Unplanned pregnancy counselling and pregnancy termination: are women accessing the services they need?
Pregnancy termination is one of the most common medical procedures an Australian woman will experience in her lifetime, with one in three pregnancies being unintended and 70% of terminations the result of failed contraceptives. Campaigns for easier access to abortion in Australia have largely focused on changes to the law but in a recent speech to Emily’s List the Labor deputy leader, Tanya Plibersek, highlighted another crucial factor: cost.
“For many women abortions are unaffordable and unattainable,” she said. “The legal right to access a termination isn’t much use to a homeless teenager when the upfront cost of an abortion is more than $500.”
Prohibitive expenses (including travelling expenses) interact with legal restrictions to limit access to pregnancy terminations. Abortion costs are substantial, increase at later gestations, and are a financial strain for many women. Poor knowledge, geographical and financial barriers restrict method choice.
The following are some further points the Labor deputy leader made: “Putting RU486 on the PBS undoubtedly made it easier for some women to end an unwanted pregnancy.” But she said the current reality is that for many women who have decided they want an abortion, it’s still unaffordable and unattainable.
“The reality of the situation is that if you’re a middle class woman from a relatively privileged background living in a capital city, maybe you’ll agonise over the decision, there will be barriers and stigma around you getting an abortion, but you’ll probably be able to get one if you need to. If you live in a rural or remote area, if you’re experiencing poverty, if you don’t speak much English, if you’re young… it’s going to be a whole lot harder, if it’s possible at all.”
A study examining access and equity to induced abortion services in Australia, published in the Australian and New Zealand Journal of Public Health, recently showed that of 2326 women who presented at 14 Dr Marie Stopes International clinics across Australia, more than a third opted for a medical abortion. More than 1 in 10 stayed overnight. The median Medicare rebated upfront cost of a medical abortion was $560 compared to $470 for a surgical abortion at up to nine weeks. Women who travelled more than four hours, had no prior knowledge of the medical option, had difficulty paying and those identified as Aboriginal or Torres Strait Islander were more likely to present later than nine weeks.
Experts say that along with changes to laws, increasing the number of GP and nurse providers would improve access and reduce costs. But these groups can be reluctant to get involved in abortion, or to publicise their involvement. The significant legal and cultural barriers that discourage doctors and hospitals from providing abortions and push their provision into the private sector are a considerable barrier to women according to Children by Choice.
Geography often compounds existing impediments. Access to any medical service is limited in rural and remote areas. While in WA pregnancy terminations can be legally performed outside a medical facility, a woman still needs to be less than nine weeks pregnant, be within one hour of a medical facility in case of complications, be able to have an ultrasound and be able to cover the cost.
In her speech to Emily’s List, the Labor deputy leader also expressed concerns about “reproductive coercion” – when a partner attempts to control or sabotage a woman’s birth control, make threats or are violent if a woman attempts to use a condom, or even removes a condom without consent. It is a problem that must also be addressed, Plibersek insisted.
She noted the need for a comprehensive approach to improving the use of effective contraceptive, better access to healthcare for vulnerable women, and the need to improve sex education for both genders, particularly around the meaning of consent. “It’s girls who are more likely to be pressured to have sex when they don’t want to, to be publically shamed for sending selfies, to be ostracised for being too frigid or too promiscuous. It is girls who will end up pregnant, who are less likely to receive pleasure, who are more likely to be victims of violence. When our sex education system fails, girls pay a higher price.”
Recent research undertaken by Children by Choice examines the impact of poverty on women’s access to abortion services. In unravelling the cycle of poverty they gained greater insight into its contribution to women’s experience of unplanned pregnancy and choices available to her. Utilising organisational data and case studies collected over the past two years they provided a detailed analysis of the over-representation of women in poverty needing a pregnancy termination. According to Children by Choice data: 45% of contacts were Health Care Card holders and 67% reported abortion cost as a barrier to access. In response to this Children by Choice introduced a financial assistance program.
Their research showed that the main presenting issues for women are: mental health, sole parenting and family and domestic violence. They also found that the abortion experience typically involves:
- Multiple disclosures.
- Judgement from others when asking for money.
- Asking a violent or unsupportive man.
- Gestation advancing while trying to find funds.
- Escalation of mental health issues.
- Increased poverty from raising the money –
housing/rent arrears, not paying bills, etc.
Through this research, we see traumatic life circumstances - violence, benefit dependency, single parenting - surrounding and exacerbating the abortion experience.
Counselling can be an integral part of the abortion process and may or may not include support in decision-making. Counselling should be available to women if they want it either before or after a termination. Not all women experiencing an unintended pregnancy wish to speak to a pregnancy counsellor. Most women believe that it is important that a pregnancy counsellor refer for all three options: abortion, adoption and parenting. The more difficulty women have in making their decision when faced with an unintended pregnancy, the more important they felt it is to have a counsellor who will refer for all three options.
There are some serious concerns about the accuracy of information provided by some pregnancy counselling services (and their appearance high up in a google search). Some services are run by anti-choice organisations but use misleading advertising that implies that women are offered non-directive pregnancy advice. The omission of key information can result in women not being fully informed on all the options for dealing with an unplanned pregnancy and not feeling fully supported to arrive at an independent decision The limited timeframe available to make a decision about whether or not to continue with an unplanned pregnancy increases the importance of access to complete, accurate and unbiased information.
A government-run/funded telephone counselling service that provides non-directive counselling on pregnancy options, including contact information for termination clinics, would ensure that women in WA had access to appropriate information and the options available to them.
Western Australian women would also benefit from a well-planned response to the difficulties rural, remote and disadvantaged women are experiencing in accessing pregnancy terminations.
 Marie Stopes International. What women want when faced with an unplanned pregnancy.
Melbourne: Marie Stopes International; 2006.