Dollars, distance, and political power: Inside the barriers obstructing abortion access for Australians

Australia Broadcast Center

31-05-2025

Every week, Australians seeking a legal form of health care are forced to traverse their home states and territories — sometimes crossing borders — to access an abortion.
Depending on where someone lives, and how far into the pregnancy they are, the path to this time-critical procedure can be obstructed by hurdles that amplify fear, trauma and financial disadvantage.
Abortion reform has come a long way in recent decades. No longer can a doctor, patient, or their friend or family member, be imprisoned for performing, requesting or being privy to a termination of pregnancy.
But a potency of paternalism still underpins reproductive rights in Australia.
Despite significant progress in some jurisdictions, abortion has been largely abandoned as a political issue, and stigma remains entrenched in the country's health system.
The gap in major reform and dedicated resourcing has left women — particularly those in regional and remote parts of the country — bearing the cost; navigating lengthy, convoluted and often expensive processes to seek the care they need.
The reasons abortion is still so hard for some to access are complex. But restrictions imposed at public hospitals last year have provided some clues.
At its heart, this is a story about equity, dollars and political gain.
Most people with a story of obstructed access to abortion prefer to conceal their identities. They fear that speaking out might attract judgement in their workplace or amongst friends and family.
But Kate Cahill remains so outraged by what she went through last year, she is putting everything on the line.
Kate had just moved 10 hours away from her family in Melbourne, to central-west New South Wales. She was about to start looking for a job when she discovered that, to her surprise, she was pregnant.
"It was just something we weren't ready for at the time … I was always on the side of not having kids," she says.
Kate knew she wanted to terminate the pregnancy. She had two options.
Medical abortion involves taking two separate tablets to induce termination, and can be done at home up to nine weeks' gestation. A surgical abortion involves removing contents from the uterus, usually under light sedation — the same procedure used to treat missed miscarriage.
Kate rang a local GP clinic to arrange an abortion but said the process felt "strange" from the outset.
"The receptionist booked me in with a female doctor, and then 20 minutes later they rang back and said the doctor was not comfortable providing the service that I wanted," she says.
"But I could see another — male — doctor a day later."
That doctor, Kate claims, appeared "shocked" that she wanted to terminate the pregnancy. Nevertheless, he wrote her a script for the abortion medication, MS-2 Step, which she took at home to bring on a miscarriage and pass the pregnancy.
Kate was meant to have a blood test 10 days later to confirm the pregnancy had passed. But she missed the appointment due to work.
"I blame myself a lot for that … I was so angry at myself for not getting that blood test done," she says.
Three months later she noticed her jeans felt tighter and she was unusually tired. Her suspicions were confirmed when a pregnancy test came back positive.
Kate was unlucky. According to private abortion provider MSI Australia, less than 1 per cent of medical abortions fail.
Distraught, Kate went back to the GP and then had to wait several days for an ultrasound, which confirmed she was still pregnant — now 20 weeks along.
After 22 weeks, an abortion in NSW needs to be signed off by two doctors.
Kate claims the doctor shook his head and told her: "You've got yourself into a predicament. This is your miracle baby; it would be so much easier if you just have this baby."
To be clear, it would have been "easier" for the system — not for Kate.
Because in the years since decriminalisation began, not enough has been done to improve the infrastructure that provides this care to the people who need it most.
To understand the backdrop to the current political climate around abortion, it's helpful to rewind back to 2019.
In the lead-up to the federal election that year, then-opposition spokesperson for women, Tanya Plibersek, announced a plan for lasting change.
Her aim was to end the "patchwork" of abortion access across Australia. If elected, Labor would ensure abortions were "consistently" provided in public hospitals across the nation.
At the time, New South Wales, South Australia and Western Australia were yet to follow other jurisdictions in fully decriminalising abortion. But overwhelming public support for abortion rights suggested Labor's promise would be a vote-winner, so Plibersek pushed hard.
Labor promised to make federal hospital funding for states and territories contingent on each jurisdiction improving abortion access.
