Greens give notice of bill to increase abortion access
The Greens have this morning given notice of a bill for an Act to amend the Abortion Law Reform Act 2019 to increase access to abortion health care.
Notice was given today on the final sitting day of the Upper House in the NSW Parliament by Greens spokesperson for Health including Mental Health, former GP and provider of medical abortion, Dr Amanda Cohn.
Yesterday, Dr Cohn asked the government in question time:
"New South Wales public hospitals that have functionally banned abortion services are being widely reported. Last week the Premier stated that the public hospital network has a role to play in the provision of abortion, and that this "will be fully funded, and the services will be available". Given that the recently extended funding in the New South Wales budget for abortion care is for non‑government organisations, partner organisations and GPs, how will the Government ensure that abortion is also accessible in public hospitals across the State, without having to continue to intervene on a case‑by‑case basis?"
This was followed by a supplementary question:
"In her answer, the Minister talked about local health districts providing services in public hospitals based on local needs and service capacity. It is being widely reported that multiple hospitals are not providing services where there is a local need and service capacity. What work is the Government doing to understand the pattern of that? How many hospitals are actually providing services and how many are not?"
The questions were followed by a speech where Amanda said:
"I take note of the answer from the Hon. Courtney Houssos, representing the Minister for Health, to my question relating to abortion services in public hospitals. I need to point out that the public largely expects that abortion services are available in public hospitals, and communities have been shocked and horrified to learn that in many they are not. Orange and Queanbeyan are not the only places with that problem. A representative survey commissioned by Australian Clinicians for Choice in early 2023 found that 68 per cent of New South Wales residents believe that every public hospital delivering women's health services should also provide abortion. There was majority support for greater access to abortion services among voters for both Labor and the Coalition, and support was greatest in rural areas.
In her answer the Minister spoke of the SEARCH Project. The Greens commend the extension of funding for that program, which is building the capacity of service providers in some regions. But that does not solve the issue of weaponisation of conscientious objection. Dr Anna Noonan of the University of Sydney, based in Orange, recently published excellent peer‑reviewed research in the journal Rural and Remote Health finding that a small but influential number of medical practitioners are not just refusing provide abortion services but obstructing access, leaving people unable to access terminations in many parts of the State.
I thank the Premier for his commitment last week in the other place that abortion services will be fully funded and available in public hospitals. Given the state of the public health system at the moment and the level of distress, burnout and stress among health workers, I understand that some workers are distressed by the idea of having to provide additional services on top of their already stretched workloads. I empathise with that sentiment. That is why those services have to be resourced and those workers have to be adequately paid to provide them. There are nurses, midwives, obstetricians, gynaecologists and GPs across the State who are ready, skilled, willing and able to provide those services in public hospitals. They need to have a framework, in terms of both regulation and funding, that allows them to provide that care in the regions. When we have good healthcare workers in the regions, they need to be supported to provide that care.
Because the Minister mentioned it in her answer, I repeat an anecdote that I related last week about the Pregnancy Choices Helpline. The anecdote is from a health worker who told me that they called that helpline seeking advice on where to refer someone who had passed the gestational limit for their private clinic. They waited on hold for an hour and then could not be told which hospitals provide services. They were told that the patient would have to go back to their GP, who would then have to advocate for access at their local hospital based on the availability of particular doctors and the rostering of surgical theatre lists. That is not a system. It is not the level of care that the community across New South Wales expects. I call on the Premier and the Minister for Health to intervene statewide to ensure that care is accessible."
What changes are needed (legislative and otherwise)?
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Legislation in NSW needs updating so that:
- Nurses and midwives with appropriate training can prescribe medical abortions, per TGA guidelines, up to 9 weeks gestation.
- Onerous and bureaucratic mandatory reporting requirements, which don’t exist in legislation for other similar medical procedures, can be removed
- Conscientious objection, an important provision, is only exercised as intended by individual practitioners and not weaponised by departments or institutions to obstruct access
- At least first-trimester surgical abortions should be provided at every public hospital in NSW that provides reproductive health services, by tying service provision to funding. If a hospital provides birthing services and can support someone experiencing a miscarriage, it can provide abortion. This will not only address the postcode lottery but also provide a level of privacy for people who may not feel comfortable or safe accessing a standalone reproductive health service.
- GPs should be supported to become medical abortion prescribers, so that people can access comprehensive reproductive health care in the community from a professional they already know and trust. This is medically straightforward but currently requires GPs to undertake additional training, unpaid and in their free time, because it is not a standard part of their training.