Decriminalisation is Not Enough: Addressing abortion access for rural and regional Australians
Abortion may be legal across Australia, but that doesn’t mean it’s equally accessible. In rural and regional communities, barriers like distance, stigma, and cost still stand in the way of timely, safe abortion care. In this piece, PhD Candidate Brooklyn Donnelly (@brooklyndonnelly.bsky.social) from the University of Tasmania explores how a patient-centred framework can help us better understand the hidden challenges rural Australians face and what needs to change to ensure equitable access for all.
Abortion in Australia
Abortion is currently decriminalised in all states and territories of Australia, effectively eradicating the primary barrier to abortion in Australia. Despite this, abortion access remains so uneven that it has frequently been labelled a ‘postcode lottery’. Rural and regional women are disproportionately the losers of this so-called lottery. This is magnified by the socio-economic disadvantage rural and regional Australians face. Rural and regional Australians are frequently poorer, have higher rates of unemployment, poorer health outcomes, and lower levels of education.
Decriminalising abortion is not enough to grant timely, affordable and safe abortions to the rural and regional women and people who need them. Increasingly abortion access in rural and regional Australia must take a holistic approach, incorporating a social understanding of abortion accessibility.
Defining Access
In 2013, Jean-Frederic Levesque, Mark F Harris and Grant Russell developed a patient-centred framework for conceptualising healthcare access. The framework of access is unique as it factors in the socio-economic determinants of populations into the accessibility of healthcare services. At the centre of their framework are five dimensions of accessibility: approachability, acceptability, availability and accommodation, affordability, and appropriateness. Alongside these dimensions are five corresponding abilities that a population must have in order to generate access. These are: ability to perceive, ability to seek, ability to reach, ability to pay, and ability to engage. This framework can be applied to abortion access to understand the social and economic barriers rural and regional Australians are facing.
What Needs to Change?
By applying Levesque and colleague’s framework the social factors restricting abortion access for rural Australians become evident. Subsequently, the areas of change also become evident.
Approachability: A low level of education and knowledge surrounding abortion has implications for one’s knowledge of the legality of abortion, where to get one, what happens during the procedure, and more. Thus, lower levels of educational obtainment, alongside poor health literacy, has an impact on the rural and regional population’s ability to perceive and consequently, the approachability of services.
Acceptability: Rural communities are more susceptible to the impacts of stigma. Abortion remains highly stigmatised and the increased susceptibility of rural communities to the effects of stigma can inhibit their ability to seek and subsequently, the acceptability of services.
Availability and Accommodation: The geographic isolation of rural and regional communities coupled with the scarcity of abortion providers has evidently huge implications for the ability of the population to reach abortion providers. Rural and regional abortion seekers are frequently forced to travel, sometimes for hours, outside their communities just to obtain an abortion. This impedes on the ability to reach and thus, the availability and accommodation of services.
Affordability: Rural and regional Australia tends to have a higher concentration of social and economic disadvantage compared to metropolitan Australia. This impacts the population’s ability to pay and the affordability dimension of access. This is made worse by the lack of choice in abortion providers that might see them forced to access abortion through a private provider, incurring the full costs.
Appropriateness: It has been established that there is a lack of abortion providers in rural and regional Australia. This limited number of providers leaves regional and rural abortion seekers unempowered to make the choices that best suit them, whether that be the decision to have an abortion, which type of abortion to have (surgical or medical), with which practitioner and at which clinic. Rural and regional Australians thus have their ability to engage restricted by the lack of appropriate services to meet their needs.
Future Research
Evidently, by using the framework set out by Levesque and colleagues, it is possible to see the various ways in which abortion access for rural and regional Australians is still a major work in progress, despite having been decriminalised across all states and territories.
This is why my PhD research intends to delve into the lived experiences of rural Australian women and people who have had an abortion. By growing our knowledge of the unique experiences of rural and regional Australians, we can build more appropriate and accessible policy systems that support everyone to have equal access to abortion services.
Moderator: Molly Saunders