To the Editor: A further reason for the differences in antenatal Down syndrome screening rates between urban and rural women, reported by Coory and colleagues,1 is likely to be the relative difficulties many Queensland women face in accessing abortion services. We are aware of several Queensland public hospitals that provide excellent antenatal screening services — testing for chromosomal abnormalities as well as providing the 18–20-week ultrasound scan for structural abnormalities. However, these hospitals do not offer subsequent counselling or abortion for women who make the difficult decision to terminate a pregnancy at this gestation, instead directing them to the private system. Some of these women are undoubtedly among the many Queensland women who travel interstate for abortions each year.2-5

First-trimester abortion is difficult to access for women in rural areas throughout Queensland. This is probably an important factor in women making the decision not to have early screening and/or chorionic villus biopsy, and possibly also a factor in doctors not offering it. Having to travel several hundred kilometres for the test, with the possibility of a further journey for an abortion, is beyond the resources of many rural women.

We are in agreement with Coory et al that a majority of the population would support equity of access to services and equal choices for all women in the matter of antenatal screening for fetal abnormality. In fact, amniocentesis for chromosomal abnormalities has been available, with little controversy, for more than 30 years. If early antenatal screening is made available to all women, then it is reasonable to expect that appropriate counselling and access to safe, affordable abortion is also provided.