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Doctors crippled by religious backlash
In Wagga Wagga, it is nearly impossible to get an abortion.
It is a problem of access, as most medical stories are in regional Australia, but it is deeper than that, say local doctors, a symptom of the fear cultivated within the local medical community about being labelled “pro-choice” in such a deeply religious town.
Now a handful of Wagga doctors are speaking out, hoping to bring attention to the plight of women who are forced to travel hundreds of kilometres – and spend hundreds, sometimes thousands, of dollars – to get an abortion elsewhere. Or, in extreme cases, to go through with an unwanted pregnancy.
An investigation by The Saturday Paper reveals how Wagga’s strongly religious medical community is tying the hands of pro-choice doctors, creating a culture where medical professionals fear their careers and their ability to serve their patients could be jeopardised if they choose to provide abortions.
Dr Jane Goddard, a GP who has lived and worked in Wagga for 23 years, is the only doctor in Wagga who would talk on the record for this piece. She says many doctors “fear the outrage of conservative reactionaries, some of whom are fairly senior in the medical system here”.
“There are specialists that have been active pro-life picketers,” she says.
The sense of panic extends to those registered to prescribe MS-2 Step, two tablets that induce a medical abortion, which can only be used up to nine weeks into the pregnancy.
“There is this fear that if we come forward publicly that we could be ostracised or run out of town if it was made known,” says one female GP.
Doctors say that neither Wagga’s public or Catholic hospital, nor the town’s private day clinic, provide elective surgical terminations.
It is understood Wagga Wagga Base public hospital will provide an abortion only where it is medically necessary, but it will not provide a termination to a woman for non-medical reasons. Several local doctors say this is because some hospital staff morally or religiously object to abortion. They also speculated the hospital is worried about losing some of its pro-life specialists in other fields should it start offering elective surgical abortions.
The chief executive of the Murrumbidgee Local Health District, Jill Ludford, said: “Conscientious objection is the decision of individual medical practitioners and is not representative of the policies at Wagga Wagga Base Hospital.”
The Calvary Riverina Hospital follows Catholic Health Australia’s Code of Ethical Standards, according to a spokesperson, which states that “Catholic facilities should not provide, or refer for, abortions … [because] such procedures, treatments, and medications are morally wrong because they involve the direct and deliberate killing of an innocent human life in the earliest stages of development”.
A number of health providers told The Saturday Paper they believed doctors were worried that providing abortions in Wagga could affect their ability to work at the Calvary Riverina Hospital.
Asked whether the Calvary Riverina Hospital would bar a medical practitioner from working at the hospital, should they provide medical or surgical abortions in private practice or at another hospital, a spokesperson for Calvary told The Saturday Paper that “the credentialing of Calvary doctors is determined by the services provided by the doctor at Calvary”.
Even the privately operated Riverina Day Surgery, which offers tubal ligations, vasectomies and IVF treatment, draws the line at providing abortions. When asked whether this was because it feared losing pro-life surgeons or feared community backlash, the surgery told The Saturday Paper that “as a private health facility it would be necessary for consultant medical practitioners to apply to our day facility to perform this procedure … As no medical practitioners have made an application, we have not progressed consideration of the issue.”
The upshot is that many women in Wagga Wagga must travel long distances to find a clinic willing to provide a surgical abortion – three hours by car to Queanbeyan; five to Sydney or Melbourne.
Once, these women were able to travel to Albury–Wodonga, an hour-and-a-half away. But mid-last year, Albury–Wodonga Health revealed it would not be able to treat women from outside its area after being completely overrun by neighbouring towns.
Dr Catherine Orr, who was medical director of Gateway Health Wodonga – a clinic that still provides medical abortions to women outside the area – until the end of last year, said 40 per cent of their patients seeking a medical abortion were travelling from Wagga Wagga.
“The stories we heard about the difficulties these women had accessing an abortion in Wagga was just shocking,” Orr says. “I had women coming from GPs in Wagga who were telling them abortion was illegal and they would not provide that.”
In New South Wales abortion was removed from the Crimes Act only in October last year.
Dr Goddard still practises part-time at Wagga’s Kooringal Medical Centre. Until last year, she had also been the consulting doctor at the public hospital’s outpatient women’s health clinic for more than two decades.
She says that although she has seen increasing acceptance of abortion since she moved to Wagga, “the strong Catholic hold doesn’t seem to have shifted, which has surprised me”.
“We do have an extraordinary sway held by a group of senior reactionary Catholics,” she says.
According to Goddard, concern is particularly prominent among junior doctors, who rely on references from senior physicians to get into their chosen specialty and worry about the impact being a medical abortion provider could have on their professional advancement.
“You get a bad reference for a future job and it can ruin your whole career,” she says.
Goddard is qualified to provide the MS-2 Step but doesn’t currently prescribe it in Wagga.
She says she is first trying to bring colleagues at Kooringal “on side” as MS-2 Step providers, to ensure quality and continuity of care when she is out of town.
“There are just a few people in town [who provide medical abortions],” says Goddard. “And it’s all very quiet.”
Amelia* is one doctor who provides medical abortions in Wagga. She doesn’t advertise; women have to find out via word of mouth. Even so, she has a patient needing a medical termination once a month or so.
A local GP, she became accredited to prescribe MS-2 Step about a year ago, after the Albury–Wodonga Health district said it could no longer keep up with the number of women from outside its catchment area accessing surgical terminations.
She says doctors in Wagga are afraid to provide or speak publicly about providing abortions due to the town’s strong religious community “who are very influential”.
“There are still a few doctors in town who won’t offer contraception on the basis of religious grounds, which I think is an absolute travesty. We have someone [like that] at our clinic.”
