Vulnerable pregnant women could lose access to abortion throughout Australia because of increased financial hardship caused by the coronavirus pandemic, reproductive health providers have warned.
A combination of widespread job losses, differing abortion laws around the country, and patchy access to Medicare, could mean more women need financial assistance to terminate unwanted pregnancies or will face carrying their pregnancies to term.
Some providers even fear a return to people attempting unsafe abortions if women cannot afford legal terminations.
Migrants could be worst affected, says the executive director of the Multicultural Centre For Women's Health in Melbourne, Adele Murdolo.
Demand for telehealth medical abortions at Marie Stopes has increased during Australia's coronavirus lockdown. Source: Google Maps
“So many migrant women are facing financial hardship,” she told SBS News.
“They're much more likely to be in casual positions, so many women have lost their jobs. They are also not eligible for any of the support that has been provided by the federal government.”
Temporary visa holders in Australia are excluded from the government’s COVID-19 JobKeeper and JobSeeker payments. Many are also unable to get home due to border closures and the suspension of international flights.
International students at risk
Both Children By Choice, a non-profit in Queensland that advises people on unplanned pregnancy options, and 1800 My Options, a similar service in Victoria, have reported an increase in calls from migrants worried about their ability to pay for abortions.
A medical abortion – in which a patient takes two pills to terminate a pregnancy – costs $6 with a healthcare card, up to $50 with a standard Medicare card, and $350 at full price. It is available for women who are up to nine weeks’ pregnant. The cost is higher for surgical abortions, with prices increasing into the thousands for terminations at later gestations.
“We're talking to a lot of [migrant] women who are crying on the phone, completely unsure how they're going to manage this,” said Carolyn Mogharbel, manager of the 1800 My Options hotline.
“Not only can they not manage an abortion now in terms of the cost, as the gestation increases the cost of abortion increases. And they certainly don't have the means to be able to pay for maternity care if they're unable to get an abortion.”
Ms Murdolo says international students are particularly at risk.
Demand for telehealth medical abortions at Marie Stopes has increased during Australia's coronavirus lockdown. Source: Getty Images
As part of a deed signed between the federal government and private healthcare providers, students must wait 12 months after arriving in Australia before being paid out for pregnancy services, including terminations. They are not eligible for Medicare.
Bupa Australia, one of six insurance providers for international students, waived the 12-month waiting period for terminations and miscarriages last year. Allianz Insurance said students covered by its Essentials policy did not have to wait 12 months for pregnancy payouts, while those on its Standard policy did.
The majority of providers told SBS News they encouraged students with unwanted pregnancies to call their helplines regardless of the waiting period to explore their options.
Lack of choices
One in six women in Australia has had an abortion by their mid-30s, according to research published in the Australia New Zealand Journal of Public Health last year. Women who already have children are also more likely to have an abortion than those who don’t.
Abortion provider Marie Stopes has had to limit some of its late-term abortion services due to COVID-19. Jamal Hakim, the managing director of Marie Stopes Australia said this has already meant some women have had to continue with pregnancies they would otherwise have terminated.
“What we are seeing is an amplified version of the disadvantage that's happening in Australia already, in refugee and migrant populations, in international students and in Aboriginal and Torres Strait Islander populations,” he said.
Abortion was made legal in NSW, the final Australian state to do so, last year, and service providers are monitoring the impact of COVID-19 to make sure the country doesn’t see a return of unsafe abortions.
“We can't have that in a country like Australia where we've got legalised abortion in every state,” said Daile Kelleher, the manager at Children By Choice.
“It would just be a complete, complete disaster if that was one of the outcomes.”
Marie Stopes and Children By Choice offer financial assistance for people who cannot afford to pay full price for terminations, but both organisations have warned their ability to do so will be threatened with the expected increased demand for financial help due to COVID-19.
The federal government has allowed temporary visa holders with work rights - including international students who have been in Australia for more than 12 months - during the crisis.
Last week, Tasmania also announced a $3 million package to support its temporary visa holders. Those in immediate financial hardship are eligible for $250, with a $1,000 payment available for families.
Digital doctor services
Providers are also shifting their services to accommodate women who can’t travel to access abortions due to COVID-19.
Mr Hakim said demand for telehealth medical abortions at Marie Stopes has jumped 25 per cent in the past month.
Public providers are also allowed to provide telehealth procedures via Medicare for six months during the crisis, said GP Amanda Cohn from Gateway Health, a community clinic in Wodonga, Victoria.
But Dr Cohn warns that telehealth abortions are not the solution for everyone – some people, particularly those experiencing domestic violence, do not have a safe and private space in their home in which to talk to the doctor. Others in smaller regional communities could also face stigma from local providers, she said.
“We've had some women come into our clinic and sit in a different room from the nurse and have that appointment via telehealth from within the building,” she said.
Research has shown women with less control over their reproductive health - including due to family violence - are more likely to terminate a pregnancy.
Ms Mogharbel said the 1800 My Options hotline had already noted an increase in reproductive coercion - where women are forced to either continue with or terminate a pregnancy against their will by their partner.
She said the service had also dealt with a small number of cases where women were denied doctors appointments or struggled to access the ultrasound required to obtain a medical abortion in Australia, either in person or via telehealth.
“Some women are finding it really difficult to make an appointment because an ultrasound for the purpose of an abortion is not seen as urgent or essential by some service providers,” she said.
Telehealth abortions are currently illegal in South Australia.
“We are getting calls every day from South Australians asking us for access to our tele-abortion services,” Mr Hakim said. At the moment, Marie Stopes has to deny those requests, but there is potential the ban will be lifted under powers granted by the state’s COVID-19 Emergency Response 2020 Act.
At the time of publishing, Gateway Health had also seen two women who decide to terminate pregnancies they otherwise would have continued with due to financial distress linked to COVID-19, said Ange Davidson, a sexual health nurse at the Wodonga clinic.
Catherine Orr, a Melbourne GP who specialises in sexual and reproductive health and refugee populations, says she has seen fewer women than she’d expect during the pandemic. She is worried particularly refugee women are not accessing essential healthcare due to fear of the police.
“A lot of people are frightened and not coming to the doctor, and that goes across the general Australian population, but I think it’s going to be exacerbated in the refugee population because if the police have told them to stay home, they'll stay home,” she said.
All of the abortion providers spoken to emphasised that termination services are classified as an essential service under COVID-19 restrictions and remain available.
“If you are seeking an abortion, it is safe to do so,” Mr Hakim said.
Information about abortion and a list of services where you can discuss your options are available at . They include:
Megan Clement is an Australian freelance journalist usually based in Paris.
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