The postcode lottery for abortion access in Victoria

Women are struggling to access abortion services across Victoria, with more than two-thirds of local government areas having no surgical abortion providers, a new report reveals.

The Women’s Health Victoria report has also uncovered that almost 40 per cent of the state’s local government areas have no listed pharmacies that dispense abortion medication.

The study also lays bare how disadvantaged communities face greater barriers to abortion and contraception, where women are up to three times more likely to seek abortion services after nine-weeks gestation – the cut-off period for medical abortion.

Women’s Health Victoria chief executive Sally Hasler said this was because their pregnancies were further progressed due to the limited access to abortion services.

“Denying someone access to an abortion means they can’t make decisions about their body and has intergenerational impacts,” she said.

More than one-quarter of highly disadvantaged regional areas have no providers offering intrauterine devices or hormonal implants to prevent pregnancy.

The report comes as fresh national debate over abortion laws erupts among conservatives, after Coalition senator Jacinta Nampijinpa Price told this masthead that pregnancies ended after the first trimester are immoral and arguing late-stage abortions were akin to infanticide.

The findings were based on an analysis of 30,000 calls to Women’s Health Victoria’s 1800 My Options phoneline between 2018 and 2023, mapping of more than 700 sexual and reproductive health providers and a survey of nine women’s health services.

Melton, Hume, Wyndham and Whittlesea had the highest rate of women seeking abortion in metropolitan Melbourne, while the Mitchell and Ararat areas recorded the highest in regional Victoria.

While abortion was decriminalised in Victoria 16 years ago, Hasler said it was still not a mainstream part of public healthcare due to stigma.

“We would like to see it integrated into the health system as a part of standard maternity care service,” she said.

Access to abortion in public hospitals also continues to be an issue, the report found. It pointed out that while 75 per cent of births take place in them, only 21 per cent of surgical abortions were provided in public hospitals.

“One of the most significant challenges to equitable access for surgical abortion seekers is the reluctance of many publicly funded hospitals to provide these services, despite having capacity,” the report said.

One respondent said their local hospital had only recently started offering surgical abortion after “having been hesitant for many years due to concern of protests”.

The report found that “service deserts” were more pronounced in regional Victoria, where some women were having to travel great distances, fund overnight accommodation and take time off work to access abortion services.

Women’s Health Grampians sexual health advisor Shannon Hill said some women in her organisation’s catchment area in western Victoria were waiting up to four weeks to access a GP – which sometimes meant they were no longer eligible for a medical abortion.

She said they then had to travel further afield, sometimes to Melbourne, for more expensive surgical abortions.

“The long wait times for appointments, the burden of travel and financial costs are adding to people’s stress,” Hill said.

A medical abortion costs about $620 for Medicare-card holders, while a surgical abortion in a private clinic costs $775.

Hill said the Grampians region had the state’s lowest rate of GP prescribers and pharmacy dispensers of medical abortion and patient demand outstripped the capacity of local services.

Last year, 35 Victorian providers offered surgical abortion, with 15 of these offering abortions after 12-weeks gestation. The Royal Women’s Hospital is the only provider that offers surgical abortions beyond 18 weeks.

While the surgical abortions are provided for free in public hospitals, women must first obtain a GP referral and often an ultrasound, which can be costly.

Carolyn Mogharbel, the manager of 1800 My Options, said finding a GP who was not a conscientious objector could also be challenging in some parts of the state.

While conscientious objectors must refer abortion seekers to alternative providers, this did not always happen, she said.

“GPs are absolutely the champions of the abortion system. But there are also barriers when it comes to GP services in this space,” Mogharbel said.

“If they’ve got an objection to providing the service, they need to declare the objection and refer on appropriately.”

Women’s Health Victoria is calling for better data collection on surgical abortion and further investment in low-cost and free contraception and abortion services across the state.

Victorian Health Minister Mary-Anne Thomas said the government had established safe access zones near abortion clinics and nine new sexual and reproductive health hubs across Victoria offering free or low-cost contraception, medical abortions and referrals for surgical abortion.

“Women’s bodies should never be up for debate, and in Victoria, it is very simple – abortion care is healthcare and choice is a fundamental right,” she said.

Thomas said the government was working to boost access for surgical abortions in public hospitals.

Eastern Health, Western Health and Peninsula Health started offering surgical terminations last year.

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