A view from Australia: How the country is dealing with evolving abortion care
A team of researchers from the University of Sydney School of Rural Health provide answers.
All around the world, countries have grappled with a shift in how abortion care is provided. Telehealth, combined with medication options, has changed the predominant way women end unwanted pregnancies. Lawmakers have struggled to keep up. In Australia, the major issue is the lack of abortion access in rural areas, much like the United States. It’s not as divisive an issue in the country. I spoke with Dr. Anna Noonan, a research fellow at the University of Sydney School of Rural Health. She and a team of experts compiled answers to questions I sent them via email.
First, how many abortion clinics are there in Australia?
The abortion provision environment in Australia is a quite different to the USA. In some states and territories, publicly funded hospitals provide abortion care; both abortion medication and surgical abortion. In other places, the only options are the few independent or private abortion clinics who do the same, at cost to the abortion-seeker. The estimated number of independent and/or public hospital abortion clinics (some able to provide both procedural and medication abortion, some only the latter) is between 65-70 nationwide. This is for a national population of approx. 26.5 million people, covering a geographic mass only a tiny bit smaller than the United States. All family physicians (called General Practitioners here) are able to prescribe abortion medication, and telehealth options are also available if you meet certain criteria. However only 10% of the GP workforce are known prescribers. Unlike the USA, there is only one abortion pill product called MS 2 Step approved for distribution in Australia.
Can you talk a little bit about the laws there? How did they develop? When did it become legal to get abortions? What is the history of the law’s evolution?
Each state and territory in Australia have their own laws about abortion provision, with different timelines and campaigns to remove abortion from the criminal code. The last state to remove abortion from their criminal legislation/code was Western Australia in March this year. Unlike Canada, where decriminalisation of abortion removed it from legislation all together, each state and territory in Australia now have laws that determine/restrict which healthcare providers can provide abortion care and under what conditions / gestation limits. In recent times we have seen various attempts to reintroduce more restrictive “Trumpian” legislation, and election promises from some farright conservative political parties to re-criminalise abortion if elected. However, both sides of Federal politics in Australia have stated they take a pro-abortion position.
Is there a staunch antiabortion movement there? Where does it get its funding?
While there are certainly occasional loud voices in the anti-abortion movement in Australia, we do not have the same culture of public anti-abortion sentiment as in the USA and elsewhere. You do come across the odd health clinic that operates as an antiabortion “pregnancy crisis centre” but thankfully not in the same organised and pervasive ways as in the United States. National headlines over the past week have revealed however that there is significant obstruction to provision of abortion care within the public health system itself, with several regional city hospitals in the state of New South Wales reported to have “banned” abortion care within their services. This is more the way in which anti-abortion sentiment appears to exist in Australia – sometimes aggressive but largely passive obstruction within the health system – i.e. doctors / hospitals refusing to provide care or fulfil their responsibilities to refer an abortion-seeker to another available service in a timely fashion.
Where is abortion the least accessible in Australia?
Most abortion services are located in urban centres and generally on the coast, where the majority of the Australian population resides. A third of the population live in regional, rural and remote Australia where all health services are limited, and none morseo than abortion care. Telehealth services for abortion medication in Australia are also excluded for people who do not live within 2 hrs of “emergency care” – which is most remote locations in Australia. Other populations including people who are experiencing incarceration, people who do not have financial or other material resources pay for or travel to access care, and people who do not have access to Australia’s universal public health insurance scheme Medicare (i.e. people seeking asylum, international students, tourists), also have diminished access to abortion services.
Are there abortion funds that seek to help rural women get abortions?
Some independent abortion clinics in Australia seek donations/funds to enable people to access the services their clinic/organisation provides. My understanding is that these funds usually cover the cost of services the organisation itself provides and sometimes some additional travel support to the person seeking abortion care. Again, these clinics are largely located in urban centres, so the cost to access care for rural women is incredibly high, requiring extensive travel (i.e. sometimes a number of days of travel before reaching a clinic), time off work and other life commitments, organisation of replacement care options for those with carer responsibilities, as well as accommodation and incidentals while travelling. There have been repeated calls by abortion advocacy groups in Australia for the Australian Federal Government to establish a National Abortion Fund. This is yet to materialise.
What are the politics surrounding abortion like in the Australian government? Who supports access, and who opposes it?
The current Federal Labor government promised free public abortion care in Australia as part of its failed 2019 election campaign (when in opposition). More contemporary messages from the Government are that abortion care is a “matters for the states” – however other smaller political parties such as The Greens have promised to include abortion care as part of their 2025 election campaign platform. The other major political party – the Liberal party – is known to be more conservative than the Labor party, but its leader recently stated that if elected to government, his party would not be seeking to run an anti-abortion political agenda. The current Federal Labor Government is 12 months overdue in providing its response to recommendations from a national inquiry into universal access to reproductive healthcare. Seven of the 32 recommendations from this inquiry specifically relate to abortion care provision. This silence is inferred by the abortion activism community in Australia as another method of passive obstruction – avoidance.
