An ABC investigation has encountered a culture of secrecy and fear surrounding the provision of surgical abortions in Tasmania.
While debate around providing surgical abortions in public hospitals unfolds in State Parliament, the medical community is doing what it can to make those services available now.
The closure of Tasmania’s only abortion clinic in Hobart at the end of last year left women with limited options for getting surgical abortions.
It can be revealed that at least three surgical abortions a week are happening in the Royal Hobart Hospital (RHH) and some public funds are being used for terminations in private hospitals.
But some doctors performing publicly funded terminations will not complain openly about the restrictions placed on providing abortions for fear of Health Minister Michael Ferguson shutting off funding or ordering services to be stopped.
Those in the state service also fear losing their jobs if they speak out.
During the state election campaign, the Liberal Party ruled out funding abortion through the public health system and offered travel assistance for women referred to private abortion clinics in Melbourne by their GPs.
Since being returned to office, the Hodgman Government has been accused by Labor of trying to limit access to terminations at the RHH.
The ABC has found the feeling amongst some doctors performing terminations in Tasmania is that they have to do so in a secretive manner so that the Mr Ferguson does not find out.
Since January, abortion provider Marie Stopes Australia said they have seen up to 10 Tasmanian women a month at their Melbourne clinic — up from an average of one per month before the Hobart clinic closed.
Sources have told the ABC that several terminations are also taking place at the Royal each week.
There are strict rules on who can get an abortion at the state’s biggest public hospital in Hobart.
Abortion is legal in Tasmania up to 16 weeks with the consent of one doctor, but the RHH website recently put a memo out to GPs stating that women have to be less than 14 weeks pregnant and must meet “vulnerability” criteria: “vulnerability may include, but is not limited to, socioeconomic hardship, sexual or domestic violence, physical or intellectual disability, or acute stress or mental illness”.
The Health Department told the ABC in a statement that demand for surgical terminations in Tasmania was decreasing, but did not say whether terminations were taking place in the North West Regional or Launceston General Hospitals.
“Surgical terminations are available to women at the Royal Hobart Hospital where their health is at risk,” the Health Department said in a statement to the ABC.
“Apart from the fact that demand for surgical terminations is decreasing as the availability and uptake of medical terminations increases, there has been no other change to service delivery regarding terminations in the public system in the past 10 years.”
‘Hospital asked if I’d considered adoption’
But when Tasmanian woman Deborah*, who was 15 weeks pregnant, tried to get an abortion at the Royal Hobart Hospital earlier this year she was rejected.
Strict rules apply to abortion procedures at the Royal Hobart Hospital. (ABC News: Rob Reibel)
“The representative from the hospital spoke to my GP and, amongst other things in saying no, this person also asked my GP whether I’d considered adoption,” she said.
“Whether that was standard process for these conversations I’m not sure but it certainly gave my GP and I something to talk about — we were pretty disappointed.”
The Tasmanian director of the Australian Christian Lobby Mark Brown said women should be presented with adoption as an option.
“I think adoption should be one option that is always provided for anyone seeking to have the options available to them if they have an unexpected pregnancy,” he said.
The Australian Institute for Health and Welfare Report into adoptions in Australian in 2016-2017 said there were seven adoptions in Tasmania: two were already know to their adoptive parents, three were from overseas and two children were unknown to their adoptive parents.
Termination in Melbourne cost $4,500
Because the only private clinic doing surgical abortions for $500 closed in Tasmania at the end of last year, Deborah had few options.
She tried to book into a private hospital for an abortion that would have cost $3,300.
But because surgical abortions were only being done once a week, Deborah missed the opportunity to have a termination at less than 16 weeks, where only one doctor has to sign off on the termination.
In the end, she had to fly to Melbourne for a termination and spend $4,500 on the procedure and travel.
The State Government is offering travel rebates for women who go to Melbourne for surgical abortions and said that four women have travelled there since the private abortion clinic closed at the end of last year.
But Deborah, who went there in February, said she did not bother applying for state support.
‘A lot of secretiveness’
Deborah said during the process of trying to have an abortion in Tasmania, the pathway was not clear.
“My GP wasn’t clear either on what the pathway was, so we went out together to look at different opportunities for referrals to various people who potentially were providers,” she said.
“[We] had to navigate a system with no pathway and no clarity and a lot of secretiveness.”
There is a way for women who are poor and vulnerable in Tasmania to access funding for an abortion in the private system, but it is not widely known.
Hobart Women’s Health Centre CEO Jo Flanagan said they had a Women’s Health Fund made up of private donations and some State Government funding that was used for various health issues.
Jo Flanagan says State Government funding has been used by women seeking abortions. (ABC News: Natalie Whiting)
Besides being accessed for things like chronic health conditions and physiotherapy, the money has been used to help women get terminations.
“It is a very small pot of money and will eventually be gone,” Ms Flanagan said.
Ms Flanagan said the State Government was aware that the money was being used to pay for terminations.
“They’re aware of it’s applied for use in a range of areas,” she said.
“Access to termination is just one of the health needs.”
The office of Health Minister Michael Ferguson would not confirm whether the Government was aware of money being used for terminations.
“Funding for the Women’s Health Centre is administered by the Department of Health and Human Services, in accordance with a grant deed,” a statement said.
Funded abortions ‘would not go down well’
Mr Brown from the Australian Christian Lobby said many Tasmanians would not be happy about their taxes being used to fund abortions.
“Abortions are not routine operations, and I think the fact they are being treated as such would certainly not go down well with most Tasmanians when they found out that their own taxpayers’ money is being used in this way,” he said.
But terminations are covered under Medicare, meaning doctors receive federal government rebates for the procedure.
This should make terminations easy to track, but it does not because the abortion data is combined with procedures such as treating women who have miscarried.
Federal health data shows that from July 2017 to April 2018, there were 14 surgical procedures in Tasmania that were either for procedures to the uterus performed for a range of gynaecological reasons including miscarriage or terminations between 14 to 22.6 weeks.
The data for the majority of surgical abortions, which are performed between 9-14 weeks, is even more difficult to decipher.
Tasmanian and Victorian statistics are combined, and in those states from July 2017 to April 2018 there were 9,712 procedures.
No-one can say how many of those were terminations.
“There’s no standardised national data collection on unplanned pregnancy or abortion in Australia, and it’s because the item numbers are not exclusively for abortion procedures — they are also used for miscarriage and some other gynaecological procedures,” Associate Professor Kirsten Black, from the Royal New Zealand College of Obstetrics and Gynaecologists, said.
Women in rural areas disadvantaged
Associate Professor Black said that abortion was a health issue and that health decisions should be based on data.
Associate Professor Kirsten Black says Australia should collect better data on abortions. (Supplied: Kirsten Black)
She said there was an inequity of access around Australia.
“Women who come from rural areas are more likely to have trouble paying, they’re more likely to present later in pregnancy and therefore not be eligible for a medical abortion, so there’s major major barriers for access,” she said.
Mr Brown also thinks the available data should be more clear.
“It’s important to see the true rate of abortions and to see if they are declining, as we appear to be seeing,” he said.
“I think it’s important when we’re talking about something so important as the life of vulnerable children that we do have all the correct data available at our fingertips.”
National health data shows that from July 2017 to April 2018 there were 1,467 prescriptions of medical abortion medication recorded in Tasmania.
That does not mean that all that medication was used for abortions in Tasmania because some of the medication would have been sent by post to women interstate.
* Not her real name