After months of anticipation and delays, Australia’s first-ever Senate Inquiry into universal access to reproductive healthcare is due to be released today.
We – a group of researchers dedicated to improving sexual and reproductive health and rights – are among those eagerly hoping it carries with it fiscal commitment to abortion care. The 2023-2024 Budget announced on May 2 certainly did not.
Gender equity advocates have praised the 2023 Federal Budget for its gender responsiveness, particularly in relation to improved workplace and economic policies.
Global indicators of gender-equitable governments include more abortion-supportive laws and policies, which are associated with community support for abortion and quality abortion care. With legal, available, and affordable abortion comes better health, economics, and prosperity for individuals, communities, and countries.
Thus, the Federal Government’s silence about abortion on Budget night was deafening. By not mentioning abortion, it risked reinforcing abortion stigma and its associated health, care, and economic consequences for individuals, communities, and societies.
The Budget contained other non-progressive traditional gender tropes too. It conflated gender responsiveness with the needs of motherhood, simultaneously excluding women and non-binary people who are not parents, and essentialising women as mothers rather than people with diverse sexual and reproductive needs and desires.
It yet again celebrated changes to the cost and availability of childcare as a win for mothers, not for all parents.
It did not extend Medicare telehealth sexual and reproductive health items – a legacy of COVID-19 measures which improve equitable access to Australia’s healthcare system – beyond 2023.
It ignored (again) its own 2019 election promise to fund public abortion care.
Overwhelmed service providers nation-wide are exasperated. “It’s unclear how this Budget will assist those who call our clinics every day asking for financial support to access an abortion,” said Bonney Corbin, head of policy and advocacy at MSI Australia the largest abortion provider in the country.
Did stigma play a role in the silence about abortion in the Budget?
Was it simply unfortunate timing that the Senate Inquiry report recommendations missed the Budget deadline?
As advocates of evidence-based practice, we acknowledge the logic of awaiting the report recommendations and following due process in allocating resources. But we remain sceptical.
Despite World Health Organization guidance and ample evidence that abortion is a safe, necessary, and beneficial part of health care, abortion continues to generate a political quagmire. Abortion stigma frames abortion as morally wrong and socially unacceptable. It delegitimises people who have, provide, and support abortion and shapes our understanding of abortion as conditional and contested. Stigma and the related silence around abortion create an illusion that abortion is uncommon. Yet we know there were over 88,000 abortions in Australia during 2017-18, with around one in four women having an abortion in their reproductive lifetimes.
In failing to address abortion directly, the 2023-2024 Budget reinforces the systematic stigmatisation of abortion. The seeming unwillingness of the Federal Government to publicly dedicate funds to improving abortion reflects what is described as ‘abortion exceptionalism’ – a deliberate positioning abortion as external to or exceptional from Australia’s health system despite being empirically justified.
Our research demonstrates some of the complexities of abortion stigma in Australia
A 2019 survey of over 70,000 Australians found that most Australians support the right to choose an abortion. Indeed, rural people, who are often cited as those disproportionately disadvantaged by Australia’s current health system, expect informed, efficient, person-centred, comprehensive reproductive healthcare that meets their needs in primary care.
Despite support for and expectation of accessible abortion care, abortion stigma persists.
For example, young people around Australia fear abortion-related judgment and harassment, reflecting the awkwardness and silence of adults around abortion at school, in higher education, and in the media. These experiences demonstrate abortion is seen as taboo and contested in Australia.
Another study found Australia’s legislation make people and services “jump through lots of hoops” to access and provide abortion. That Australia’s systems make it possible for people and institutions to avoid providing abortion care, while also having the power to prevent stigmatisation and make abortion access easier, for example through safe access zones. Perhaps stigma is why only 2 of over 220 public hospitals in NSW provide public abortion care.
Research with people who sought abortions between 2020 and 2022 in Australia provides evidence of denial of care, rushed interactions, mistreatment, widespread assumptions about their pregnancy intentions, and judgment from healthcare providers.
Our work adds to the growing body of evidence, in Australia and internationally, showing that the stigmatisation of abortion inhibits access to quality care.
What can be done to de-stigmatise abortion and secure access to quality abortion care?
The antidote to stigma is normalisation, a process through which abortion becomes understood as a regular part of healthcare rather than deviant, illicit, or “other”.
The Senate Inquiry announced in late 2022 gave us a glimmer of hope that there is genuine Federal Government commitment to gender responsiveness in its fullest of forms – to work against harmful and antiquated unequal gendered power relations, the patriarchal influences of Australia’s medical system, the control of female sexuality and bodies, and the idealisation of motherhood as the central role of women.
The collective message among hundreds of submissions to the Senate Inquiry is clear: Abortion is an essential and normal part of health care. Investments are needed to achieve accessible and high-quality abortion care.
And there are some promising signs that much-needed changes to abortion may be afoot.
In the wake of an inquiry into ACT’s abortion services, all people living in the ACT will soon be able to access free public abortion care up to 16 weeks gestation – an important precedent for the rest of Australia.
Last week Senator Larissa Waters, the original sponsor and champion of the Senate Inquiry, indicated that the Therapeutic Goods Administration (TGA) may approve all GPs and nurses and midwives as prescribers of medication abortion (a combination of misoprostol and mifepristone medication) for pregnancies under 9 weeks gestation (‘early medical abortion’).
This would expand the abortion workforce and promote access across Australia, a pressing need because less than 7% of GPs in Australia were registered to prescribe early medical abortion in 2021 (despite all GPs being eligible). Nurse and midwife abortion provision has been called for by research and professional bodies internationally. In fact, Australian nurses and midwives already provide abortion care to people affected by gender-based violence and are “commit[ed] to safe, timely, and stigma-free care and putting aside conflicting personal values”.
Most Australians support reproductive choice but does the Federal Government?
Is the current Federal Government, albeit better at gender-based listening than the previous, ready to move past anticipated debate and engage publicly with abortion as a demonstration of its commitment to gender-responsive and rights-based governance?
When the Senate Inquiry report into universal reproductive healthcare is finally released, the Federal Government has an opportunity to demonstrate its commitment to gender equity by amply funding the Senate Inquiry’s recommendations.
Our fear: That the people accessing and providing abortion care will be forced to wait for another year, another budget, another set of excuses.
Our hope: That the Senate Inquiry recommendations include robust funding which the Federal Government make available in this fiscal year. The time is now to ensure transformational and sustainable change. We simply cannot wait any longer.
About the authors — Sarah Ratcliffe, Shelly Makleff, Anna Noonan and Kari Vallury:
We are members of a collective of scholars working on reimagining abortion access and eradicating abortion stigma in Australia and beyond. Our work takes an equity-responsive position and seeks to better understand how and why abortion remains exceptional to mainstream healthcare when Australians and science support reproductive choice.
You can find the author contact details on Twitter: @sarahratcliffe0 @SMakleff @AnnaNoonan4FASS @kVallury