The real right to choose
Access to abortion remains difficult in Australia, and the persistent stigma around this and other crucial reproductive health services puts patients at risk.
Dr Leslie Cannold believes that how a society treats abortion is a litmus test for those of us with uteruses. “Is it free? Is it accessible? Is it unstigmatised? That’s a society where women are equal,” she says.
Cannold is the head of programs at the Cranlana Centre for Ethical Leadership, and a long-time campaigner for abortion law reform. As we contemplate the struggles facing America since the reversal of
Roe v Wade, it’s easy to assume that because abortion is now legal across Australia, the battle for reproductive rights is won.
But as recently as September, Dr Shannyn Rosser and her colleagues published a report in The Medical Journal of Australia acknowledging that abortion remains hard to access in this country.
The last state to decriminalise abortion was South Australia, and only this year. Most legislation across the country specifies a term of up to 16-24 weeks, beyond which point additional medical approval is required. Yet Rosser’s study notes, “Despite advances in imaging and prenatal screening, not all fetal abnormalities are detectable early in pregnancy.”
And legal or not, the stigma around abortion makes it harder to access and puts patients at risk. It reduces the number of doctors prepared to provide such services, which reduces access, particularly for people rejected by their original health provider. It also reduces the number of doctors trained in such procedures. “The system itself predisposes some people to have later terminations than necessary,” says Dr Carol Portman, a maternal foetal specialist.
As is the case in the United States, there are people in this country – albeit a small minority, and often on religious grounds – who are opposed to allowing women, trans men and non-binary people to terminate a pregnancy for any reason. The fact that 21 public hospitals in Australia are operated by Catholic Health makes this situation particularly fraught. One of these “public” hospitals is the Mater in Brisbane, which includes the Mater Centre for Maternal Fetal Medicine. According to its website, the centre “provides expert diagnosis and management of complex pregnancies for women with high-risk pregnancies”. However, it also makes clear that “in accordance with the principles of the church, we do not provide termination of pregnancy or contraceptive procedures”.
This raises the question, says Professor Caroline de Costa, an author as well as an obstetrician and gynaecologist: “Why would you test for anomalies if you’re not prepared to do anything about them?” In an article that referenced Rosser’s study, de Costa noted that the people who receive grim news about the health of their foetus at this public hospital would then have to find another doctor to refer them elsewhere for treatment, “causing delays in appropriate care, increasing their stress and perpetuating the stigma attached to abortion”.
Consider that in 2013 abortions had been legal in Victoria for five years, but later-term abortions remained both hard to access and expensive. One clinic that offered them was in Croydon, in Melbourne’s east. That year, more than 50 of its patients discovered they not only had to weather societal disapproval and pay thousands to get reproductive healthcare, but they had also been infected with hepatitis C, thanks to an anaesthetist working at the clinic. Addicted to fentanyl, Dr James Peters was injecting the drug into himself before using the same needle to inject his patients. He was jailed for 14 years and, in 2014, the infected patients won a class action that awarded a total of $13.75 million in compensation.
“It’s not just about abortion being legal,” says Delaram Ansari from the Multicultural Centre for Women’s Health. “There are many barriers to access that make it difficult for some women and people to get the help they need. Sexual and reproductive healthcare, as it currently is, is not equitable.”
But it is not just abortion that is stigmatised and hard to access. All sorts of reproductive healthcare can be withheld by hospitals, obstetricians, GPS, pharmacists and a host of other medical providers who claim a conscientious objection. This includes contraception, the morning-after pill, hysterectomy, tubal ligation and vasectomy.
I have been inundated with stories from people who have been refused legal reproductive healthcare. After having twins by caesarean and a termination, one woman still had to battle to control her own fertility: “Fell pregnant again and this time I asked my gyno who also delivered my twins to tie my tubes while he was doing whatever he was doing there. He was good; he understood why I wanted this so badly. But the GP was an old Catholic who kept banging on about how children were a blessing and what happens if one of my children dies … He made me feel guilty.”
Refusing a woman’s request for a tubal ligation while she is having other abdominal surgery has real risks attached, according to Dr Catriona Melville, deputy medical director at MSI Australia (formerly Marie Stopes). It may mean she will have to have two operations and go under general anaesthetic twice.
When Bianca was 24, she sought a hysterectomy. A survivor of sexual assault, she suffered chronic pain and bleeding that also triggered memories of her trauma and caused her to self-harm. To get the hysterectomy, she had to get her psychiatrist’s permission. He refused, telling her she should wait in case she wanted kids later on. It took Bianca five years to find a psychiatrist who would acknowledge that it was her body and her choice, and this woman approved the procedure. Bianca has recently had the operation. “I am like a whole different person.”
Another woman confided that it had taken her five attempts to get the courage to tell me her story. She was in the very early stages of pregnancy when she consulted a GP. “His religious faith prevented him helping me obtain a termination. He refused to refer me to another doctor. Through a friend I was able to contact Children by Choice,” she says. “They referred me to a centre in Sydney.
There was nothing in Queensland. I travelled there alone and had the termination, later than I should have. This experience has left me scarred emotionally.”
Her experience is another example of how stigma can increase the risk of poor quality care, says Children by Choice chief executive Daile Kelleher. “People will take a bad abortion over no abortion,” she says.
Paternalistic attitudes about women and their choices have far-reaching consequences, beyond their damaging effects on people who do not want to have children. Hannah Diviney, a young disability activist, is worried about her right to reproduce. “I would like to have children one day, but I am frightened that
I will have to justify why I should be allowed to have them.”
Which rather makes you wonder, if the first duty of any health provider is to do no harm, what about the harm caused by refusing to provide care?