In Roe v Wade’s shadow, there’s an urgent need to tackle abortion stigma in Australia

In an exploratory interview study about the timely topic of abortion, Australian women and pregnancy-capable people spoke about their recent experiences seeking abortion care.

The six-month study, conducted by our team at Monash University’s Global and Women’s Health Unit, highlights the pervasive stigma and roadblocks to care.

With the constitutional right to abortion as set forth in Roe v Wade coming under attack in the United States, we’re reminded once again that the legal protection of bodily autonomy is never permanently guaranteed.

One of the 18 people we interviewed said her GP in regional Victoria tried to dissuade her from having an abortion, telling her she would “regret” the decision because of her age.

The interviewee told us she wished the doctor had provided “more information and less opinions”, as they would do with any other type of health service.

In Australia, abortion was criminalised until 2002, but all states and territories have since (mostly) decriminalised, most recently in South Australia in 2021. This has effectively moved the regulation of abortion out of the criminal code to the domain of health law.

Decriminalisation across Australia was an important step, yet the journey of an average person seeking abortion care isn’t a simple one. Barriers to abortion access and substandard quality of care remain common across Australia, particularly in regional and remote areas.

In our interviews, we found that some doctors tried to talk patients out of having an abortion, such as in our regional Victorian case.

Many healthcare providers, including GPs, technicians taking blood, and ultrasonographers, assumed participants wanted to retain their pregnancy.

These providers often congratulated the participants for being pregnant. One urban participant said that conversation felt like “taking a bullet”.

Healthcare providers ‘uncomfortable’

Many participants said their healthcare provider appeared very uncomfortable with abortion, and wanted to end the conversation as quickly as possible. This meant they left their appointment without sufficient information about how to get the service they needed.

For example, one participant in Queensland said she called the doctor to help her navigate an unwanted pregnancy, and the GP responded that “we don't do that here”.

The participant felt dismissed and judged. She told us the call was just three minutes long, yet she had to pay $75. Not only that, she left the appointment even more confused about her options.

Even worse, participants in different states also described being denied access to their GPs altogether by the receptionist.

Read more: Overturning Roe versus Wade will be a devastating blow for women, and women’s rights

With decriminalisation of abortion in Australia so recent in many states and territories, Australia is only at the beginning of the journey to address stigmatising norms and beliefs about abortion that affect healthcare provision.

Participants in our interview study described to us the sometimes judgmental interactions with healthcare providers both before and during their abortion service. They said their providers made them feel “uncomfortable”, were “stern”, or expressed “zero understanding” for their situation.

Positive examples critical to improve care

It’s important to note that some of our study participants described high-quality, non-stigmatising and supportive interactions with their healthcare providers. They described positive aspects of care including being “supportive”, “understanding”, “friendly”, “warm”, “respectful”, non-judgmental, and providing detailed information.

These positive examples are critical to help us understand what the health system and providers should strive for in delivering accessible and high-quality abortion care.

So, what do these challenges to accessing abortion care mean for Australia, particularly in the context of Roe v Wade being potentially overturned in the US?

First, an overturning of Roe v Wade is likely to embolden the expression of anti-abortion views in public and political domains.

This means abortion stigma may be further exacerbated in an environment where it’s already rampant. This has implications for abortion care, as stigma can deter people from gathering information and seeking the services they need.

In other countries and jurisdictions where abortion has been decriminalised, public approval of abortion has increased over time with decriminalisation processes – as is the case in Mexico City, Mexico more broadly, and Argentina. Efforts to shift social norms about abortion in Australia are needed to counter the global anti-abortion discourse likely to follow the news about Roe v Wade.

Providers also need support

Abortion providers need support as well. New provider-focused approaches in Australia include the AusCAPPS network, a multidisciplinary online community of practice to provide support and resources in the provision of contraception and medical abortion services, and ORIENT, a nurse-led model of care in general practice to increase access to medical abortion in regional and rural areas.

The NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care (SPHERE), based in Monash’s Department of General Practice, and in partnership with stakeholders across the country, leads these approaches, as well as to improve availability and access of abortion.

But there remains an urgent need to address stigma and improve patient-centred care. We’re seeking funding to build on the data from our interview study to develop innovative approaches to tackle abortion stigma as a way to promote high-quality and accessible abortion care in Australia. 

Some of the interview quotes featured were modified slightly for clarity.