Fear, anguish, guilt. It’s only a phone call but you can hear all of these emotions in Sarah’s* voice.
Sarah has two young children. Her husband is a fly in, fly out worker on a remote mine site and they have just found out Sarah is pregnant. Sarah is raising two children under four. She has no family around her and her husband is rostered one month on, one month off. She has made the decision to have an abortion because mentally and physically, a third child would be too much for her and her young family right now.
Sarah is one of more than 1,000 women from regional Australia who call us each year seeking an abortion.
The decision to have an abortion is not one that a woman makes lightly. Fear, guilt and anxiety are common. But the decision is ultimately hers and anyone else she chooses to involve in the process.
Supporting women like Sarah so she has reproductive autonomy is challenging because women in rural communities must contend with more barriers than those in metropolitan areas.
The logistics of accessing an abortion are more complex and often involves many hours driving to and from a clinic, or, in some cases, flying to a capital city for the service, adding time and cost.
The advent of telehealth has helped to remove some of the geographic barriers, as women up to 56 days gestation can access a medical abortion through Skype and telehealth with a doctor and specialist nurses. However, teleabortions rely on a doctor providing a referral for the service and relevant pathology such as blood tests and ultrasounds. If their local GP is a ‘conscientious objector’ they may experience deliberate delays or have problems getting a referral.
Running clinics in regional and rural areas can be costly and complex. There is a distinct lack of doctors, anaesthetists and nurses, which means clinical staff often need to be flown in to perform abortions in-clinic. Finding ways to freeze or decrease the cost to regional patients is a challenge but one that we are working to resolve across our regional clinics.
The reality is that rural women lack access to safe affordable contraception and abortion services and this should not be acceptable in one of the world’s wealthiest nations.
Supporting rural women and men to take control of their sexual and reproductive health requires a multi-agency approach. Private providers, GPs and government all have a part to play. But above all, it is vital that there is a central coordinating body to avoid duplication, coordinate services and encourage network collaboration.
For many years the concept of a Rural Health Commissioner has been discussed at a federal level. While it is heartening to see some progress on this, there is a lot of ground to cover in order to redress the disparity between the health of metropolitan and rural communities.
• A national reproductive and sexual health strategy backed by funding that targets training for rural GPs and nurses, more consistent funding to ensure clinics are viable in regional and remote areas and patients have access to financial support for travel and accommodation should they require clinical care
• Federal government leadership backed by nationwide research to best direct funds for the benefit of women in rural and remote communities
• Coordination of funding to tie together public and private sexual and reproductive health services
• More investment in e-health and telehealth including improving internet access for telehealth services such as teleabortion.
Over the past week and part of this week, rural health professionals have been meeting in Cairns to address many of these issues. And while it is commonly acknowledged that addressing the health outcomes gap between metropolitan and rural communities can be complex, it is not impossible. It requires a national approach and national commitment so that Australians like Sarah can take control of their health.
Michelle Thompson is CEO of Marie Stopes Australia.
*Not her real name