Termination of pregnancy: a long way to go in the Northern Territory

To the Editor: The Northern Territory's reproductive health services are fraught with access problems due to remoteness and disadvantage. Staff shortages and high staff turnover in the health workforce are well known.1 With the recent resignation from the public health system of the main termination of pregnancy provider in the Top End of Australia, women's access to basic reproductive health services could be severely diminished and complicated.

Each year, about 1000 women undergo a termination of pregnancy in the NT. The only remaining services providing termination of pregnancy in the NT include one private hospital (at which a few doctors can provide surgical abortions) and one public hospital (Alice Springs Hospital, at which a couple of doctors can provide surgical abortions). Each week, about 20 women present to the public health system in Darwin for a surgical abortion in their first trimester. These women no longer have public access. The question is who will provide this procedure?

One possibility is that women may have to be flown interstate for this procedure. Some state laws prevent this — for example, South Australian law has residency limits on the provision of termination of pregnancy. Also, interstate travel poses a considerable burden for women and girls in terms of delays, logistics and increased stress, and is not cost-effective for the health system.

How acceptable this arrangement will be to women in the NT is yet to be tested. But we already know that women who feel compelled to end their pregnancies will do anything regardless of how demeaning, undignified or dangerous it is.2,3

Another solution would be to reform the Medical Services Act (NT) as in force at July 2014, which prohibits the practice of early medical abortion using misoprostol and mifepristone outside of a hospital setting, thus precluding ambulatory early medical abortion. Currently, the Act limits provision of abortion to obstetrics and gynaecology specialists and limits the type of procedure to surgical methods only. If the Act were reformed, it would be possible for general practitioners in various primary health care settings to provide information and prescriptions for early medical abortions.

There is overwhelming medical evidence showing that early medical abortions are efficacious, safe and well accepted.4,5 In terms of the health system, shifting the task to GPs and freeing up precious theatre resources would be far more cost-effective than flying patients or doctors interstate.

However, the political reality is that politicians are often reluctant to step into the perceived controversy of reproductive health rights for their constituents.