(Image: Private Media)

This is the third in a three-part series examining how Marie Stopes became the leading provider of abortion services in Australia, the sole provider of RU-486, concerns about its dominance, and what the future holds. Read the rest of the series here.

Australia is moving to make access to sexual and reproductive health universal by 2030, including abortion services in the public health system in line with the National Women’s Health Strategy.

Women have been reliant on costly private clinics for decades, with many hospitals only stepping up to provide services once these clinics close — usually due to lack of funding.

There’s a lot to do before abortion access is universal, but once it becomes integrated, it’s not clear what the future holds for private clinics and Australia’s largest abortion provider Marie Stopes. 

The National Women’s Health Strategy 

The National Women’s Health Strategy states federal and state governments will “work towards universal access to sexual and reproductive health information, treatment and services that offer options to women to empower choice and control in decision-making about their bodies, including contraception and options for addressing unplanned pregnancies, including access to termination services”. 

Currently, some states, such as South Australia, offer abortions in public hospitals while others, such as NSW, require women to go to private clinics or a single state-run clinic in Sydney.

Other states have been forced to add abortion services to public hospital systems after private clinics closed down: in 2021 Marie Stopes International (MSI) Australia was forced to close clinics in Townsville, Rockhampton, Southport and Newcastle due to a lack of funding. As of last week, abortion services were made available at Rockhampton Hospital. Four years after the last private abortion clinic closed in Hobart, abortion services were finally made available across three public hospitals in Tasmania in 2021.

But Professor Danielle Mazza, chair of general practice at Monash University and a leader in women’s health, told Crikey there was a lot of work to be done before abortion services could be considered universally accessible. 

“It’s a question of us having the workforce to actually support it … and we need to provide a lot more specific direction and support in training [medical staff],” she said. The Royal Australian College of General Practitioners is currently examining these issues and attempting to integrate abortion services training into the curriculum. 

A huge issue is the number of registered prescribers of the medical abortion drug mifepristone: the drug is more heavily regulated than others with comparable safety and efficacy data, and doctors and pharmacists have to undergo an online training course, run for free by MSI Australia, to be able to prescribe and dispense the drug.

Data provided to Crikey shows that as of June 30, 2022, there were just 3441 medical practitioners actively registered to prescribe abortion pills, and 4896 pharmacists certified to dispense the drug. This is a huge decrease from the same period in 2021 when there were 5556 registered dispensers. There was a slight increase in registered prescribers from 3018. 

Mazza said even with public termination services, there’d still be a place for private clinics thanks to Australia’s mix of public and private services with private clinics offering a one-stop shop for abortion counselling, medication, scans and checkups. 

MSI Australia to ‘run itself out of a job’

When asked about MSI Australia’s future, the company’s head of policy Bonney Corbin told Crikey ideally the organisation would “run itself out of a job” by advocating for universal public access to abortion. 

While universal access isn’t one of the company’s three priorities listed on its website — with nurse-led care, reproductive coercion and safe-access zones taking those slots — Corbin, who works for a number of other women’s advocacy groups, said it was a focus. 

But she added that MSI Australia would still exist in other capacities. “Abortion isn’t our primary and isn’t our only service,” she said, pointing to vasectomies, mastectomies and contraception as other services. 

The organisation is also international and would continue to advocate for equitable access globally, she said. 

Finally, Corbin added, there’d likely still be a need for private clinics and specialist providers given there are still so many gaps in care for people who are gender-diverse, from linguistically diverse backgrounds, in prisons, with disabilities, and/or are from Indigenous or Torres Strait Islander communities.

Australia’s female prison population is small, but many incarcerated women have ongoing health problems. Fewer than one in five women entering prison rated their physical health as very good to excellent, while two in five said their health was fair to poor. In 2017, 114 women were pregnant when they entered prison and 25 gave birth while in custody. 

Abortions among Aboriginal women in Australia have been trending upward — 14.1 per 1000 women as of 2017 — likely due to an increase in cultural-specific services and accessibility of medical abortions through telehealth. This rate sits slightly below the abortion rate for non-Aboriginal women.

“There are still so many cultural safety issues for so many different communities,” Corbin said. 

“Universal access to abortion care isn’t just simply being able to call any health service and book an abortion … It’s also about a journey of choosing to access and finalise abortion care and walk away from that experience without any unresolved concerns.”