Safe Access to Reproductive Health Care in Australia

Formulating proposals for changes in law and policy at both the federal level and State level to remove barriers to access.

Access to the information and services needed for good reproductive health care is not equitable across Australia (de Costa et al. 2015, Livsey 2017, Rushton 2017). Many factors – legal, economic, and spatial – have an impact on individual women’s access to these health services. For example, laws vary markedly from state to state (Reproductive Choice Australia 2017) affecting not only doctors’ ability to provide services, but also infringing upon women’s human rights (Sifris and Belton 2017). Some locations are subjected to regular protests, which additionally impede access to services (Shankar et al. 2017). Even within a state, where a woman lives strongly affects the cost and availability of services, particularly if extensive travel is required. The degree and variability of this inequity forms a complex patchwork, the detail of which is not always clear. This project will conduct a comprehensive analysis of the multiple factors that contribute to this national issue, revealing insights and opportunities for improving equity of access to reproductive health in Australia.

A recent study in the US highlighted the critical and constitutional need to consider the concept of spatial burden in legislation (Statz and Pruitt 2017). However, laws and policies addressing issues around reproductive health care rarely consider the issue of distance. Like the US, Australia is composed of states and territories where there is often considerable distance between the metropolitan centres and the rest of the state. This distance constitutes more than the mileage, with wide gaps in access to information and additional financial barriers that disproportionately affect women in rural areas (Shankar et al 2017). Preliminary research by Penovic and Sifris (Castan Centre) has shown that there is a strong distinction between reproductive health services available in the various Australian jurisdictions, with women in remote areas frequently facing substantial geographical challenges to access.

The project will comprehensively map these access factors across and within all states and territories in Australia, following the precedent of a US study led by Professor Lori Brown, who is an advisor to the project (Brown 2013). As well as a comprehensive state-by-state comparison, it will detail a finer-grained analysis of accessibility through careful use of diagrams and infographics. Making the information clear and legible is a critical part of the project.

This research will be extended and augmented through a number of case studies of providers from different jurisdictions and geographical locations in order to identify specifically the barriers to access stemming from law, policy and practice throughout Australia. For example, we will analyse the operation of legislation providing for safe access zones in Victoria, Tasmania, the ACT and NT. These laws are particularly pertinent as the activities of protesters who oppose access have had a significant and deleterious impact on the rights of women seeking medical information and reproductive health services. They undermine the health and wellbeing of women accessing lawful medical services in the context of intimate and often difficult personal choices. Prior study has also indicated that the impact of protests on access to services differs, for example, where clinics are designed exclusively to provide reproductive health services compared to generalized health service facilities which include reproductive health within the scope of a wider range of services. The selected case studies will span these variables as well as considering other barriers to access, such as financial cost.

This project proposes to undertake an interdisciplinary investigation of this complex issue through a variety of collaborative research activities and case studies. The aim of this study is to formulate proposals for changes in law and policy at both the federal level and State level to remove barriers to access. It will do so through:

  • Conducting an online survey with clinic staff (including doctors, nurses, psychologists, and social workers) to generate an additional data set and identify appropriate sites for in-depth case studies
  • Conducting in-depth interviews with clinic staff and others involved in formulating law and policy on this issue both in jurisdictions that have introduced safe access zones as well as those who have yet to implement such measures.
  • Geographic analysis of clinic sites through mapping accessibility (on foot, car, public transport), security (digital and physical), location and proximity of protesters and anti-choice propaganda
  • Inventory analysis of the spatial factors of places of protest
  • Visually mapping spatial context and behaviour using design-based visual methods
  • Analytical axonometric drawings of selected case study clinic sites (where the survey has shown implementation of the Safe Access Zone act has had various degrees of success)
  • Co-design workshops with clinic staff, law academics, design academics, members of local government, city planners and women from urban and rural areas to improve access

References

  • Brown, Lori (2013). Contested Space: Abortion Clinics, Women’s Shelters and Hospitals. London: Ashgate.
  • de Costa, Caroline, Heather Douglas, Julie Hamblin, Philippa Ramsay and Mandy Shircore (2015). “Abortion law across Australia – A review of nine jurisdictions.” Australian and New Zealand Journal of Obstetrics and Gynaecology 55: 105–111.
  • Livsey, Anna (2017) “How much do abortions cost across Australia? – explainer.” The Guardian, posted 22 August. https://www.theguardian.com/news/datablog/2017/aug/22/how-much-do-abortions-cost-across-australia-explainer?CMP=Share_iOSApp_Other
  • Reproductive Choice Australia (2017). “Summary of Australian State and Territory Abortion Laws.” August. http://www.reproductivechoiceaustralia.org.au/
  • Rushton, Gina (2017) “This Chart Shows How Much Abortion Costs in Each State.” Buzzfeed, posted April 28. https://www.buzzfeed.com/ginarushton/this-is-how-much-abortion-costs-in-australia?utm_term=.mglPyZaxV#.cxejqEPly
  • Shankar, Mridula, Kirsten Black, Philip Goldstone, Safeera Hussainy, Danielle Mazza, Kerry Petersen, Jayne Lucke, and Angela Taft (2017). “Access, equity and costs of induced abortion services in Australia: a cross-sectional study.” Australian and New Zealand Journal of Public Health 41:309-14; doi: 10.1111/1753-6405.12641
  • Sifris, Ronli and Suzanne Belton (2017). “Australia: Abortion and Human Rights.” Health and Human Rights Journal 19(1): 209–220.
  • Statz, Michelle, and Lisa R. Pruitt (2017). “To Recognise the Tyranny of Distance: A Spatial Reading of Whole Woman’s Health v. Hellerstedt.” UC Davis Legal Studies Research Paper Series, http://ssrn.com/abstract=3013818