Women's access to abortion after 20 weeks' gestation for fetal chromosomal abnormalities: Views and experiences of doctors in New South Wales and Queensland

Abstract

Ethics committee involvement for late-term abortions is required by state health policy in NSW and Queensland, where abortion is still a criminal offence. This process is seen by abortion providers to hinder timely access to services and excludes women from the decision-making process.

Intended and unintended consequences of abortion law reform: perspectives of abortion experts in Victoria, Australia

“…While Victorian law now offers a clear and simple legal framework for providing abortions up to 24 weeks, this research suggests that other barriers continue to limit provision even in situations where the legal criteria could be met. Barriers could include hospital policies that result in limited access12 or a lack of services willing to offer this procedure due to the added complexity, cost and fear of legal consequences 12 23. This is perhaps unsurprising given that historically, abortions performed after 20 weeks have been the subject of tense ethical, medical, political and social debate in Australia and internationally.…”

“…The Abortion Law Reform Act 200810 renders abortion provided by registered health practitioners (defined in the Act) a matter for health regulation, like other health care, removing criminal sanctions from women seeking abortion and qualified health practitioners providing it. While legal status alone does not imply accessible services, there is evidence that the legal status of abortion does affect the practice of doctors and their willingness to provide abortion services 11 12. Legal status is also assumed to contribute to women's experience of stigma, and the associated negative psychological outcomes 13 14.…”

“…According to Black and colleagues, many of the abortions conducted after 20 weeks in New South Wales and Queensland are performed following prenatal genetic testing for fetal abnormalities 12. Their qualitative research with abortion providers in these two states has shown that in practice, access to abortions after 20 weeks in public hospitals may be delayed at least in part because of the requirement to involve an ethics committee.…”

Medical abortion is fundamental to women's health care

“…Australian research has consistently indicated that 70–80% of the public support a woman's right to access abortion and believe it should be lawful . Practitioners report that the current complex and varied legal status of abortion across Australia has a significant impact on service provision and compromises patient care …”

Confusion, inequity and inconsistency: Abortion in Australia

“…Although several states and territories have modified abortion legislation in recent decades, New South Wales and Queensland have not done so, resulting in the potential for abortion access difficulty and legal confusion . Even for those jurisdictions where legislation has been altered, there is substantial variation in abortion provision, particularly for the more advanced gestation cases . Although terminations of pregnancy beyond 20‐weeks' gestation comprise <1% of abortions, they may be ethically challenging and generate a diverse range of opinions in communities.…”