WA eyes streamlining of abortion care

Under certain circumstances, women may not have to go through a GP to get an abortion in the state.

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Proposed reforms to abortion law in Western Australia could cut through red tape for people who want to terminate a pregnancy, bringing the state in line with the rest of the country.

In 1998, WA became the first jurisdiction in Australia to decriminalise abortion, but the state has since been left behind when it comes to more progressive legislation.

WA legislation has three key differences from the abortion laws in the majority of other states and territories:

• Counselling is mandatory, rather than optional.
• At least two practitioners must be involved in counselling and care for terminations before 20 weeks.
• Terminations after 20 weeks must be approved by two doctors sitting on a six-person ministerial panel.

Under the reforms, which were announced yesterday, all three requirements could be scrapped and the gestational age limit – after which additional requirements apply – would be raised to 24 weeks.

The first two requirements essentially mean that all women have to get a GP referral to at least one other provider, either for counselling or to receive the abortion.

In other jurisdictions, women can book in for a termination directly, either with their own GP or with a specialist reproductive health service like MSI Australia (formerly Marie Stopes International).

While the RACGP would usually argue for GPs to remain at the centre of care, WA chair Dr Ramya Raman said the college would be considering all options.

“While we genuinely support the GP’s role in all aspects of care, the removal of the requirement to get a GP referral may be helpful in certain circumstances,” she told TMR.

“But we need to just work through that consideration and look at the pros and cons … every patient and every woman’s circumstances are going to be different.”

While the RACGP is yet to take a detailed look at the proposed changes, Dr Raman said it would be supportive of removing clinical barriers to abortion.

“Streamlining the care pathways is a key component of healthcare for women right across the state,” she said.

Earlier this year, the World Health Organization released updated guidelines on abortion which advocated for lower barriers to care.

GP and women’s health researcher Professor Danielle Mazza told TMR that making the process simpler will benefit women.

Ultimately, she said, women are likely to come up against conscientious objectors and practitioners who don’t quite understand the options that are available.

Considering that medical abortion can only be provided at nine weeks’ gestation or less, it really can be a race against time.

“Women need to be able to access medical abortion services as quickly as possible once they’ve made a decision and to be able to self-refer to those services,” Professor Mazza said.

“It’s the same for surgical abortion, there’s no reason why they should require a referral.”

Increasing the gestational age limit on abortions will also help increase the availability of care and have the added benefit of reducing pressure on the healthcare system in neighbouring states.

The entire country currently has a shortage of providers with skills in late-term abortion care, Professor Mazza said.

“What’s happening currently is that women from Western Australia are struggling to get access to late-term abortions and are often having to find their way to other states in order for that to occur,” she said.

Fetal abnormalities often go undetected until the 20-week scan.

“Consequentially, a pregnancy may be more than 20 weeks of gestation before an abortion procedure can be performed,” the state government wrote in a discussion paper.

“In almost all cases, these pregnancies are very much wanted but the health risks to women or the likely outcome for the fetus, if born, have contributed to the difficult decision.”

If a woman were to discover that her baby had a significant abnormality at the 20-week scan, she would have to get the approval of a panel of doctors before scheduling a termination.

The WA government was firm about the legality of abortion not being up for debate; the restrictions will either be loosened or remain unchanged.

“It is not part of this consultation to consider if abortion should be precluded or prevented. Abortion is legally available in WA,” it said.

“Rather, this discussion paper focuses on the legislation that could be in place around these medical procedures.”

It remains an offence for a non-medically trained person to provide an abortion. The changes are open to community consultation until Saturday 17 December, with the WA government specifically calling for feedback from healthcare providers.