Public hospitals ‘not transparent’ with abortion referral criteria, doctors say

"GPs need transparent information on abortion options", says Dr Heather McNamee

Public hospitals present themselves as last-resort options for abortion, using restrictive or hidden referral criteria to push patients into the private sector,

GP researchers say.

Their study of the HealthPathways referral network found that two-thirds of public abortion services listed either warned GPs to prioritise private

providers or spelled out restrictive criteria for accepting patients.

These included “medical or obstetrically complex patients only” or “fetal abnormality or fetal death in utero only”.

Out of the 17 HealthPathways in the study, five did not list any public abortion services.

While 11 listed public medical abortion services and nine listed public surgical abortion services, several warned GPs they “should” refer to private providers instead.

Others said public appointments were “limited … for women with complex health needs and no ability to have a termination in the private sector”.

The Monash University researchers, including Professor Danielle Mazza, concluded there was “inadequate information to support GPs in referring women to abortion services when they need them”. “Approximately two-thirds of available public services listed additional warnings around accessibility, suggesting public services should be considered only as a last resort,” they added.

Dr Heather McNamee, a GP with a special interest in sexual health, told Australian Doctor that, while her local hospital in Cairns had a public abortion service, it was “very unusual”.

“There are places in Queensland where, even if you failed your medical termination, you cannot get a public surgical termination,” she said. “The drugs used for medical abortion damage the fetus, so in that situation, it will be at risk of significant abnormalities. “Despite that, there are hospitals in Queensland that refuse to offer surgical abortion in that situation.”

Given gestational limits, GPs needed clear information on their patients’ options to move quickly, she said. “You need to know the criteria to refer patients because otherwise you’re wasting the system’s time and the patient’s time making a referral.”

She added that the cost of an abortion and related procedures in the private sector could be prohibitive for women, such as privately billed ultrasounds, which alone could cost around $150. “You can’t access an abortion in Australia without an ultrasound,” Dr McNamee explained. “But now, one of our local radiology practices has stopped bulk-billing, so some women can’t afford the ultrasound.

“The more remote and rural you are, the less chance you’re going to get a free one.

“The other day, we saw a woman from a rural area and bumped up the local X-ray place, and they said, ‘The next scan is in three weeks.’ “That is going to push her over the limit for medical abortion, and she can’t afford a surgical abortion.”

To deal with out-of-pocket costs, she said her clinic had limited STI screening to high-risk women and minimised blood tests unless clearly necessary. “We’ve really brought it down to the simplest process to try to make it as cheap and convenient as it can be.”

Republished with approval from Australian Doctor (AUSDOC)