‘It’s a bit of a whisper in the corridors’: Women are being forced into underground abortion networks in rural NSW, investigation finds

A small but influential number of doctors who actively oppose or are not interested in providing abortion care are leaving women unable to access abortion in many parts of rural New South Wales, a study has found.

It has led to informal and often underground networks of health professionals providing information and access to abortion care to patients, the study found, with these providers burning out due to high demand for and attitudes toward them.

Dr. Anna Noonan, a research associate at the University of Sydney’s School of Rural Health, interviewed 16 healthcare providers, including general practitioners, midwives, nurses, midwives and health care nurses, and asked them about unintended pregnancies.

All staff worked in the Western Region of NSW, where 17% of the population is female and of childbearing age (15-44 years), and where there is only one publicly advertised abortion service.

“We found that the decision of one person in a position of power can result in no access to an abortion service at all,” Noonan said.

“What I ultimately heard from primary care providers was that they were experiencing this constant, often passive obstruction by the health care system at multiple levels.”

For example, physicians trained as rural generalists who were prepared to provide abortion care found that the rural inpatient hospitals where they interned did not provide abortions.

“So they learn to provide health care without any clinical training or exposure to abortion,” Noonan said. “It meant that many felt inadequately prepared and trained to provide (surgical abortion) care.”

The study – published in the journal Rural and Remote Health – found that one tertiary institution even requested censorship of education about abortion services during student clinical placements.

One health worker interviewed for the study said: “The problem is you have a number of conscientious objectors in the hierarchy of these larger hospitals… that will be very difficult to get past because they are the people who make the rules.”

Most study participants cited professional stigma as the reason abortion services were limited, hidden, and unadvertised.

A health professional said patients who Google the name of a gynecologist who offers abortion will not find information about the service online. “It’s like this underground service he provides,” the health worker said.

Another participant in the study described how “… there’s a bit of a whisper in the corridors, like – ‘do you know anyone who does abortions?’”.

The reluctance of health care providers to openly share information, even about where medications to end early pregnancies could be prescribed or dispensed, meant that some health professionals spent significant clinical time searching for answers, calling around to pharmacies, asking if they could get the medications had stock and came up with a plan. for the patient.

Noonan said health workers trying to refer patients to services found it difficult to determine who to call and where to go. Some health workers are coming up with their own informal, underground solutions, the study found.

A nurse at a rural clinic said she would connect patients to a primary care physician who would prescribe abortion medications via telehealth. In NSW, nurses and midwives are not allowed to prescribe abortion drugs. The nurse then took care of all pre- and post-abortion care.

“That worked well for two years,” the nurse said, until “we got a new medical director, and he quit.”

Noonan said these types of solutions were sometimes dropped because managers believed abortion care should be provided by obstetricians and gynecologists, and because it was too time-consuming for general health care providers to manage alongside other health care.

“Australia has the most extremely narrow view of abortion, often treating it as an obstetrics and gynecology issue,” Noonan said.

“And maybe it is for the really complicated surgical cases, but not for the routine prescription of an abortion pill for a pregnancy of less than nine weeks. We continue to perpetuate this catastrophizing of abortion, this exceptionalization of abortion, where abortion is seen as something that is so specialized that it has to be managed by a small population of health professionals, and that is a misguided approach.”

Evidence from the World Health Organization shows that nurse-midwifery-led abortion care models are safe and effective. Noonan said delays in finding a medical abortion provider can result in a patient being pregnant for more than nine weeks, leaving surgical abortion as the only option, which is also difficult to access.

The research found that the lack of GP abortion providers means existing services are “inundated with requests from other frontline health workers trying to find local options, causing tension and overwhelm”.

One midwife, who asked not to be named because of some colleagues’ attitudes towards abortion, told Guardian Australia that one in four Australian women will need an abortion during their reproductive years.

The doctor, who is also a spokesperson for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, agreed with Noonan that abortion care should be seen as normal, routine healthcare, but it often is not.

“Abortion care is a service that is in high demand,” she says.

“I think another reason health care services are reluctant to provide this is that there is such a chronic shortage of funding for women’s health care, and Medicare rates for women’s health care are very low.

“To do a more complex ultrasound on a woman, you actually get paid less than a very simple scrotal ultrasound on a man.”

She said some health care services fear they would be overwhelmed by an increase in patients if they were to provide abortions.

“For that reason they want to keep abortion care out of regular care,” she says. “It doesn’t make financial sense to provide this when women’s health care is already so underfunded.”

She said any hospital funded with public money should work within the full scope of their facilities to provide all health care services for women, including abortion.

Greg Johnson is the chief executive of MSI Australia, a not-for-profit organization and provider of abortion and contraceptive services. He said although Noonan’s study was small and focused on one region, “the experiences ring true with all the things we hear at MSI Australia in national and regional care”.

“Fundamentally, abortion is still on the periphery of a disjointed health care system,” he said.

“Abortion care should really be seen as an equal and accepted part of healthcare. Until we get there, we will continue to face the problems we currently have, especially in rural and regional Australia.”

Do you know more? melissa.davey@theguardian.com