Labor has announced a national sexual and reproductive health strategy to improve access to contraception and abortion. A major plank of this policy is to “support all women to access termination services in public hospitals”, raising a number of crucial questions:
What has Labor announced?
As part of the broader package, Labor this week announced that if they’re elected, they would work to ensure abortion is provided “consistently” in public hospitals throughout Australia.
Abortion is regulated by the states and territories, but Labor say they could achieve their aim by tying it to federal funding provided in the five-year commonwealth-state hospital funding agreements.
Labor’s deputy leader, Tanya Plibersek, said this measure was necessary to end the “patchwork” provision of abortion that currently occurs across the country.
Where do Australian women access abortion now?
Only up to about 10% of abortions in Australia take place in public hospitals, according to family planning organisation Marie Stopes. The remainder are provided privately though Marie Stopes warns that figure is only an estimate as there is no nationally consistent data available.
Provision differs widely between states – in South Australia, all terminations take place in the public system, while in NSW, public services are very limited.
“Marie Stopes see many women who have been turned away from NSW public hospitals, even women who have had significant health complications,” said the acting chief executive, Jamal Hakim, in a statement.
What does it cost to have an abortion in Australia?
Procedures can be provided for free in public hospitals, but the costs incurred by using a private provider varies around the country, and increases for pregnancies that are further along.
According to a 2017 study, the median, Medicare-rebated upfront cost of a medical abortion was $560 and a surgical abortion was $470 in the first nine weeks. The median cost of abortions after 19 weeks, which are rare, was $7, 700. The study found women routinely incurred additional costs in the course of having a termination, such as travel and accommodation, adding up to an average of $150 each.
Will all public hospitals be required to provide abortions?
No. The requirement would be for abortion to be provided consistently, not necessarily universally. Labor says individual hospitals and doctors would not be forced to provide abortions, but it would be up to the states and territories to demonstrate that the public health system was offering women across their state access to a safe abortion.
What about states where abortion is still a criminal offence?
Labor has said it would work with the two states where abortion has not been decriminalised – New South Wales and South Australia – to make that happen.
But it’s not necessary for these agreements to go ahead. Abortions can already be performed lawfully in both states if certain criteria are met: in NSW, a doctor must be of a reasonable opinion that continuing the pregnancy risks the woman’s life, or mental or physical health, taking into account economic and social factors. In SA, abortions are lawful if two doctors believe the woman’s physical or mental health is at risk, or if there is a serious foetal abnormality.
“We’ve never said decriminalisation will be a condition of hospital funding,” said a spokesman for the shadow health spokeswoman, Catherine King.
Why was there a special announcement about Tasmania?
Labor also pledged to build a reproductive health hub in Tasmania, which will be part of the public hospital system.
Abortion has been decriminalised in Tasmania since 2013 but accessibility has been in the news after the primary provider of surgical abortions closed in 2017. Within months, there was a reported increase in women travelling to Melbourne to have a surgical abortion.
The state government announced last November that a low-cost provider, Hampton Park Women’s Health Care, would open its doors imminently, but that is yet to happen. The state health minister, Michael Ferguson, said on Wednesday that an alternative “low-cost provider has been in place, after some period of disruption, since November of last year”.
The Women’s Health Tasmania chief executive, Jo Flanagan, described the current provision as “patchwork and murky” but said women could access safe terminations in Tasmania.
What happens if states and territories don’t agree with Labor’s plan?
The commonwealth needs to reach a national agreement with all states and territories, but within that agreement, there can be carve-outs or exceptions. “If there are governments that don’t want women to have access to these critical health services in the public system, they should say why,” said King’s spokesman.
What did the Coalition say?
The prime minister, Scott Morrison, scolded Labor for raising the issue of abortion access on the eve of an election “in a very politically charged context”.
“These are matters that are dealt with by the states and territories. I have no desire to overstep what the constitutional authorities are of the commonwealth in these matters,” he said on Wednesday.
The federal health minister, Greg Hunt, said the government was working on its own women’s health policy, which would be released soon, and cast doubt on Labor’s ability to enact this policy: “To be clear – access to termination services is a state and territory responsibility and the Australian government has no constitutional powers in this area.”