But the move angered members of Labor's right factions, particularly those aligned with the socially conservative Shop, Distributive and Allied Employees Association.
Weeks later, Labor lost a seemingly unlosable election. MPs in more religious and ethnically diverse seats argued the abortion policy cost them votes, after pamphlets claiming Bill Shorten had an "extreme late-term abortion agenda" were dropped in letterboxes and handed out at pre-poll booths.
In the aftermath, Labor conducted a sweeping review of what went wrong during the campaign. Curiously, the words "abortion" and "termination of pregnancy" are nowhere to be found in that document.
The review points out that Labor did not "project an image" that was "appealing to devout Christians", and notes that announcing the sexual and reproductive health strategy 10 weeks out from the election "enabled conservative groups to target Christian voters in marginal electorates" and "traditionally safe Labor seats".
"The party would be wise to reconnect with people of faith on social justice issues and emphasise its historic links with mainstream churches," it states.
Internally, it was decided there was nothing to gain from upsetting anti-abortion and religious groups across the country, when the states had responsibility for abortion care anyway.
When Labor came to power three years later, Health Minister Mark Butler ruled out returning to the 2019 abortion policy.
"It's not our policy now. It's not the policy we took to the [2022] election," he said.
Abortion care, Butler has emphasised, "is a matter for the states".
While it was no longer on the federal government's agenda, abortion access was making global headlines.
It was around this time that the US Supreme Court overturned Roe v Wade, the landmark decision granting Americans a constitutional right to abortion.
And here in Australia, abortion services were up for debate at a public hospital in regional NSW.
Abortion had been provided, although not advertised, at the hospital in Orange since the 1980s. The service was infrequent, but it was offered regardless of a patient's reasons for seeking a termination.
In more recent years, people had been able to get abortions through a public gynaecological clinic at the hospital.
But in August 2022, the hospital executive started asking questions about why so-called "social terminations" — abortions for unwanted pregnancies — were being provided at the hospital, and about the capacity to resource them.
Last year, the executive sought advice from the Western NSW Local Health District (WNSWLHD), which oversees the region's public health facilities, on whether a new service needed to be established for unwanted pregnancies.
In the meantime, the obstetrics and gynaecological team was advised to "hold" all abortions, unless there were medical reasons to terminate a pregnancy.
The LHD later provided their advice, but more than two years after the questions were first raised, the executive had still not given permission for the service to resume.
Women like Kate Cahill became collateral damage.
In September 2024, Kate sat in her doctor's office with tears streaming down her face, feeling terrified she would miss the 22-week deadline for an abortion.
Her doctor had called Orange Health Service but was told their abortion service had been "suspended".
No other local providers could assist her at this point in the pregnancy. The GP rang Westmead Hospital in western Sydney, but he was told Kate should be able to have the procedure in Orange.
That wasn't going to happen. So, the GP wrote a referral letter for Kate and told her to present to Westmead, a four-and-a-half-hour drive away, the following Monday.
Not convinced, Kate went home and called Westmead herself. The staff member she spoke with told her that "just showing up" was "not an option". They were willing to help but said there was a process that had to be followed.
Kate started ringing clinics all over Sydney. But none would take her because of how far into the pregnancy she was.
Then her GP called and said that outer Sydney's Nepean Hospital — also a four-and-a-half-hour drive away — would admit Kate.
"He told me that it was the same procedure that I went through at home, but at hospital where I [could] be monitored," Kate says.
She thought it sounded straightforward. But when she spoke with someone at Nepean, Kate was told she could be at the hospital for up to a week.
Kate would have to go through induced labour to pass the foetus.
In the lead-up, she was required to undergo counselling with one of the hospital's social workers, and make arrangements for a birth and death certificate, given the foetus was more than 20 weeks.
But if her GP had known any of that, he did not explain it to Kate.
Kate Cahill comes across as a strong, determined woman. But months later, the anguish she feels while recalling her story is palpable.
"I feel like a monster … Because I should have done more to take care of this sooner," she says.
