Three years ago Jane Hughes, coordinator of the Women's Resource Centre in Bega, tried to make a list of supportive local GPs who offered early pregnancy termination services in her area.
No medical centre contacted at the time would publicly acknowledge they offered these services.
According to one Australian survey, one-third of unintended pregnancies end in abortion. But like most health services, access for those living in regional and remote areas was problematic.
Abortion is compounded by social stigma as well as geography. Women in regional and rural areas often travel to access services, not only because they avoid going to their local GP where everyone knows everyone, but also because there were limited surgical abortion services available locally.
A study published in the Medical Journal of Australia found that while the rate of early medical abortion (within nine weeks) is greater among women in remote and regional Australia than in major cities, many of these women didn't access a medical abortion locally, including about 50 per cent of those in remote Australia.
Supporting GPs in the delivery of early medical abortion services locally should be a focus of health policy, the study concluded.
In NSW, an abortion can be carried out in one of two ways.
If a patient accesses services within nine weeks of conception, they can be prescribed two drugs that induce an abortion and can be taken at home, known as a medical abortion. No surgery or anaesthesia required.
To prescribe MS-2 Step for a medical abortion, GPs and other specialised prescribers need to have registered and undertaken mandatory online training, with 2021 data showing there are only 850 actively certified prescribers in NSW.
If the termination happens after nine weeks, it is a surgical abortion, requiring a day procedure and usually under light sedation. Most women access surgical abortion through private services, rather than the public health system.
Anecdotally, telehealth has improved regional access to health services, including medical abortion. Recent pandemic-inspired improvements to Medicare mean these telehealth consults are more easily available and can be bulk billed.
But even now, this has been rolled back. According to the Department of Health, telehealth consults covered by medicare are only available to patients who have attended the medical practice within the previous 12 months.
Alternatively, private providers like MSI Australia (formerly Marie Stopes) were available and mail out the medication for medical abortion, but with high up-front-costs attached it was a financial impossibility for some.
"There are a number of barriers that are exacerbated for people that live in rural and regional areas."- Jessica Moulton, PhD Candidate at Monash University's SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care.
As Jessica Moulton, PhD candidate at Monash University's SPHERE Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, explained, "There are a number of barriers that are exacerbated for people that live in rural and regional areas."
The main two barriers being cost and local access.
"With everything that's happening in America, it is just really important for us to keep engaging with research in this area and to be advocating for these services, because it is an essential service," Ms Moulton said.
"Reproductive choice is so important, everyone should be able to access these services if they need them."
According to the Framework for Abortion Access in NSW published by Family Planning NSW, "the largest gaps in access are to fully publicly funded, or subsidised abortion services, for financially disadvantaged women and to those living in rural and remote areas".
"There are some hospitals that do offer surgical termination, but demand is quite high," Ms Moulton said.
"We have these really fantastic private organisations, and we have GPs, but we also need to have hospitals and publicly funded services available that can provide that reduced cost care as well."
ACM has been told that in Bega and Moruya, surgical abortion is only available to patients who require a termination due to medical issues or complications.
Ms Moulton is a PhD candidate researcher working on The Orient Study, a trial that will evaluate how a collaborative nurse-led model of care in general practice can improve access to medical abortion.
"Nurses are very well placed to assist in providing these services, especially in rural and regional areas where there are less GPs available in certain rural and regional communities, or where GPs fly in and fly out, so they are only there one day a week," she said.
"Having a nurse who is trained and able to work with GPs to provide these procedures makes it more accessible."
When Narooma Doctor Gurdeep Bagari opens his new bulk billing practice in Bega, those seeking early termination will find a supportive GP.
"We are here to help those in need. We do have doctors, not only myself, but others here who are able to prescribe the medication for termination up to nine weeks," Dr Bagari said.
"We are very non-judgemental in the way we consult the patient."
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