Doctors not developing skills, understanding necessary to provide abortions

 

It’s not just the cost of abortion that women find terrifying.

And it’s not just the ranks of trolls hanging outside abortion clinics, determined to harass and undermine a woman’s right to choose.

It’s also finding enough qualified and expert people who can provide abortions in a public setting.

“What we know is that private clinics provide abortions but we want to expose medical students to abortion training so they can incorporate it into their careers,” says Deborah Bateson, medical director at Family Planning NSW.

She’s right. Part of the problem is that even in medical schools across Australia, plenty of medical students get no exposure, no instruction, about abortion.

Caroline de Costa, professor of medicine and a leading reproductive rights advocate in Australia, says training is the initial problem.

“I’m aware that there are medical schools which do not provide instruction in abortion in their curriculum and it’s not just Catholic universities,” she said.

So, even at that early stage, those who would be our doctors are not developing the skills and understanding necessary to provide this common medical procedure.

But de Costa is convinced that one significant move will make a difference. From next year, at the direct request of the board of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, a reproductive health module will be trialled in Melbourne and then rolled out across Australia. It will be available for some year 5 and 6 trainees in the pilot stage – although not all will want to take it up.

She says the change in awareness at the college started in 2005 – so a long time coming. Now the college and its members have demonstrated an increased appreciation of the importance of abortion to Australian women, by issuing support statements on this and on the RU486 legislation.

“There has been quite a shift in the way the college approaches medico-social issues and I think that is much better than it was,” she says.

And Kirsten Black is one of those driving the change.

Black, an associate professor at the University of Sydney and an award-winning academic, is now in charge of a new strategy that will revolutionise abortion provision in this country.

Yes, her job is to wrangle trainee obstetricians and gynaecologists so they understand sexual and reproductive health, much more than the cursory lecture on methods that they currently attend. Strange to say, it’s only ever been on-the-job training in the past, which means that through the entire training package of a medical student or specialist, there has been no express teaching of how to perform abortions or vasectomies. Black and others developed a special interest group in the area within the college to try to address the dearth of abortion providers in Australia.

“We need to build the expertise of college members in the fields of abortion and contraception,” she said. So, tick contraception and abortion, now on to sexual health, which is the next module to be developed.

Getting good access is just another hurdle for women seeking abortion, in a country where abortion is subject to criminal law everywhere except the ACT. But there are other issues about how women in Australia find out where to go and how to have a termination.

If you Google the phrase “medical abortion”; you will discover a host of providers coming up in the advertisements. What you won’t read in those ads is exactly what drugs will be used in that procedure.

That’s because on the Google advertising guidelines, Australia is the only country that has this specific wording in the conditions for healthcare and medicines: “In Australia, Google doesn’t allow ads related to abortion-inducing drugs.”

There are long lists of countries where you can’t advertise abortion or birth control. A Google spokesperson said the company complied with the Therapeutic Goods Act in Australia. There are, however, many countries that do not allow advertising of prescription drugs to consumers. But Australia is the only one that has this particular provision.

Deborah Bateson says people turn to the internet, and Family Planning NSW fields many calls about where to get an abortion. Sometimes, though, women find themselves ringing what looks like an abortion counselling service but end up finding an anti-choice site.

“There is good credible information but mostly from private services, where there is a financial gap.”

But from next year, there will be less of an information gap. Now the access gap will have to change too.