Kate arrived at Nepean Hospital on a Tuesday. Labour was induced on the Friday and she delivered the foetus the following night, four days shy of the legal deadline.
She left the next morning feeling numb.
"I felt like I'd nearly done something wrong … It was very strange going to hospital having a baby and then leaving with nothing," Kate says.
In November 2024, Orange Health Service formalised a policy that put the restrictions around abortions in writing.
The ABC obtained and published a flow chart that directed staff to refer anyone wanting a termination for non-medical reasons to Family Planning NSW or a local GP.
That meant anyone seeking an abortion because they were experiencing an unwanted pregnancy — perhaps also dealing with drug addiction, financial disadvantage or domestic violence — could no longer rely on the Orange hospital.
Hours after that news broke, NSW Health Minister Ryan Park made an unusual intervention, declaring on Instagram that all abortion services in Orange had been restored.
Orange Health Service has been working on a formal abortion policy and is expected to start offering an expanded, routine service in July.
When it comes to abortion care, timing is critical. If a person misses the nine-week window for a medical termination, their choices become much more limited.
Depending on where you live, surgical abortion can be hard to come by.
Private providers can be expensive and are typically located in cities, and the provision of free surgical terminations through the public system remains ad-hoc.
The story of what happened to another woman living in regional Australia exposes just how difficult and convoluted the process can be, even when the termination is due to medical complications.
Tori, who is using another name to protect her identity, had her first daughter at a hospital in regional NSW. She lives in one of the state's border towns, but the health services closest to her are Victorian.
When she needed them for an abortion, however, her address worked against her.
Tori was 13 weeks pregnant when she and her husband learned their foetus had screened highly probable for Trisomy 21 (T21), or Down syndrome. Her GP referred her to a specialist in Melbourne — a three-hour drive away — to confirm.
Four days later, having arranged child care for her toddler and taken time off work, a genetic counsellor confirmed Tori's foetus had multiple markers for T21. Tori and her husband indicated they wanted to terminate the pregnancy.
The genetic counsellor wrote to Tori's GP with the results, and Tori made an appointment to discuss termination options for the following Monday.
At that appointment, the GP asked Tori – now 14 weeks pregnant — if she wanted a medical or surgical termination. Tori pointed out that she had missed the legal cut-off to take MS-2 Step at home, and told the GP she wanted a surgical abortion.
The doctor referred her to a women's health clinic in Shepparton, in north-east Victoria, but when Tori rang to book an appointment she was told they only provided medical terminations.
For the next hour, Tori sat outside a cafe calling clinics and public hospitals in Shepparton, Albury and Melbourne to find a suitable provider, but she was repeatedly turned away.
At one point Tori says someone told her "because you've waited so long, there are less options".
Some facilities couldn't provide terminations beyond 14 weeks, others told her they couldn't care for patients who lived outside Victoria. She explained she lived in a NSW border town, but worked and used health services in Victoria. It was no use.
Tori called the genetic counsellor she'd seen in Melbourne for guidance. They told her they would call her original GP and "not to worry".
In the meantime, Tori contacted a privately operated clinic in East Melbourne, which was able to book her in for a surgical abortion two days later.
Tori arranged for her husband's parents to travel two-and-a-half hours to look after their daughter, booked a hotel in Melbourne, and drove with her husband for the appointment.
They paid $1,650 up front for the procedure.
A week later, Tori's GP rang and told her they'd written a referral for Tori to have a surgical abortion in Melbourne. They said that if the letter was marked with "urgent", she would likely have the abortion within two weeks — by which stage, Tori would have been almost 18 weeks pregnant.
She told the GP the situation had been dealt with and hung up.
Tori has spent months reflecting on the confusion and inconsistency she experienced.
"Why is there not just a simple national website that lists the providers, what they can offer, what they can't, if they're free or if they charge and then their number?" she says.
If Tori had not been able to afford the procedure, travel and accommodation, had not had child care and time off work, and most of all had not had a close support network, she believes she would have continued with the pregnancy.
