NEWCASTLE AND REGIONS:
Providers say Telehealth way forward for abortion care, but need for clinical service provision ignored by gov't
The closure of Marie Stopes Australia’s Broadmeadows reproductive care clinic is already having an impact on people in Newcastle and surrounding regions, with reports that people wanting surgical abortions are being forced to travel to Sydney to access clinical care, due to the closure, local activists have told WAAC. This follows a recent online forum hosted by WAAC, which sought insight from leading health services about the impact of reduced clinical care availability after the Broadmeadow clinic closure.
After her petition calling for the clinic to remain open attracted over 7,500 signatures, Newcastle based reproductive rights activist Larissa Scully approached local MPs and MSA to try to find out what forward planning was being done for people needing reproductive health care in Newcastle, and the surrounding regions from which people travelled to Newcastle for clinical care.
Ms Scully has been working to raise awareness about the effects on people needing reproductive health services in Newcastle and surrounding regions since an announcement by MSA that their busy Broadmeadow clinic would close in August 2021. At the same time, clinics run by MSA in Southport, Townsville and Rockhampton in Queensland were also closed.
“WAAC was able to provide a forum that provided current and important information to the Newcastle community and the wider regions,” WAAC member Samantha Campbell said.
Ms Scully chaired the online forum.
“Abortion law reform in 2019 created the legal platform for equity of access and should have been followed by substantial government funding and a planned response to increase statewide access and support across NSW," Ms Campbell said.
“Whilst we acknowledge that the COVID-19 pandemic put unprecedented time and resource pressures on the NSW Government, it is not an either or situation. Access to abortion and reproductive health services is not a healthcare issue that has the luxury of time,” she said.
“The pandemic meant that is has become unsafe and complex for regional women to travel to Greater Sydney for procedures or to access permits, which adds a layer of complexity, cost, time and risk to confidentially.
“Now, more than ever, it is a time to swiftly ensure that access to reproductive health care in regional NSW is a priority. The COVId-19 pandemic increases the need for safe, affordable and accessible options for reproductive healthcare with many experiencing a reduction in household income, isolation from family and friend support systems.”
“Telehealth is practical for many people,” Newcastle activist Larissa Scully said, “But for people needing an abortion or vasectomy it’s never going to be a total solution. My concern is, what sort of service will now be available for people who can’t access telehealth, or where telehealth isn’t the health care they need?”
Dr Deborah Bateson of Family Planning NSW (FP NSW), Dr Philip Goldstone of Marie Stopes Australia (MSA) and leading Hunter region reproductive health care provider Dr Robert Vickers generously gave their time to discuss the topic, "What's ahead for reproductive health services: Newcastle and the regions".
Dr Philip Goldstone, Clinical Director for MSA, told the online forum that MSA had made the decision to close the regional clinics for a number of reasons, including staffing issues during COVID-19 times, and that the State government and NSW Health “have not been able to develop and bring to the table an integrated approach” to reproductive health care, including abortion care.
He said that ways were being explored to expand capacity at the service’s Westmead hub, and that a referral pathway to Newcastle’s John Hunter Hospital would still be available. He said that the Hospital would accommodate and prioritise financially needy and vulnerable patients for abortion care.
He also advised that MSA would be moving to extend their telehealth services and were working to support people in regional areas to access NSW Health travel funding if they need clinical procedures.Dr Goldstone said MSA remained committed to choices for women and pregnant people, including safe and compassionate abortion care provided in a sustainable way, which is embedded in MSA’s guiding principles.
Dr Robert Vickers, who has worked at MSA and in public hospitals throughout regional NSW, said that abortion care is especially at risk due to the closure of MSA in Newcastle. While a smaller local clinic could support some abortion care, he was unsure if the capacity existed to enable all wanted abortions to be carried out.
While speaking highly of the clinical standards in public hospitals, he said various factors made it difficult for abortions – and sometimes other reproductive procedures – to be carried out in smaller hospitals, including issues such as confidentiality, part time staffing making available surgical appointments difficult to access, the role of so-called ‘conscientious objection’ by some staff.
He pointed out that with sometimes lengthy public hospital wait times, some smaller regional hospitals had previously referred reproductive procedures to MSA for timely and appropriate management.
MSA staff are trained to provide appropriate and respectful care around reproductive health, including current practice, Dr Vickers said. However, he pointed out, staff in public hospitals do not necessarily have access to similar training.
WAAC will continue to provide support to activists in Newcastle
and regional areas in their work towards better,
more equitable health care for all.
If you would like to sign Ms Scully’s petition, please see here:
For ‘all options’ pregnancy advice, contact the NSW Pregnancy Helpline: 1800 008 463, 8.00am to 8.00pm Monday to Friday.
Dr Vickers said an ‘ideal model’ would be to upskill GPs , especially in smaller regional areas, around reproductive care including abortion and contraception provision. Unfortunately, he said that issues such as conscientious objection had a very real bearing on service provision in many regional areas where people had little choice of health care provider.