Amelia says she has seen patients delayed from accessing a medical termination or early-term surgical abortion by a pro-life doctor who told them, “No, it’s unavailable. You need to have the baby.”
She says she’s had several patients come seeking an abortion later in their pregnancy. One of them, who was 18 weeks pregnant, needed about $3000 for an abortion out of town, plus travel expenses. Her financial situation forced her to go ahead with the unwanted pregnancy.
“I feel sad for them because they are forced into a situation that was not ideal for them in the first place, simply because they could not access services locally or that were affordable,” Amelia says. “And most of the women I see are from low-SES [socioeconomic status] backgrounds.”
Thomas* and Alex*, both GPs, say some doctors in Wagga are concerned that providing the MS-2 Step could put them in conflict with doctors at the town’s hospitals.
“If complications arise [from the medical termination] and they go to hospital and see the obstetricians there, they could disagree with the fact you are enabling abortions and could think you are creating a problem for them,” Alex says.
Thomas provides the MS-2 Step to “any woman who comes to me needing it” but wanted to remain anonymous to avoid becoming “the face of abortion in Wagga”. Alex hasn’t become qualified to provide medical abortions due to “the grief that would cause me, personally, at the moment”, citing the potential backlash from other medical professionals in town.
Both add that the lack of anonymity in Wagga escalates the fear of not only medical but also broader community backlash.
“Maybe this fear is unfounded,” Thomas says, glancing around the cafe where we’ve met. “But here, I mean, in the last hour alone, I’ve seen 10 people who I have looked after as patients.”
Almost all the Wagga doctors who spoke to The Saturday Paper mentioned one physician, Dr Pieter Mourik, as a cautionary tale of what can happen if you get on the wrong side of the pro-life community.
Now retired, the obstetrician-gynaecologist practised in nearby Albury, and was a pro-choice advocate who frequently wrote letters to the editor of the local newspaper calling for better abortion access. He joined the advocacy group Rights to Privacy and petitioned for protest exclusion zones. That was when the campaign against him took off.
Members of the pro-life community, including doctors, sent letters to the University of NSW, where Mourik taught, and to the Australian Health Complaints Commissioner, demanding the doctor be fired and disqualified over his pro-choice beliefs.
Mourik warned that pro-choice doctors in Wagga “need to be aware that [this group] will do anything to cause damage … to their business, as much harm as they can do.
“It may be a small group, but they are very determined … as one of them said to me, ‘We’ve got God on our side.’ ”
Wagga Wagga has long been a battleground for reproductive rights and religious conservatism. In the lead-up to the NSW abortion decriminalisation vote last year, Wagga locals petitioned the state MP, independent Dr Joe McGirr, to support decriminalisation. McGirr, a devout Catholic who described himself to Guardian Australia in 2018 as “not pro-choice”, voted against the bill.
“The community has made it clear about the services that need to be available,” he told the newspaper in 2018. “They need to be available in a safe and appropriate way.”
But the situation in Wagga, and many towns like it across the country, will be exacerbated by the government’s proposed religious discrimination bill, says Dr Chris Moy, chair of the Australian Medical Association’s Medical Ethics and Medico-Legal Committee.
The bill in its current form, Moy explained, would allow doctors to not only conscientiously object to providing a procedure they disagree with on religious grounds, such as abortion, but also to refuse to refer the patient to a doctor who will provide the procedure.
“Doctors may have morally objected to abortion before, but still have felt under the law they need to refer [the patient],” he says. “People would now have that bar lowered about what is demanded of them in terms of referring and be able to avoid that completely”.
Jan Roberts, who helped found the Wagga Women’s Health Centre 40 years ago, blames not only the town’s strong Catholic community for the lack of reproductive services, but also an influx of doctors from other Christian denominations, for creating “a more conservative medical world here”.
“No doctor wants to be known as the doctor who does abortions because they feel there will be kickback,” she says.
“We have had in the past services come to Wagga that were competing with very well-established fields, and they were squeezed out very effectively.
“[This] has quite an influence on the willingness of practitioners to do or even refer for an abortion.”
While the Wagga Women’s Health Centre doesn’t have the medical staff or infrastructure to provide abortions, Roberts says it has always referred women to the closest termination providers.
It is hard to know how many women in Wagga Wagga are trying to access abortion services, but figures obtained by The Saturday Paper from local providers suggest at least 20 women a month.
The family planning organisation Marie Stopes told The Saturday Paper it sees an average of 16 women a month travelling from Wagga to its clinics in Canberra, Sydney and Melbourne. Another three women a month in Wagga are accessing Marie Stopes’s tele-abortion service, which provides phone consultations and MS-2 Step tablets in the mail.
But there are small signs of progress.
In October, Marie Stopes and the Murrumbidgee Primary Health Network collectively ran a workshop in Wagga to accredit general practitioners, pharmacists, specialists, obstetricians and practice nurses to provide medical abortions.
But without a local bulk-billing abortion clinic, both Alex and Thomas agree that surgical terminations will remain inaccessible for many Wagga women. The catch-22 is that while the local demand is there, 20 women a month is not high enough to justify public funding for such a facility.
Dr Jane Goddard says that, in addition to more GPs becoming MS-2 Step providers, she is looking towards Wagga Wagga Base Hospital to step up and fill the gap.
“There are structures already in place that we could utilise. We have a public gynaecology clinic, we have a women’s health clinic as part of the outpatient department … we have an emergency department,” she says.
“There is no reason why Wagga couldn’t, because we have the infrastructure. It’s whether we will.”
* Not their real names.
This article was first published in the print edition of The Saturday Paper on Feb 29, 2020 as "Doctors crippled by religious backlash".
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