Public hospitals play a crucial role in healthcare, but the issue of whether they should be able to "opt out" of providing abortions has been a topic of much debate. According to Greens MP Dr Amanda Cohn, despite abortion being decriminalized in New South Wales five years ago, "far too little has changed." Her comments came in response to data showing that only three public hospitals in the state provide surgical abortion outside of emergencies, leaving many areas as "abortion deserts."

Ensuring Accessible Abortion Care in Public Hospitals

Why Abortion is Healthcare

Abortion is an essential aspect of healthcare that should not be denied to those who need it. Just as public hospitals provide care for patients with diabetes or those requiring knee replacements, they should also be obligated to offer abortion services. It is a fundamental right that should be accessible to all. Dr Amanda Cohn emphasizes this point, stating that "abortion is healthcare – it’s not something hospitals with public funding and the capability to provide abortion should be able to opt out of." This highlights the importance of comprehensive healthcare services within public hospitals.

Clinicians in public hospitals are doing their best to provide abortion care, but the lack of clear information and communication about available services adds to patients' distress. When Guardian Australia asked 15 local health districts about which public hospitals provide abortion and under what circumstances, none responded. This lack of transparency makes it difficult for patients to access the care they need in a timely manner.

The Need for Change

Decriminalizing abortion in NSW five years ago was a significant step, but as Dr Amanda Cohn points out, "since then far too little has changed." People still travel from across western NSW to Wodonga in Victoria to access care, indicating that there is a gap in local services. The current situation where only a few public hospitals provide abortion outside of emergencies is unacceptable and needs to be addressed.

Cohn has given notice of a bill that would allow nurse practitioners and midwives with appropriate training to prescribe medical abortion. This is an important step towards expanding access to abortion care. She has also called on the NSW government to fund abortion care in all public hospitals that provide reproductive health services. This would ensure that patients have access to the necessary care regardless of their location.

The Role of Politicians and Health Leaders

Politicians and health leaders have a responsibility to ensure that abortion services are available and accessible. However, in NSW, there is a lack of information and response to simple queries. The NSW premier, Chris Minns, did not respond to questions about funding of abortion care and the lack of information provided by health districts. This lack of action implies that the health system and its decision-makers are contributing to the inaccessibility of abortion care.

Dr Madeleine Belfrage from the University of Sydney's Social Sciences and Humanities Advanced Research Centre emphasizes that decriminalization is only part of the solution. "We are yet to see the necessary changes in the health system to ensure that abortion is provided as routine healthcare," she says. This highlights the need for systemic changes to ensure that abortion is integrated into the healthcare system.

The Importance of Transparency

Sue Shilbury from Family Planning Australia points out that NSW "does lag behind other states in providing access to abortion services in the public health setting." One of the key issues is the lack of data published by NSW Health about abortion services. Publishing this data would lead to greater transparency around demand and provision of services. Additionally, legislation needs to change to allow for nurse prescribing of medical abortion and services need to be expanded beyond just hospital settings.

For example, John Hunter hospital in Newcastle and the Royal Women’s hospital in Sydney provide surgical abortion, but only for women in their local catchment area. There needs to be greater clarity about the role that regional-based hospitals play in providing access to abortion services and more clearly delineated pathways for women. It should be easy for women to know exactly what and where their options are at different stages of gestation.