Access to abortion care in Tasmania is "inconsistent and inequitable", a soon-to-be-released research paper has found, with the quality of care received by patients largely dependent on luck.
Researcher Kathryn LaRoche from Macquarie University said that some Tasmanian patients are still flying to Melbourne to access abortion services rather than navigating Tasmania's labyrinthine system.
Ms LaRoche interviewed 20 Tasmanian residents who had obtained at least one abortion since 2010, and12 key stakeholders including abortion providers, as a PhD study. Her paper is undergoing the peer review process before publication.
She found that patients had highly varied experiences that were dependent on the attitude and competence of their first point of contact - usually a GP. It found the lack of a clear referral pathway to an abortion was giving undue influence to "gatekeepers" within the healthcare system, who at times were judgmental or obstructionist.
That was the experience of Georgia Ingall - who was interviewed by The Examiner not Ms LaRoche - a Hobart woman who navigated the abortion system in 2015.
After taking a pregnancy test Ms Ingall went immediately to an after-hours doctors surgery. There she requested information on a medical abortion - a pill that triggers a miscarriage - which has been legal and available since 2013.
However, the doctor told her a medical abortion did not exist, she said. Instead, he gave her a pamphlet and the address of a clinic which, it turned out, had closed: the Fertility Control Clinic.
"He signed a form for my referral and said, 'go there tomorrow'," she said.
"I got up really early because I couldn't really deal with what was happening in my body. So I went there, to the Fertility Control Clinic in Moonah with my piece of paper, and I couldn't find it. I was knocking on all these doors, looking for this number - and it actually just didn't exist.
"I'm a bit scattered, I'm talking to people in cafes that were at the address where this clinic was supposed to be. And eventually one of them took me aside and said, 'I think I know what you're looking for, and that hasn't been open for two years'. That didn't help my feelings, because it was like, 'Why is a doctor referring me to a place that doesn't exist?' It was so stressful."
Her sister found the number of a respected gynecologist, but he required a referral. So they went to another GP. There, they encountered another set of problems.
"He knew that it was for a termination, but he persisted in trying to persuade me to have a kid," Ms Ingall said. "He was talking to me about, when did I lose my virginity? And measuring me.
"He was saying to me, 'You'd make a great mother, you're young and healthy'. It didn't make me feel very good."
Eventually she was able to convince him to sign the referral, and received professional, timely care from the gynecologist - but at a cost of over $1000.
A clinic in Hobart was open at the time, but it was not able to schedule an appointment for her in the time period she was able to have an abortion.
Tasmania used to have three dedicated abortion clinics, but all three have closed. Some private providers in Hobart are providing surgical abortions but these providers are not publicly known, and require a referral from a GP or the Women's Health Centre Tasmania, Family Planning Tasmania, the Link Youth Health Services or St Paul Youth Services.
Ms LaRoche said it was not clear to the average woman how an abortion could be accessed.
"You technically can get an abortion in Tasmania, although there has been a perception that you can not get an abortion in Tasmania at all," she said.
"People have been having vastly different experiences depending on who their first point of contact was. So if they went to a GP who was knowledgeable, or had information, then people were able to obtain care and get financial help.
"But a lot of the time people's first point of contact - at best they were uninformed and at worst they were shaming, stigmatising, and judgmental."
She added that the further a patient was from Hobart, the more significant the barriers to accessing an abortion.
"I was hearing a lot that at certain times of year it's actually cheaper to fly to Melbourne than to go to Hobart [from the North-West]," she said.
"In Melbourne you can access the services a lot quicker, the wait times are shorter, and you're guaranteed an appointment - it was a more feasible logistical option in a lot of cases."
Ms LaRoche's recommendations are for the state government to: provide both abortion seekers and GPs with more information; ensure information is shared with the general public and not just clinicians; develop an information hub for abortion seekers; create a clear referral pathway for abortion care; and ensure that there is at least one service for which abortion seekers are able to self-refer.
She also found that there are "appears to be broad support for the integration of abortion care into the public hospital system", from both women undergoing the procedure, and from health care workers in the sector.
In response to questions asking if the government would implement the recommendations, a spokesperson said, "The government remains committed to ensuring Tasmanian women are able to access the full range of women's health services."
"Low cost surgical terminations continue to be available in Tasmania, having been provided since 2018 through local specialists. Anybody needing to travel to access these services is able to be supported through the Patient Travel Assistance Scheme," they said.
"Women seeking information about their health care options and support, including if they need to access a surgical termination service, are encouraged to speak with their GP or the prescribed health services.
"These organisations offer free information, advice and counselling about the full range of pregnancy and women's health options, and play an important role in supporting Tasmanian women."
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