Welcome to Australia's 'abortion deserts'.

Having spent a year travelling and working in the US, Natalie* was looking forward to a new chapter in her life. 

At 26, she decided to spend a few months at her parents' home to wind down after her international adventure, and figure out the next stage of her career. 

She was planning to move to Melbourne, and — armed with her Master's degree — was excitedly searching for apartments and jobs. 

"While I was in the US, I lived the good life," says Natalie. 

Watch: Naomi Watts talks about menopause and women's health. Article continues after the video.

"I had the opportunity to meet incredible people and I fell head over heels for an amazing man who adored me, and we spent eight blissful months together.

As incredible as it was, though, they both knew their love affair was temporary. And while she kept a special place for him in her heart, Natalie was excited about what lay ahead back home in Australia. 

But then, her period was late. Natalie's parents lived in a small country town, so she went to the family GP and told them about her skipped period. 

"He told me to pee in a cup and did the test. It was positive. I immediately burst into tears.

"How can I be pregnant? We'd been so careful. I was on the pill, we always used condoms – and this wonderful man was literally 20,000 kilometres away from me."

Listen to The Quicky discuss Australia's abortion deserts.

The GP, who had known Natalie since she was 5 years old, offered her an appointment with the nurse. Natalie said she'd prefer a referral to an abortion clinic. 

"I can't give you that," the GP said. 

"I would later find out this meant 'I don't agree with your decision from a religious standpoint and I don't do abortion referrals.' 

"This meant I needed to see another doctor to get another referral. Another bill. Another doctor's office."

Natalie was absolutely gutted. She was already heartbroken leaving the man she loved, and now found herself "a little bit homeless" and pregnant. 

"I was too young. I had no foundations. There was no dad. We were a world apart, and I had nothing to make this work."

Without telling anyone, Natalie went home and started researching her options. 

"I assumed it would be simple. Why wouldn't it be? This was a medical procedure that was legal in my country," she says.

"The local hospital only offered abortions once a fortnight, and they were largely booked out for a month. I did not want to be physically carrying a baby for a month."

Meanwhile, Natalie was sleeping on her parents' pull out couch, attending job interviews and trying to build her life. Eventually, she found a clinic in Melbourne that could perform the procedure in three days. 

"But it was 350km from me. I needed to drive up there, spend at least two nights in a hotel room, get medication – and do it alone."

"At the same time, I got a job offer for my dream career. I was so grateful and yet everything felt like it was falling apart. 

"I sat on the kitchen floor and I booked a hotel room, an abortion and pulled out my 'in-case- of-emergency' credit card.

Natalie made the three and a half hour trip to Melbourne and spent the night alone in a hotel, before her 7am appointment. 

"It was cold and metal and I remember just sobbing.   A wonderful nurse held my hand while I sobbed and fell asleep."

In the end, Natalie's termination put her into $1000 worth of debt. Despite the mental toll, Natalie was fortunate to have been able to make it happen. For some women, living in Australia's 'abortion deserts', the financial and time costs are insurmountable. 

What is an 'abortion desert'?

Image: Getty.

According to University of Sydney research, abortion deserts refer to regions where the nearest service is more than 160 kilometres away. Shockingly, this applies to a larger area of Australia than most would assume. 

"I think we all expected after years of campaigning, that once legal, abortion would seamlessly become integrated into routine public healthcare under Australia's otherwise fantastic universal health coverage under Medicare," says Dr Anna Noonan, Research Fellow at the University of Sydney's School of Rural Health, who conducted extensive research into NSW's abortion deserts. 

"How far off the mark we were."

Abortion care in Australia either takes place as a surgical procedure in a clinic setting or with medication – the latter is only available for pregnancies up to nine weeks gestation. 

"There is currently one abortion pill approved by the Therapeutic Goods Administration, and in August 2023 the TGA relaxed its regulations to allow nurses and midwives with specific qualifications to join doctors as abortion pill prescribers," says Dr Noonan.  

"Yet in some states and territories, this is overridden by laws which state that only doctors can prescribe.

Despite 1 in 4 people being likely to experience at least one abortion in their reproductive lifetime, there is still no national policy, approach or model of care that offers people access to the abortion care they should be entitled to, says Dr Noonan. 

Each state and territory has its own law reforms, regulations and models of care, meaning the circumstances under which you can or can't get an abortion really do depend on where you live.

"Access to abortion is patchy, inconsistent and hard to find unless you know where to look, or who to ask, or have been down this road before," says Dr Noonan. 

For example, in South Australia, abortion care is routinely provided at the Pregnancy Advisory Centre in Adelaide – a public health service available at minimal cost. Yet in NSW, there are only a handful of public hospitals that offer abortion care across the state, and alternative private services are clustered in big cities on the coast, sometimes with long waitlists.

"In the absence of any policy directive assuring both surgical and medication abortion are available in public hospitals, it is left up to a small number of incredibly hardworking clinicians at private clinics, NGOs and individuals within public hospitals to make abortion available," says Dr Noonan. 

"Telehealth services for direct-to-home medication abortion are now on offer through private clinics like MSI Australia or with GPs, but most still require an ultrasound — which for people living in rural and remote communities or with low financial resources can be arduous – sometimes impossible — to do."

Small communities don't have access.

