This Is Why Having Less Money Limits Your Reproductive Choices


“We literally sell tea towels and tote bags to raise money
for abortions.”

Posted on August 21, 2017, 04:53 GMT

“The reality is that for many women who have decided they
want an abortion, it’s still unaffordable and unattainable,”
deputy Labor leader Tanya Plibersek
said in a speech last week.

Plibersek added abortion drug RU486 to Australia’s
Pharmaceutical Benefits Scheme (PBS) in 2013 when she was
health minister.

The medicine was supposed to cost $6 dollars with a health
care card. But the
average price women actually pay for a medical
termination is $560 dollars and can rise to almost $800 in
some parts of the country.

“The reality of the situation is that if you’re a
middle-class woman from a relatively privileged background
living in a capital city, maybe you’ll agonise over the
decision, there will be barriers and stigma around you
getting an abortion, but you’ll probably be able to get one
if you need to,” Plibersek said.

“The legal right to access a termination isn’t much use to a
homeless teenager when the upfront cost of an abortion is
more than $500.”

The cost of, and access to, reproductive health care
varies drastically from state-to-state across Australia.
In some states abortion is free and accessible in hospitals;
in others, women need to stump up hundreds of dollars at
short notice to pay for a termination at a private clinic.

Michelle Thompson, chief executive of Marie Stopes Australia,
the nation’s largest provider of pregnancy termination
services, said sexual and reproductive health, particularly
abortion, was not considered a priority in the nation’s
public health care system.

“Australia has a universal healthcare system,” Thompson told
BuzzFeed News. “Yet when it comes to abortion, the stigma of
the service impacts on service delivery, which impacts on
cost.”

One in three pregnancies in Australia is unintended and

it is estimated that one in five pregnancies is
terminated.

“I do not accept that a medical procedure so prevalent, so
life-changing and so desperately needed by women in our
community, should be marginalised in this way,” Thompson
said.

Stigma limited workforce recruitment, she said, which drove
up the cost of abortion services.

“For instance, if you are a national provider like us, you
often need to fly staff to different areas to deliver a
service.

“It also limits the growth of the workforce because
obstetrics and gynaecology registrars do not have access to
training in the public sector, which means we are not getting
as many new doctors coming into the abortion care field, and
the less doctors you have, the higher cost.”

The fact abortion was not delivered through the public health
system in all states and territories meant private providers
were often the only option for some women.

In Queensland and New South Wales, abortion is still written
into 100-year-old criminal law; in Victoria and Tasmania
abortion is not only legal but women are able to access
clinics without fear of harassment and intimidation by
protesters, thanks to the enactment of “safe access
zones”.

The
patchwork legal situation across the country also
resulted in a financial impact, particularly when it came to
gestational limits, Thompson said.

“The later the gestation, the higher the cost. Women may need
to travel long distances to access the service in a different
state, as there are only a limited number of places and
qualified doctors who can provide second-trimester abortions,
and this certainly has a financial impact.”

Over the past two years
pro-choice counselling service Children by Choice in
Queensland has provided over $225,000 in total to more
than 550 women for abortion and contraception access in the
form of grants, loans and support from other non-profits, and
negotiated discounts from abortion providers.

Children by Choice/Facebook

“All the grants we provide to women for abortion come from
donations and fundraising,” the organisation’s Kate Marsh
told BuzzFeed News.

“We literally sell tea towels and tote bags to raise money
for abortions.

“We’re lucky enough to have some really committed donors who
contribute regularly.”

When the organisation has “run out of other options”,

Marsh calls for donations via the Children by Choice Facebook
page.

“We try not to do it too often, but we’re always overwhelmed
by the strength of the response, and by the beautiful words
of support, from folks who follow us on social media, for the
woman who we’re trying to find money for,” she said.

“Being able to pass those words on … is a really amazing
byproduct of having to crowd fund, and women tell us it makes
them feel very cared for and supported by the strangers
they’ve had to turn to for help.”

Most of the organisation’s financial assistance clients were
able to contribute, on average, 53% of the money needed for
their abortion. Marsh said this came “from their own money,
asking friends and family, getting a no-interest loan from us
that they’ll repay”. The other 47% of the cost was from
“strangers” — grants, discounts from providers and social
media appeals.

Marsh said less than 8% of financial assistance cases (44)
involved financial contributions from the man involved in the
pregnancy.

“You can understand why there’d be no contribution from the
35% or so of cases where the man involved is violent, but
that still leaves a big gap.”

Marsh said abortions aren’t affordable for many women in her
state, where
abortion is still a crime and is only lawful to “prevent
serious danger to the woman’s physical or mental
health”.

“Half the calls our counsellors take or make relate to
financial assistance for abortion, and a quarter are about
our no interest loan scheme for abortion and contraception.

“That doesn’t count the ones who don’t find us, obviously,
and it also doesn’t count the ones who enquire with us and
maybe go some of the way to setting up a no interest loan or
exploring other pathways before they give up because it
becomes too difficult.

