South Australia decriminalised abortion, yet barriers remain

Unequal access to safe abortion services may persist if the state's new abortion laws are not properly resourced.

In March last year, the South Australian Parliament passed the Termination of Pregnancy Act 2021, making it one of the last Australian states to decriminalise abortion. The legislation allows abortion up to 22 weeks and six days gestation on the patient's request, and after this time with the approval of two doctors. On the 7th of July, the legislation was enacted.

Despite being such a crucial win for the South Australian campaign for abortion rights, barriers continue to limit access to safe abortion services.

Flinders University researchers found that GPs need to become intimately aware of their role in ensuring the law is adequately enforced. This includes seeking registration to prescribe medication.

"The new law allows for GPs to provide medical abortion directly, including via telehealth, but many GPs are not yet trained and registered to prescribe the medication, and some may not yet understand their role in making the new laws work," says Flinders Associate Professor Catherine Kevin who campaigned for the new laws.

Medical abortion through telehealth has been lauded as a service that provides patient control, autonomy, and privacy. The process involves a preliminary telephone or video consultation, followed by an ultrasound and the mailing or courier dispatch of medication.

In 2020, South Australia was the only state that did not provide access to medical abortion from local GP clinics or telehealth. Before the pandemic, Flinders University researchers found that 83% of people in non-metropolitan areas travelled to the state's capital city to access the service.

Medical abortion via telehealth was emphasised by pro-choice groups as an essential healthcare service during the beginning of the COVID-19 pandemic when the South Australian government imposed emergency pandemic measures.

The South Australian Abortion Action Coalition (SAAAC) heavily lobbied relevant ministers and the Chief Public Health Officer to suspend aspects of the then abortion law to enable safer access to services. 

Yet, the government's unwillingness to allow medical abortion via telehealth exposed those seeking the service to the risk of COVID-19. This risk was considerable given the physical distance many individuals had already travelled to access abortion services in South Australia.  

Coupled with the pandemic's exacerbation of pre-existing barriers to accessing abortion services, the government's decision to disallow medical abortions via local GPs and telehealth strained reproductive rights. 

Notably, the public health system provides almost all abortion care in South Australia. So, resourcing issues will see continued unequal access to medical abortions throughout the state.

"The pandemic amplified pre-existing limitations in the law, but now we have the law and abortion is decriminalised, GPs must be advised on how to translate the law into better access for South Australians – no matter where they live," Dr Kevin says.

"As new variants emerge, and COVID-19 continues to infect communities everywhere, this is more crucial than ever.

"In all, the rollout of the new abortion laws are long overdue, so we need to make sure it's as seamless as possible, and resources are adequate in all communities across the state."

The article, When More is Less: Emergency Powers, COVID-19 and Abortion in South Australia, 2020, is available here: