the Tasmanian Government’s response to the closure of the state’s last private abortion clinic is inadequate.

“The minister for health should provide a public service for women above nine weeks rather than abrogate his responsibilities to another state,” Dr Hyland said.

Following the closure of Mr Hyland’s clinic, Health Minister Michael Ferguson announced the Government’s Patient Travel Assistance Scheme would be extended to women referred by their GP to Melbourne for surgical abortions.

Mr Ferguson said the measure was temporary while the Department of Health and Human Services investigates other options.

Mr Hyland said this was an example of “men controlling women’s lives”.

“Women should be allowed to go to their public hospital locally,” he said.

From an equity of access perspective, advocates of women’s health and rights say the Tasmanian Government’s response needs an “urgent” rethink.

Hobart Women’s Health Centre executive officer Ms Glynis Flower said access to terminations, which have been legal in Tasmania since 2013, is a “legal and health issue”.

“There’s an urgency here,” she said.

Ms Flower said surgical abortions should be treated much the same as any surgical procedure, and made available to public patients in every state.

While women who can afford a private practitioner can still access surgical terminations in Tasmania, the issue is equity of access for women going through the public health system.

Ms Flower said forcing those women to travel interstate means they are further from support, and creates many added pressures — such as extra time off work and arranging care for other children.

Women’s Legal Service chief executive Susan Fahey said forcing women to travel interstate for surgical terminations could have unintended consequences.

She said young women who needed medical terminations could struggle to travel interstate, and end up with unwanted pregnancies which force them to drop out of school.

“Imagine the young woman who may not have her family’s support — how can she quietly go to Melbourne on her own?”

Ms Fahey said access needs to be across Tasmania, regardless of where a woman lives or their financial circumstances.

“This is a litmus test about care for women. If you don’t provide basic women’s health services, then you are not providing care.”

There’s an urgency here ... Imagine the young woman who may not have her family’s support — how can she quietly go to Melbourne on her own?

Hobart Women’s Health Centre executive officer GLYNIS FLOWER