“Over 80% of our financial assistance clients already have
children, so making sure they are cared for while she’s
having the termination can involve extra costs.

“Travel to a clinic might be extra petrol money but for
others, it involves flights and accommodation as well,
particularly for those in rural and regional areas of
Queensland.”

One in ten women have to stay overnight in the town they’ve
travelled to for the termination — drastically increasing the
cost, according to a
study published earlier this year in the Australian and
New Zealand Journal of Public Health
.

“The average gestation when they first contact us is over
nine weeks, so that already puts them beyond the point when a
medication abortion is possible, which means they have to get
to Brisbane — or the Gold or Sunshine Coasts — Rockhampton or
Townsville,” Marsh said.

“The travel distances can be huge and so can the costs
associated with it — over 15% of our financial assistance
clients who were outside the southeast corner had to travel
over 600km each way to get to a provider.”

A third of the organisation’s financial assistance clients
were living with violence being perpetrated by the man
involved in the pregnancy.

Gina Rushton/BuzzFeed News

Children by Choice, Queensland.

Over a third of financial assistance clients have mental
health problems.

Housing instability or homelessness, drug and alcohol abuse
and single parenthood (around 40% were single mothers) were
other common factors among clients who needed financial help.

In the cases where poverty was the sole access issue, it was
sometimes more complicated to secure funding.

“They are actually the really tricky cases…when there is
violence involved, for example, we might be able to find a
violence service to help offer some support,” Marsh said.

It was “very rare” to organise a termination for a client
through the public system, she said.

Children by Choice/Supplied

“Even those with catastrophic life circumstances are
generally not able to access a hospital abortion.

“We’ve had clients pregnant after sexual assault, or who were
hospitalised because of domestic violence, refused assessment
for abortion by their public hospital.”

Marsh said most hospitals in the state did not have a “clear
process” for deciding who might be eligible for an abortion,
often taking weeks to determine.

“Meanwhile the gestation of the pregnancy is pushed up, which
makes it more expensive to get a termination privately if the
hospital ends up denying the request,” she said.

“Of the very small number [of abortions] which are done in a
hospital, we’re talking less than 300 statewide in 2015
according to Queensland Health, most of them are done via an
induction of labour, not a surgical procedure.

“For some women, this is just too traumatic, particularly if
they have a history of miscarriage or stillbirth, or if the
pregnancy is a result of sexual assault — even investigating
the public hospital pathway isn’t worthwhile for them.”

If abortion was decriminalised in Queensland the impact would
be “big” for women with less money, Marsh said.

“We’d hope that decriminalisation would lead to more
hospitals feeling comfortable enough in the legal status of
abortion to be able to build clear pathways for access for
women and pregnant people in their area, even if [it was
only] for those experiencing violence, health problems or
financial disadvantage,” she said.

“The other potential impact [of decriminalisation] would be
more GPs providing medication abortion through their
practice, which for women who are early in their pregnancies
could potentially mean they could access a termination closer
to home and at vastly less expense.”

Gina Rushton/BuzzFeed News

Rally to decriminalise abortion in Queensland, 2017.

Queensland mother Marina (not her real name), would never
have been able to afford to terminate her pregnancy had she
not just returned to full-time work when she discovered a
“very much unplanned” pregnancy in 2013.

“I was 39, I had just got back to full-time work after a
painful divorce and my daughter was going to start school the
next year,” she told BuzzFeed News.

“There was no way I could cope with [another child]
physically, emotionally or financially.”

Marina wasn’t sure what the legal status of abortion was in
Queensland, but she had read about a Cairns couple who had
been
charged with procuring an illegal abortion, and wasn’t
sure of her options.

“I had no idea what the situation was with abortion in
Queensland; I wasn’t really sure if it was legal or illegal,”
she said.

She booked into a Marie Stopes Australia clinic and was told
she was at an early enough gestation to have a medical
abortion, for which two drugs are needed, Mifepristone
(RU486) and Misoprostol.

The pills,
which should cost an Australian patient $38.80, as they are
subsidised by the PBS, can cost women in regional areas
upwards of $800.

A national ban on Mifepristone was lifted in 2006, but no
pharmaceutical company successfully applied to import and
distribute it in Australia until 2012.

Telehealth service
the Tabbot Foundation provides medical abortions via post
for around $250, however a web of legal requirements means it
is not available to women in every state or territory, and it
wasn’t available when Marina had her termination.

“I nearly fell off my chair when I heard it would cost me
nearly $700,” Marina said.

“I was so shocked it was $700 just to take two pills. I find
it so scary to think about what would have happened if I was
a student, or not working full-time, or if I didn’t live in
Brisbane.

“It really opened my eyes to how privileged I am.”

Gina Rushton is a breaking news reporter for BuzzFeed News
and is based in Sydney.

Contact Gina Rushton at gina.rushton@buzzfeed.com.


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