Travel restrictions and isolation requirements due to Covid-19 have left doctors unable to fly interstate to perform later gestation abortions, prompting anurgent call for assistance.
The travel restrictions had especially affected a later gestation clinic in Victoria, which provides services to women whose lives may be at risk by continuing with the pregnancy or in cases of severe foetal abnormalities, according to the national not-for-profit sexual and reproductive health organisation Marie Stopes.
Marie Stopes Australia’s director of policy, Jacquie O’Brien, said doctors for this clinic were based in South Australia and flew to Victoria.
“Unfortunately they are not able to any more, due to restrictions on the South Australian side, as they would need to quarantine for 14 days,” O’Brien said. “So, we have decreased the gestation limit from 24 weeks to 20 weeks.”
The doctors can not afford to quarantine when they get back to South Australia as they also provide services in their home state. They are trained provide the service up to 24 weeks’ gestation. There are very limited numbers of specialised doctors who can provide these terminations, making it hard for clinics to fill the gap with other staff.
“What this has meant is that at least three clients were impacted last week who were travelling from interstate.” O’Brien said. “If women can’t access a termination, they are likely to continue the pregnancy. This can be very difficult, particularly if there is a foetal anomaly diagnosis.”
In Australia, abortion is largely classified to be an elective or semi-elective procedure. While non-urgent elective surgeries have been cancelled to increase capacity for Covid-19 patients, critical gynaecological procedures, including abortion, are classified as essential and urgent. But there are other challenges to access.
On Monday Marie Stopes Australia published a situation report calling for urgent assistance from the federal, state and territory governments, professional associations and hospitals to support abortion access. Where possible, doctors and patients should be able to travel to deliver and access surgical abortion care, the report says.
“Doctors should be exempt from mandatory isolation providing they do not have a diagnosis or symptoms of the Covid-19 virus, or a history of high-risk exposure,” the report says. “Governments should consider fully funding all patients who choose abortion, particularly those with health care cards and those with or without Medicare access who are experiencing financial hardship.”
Women in Western Australia who are beyond 20 weeks’ gestation are not able to access a termination, unless it has been approved by the medical panel set up as part of the WA legislation. New South Wales and Queensland have gestation limits of 22 weeks, after which it becomes much more complex to access the service in their home states. Abortion is largely inaccessible in many regional, rural and remote areas of Australia, making travel essential.
Medical abortion through taking the drug mifepristone, known as RU486, is only provided up to 63 days’ gestation, after which surgical termination is the only safe option. South Australia is the only jurisdiction that cannot access medical abortion via telehealth, as the first dose of mifepristone is required to be given in a clinical setting. Marie Stopes has called for the telehealth provision to be urgently extended to SA.
Mifepristone should be prescribed up to 10 weeks’ gestation during the pandemic, the report recommends, and covered by the pharmaceutical benefits scheme in those cases, as it is for those using it up to nine weeks’ gestation.
The report predicts isolation will cause the rate of sexually transmitted infections, sexual abuse and sexual violence to increase, and pregnancy and sexually transmitted infection testing will be less accessible due to health system pressures.
The president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Dr Vijay Roach, said he welcomed the health minister Greg Hunt’s recognition that surgical abortions were urgent and essential. But Roach said this needed to be extended to the use of telehealth, pharmacy access and outpatient services for counselling, prescribing and the supply of medication for medical abortion.