Since launching online medical termination service the Tabbot Foundation in September last year he has been forced to closed his Launceston abortion clinic due to its unviability.

But to Dr Hyland, the Tabbot Foundation’s medical director, establishing the world-first service was a matter of necessity.

He said medical abortion was suited to delivery by telehealth because there was no need for a physical examination aside from an ultrasound and blood test.

The seven-step process begins with a phone call to the service’s hotline and ends with a blood test to confirm the pregnancy has been terminated.

Mifepristone and misoprostol, antibiotics, analgesics and anti-emetics drugs are sent to the patient’s home, who is guided through the abortion process by a registered nurse and a 24-hour on-call doctor.

By May this year the Tabbot Foundation had delivered 600 medical abortions at a cost of $250 to each patient. Three out of the 600 were failures while eight were incomplete abortions, eight people attended hospital for excessive bleeding and four went for additional analgesia. The low-risk process has proven 98 per cent effective in early-term termination.

The Tabbot Foundation was first launched in Tasmania and is now moving to become a registered charity to ensure the service is sustained into the future.

“We aren’t making a profit out of this. I’m not too sure we are covering our costs at present because of infrastructure costs,” Dr Hyland said.

“I did it because it had to be done and once it’s done I want to give it away – and the way of giving it away is to make it into a charity. 

“Once it’s a charity we can get donations and benevolent benefactors to contribute to this so we are then able to provide medical terminations throughout all Australia free of charge.”

The Tabbot Foundation’s website averages 120 hits a day, sometimes generates up to 90 calls a day and consults with between 30 and 40 patients each week. The average age of those accessing the service is 30.

Protest against the initiative has proven unsuccessful with none of the 65 submissions to the Therapeutic Goods Administration against the Tabbot Foundation leading to federal intervention.

But its establishment has not been without challenges.

Differing legislation between states and territories initially made it difficult to provide an equal service across the nation. Medication cannot be delivered to women in every region – those in the Australian Capital Territory, for example, must travel to New South Wales to collect the pills.

One surgical termination provider complained the service may undercut their profits so severely it would affect their charity work overseas.

“I had one email (from) one surgical provider who was a business partner of mine saying ‘You must be f—ked in the head to say this’ because it was ruining their business,” Dr Hyland said.

Law states that drugs cannot be advertised and a traditionally conservative medical culture has made it difficult for word to spread.

“It makes it very difficult to educate the population that medical abortion is an alternative, and indeed preferable to surgical abortion,” Dr Hyland said.

“This culture of obstruction exists in all levels of society – medical, nursing, politics, religious, business – and we are trying to break down barriers every day. You can put a billboard on the road saying ‘Don’t have an abortion, you’ll go to hell’, but you can’t have a billboard saying ‘If your pregnancy is unwanted, here are your options’.

But it is difficult, if not impossible, for people on either side of the abortion debate to fully empathise with the position of their opponent.

It depends on who you talk to. Abortion is murder or it is a medical procedure. It is a question of women’s rights or an attack on the rights of a child.

For former state Health Minister Michelle O’Byrne, the woman behind the decriminalisation of abortion in Tasmania in 2013, it was a matter of equality.

Labor’s nation-leading legislation aimed to clear up the language around abortion, remove it from the criminal code, improve access to termination and ensure those who did undergo the procedure were free from harassment.

“I don’t think you can have that conversation without thinking about where sentience takes place. There’s no evidence to show it occurs any earlier than 26 weeks,” Ms O’Byrne said.

“But women aren’t incubators. There’s no point where the rights or needs of the women shouldn’t be paramount.

“If you fundamentally believe women have equality, then everything you do must demonstrate that equality.”

Some of Ms O’Byrne’s staff took stress leave after the legislation passed. Her office was bombarded with fake fetuses and emailed “appallingly graphic” pictures throughout the lengthy debate.

Family Voice Australia state director Jim Collins was heavily involved in lobbying against the legislation but said he did not participate in sending offensive material to those on the other side.

He said the passing of the legislation took a personal toll on him too.

“I’m certainly not one who thinks a woman should be made to feel guilty, but the reality is a life’s been taken and they may have been coerced or not understood the implications,” Mr Collins said.

“One of the points consistently raised during the inquiry was that abortion is just like any other medical procedure. That’s patently not the case.

“When you are passionate about the lives of babies and mothers … it’s a human tragedy.”

Mr Collins said there was a “community groundswell” of people throughout Australia speaking against Tasmania’s laws.

“There’s a significant cohort of people who are deeply disturbed by the precedence Tasmania has set,” he said.

One concern was for protesters’ freedom of speech, Mr Collins said. 

A protest-free 150-metre access zone around abortion clinics was set in place once the laws were passed and one person has been arrested for breaching the perimeter.

Right to Life Australia has urged its members to lobby the Queensland government against amending its laws and used Tasmania’s as an example of what not to do.

Women’s Legal Service chief executive Susan Fahey spoke strongly against suggestions Tasmanian laws impinged on freedom of speech.

“Where the access zone is concerned, anyone who suggests it’s an assault on free speech is speaking absolute rubbish,” she said.

“They can protest outside Parliament, they can protest anywhere, just not outside a clinic. 

“(Protesting outside a clinic is) not a protest against the law, it’s a protest against the person, and it’s done to make that person change their mind.”

But Ms Fahey said it seemed access to surgical abortion had decreased since the 2013 laws passed.

“Access has actually gotten worse because a couple of the clinics have now closed down and the fact we have the Tabbot Foundation tells us access is not as it should be,” she said.

“There are some doctors who say they won’t refer and that is a concern. If that happens the person needs to report it to AHPRA (the Australian Health Practitioner Regulation Agency).”

Women’s Health Tasmania executive officer Glynis Flower agreed access to surgical abortion had not improved in the past three years.

“The legislation is somewhat clearer, and clearing that is a big thing, but the problem is there is almost no option for a service within the government sector,” she said.

“There’s less options in Tasmania, though there are some medical options that weren’t available at the time.”

And Mr Collins said he was aware of some lobbying taking place to alter or overturn the laws, though a government spokeswoman said there was no intention of making any changes.

“There are some doctors who have spoken to the Health Minister who have been concerned particularly about the impact of conscience,” Mr Collins said.

Dr Hyland pointed out one in three women had an abortion in their lifetime.

He will continue to fight for better access to pregnancy termination and said medical termination was the way of the future.

“With government contribution and a benefactor we should be able to make this free of charge,” he said.

“It should be no trouble to get the richest people in Australia to contribute to providing medical termination.

“You don’t do it for money. I’m retired, I don’t need this. I wanted to put this in place and leave it in perpetuity for Australia.”

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