How has medication abortion been treated in Australia? Do the laws there permit telehealth? Has that helped alleviate some of the issues with access in some of the more remote parts of Australia?
Medication abortion was approved by our Therapeutic Goods Administration (FDA equivalent) in 2012, and listed on the Federal Government’s subsidised pharmaceutical list in 2013. The single approved product – a combi pack of 1 mifepristone and 4 misoprostol – is approved for pregnancies up to 9 weeks gestation (i.e. lower than the WHO-recommended 14 weeks). After this time, an abortion-seeker would need to access surgical services. Having only one abortion pill product in Australia is problematic for a number of reasons, including supply as well as a monopoly on pricing for telehealth abortion services upwards of AUD $270 (equiv USD 180), excluding additional costly requirements such as ultrasound services, and other related costs. Note, abortion-seekers are required to pay the full amount before receiving a rebate from the Medicare system – a cost that is prohibitive for many people. [ see above re telehealth services]
Can you talk a little bit about your study that was published last year about abortion access? What were its key findings?
My research looks specifically at the experiences of rural abortion seekers and rural primary care health workforce in navigating a sometimes hostile health system to access or provide abortion. For abortion-seekers in rural NSW, the pathway to abortion care is fragmented and opaque, with scarce local abortion service options (including GPs prescribing medications) and the few willing healthcare providers often booked up/unavailable until after 9 weeks gestation, meaning the abortion-seeker has no other legal option other than to travel large distances to a surgical abortion service. Interestingly, local healthcare providers also spoke of difficulties working within the health system to support rural abortion seekers; that they too were only able to locate willing providers, that those who do provide abortion care needed to do so in secret (making them harder to find), and there was significant obstruction within the health system itself, including hospital executive or other healthcare providers actively discouraging them to provide this service, or denying their patients follow up care if required. As we have seen in the past few weeks in rural NSW, there is strong community sentiment rising that abortion care should be provided in every public hospital across the country, and any attempts to prevent, dent or ban abortion care by rural hospitals in particular (often the only service for 100s of kms) is under close scrutiny. Rural people expect these services to be available to them locally, and are outraged that covert bans and lack of a more sophisticated service provision policy is in place.
What about this podcast? What is its goal, and what does it do? How was it conceived?
This project emerged from a Research Impact Accelerator that united academics across multiple disciplines to examine abortion access in depth. Our research suggested that since abortion is legal across Australia, many take this right for granted without recognising ongoing barriers to access. The podcast uses storytelling to illuminate how access to abortion services remains deeply uneven, often determined by an individual's financial resources and geographic location. Through carefully crafted narratives and expert insights from our multidisciplinary team - spanning regional NSW and Sydney - we explore both systemic barriers and potential solutions. By sharing these stories and research findings, we aim to foster deeper understanding of the complexities surrounding abortion access and inspire meaningful change. Our goal is to engage listeners not just as passive audiences, but as potential advocates and change-makers who can help build more equitable healthcare systems.
What kind of policy changes do you support happening in Australia to improve reproductive care and advance reproductive rights?
There are a number of policy changes that would advance abortion access in Australia in all states and territories:
A nationwide (Federal) mandate that all public hospitals (funded by Australian tax payers) be required to provide free and public abortion care.
Expansion of healthcare workforce permitted to provide abortion care including nurses, midwives and Aboriginal health workers
Expansion of the number of abortion pill products on the Australian market, and removal of any legislative or regulatory barriers to Australia-based abortion seekers obtaining services from established international online pill providers
Following its success in Canada, the full removal of abortion from all state/territory and Federal legislation to allow abortion service provision to be determined by evidence-based clinical best practice and WHO recommendations, not by politics
Is there anything else you want to say about the state of abortion care in Australia?
We are shortly planning to release a new study and interactive data visualisation tool that maps “abortion deserts” in the state of New South Wales. Abortion desert is a term coined by USA academic Alice Cartwright where the nearest abortion service is more than 100miles (160kms) from where you live. We are often inspired by the work of activists, advocates, academics and journalists working in the USA who are constantly raising the importance of abortion access as key to reproductive rights. While we are certainly not experiencing the same anti-abortion pressures, we are always aware that our pendulum could swing at any time.
Here are my studies and some recent media coverage:
Publications:
2024
RRH: Rural and Remote Health article:
What women want from local primary care services for unintended pregnancy in rural Australia: a qualitative study from rural New South Wales
2023
Sexual and Reproductive Health Matters
“Almost like it was really underground”: a qualitative study of women’s experiences locating services for unintended pregnancy in a rural Australian health system
Australian Journal of Primary Health
What women want from local primary care services for unintended pregnancy in rural Australia: a qualitative study from rural New South Wales
Recent media:
Sydney Morning Herald: Abortion care limited for women in rural areas
Radio National interview: Concerns of 'unspoken ban' in abortion care in regional Australia - ABC