"That would've been to the detriment of my mental health, [and] the health of those who rely on me for support," she says.
Paddy Moore, who heads up the Abortion and Contraception Service at the Royal Women's Hospital in Melbourne, is neither surprised nor shocked to hear what Tori went through.
The Royal Women's is Victoria's biggest provider of abortion services and Dr Moore is renowned nationally for her advocacy.
"We have about three or four cases a week of women in border towns going backwards and forwards between services," she explains.
"We are not funded to take them, but do our best to accommodate the demand as we understand the distress the patients are enduring."
It's a loophole, Dr Moore says, that could be fixed if public hospitals had more surgical capacity, provided surgical terminations at later gestations and if interstate residents could access free abortions.
"A lot of foetal anomalies [such as Tori's] are diagnosed at around 12 to 14 weeks, so if [public hospitals] all provided surgical terminations up to 14 weeks, that would really help these cases," she says.
Recent polling shows most Australians support increased access to abortion.
The ABC's Vote Compass found two-thirds of those surveyed during the most recent federal election campaign thought abortion should be more accessible, with 44 per cent saying "much more" and 21 per cent saying "somewhat more".
Another survey, from Ipsos in 2022, found 74 per cent of the 1,000 respondents believed abortion should be legal in the first six weeks of pregnancy, and 39 per cent said it should be legal in the first 20 weeks.
Barbara Baird, an associate professor of gender studies at Flinders University, has been writing and campaigning for better abortion access for decades.
She says while Australia is "out in front" in terms of decriminalising abortion, that hasn't always led to improved access — "and in some cases, like NSW, barely at all".
Gestational limits on abortion range from 16 weeks in Tasmania to 22 weeks in New South Wales and Queensland, 23 weeks in Western Australia, 22 weeks and 6 days in South Australia, and 24 weeks in Victoria and the Northern Territory. There are no gestational limits in the ACT.
After each of those limits, the law stipulates that two doctors must sign off on the procedure — apart from in the ACT, where that approval is not required.
For more information on abortion services in your state:
At a federal level, there has been work to expand access to early medical abortions.
In 2023, the Therapeutic Goods Administration (TGA) relaxed restrictions around MS-2 Step, allowing more GPs, nurses and midwives to prescribe the medication and more pharmacists to dispense it.
TGA data showed the number of GPs prescribing MS-2 Step for the first time almost tripled in the following year, and the number of pharmacies dispensing the medication for the first time doubled.
But the change required states and territories to amend legislation so that relevant health practitioners could start prescribing. It wasn't until last month that NSW's parliament passed a bill to expand that access, in line with most other jurisdictions.
Victoria's Rural Doctors Association president Louise Manning says "anecdotally, there hasn't been an increase" in the number of prescribers.
Jo Flanagan, chief executive of Women's Health Tasmania, agrees. Every six months, her team contacts GPs and pharmacies asking if they want to be included on the Pregnancy Choices website, which provides abortion seekers with information on where they can access services and counselling.
The response from GPs, Dr Flanagan says, has been underwhelming.
"We've seen a tiny increase — maybe 5 per cent. It's not always that GPs don't want to prescribe MS-2 Step," she says.
"Sometimes GPs just don't want extra patients because they'll be overwhelmed. They're struggling so much to keep up."
As with medical abortions, there have been moves to improve access to surgical abortions in recent years.
A Senate inquiry into reproductive health care recommended in 2023 that all public hospitals "be equipped to provide" surgical terminations, or "timely affordable pathways to other local providers".
Turning that policy into a reality is complicated. Latrobe University's Erica Millar, whose recent work focuses on public provision of abortion, says "access across the country remains really patchy and really uneven".
Broadly, Dr Millar says, New South Wales is "by far the worst" when it comes to access, followed by Western Australia, then Queensland. Victoria is "somewhere in the middle".
Access has improved where state and territory governments have intervened with guidelines, laws or policies for public hospitals to adhere to. In the NT and SA, for example, abortion has historically been provided in the public system due to legislation passed in the 1970s.
