Just three of New South Wales’ 220 public hospitals are routinely providing abortions, according to research by the University of Sydney.
The research, which maps lack of access to abortion in the state, also reveals that a majority of the state’s cities and towns are “abortion deserts”, meaning the nearest service is more than 160km away.
Abortion is basic healthcare that is legal in NSW. Despite the World Health Organization recommending that all public hospitals provide it, uncovering where it is offered, and under what circumstances, is difficult.
The only public hospitals openly providing abortion outside of a medical emergency are Broken Hill hospital in the state’s far west; John Hunter hospital in Newcastle on the north coast; and the Royal Women’s Hospital in Sydney. Women elsewhere are left trying to access one of just 13 private providers, which cost a minimum of $775 if you have a Medicare card, and are not easy to find in any directory.
Because there may be unadvertised abortion services at other public hospitals, Guardian Australia separately contacted all NSW local health districts to ask which of their hospitals provided abortion and what happens to people seeking abortions in their district if they don’t. None of the health districts replied.
The peak body for obstetricians and gynaecologists described the lack of information about abortion access at public hospitals as “completely unacceptable”.
To better understand where women in NSW are most struggling to access abortion, researchers led by the University of Sydney and the data visualisation specialist Ri Liu, mapped access to surgical abortion (a procedure undertaken in a clinical setting) and medication abortion (taking prescribed abortion pills) across the state.
They used publicly available directories but noted that not all abortion services were openly advertised or easy to find, providers could change, and that the circumstances under which abortions were provided was not transparent. The project was inspired by US researchers, who first used the term “abortion desert” to describe places 100 miles (160km) or more from the nearest abortion service.
For those living in an abortion desert, transport is required. This could mean at least a four-hour round trip by car, possible overnight accommodation and additional travel funds beyond the cost of the abortion itself.
“There are a whole lot of service gaps around abortion that people in the general population really don’t know about until they try to access one,” said Dr Anna Noonan, from the university’s school of rural health.
“They don’t know that you can’t just go to a public hospital and say, ‘Can I have an abortion,’ or that they would be turned away,” she said.
“There is research about where abortion services are, and the experiences of the people who access those services. But what we hardly ever hear is what it is like to not have access to the service at all.”
Anne* is one of many in an abortion desert, living in a large regional town in NSW. When she discovered she was pregnant the news came as a surprise. Her hormonal contraception had failed and she was already in her second trimester when the pregnancy was detected.
She and her partner had met later in life and both had children from previous relationships. They decided not to have another child.
Anne was seen at her local hospital but there were no providers who could perform an abortion at her gestation of pregnancy. To access the procedure, she and her partner had to travel hundreds of kilometres to Sydney, each taking three days of leave from work.
The couple paid several thousand dollars for a surgical termination and accommodation costs.
“Luckily, we could afford to take the time off work … that time, that flexibility, that money would not be available to a lot of people in that situation,” her partner said.
Guardian Australia asked all 15 NSW local health districts which public hospitals under their management offer surgical abortion, under what circumstances abortion is offered (for example, is it only offered if the health of the mother and/or foetus is at risk?), and what happens when a woman is told no abortion service is available (are they referred on, as required by law, and what does an onward referral involve?).
None of the LHDs would answer any of the questions asked by Guardian Australia, despite being provided multiple opportunities to do so. Instead, Guardian Australia was referred to NSW Health, which also refused to answer specific questions about the hospitals which offer abortion, and under what circumstances.
The NSW health minister, Ryan Park, also would not provide this information.
“In most cases, medical or surgical abortions can be provided in the community or non-admitted settings,” he said. He did not answer where those settings were or which cases were approved.
Prof Kirsten Black, the Sexual Reproductive Health Committee chair for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said: “It is completely unacceptable that there is no transparent access to information about abortion care” in NSW.
She said the only way to ensure that there was equitable access to termination services was to ensure there was public hospital availability across all hospitals in the state.
“RANZCOG believes that abortion is essential healthcare,” she said.
Dr Madeleine Belfrage, from the University of Sydney’s Social Sciences and Humanities Advanced Research Centre, said the researchers already knew that the distribution of services for both medication and surgical abortion in NSW disproportionately disadvantaged people who don’t live in Sydney or near the coast but the extent was “shocking”.
“Seeing the sheer size and magnitude of abortion deserts across such a vast expanse of NSW shocked our team,” she said.
“Perhaps even more shocking was how much the abortion deserts would shrink if all public hospitals provided this care,” Belfrage said.
“It led us to question: why on earth are NSW public hospitals, particularly those outside urban centres, not providing this care to their rural communities?”
She said it was clear that abortion is still not integrated into mainstream health service provision, despite being legal in all states and territories.
“It is both disappointing and not a surprise to hear that LHDs were not able to confirm if, when, and where abortion services are provided within their public hospital networks,” Belfrage said.
“As our maps show, in many areas of NSW the lack of local services, particularly by public hospitals, forces people seeking an abortion to travel hundreds of kilometres away.
“There is no other public health service we can think of where duty of care to provide a routine procedure is obfuscated in this way, leaving communities in abortion deserts with significant unmet need,” Belfrage said.
Last Thursday a report published by Family Planning Australia revealed that women in regional and rural NSW sought medical abortion at more than double the rate of city women. In remote NSW there were 10 medical abortion prescriptions issued for every 1,000 women, the latest available data, from 2022, showed. In major cities there were 4.2 medical abortion prescriptions for every 1,000 women.
Guardian Australia previously reported that a small but influential number of medical practitioners who obstruct abortion care or were uninterested in providing it were also leaving women unable to access abortion in many parts of rural NSW.
Black said that abortion should be provided like any other health service. “There should be available pathways through all public hospital systems,” she said.
“Referral pathways must be transparent and easy to access, both for the public, and general practitioners who need to refer women who require a surgical termination or those who have had a medical abortion who require further care.
“The provision of abortion services in public hospitals normalises this care and provides nurses, midwives and doctors with training and experience in termination services.”
*Name has been changed for privacy
• Do you know more? melissa.davey@theguardian.com
The Abortion Desert Map was developed by the Access All Areas research collective at the University of Sydney and Ri Liu, an independent data visualisation specialist. Access All Areas is led by Dr Anna Noonan (Sydney school of rural health) and Dr Madeleine Belfrage (Sydney social sciences and humanities advanced research centre). This iteration of the Abortion Desert Map was created in partnership with Guardian Australia