The further you are from an urban centre, the harder or more complicated it is to access the care you need. Abortion is no exception.

Parts of regional NSW have no options for surgical abortion services other than travelling to Sydney, Newcastle or interstate. 

"We are now seeing great interactive online directories pop up in each state and territory that provide searchable information about where abortion and other sexual and reproductive health services can be found. Most of them are run by NGOs (non-profit organisations)," says Dr Noonan.

Many rural clinicians are keen to ensure they are well-positioned to provide high-quality abortion care. 

"To do this they may need support from their colleagues — findings from my research show that this is often not the case when it comes to abortion," says Dr Noonan.

"GPs willing to provide abortion care still feel reluctant to have their services listed publicly, and there is often resistance within the medical profession itself. 

"Informal networks do exist to help people in rural and other communities with disadvantaged access to abortion services, but the question remains — why is it that Australia's health system treats abortion as something other than worthy of public healthcare service?"

Abortion services are usually straightforward, safe, (and) effective — it is the willingness of the public health system, yep the same one that provides vasectomies, to accept that abortion is a necessary, common and important part of reproductive health and rights."

Mamamia contacted each of Australian state and territory health departments to find out what services were available, and how easy it was for women to source information on accessibility.  Here are their responses. 

South Australia

"SA Health provides free access to Unplanned Pregnancy Services, including medication and surgical terminations, across metropolitan and regional areas. These sites include the Flinders Medical Centre, the Pregnancy Advisory Centre, The Queen Elizabeth Hospital, Noarlunga Hospital, Lyell McEwin Hospital, Mount Barker District Soldiers' Memorial Hospital, Kangaroo Island Health Service, Naracoorte Health Service and Mount Gambier District Health Service.

"Where possible, regional hospitals will also facilitate medical and surgical terminations, subject to appropriately trained medical officers being available or through service agreements with private GPs. For additional assistance, rural and remote consumers are also able to receive clinical help through telehealth services with private providers.

"On some occasions women may need to travel to one of our metropolitan sites, due to patient choice or other clinical reasons. Our Patient Assistance Transport Scheme (PATS) assists South Australians who are required to travel more than 100km each way to access medical specialist services that are not available locally.

"Women can speak to their GP or health provider for advice and information on appropriate services for their needs, or call SA Health's Pregnancy Advisory Centre on (08) 7117"

Western Australia

"Publicly funded Abortion services are provided by a range of hospitals and contracted services across Western Australia (metropolitan and country sites), ensuring equity of access and care. The options available will depend on how many weeks pregnant you are (gestation), where you live, your personal circumstances and the type of abortion you may need. Further information can be accessed through King Edward Memorial Hospital - Considering an abortion (health.wa.gov.au), Abortion in Western Australia (healthywa.wa.gov.au) and Abortion - Sexual Health Quarters (shq.org.au).

New South Wales

"Affordable and timely access to abortion services is a whole of sector responsibility shared by the public health system, private providers, primary care and accredited non−government organisations. The NSW Government has made a commitment to ensure that women have safe access to abortion care. Measures to support improved access to abortion care under the NSW Government commitment are being considered.

The 2023 NSW Budget allocated an additional $3.5 million over four years to support this. Under the commitment, the SEARCH project, to improve access to affordable pregnancy termination specifically in rural and regional NSW, has been extended by two years with an additional $800,000 to be committed over 2024-25 and 2025-26.

This extension builds on the initial $1.2 million investment into the SEARCH project (to a total of $2 million). Termination of pregnancy is provided in most local health districts in NSW. In most cases, medical or surgical abortions can be provided in the community or non-admitted settings.

"NSW public hospitals primarily provide abortion care for women with complicated cases and later term pregnancy gestations. This includes acceptance of referrals from other abortion providers for women experiencing complications.

Local health districts determine the provision of abortion care based on local need and service capacity. Several local health districts have established dedicated medical abortion care services within the Women's Health Service, Sexual Health Service or Community Health Service, or provide funding support to a local Community Women's Health Centre (NGO) service.

"Personal beliefs of staff cannot impact a woman's right to access abortion services. If individual clinicians conscientiously object, referral pathways are in place to ensure women can safely access care. NSW Health also recognises that supporting GPs and other primary health clinicians to provide abortion care is important to improving access, particularly in rural and regional NSW. The Australian Government and Primary Health Networks have a key role in promoting access to abortion care through primary care services."

Northern Territory

"Information on abortion services in the Northern Territory is available via:

https://nt.gov.au/wellbeing/hospitals-health-services/abortion-termination-of-pregnancy-in-the-nt"

Victoria, Queensland and Canberra's health departments had not supplied statements at the time of publishing.

For Natalie, the cost and emotional toll of her abortion was heavy, but "a drop in the ocean of what it would cost if I was forced to have a child. 

"This is extremely prohibitive to young women. The cost is a real issue. Small communities don't have access," she said.

"Women that can least afford them are being forced to wait long periods or time or travel. People will be having children because they are in abortion deserts."

Natalie believes access should be accessible for all Australians, regardless of where they live. 

"With the overthrow of Roe v Wade in the US we need to seriously understand that this could happen to us.

"We will not go back. Women should not be forced to birth."

*Name has been changed.

Feature image: Getty/AMA.