Canberrans seeking an abortion will be able to access the healthcare service free of charge from today, as the ACT government's pledge to make reproductive care more accessible becomes a reality.
The government made the commitment in August last year, announcing the services would also be accessible to people without a Medicare card.
The initiative to remove out-of-pocket costs will cost the government $4.6 million over four years and aims to improve access to affordable, accessible health services as part of the ACT Women's Plan 2016-26.
ACT Health Minister Rachel Stephen-Smith said they were proud to see the change take effect.
"We're really proud that the ACT is becoming the first jurisdiction to provide people with free surgical and medical abortions for anyone who needs it, up to 16 weeks," Ms Stephen-Smith said.
She said those seeking a pregnancy termination in the nation's capital will now be able to do so "without the stress and financial impact that has so often accompanied this really critical healthcare service."
Free medical, surgical abortions and long-acting contraceptives
As a result of the change, Canberrans will now be able to access free medical abortions up to nine weeks' gestation through Canberra's long-running MSI Australia clinic.
MSI Australia will also offer free surgical abortions up to 16 weeks' gestation.
Medical abortions involve a combination of medications to induce termination.
According to healthcare experts, the procedure has a high success rate with a very low risk of complications, but it involves some pain and bleeding.
Surgical abortions can be performed by a doctor and anaesthetist in a day surgery.
The initiative will also cover the cost of providing some patients with long-acting reversible contraception, such as the insertion or an intra-uterine device (IUD).
Ms Stephen-Smith described it as the "first step" and said she hoped to expand the scheme to include other providers.
Survey uncovers harrowing coercive control, insensitive care
The introduction of free abortion care follows an ACT Legislative Assembly inquiry report that examined the experiences of those seeking the service in the ACT.
The inquiry into abortion access in Canberra heard of the struggles some women have faced in seeking treatment — including having to travel to Brisbane for access.
And the ACT's peak body for women's health recently surveyed 90 Canberrans who had sought abortions, uncovering some distressing stories about cost barriers.
"The cost and being a victim of [domestic violence] made it almost impossible for me to access because I was already in debt from my ex and it was hard to find the money, let alone have the procedure," said one respondent.
"[It was] financially expensive since I was a full time student at the time, and had used up all of my savings," another said in their submission.
Women's Health Matters chief executive Lauren Anthes emphatically welcomed the new government initiative but said much more work was needed in order to make the service truly accessible.
"We've learnt through our research how different barriers work together to make it really challenging to access what is a time-sensitive medical procedure," Ms Anthes said.
She urged the ACT government to put together a sexual and reproductive health strategy that would combat additional barriers, including stigma and reproductive coercive control, which is a form of domestic violence.
"We also have an issue in the ACT at the moment around gestational limits, which means that women who are over 16 weeks' gestation can't access surgical abortions — and that is due to facility and workforce limitations," Ms Anthes said.
"It means that [those patients] will still need to go to NSW, and that's a critical problem."
This week's report into ACT abortion access also recommended the government invest in allowing women to have abortions in Canberra post 16 weeks' gestation.
Ms Anthes said the WHM survey also shone light on how a shortage of trained doctors and willing pharmacists impacted some of those seeking an abortion, with one participant detailing the steps involved.
"[I had an] initial appointment with my GP who sent me for blood tests and an ultrasound, [then an] appointment with another GP at my clinic to try and access medication," she said in her submission.
"[I was] denied the prescription by the GP. [I had] a follow-up appointment with my regular GP to confirm pregnancy and prescribe medication. [I went to the] pharmacy to purchase medication, a follow-[up] ultrasound, follow up GP, second follow up ultrasound and consultation with a gynaecologist at a public hospital. Then day surgery for a [dilatation and curettage procedure] due to retained product and a follow up appointment GP."
Another woman told WHM that she believed the care needed to be more sensitive and informed by trauma:
"I feel like I was rushed. I was also coerced by my partner at the time, and I don't feel there was enough done to find out about my circumstance, or any therapy or after-care. This was extremely traumatic and caused me a lot of grief — mentally, spiritually and emotionally," the patient told researchers.
"No aftercare or follow up. No warnings of the physical and hormonal side effects of a termination," another ACT respondent said.
While a further woman said she was "just walked out onto the street. No follow up, no comfort, no nothing."
The survey also highlighted that some women felt they had not been armed with enough information to make an informed choice about whether to opt for a medical or surgical abortion.
Peak body calls for more women to come forward with stories
Ms Anthes said despite a number of troubling responses, just over half of those surveyed said they were satisfied with their abortion care.
However, 12 of the 90 women who participated were unable to access an abortion in the ACT at all, largely due to refusals by practitioners.
"We are really interested in continuing to hear the stories from women … because it helps us shape our recommendations to the government," Mr Anthes said.
"It's really important that we're learning from people's bad experiences."