Professor Baird argues state governments such as those in NSW, WA and, to an extent Queensland, Victoria, and South Australia, have "devolved responsibility for abortion to individual public hospitals".
The result, she says, is that progress depends on individuals within those hospitals who are willing to go above and beyond to ensure essential health care is provided.
"Improvement of services always relies on champions, and if there's not a champion nothing will happen," Professor Baird says.
Just as champions can work to improve abortion access, individuals can influence policy in the opposite direction.
The ABC has spoken to clinicians right across the country who have witnessed senior health workers and practitioners, hospital managers and executives restricting access to abortion.
The reasons range from budgetary and resourcing pressure to stigma and conscientious objection.
Abortion laws specify that health practitioners must disclose their conscientious objection and either provide information about where to get an abortion or refer a patient on.
In a hospital setting, that might involve a nurse or specialist refusing to take part in a surgical abortion and letting their managers know.
But Professor Baird says the law does not allow managers or executives that privilege.
"Adequate provision of services in a hospital should not be at the whim of the thoughts and preferences of any one manager or administrator," she says.
"Clinicians directly involved have a right to conscientiously object but no-one else."
The ABC submitted a Freedom of Information request for an email in which a senior manager at one public hospital disclosed they were a conscientious objector during discussion about whether abortion services should be provided or not.
The request was knocked back due to concern for the individual's personal safety and mental health, noting the person had been subjected to "ongoing threats and aggressive complaints".
An obstetrician at a West Australian public hospital told the ABC there are "little pockets all around Australia that are full of conscientious objectors".
They explained that their hospital's former head of nursing and midwifery was a conscientious objector. "Then they left, and we were able to start providing abortions."
But that hospital still doesn't offer a routine or easily accessible abortion service, nor does any public hospital in WA.
That makes it harder for doctors who want to perform surgical terminations to get access to theatre time.
Every day, in hospitals across the country, surgeons compete for resources in what doctors argue is a chronically under-funded and under-staffed health system.
Abortion is considered by many to be an elective procedure, even though it is time critical. Advocates say that surgeries such as hip replacements are often given higher priority.
Dr Millar points out that's partly because a lack of funding has made it difficult for executives to establish "new" services.
"Whenever I've talked to clinicians who are wanting to add a new service, they have to put in a business case that proves the hospital will not lose and, optimistically, will make a profit by offering abortion services," she says.
But she also argues in some cases, "resourcing" can be used as an excuse to refuse and obstruct essential health care.
In November last year the ABC published a memo confirming Queanbeyan Hospital had ceased providing surgical terminations after an email was sent on behalf of the executive stating that there was "no supporting framework" within the hospital to provide the service.
Surgical abortion services were reinstated at Queanbeyan and expanded across the region after the ABC's investigation.
Professor Baird points out that hospitals and GPs often refrain from advertising abortion services because "they don't want more customers".
She says the lack of transparency exacerbates abortion stigma which remains "embedded in Australia's health system".
There is no national data collected on how many terminations are performed each year, so arguments that hospitals could become overwhelmed with abortion seekers are hard to substantiate.
Since the revelations about Orange Health Service, the number of abortions being performed has increased from three to four per month to around eight per month. Clinicians have told the ABC the caseload hasn't been a burden.
While an internal review of the abortion ban suggested there was no evidence of "serious maladministration", Kate's partner Steve believes conscientious objection and stigma were part of the problem.
"I've got no issue with people not agreeing with it … But don't get a job there and don't use your power to force your views onto somebody else," he says.
What happened in Orange is just one example of how decisions made at the very top of the chain trickle through the system, affecting the health professionals working in it, and the people seeking treatment.
Bonney Corbin, from private abortion provider MSI Australia, puts it like this:
"The reality is that the people in positions of power … will dictate whether abortion is provided or not.
"And those people are not necessarily single mothers or women of colour or Aboriginal or Torres Strait Islander community leaders. They are often people with medical backgrounds, they're often men.
"They can't empathise on the level that we need to understand how important abortion care is for access to education, access to employment, access to future choice."