However, there would always be patients who need the high level care available in a clinical setting, and such patients would now have to travel much further – usually to Sydney or Brisbane, and incur the additional costs associated with longer travel times as well as facing the need to explain longer absences from home or work.
He said travel to Newcastle from far west NSW to Newcastle was already a cost barrier – the extra travel to Sydney would just increase this barrier.
Dr Vickers said this would especially impact patients already facing barriers to access – including Aboriginal women, women at risk of domestic or family violence and women needing later procedures
While he will work with a smaller reproductive health care clinic in Newcastle, Dr Vickers is concerned at losing the capacity of the larger MSA service.
Dr Deborah Bateson, Medical Director of FP NSW, said that since the decriminalisation of abortion in NSW, it has become very obvious that legal change does not equal improved access, and that while healthcare should not depend on postcode, in fact access to reproductive health services is spread inequitably across the state.
She agreed with Dr Vickers’ comments regarding barriers for women in regional areas, including travel and out of pocket expenses, the need for skilled staff with current training and the role so-called ‘conscientious objection’ plays in limiting options.
Dr Bateson also said that doctors providing reproductive health care also often feel unsupported in regional areas, due to stigma, possibly being unable to refer to a local hospital and also that local people are not always aware of which doctors provide which reproductive health services.
However, she pointed to recent success in upskilling staff in one regional hospital and explained the role of medical abortion as providing greater access to abortion care, even in remote areas, because it can be made available via a GP or by utilising telehealth and the pills can be taken at home.
COVID restrictions have pushed the popularity of this approach along, she said.
Dr Bateson said that FP NSW took the view that abortion provision, and all reproductive healthcare, needed to be accessible and affordable, ideally utilising a mix of community, private and public service provision.
This included a ‘whole of hospital’ approach, which would need focus on staff and doctor training around issues particular to reproductive health.
She said that FP NSW is working on a new service model to provide sustainable medical and community abortion services to meet the needs of Indigenous women, which includes new service guidelines.
In addition, FP NSW is working with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists to make abortion training part of every doctor’s experience, and with NSW Health to provide expertise for the NSW Pregnancy Choices Helpline*.
In response to questions from attendees at the forum, the speakers expressed hope that telehealth service provision would make reproductive health services more easily available to more people across rural and regional NSW.
Asked about women seeking reproductive health care, especially abortion, who are living with DV, the speakers stated these would be the type of cases on which John Hunter Hospital would be focussing their services.
Following the Forum, Ms Scully said she felt the speakers had been very informative and generous in sharing their expertise, but she feels the outlook is problematic for local people needing reproductive health services for whom telehealth is not a viable option.
“Telehealth is not necessarily time sensitive, and with abortion for instance, time is so important,” she said.
Ms Scully pointed out that telehealth for medical abortion is not just ‘put two pills in the post”. It means a series of appointments – an appointment with a doctor, a scan, speaking with a nurse and again with a doctor, before the pills can be prescribed.
Then having to attend a pharmacy, which may mean travelling, dealing with pharmacists or staff who are obstructive, or facing lack of privacy because everyone knows you have been to the doctor and will wonder why.
Additionally, telehealth is “not interchangeable” with clinical service provision, Ms Scully said.
“Unfortunately, I feel the barriers to abortion care and reproductive health service are not being lifted for the people of Newcastle and surrounding regions,” she said.
“I am pleased however that local MP, Sonia Hornery attended the forum and has been in touch to confirm her support for equal access to reproductive health care in Newcastle and the regions.”
“WAAC invites further exploration of Dr Vickers knowledge and approach to increasing options for regional services and the difficulties of deferring women to Telehealth and Sydney based clinics,” spokeswoman Samantha Campbell said.
“People in regional and rural NSW deserve the respect of access to clinical AND telehealth services, it is presumptuous and disrespectful to assign access to telehealth as the preferred option.
"The fact remains that for regional access to reproductive health services, in particular abortion, it is necessary to have government funded stand alone clinics as well as telehealth options, that respect and acknowledge the diverse experiences and reproductive health care needs of NSW people, she said.”
What's ahead for reproductive health services in Newcastle and regions after Marie Stopes' clinic closure this month? Join us to find out! Marie Stopes Australia will close its reproductive health care clinic at Broadmeadow this month.
The clinic provides a range of reproductive health care services - including abortion, vasectomy and contraceptive provision - in a clinical setting.
Patients travel from around the Hunter and further afield to the clinic, to avoid a costly and time consuming trip to Sydney.
So, what impact will the closing of the clinic at Broadmeadow have on access to reproductive health care services in Newcastle and the surrounding regions? Join us for a short but informative online forum to find out more about why Marie Stopes is exiting this busy regional practice and what services will remain.
We'll also look at what type of reproductive health services Newcastle and regions need - and should have, who's responsible for providing it and what new directions are in the works.