specialty focus
Nurses and midwives , especially in the private sector , tend to do the majority of the work in that space anyway : prepping and educating the patient . It ’ s just the prescription of the drugs that the medical provider does at the moment . And if nurse practitioners or certified midwives could do that , that would stop people bouncing around the healthcare system and going to different providers for different steps .
In most states there has to be two GPs present or at least to agree to the procedure . What barriers does this bring for people wanting to access abortion ? Those laws are barriers in and of themselves . The two GP issue is a major barrier in regional centres where there ’ s a lot of anti-abortion sentiment . So if you ’ ve only got one GP in the community and everybody else is anti-abortion , it ’ s a huge stumbling block for access to abortion .
What I found in my PhD research is that nurses and midwives will pretend that they are a medical provider to sign the referral , so it looks like there ’ s two GPs signing off on the procedure . That ’ s illegal , but they should not be put in that situation in the first place .
Every day that ticks over as you ’ re waiting for that second GP referral , or the ultrasound scan , or the blood test , or the travel to a hospital somewhere that provides abortion becomes more critical because you ’ re becoming more and more pregnant . And the more pregnant you get , the fewer options you ’ ve got .
What barrier does conscientious objection play ? It probably impacts abortion care far more significantly than people realise . We know where GPs say , ‘ Sorry , I don ’ t agree with abortion . And therefore I can ’ t provide it to you ,’ they ’ re supposed to refer you to somebody who does provide abortion care . But if they ’ re the only GP in town , there ’ s no one they can refer you to . Or if they do refer , you ’ ll have to travel for abortion care , which is logistically difficult for people who might have to travel hundreds of kilometres or people who have got complex lives , who can ’ t just get in the car and travel across town to see a different provider .
Many religious-affiliated private hospitals just don ’ t provide abortion , but they don ’ t provide many contraceptive procedures also . In the public sector there are people at high levels , the director of a maternity unit for example , who may be a conscientious objector and therefore abortion isn ’ t allowed in that hospital .
Another way that it ’ s blocked is if you have , for example , nursing and midwifery conscientious objectors who say they won ’ t take part in a surgical abortion , and that can slow a whole theatre down . It puts the burden of work on people who are pro-choice and will be part of the abortion .
I understand that people have the right to object , and I understand that people are pro-choice . I think in that situation healthcare systems have the obligation to have a look at their workforce and plan accordingly on days where abortions are being performed .
I ’ ve known of people who have had to sell their cars and take out loans to get an abortion in the private sector , because it was just taking too long , or they couldn ’ t access abortion in the public sector .
The other major issue that I haven ’ t spoken about is in Western Australia where the public health system has been , I don ’ t know if outsourced is the right word , but a Catholic organisation is running the public hospitals in Western Australia . So all of the abortions are outsourced to a private organisation and that ’ s brilliant that the private organisation can do that , but it is not the role of our public health system to outsource care .
What changes in law should we make to improve Australia ’ s abortion services ? We need to change the law about who can prescribe mifepristone and misoprostol . Certified midwives and nurse practitioners should be able to do it . So that needs to be changed at a federal level . The other thing that needs to change is nurse practitioners need to be able to order ultrasound scans without it being an extra cost to their patients .
The Nursing and Midwifery Board of Australia needs to have a good , hard think about the clause in our standards for practice about following legislation , and considering what we do when legislation doesn ’ t protect human rights or is antithetical to human rights .
Funding to hospitals and health services should be tied to abortion care . So if a hospital does not provide abortion care , it doesn ’ t get its full allocation of funding from the state or the federal government .
Could you tell us a bit about your PhD and what you found ? I wanted to know how nurses and midwives provide abortion care in Australia for people victimised by gender-based violence , and what was happening in the environment around them that made them provide care that way .
I found that nurses and midwives probably don ’ t have much time to think about the gender-based violence component of their care because getting access to the abortion in the first place was a major issue for them .
The attitudes from people in high levels about abortion care were making the nurses and midwives feel like they were being backed into a corner , and that there was nothing they could do within the law or within the policy of the hospital or healthcare service to help people access abortions .
So they would find ways to help people get abortion care that were either against policy or against the law . Some would be part of teams in those religious-based health services that would sneak people in to have abortions under made up , fictitious diagnoses .
Nothing much happened for the genderbased violence , because it all had to be very hush hush , and nobody could know the real reason why the woman or the pregnant person was in the hospital .
Other people created pathways where they would help patients get to the metropolitan areas where they could have abortions in secret . Others would sign off as the doctor , to be that second medical provider to sign the paperwork . Other people would fudge paperwork to get people free travel or transport to the abortions .
There ’ s heaps of stuff going on because access to abortion is so hard . And when I asked how it made them feel , most were absolutely fine about their decision . Some were anxious because they had to make the decision , but when I asked would you do it again they said , ‘ Yes , absolutely .’
I think that shows we ’ re putting nurses , midwives and other healthcare providers in really precarious situations by the dumb laws and stupid logistical issues we have around abortion care right now .
It shows that nurses do take part in political acts . We are highly political , but we just exercise our politics quietly . It ’ s really important that in many instances , our politics is practised quietly when nobody can see it . We resist in a way where it ’ s not recognised . ■ nursingreview . com . au | 17