Abortion is essential healthcare – so why isn’t it universally affordable and accessible?
Australia’s cost-of-living crisis has been well reported. Families are struggling to meet the weekly grocery bill, young people are increasingly relying on the bank of mum and dad to buy their first home, and Australians from all walks of life are avoiding visiting the GP in a landscape where bulk-billing is increasingly rare.
In a country that prides itself on the availability of universal, publicly funded healthcare, many forms of healthcare are now unaffordable for the average Australian. There are a number of reasons for this. One reason is that Medicare is failing to keep up with rising costs. Another is attributable to the profit-driven models of some health facilities, which result in costs that may be viewed as unreasonable (bordering on unethical).
Reproductive healthcare has not been immune from this development. In fact, the underfunding and high costs of abortion care pre-date the current cost-of-living crisis. Inadequate public provision of abortion services in most of Australia and the high costs – combined with unsatisfactory subsidisation – of abortions performed in the private realm, have created significant financial barriers to access.
Deficiencies in public funding for abortion, combined with the refusal of several public hospitals to provide abortion services, has led to a dearth of public provision of abortion services. Back in 2019, when Tanya Plibersek was the federal shadow minister for women, she indicated that the Australian Labor party would link funding to public hospitals to a willingness to provide abortion services. Unfortunately, that policy was dumped by the Albanese Labor government. Consequently, many faith-based hospitals funded by the public purse continue to refuse to provide patients with the full range of reproductive healthcare services.
Tired of waiting for federal action, just last year the Australian Capital Territory took matters into its own hands, making abortion up to 16 weeks’ gestation free to all residents of that jurisdiction. It is now time for the rest of the country to follow suit. Abortion is essential healthcare; it was categorised as such in the darkest days of the Covid-19 pandemic when provision of non-essential healthcare was shut down and abortion care rightly continued. It is unacceptable that such an essential form of healthcare is not appropriately funded and resourced in the public sector.
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Reliance on the private provision of abortion care is not a satisfactory solution to the vacuum in public provision. The cost of an abortion in the private sector varies significantly depending on factors such as the individual healthcare provider or facility, the type of abortion (via medication or surgery) and the stage of gestation. For example, an abortion carried out at eight weeks’ gestation via medication rather than surgery may cost less than $20 where providers bulk-bill and the patient has a healthcare card, or it may cost hundreds of dollars. These costs may be compounded for people living in rural or remote areas of Australia as they may need to travel to access services. This may result in additional costs such as those associated with transportation, accommodation, time off work or childcare.
The cost-of-living crisis exacerbates the impact of the already existent financial barriers to accessing abortion care. While cost-of-living pressures may lead people to choose not to have children, others will not be able to exercise this choice due to inadequate financial means.
In the last 15 years, Australia has made huge strides in the advancement of reproductive rights. Abortion has been decriminalised nationwide, all jurisdictions have enacted safe access zones to prevent anti-abortion conduct from taking place outside abortion clinics, and abortion via medication has become much more accessible – giving many pregnant people a real choice between medical and surgical abortion. But recent reports suggest that financial considerations are impeding on this choice, with some patients simply opting for the cheaper option, rather than the option that is most appropriate for their situation.
In a wealthy western liberal democracy like Australia, people should be able to exercise their choice whether or not to have a child. In order for the decision not to have a child to be a real choice, governments must provide for adequately funded and resourced abortion services nationwide.
• Ronli Sifris is an associate professor in Monash University’s Faculty of Law and deputy director of the Castan Centre for Human Rights Law. She is the author of Towards Reproductive Justice, published as part of the “In the National Interest” series by Monash University Publishing on 1 March