With some WA doctors refusing to provide referrals for women seeking abortions, Curtin University researcher Meagan Roberts argues what needs to change.
The recent US Supreme Court ruling to overturn Roe vs Wade is an important opportunity to reflect on the current status of abortion laws and reproductive rights here in Australia.
Numerous barriers to abortion access still remain and there is wide variability in the way it is regulated nationwide. Recent advocacy efforts are being made to protect the legal and reproductive rights of all people in Australia.
One critical barrier commonly faced is difficulty obtaining a referral for the procedure. This process of ‘referral denial’ was explored in a recent study in WA.
GPs and other health professionals play a fundamental role in providing support during what can be a challenging time to ensure patients make safe and informed decisions. The denial of sexual and reproductive health care by health professionals has been dubbed by some as a worrisome and growing global trend.
Often termed conscientious objection, this issue refers to the refusal of services such as provision of the emergency contraceptive pill, sterilisation, infertility treatments and termination of pregnancy due to ethical, religious or other beliefs. Despite occurring in other areas of reproductive health care, conscientious objection appears most prevalent in the refusal to provide or refer for abortion services.
Current WA law
Policies and legislation governing access to termination of pregnancy services vary across states and territories. This “postcode lottery” means that abortion is still not a guaranteed right for women, and is dependent on where they live.
WA operates under slightly different legislation whereby a referral from a medical practitioner is needed for a person to be eligible for a termination. This means that two separate doctors need to be involved in the process – a referring doctor and a termination provider.
Timely and efficient access to termination services in WA is also dependent on the capacity of an individual GP or health service to meet patient needs, and the existence of effective referral pathways.
Technically, GPs in WA have no legal obligation to participate in a consultation or provide referrals for termination services. Several international studies have reported the incidence and impact of termination service and referral denial. However, there is a lack of evidence in a local context.
Referral denial exists
A recent study exploring the impact and experiences of termination referral denial from the perspective of service providers in WA found that it exists and can have profound impacts on both clients and staff.
Participants in this study were staff employed at a clinic offering medical or surgical termination services. All participants reported that at some point in their current place of employment, clients had reported to them that they had been denied a referral for a termination by a GP. This includes reports of clients “doctor shopping” where they were seeing multiple GPs before finding one who would provide a referral.
This finding is congruent with findings from a NSW study, where one participant reported visiting five different GPs before obtaining a referral.
Staff perspective
Staff working at termination clinics in Perth spoke about the impact they saw termination referral denial had on their clients, and how the process of attempting to obtain a referral would often leave clients feelings distressed when they finally reached their clinic and spoke about their experiences.
“Sometimes a girl will say to me, I found it so difficult. She’s come with her referral, but she’ll say, ‘I found it so difficult, I had two or three doctors completely refuse to give me a referral.”
Staff said this denial could add to the trauma of an already difficult and physical and emotional situation. Several staff members felt angry and frustrated by their clients’ experiences, speaking passionately about abortion being an essential health service – access to which should not be denied by anyone.
This view is shared by those advocating for reproductive rights in Australia following the overturning of Roe vs Wade and the threat of a rise in negative public attitudes labelling abortion as “bad”.
This study shows that termination referral denial limits the capacity of the health system in WA to provide accessible abortion services. The two doctor sign-off for an abortion has also been cited as being unnecessary from a medical perspective.
WA reform
With legislative reform being a long-term advocacy goal, the recommendations from this study seek to minimise the potential negative impact and experiences of WA abortion legislation and conscientious objection.
Recommendations include:
- Advocate for mandatory ‘on referral’ policies that require GPs who are conscientious objectors to be legally obligated to on-refer patients to an alternative GP or service. This law currently exists in Victoria, by requiring any objecting GP to refer the client to a health professional who does not have any conscientious objections to termination
- Provide a publicly available list of termination referral options to assist in facilitating accessible patient pathways
- Promote comprehensive GP and community education on abortion procedures and legislation
- Encourage more GPs to become prescribers of medical termination of pregnancy, as only 10% of Australian GPs are registered as providers.
ED: Meagan Roberts is a research assistant at the Curtin School of Population Health, and Dr Jacqui Hendriks is a contributing author.