Women's Access to Abortion after 20 Weeks' Gestation for Fetal Chromosomal Abnormalities: Views and Experiences of Doctors in New South Wales and Queensland

Abstract

Background: Induced abortions after 20 weeks’ gestation comprise around one per cent of all terminations in Australia and mostly occur following the diagnosis of a fetal anomaly. However, these abortions are overly represented in legal cases against doctors and challenging to organise in those states where abortion remains in the criminal code and health department directives impose regulations. This study explores barriers to abortion access after 20 weeks’ gestation in the states of Queensland and New South Wales.

Materials and Methods: We approached and sought consent from 22 doctors involved in abortion provision (15 in Queensland and seven in NSW), who responded in depth to a set of clinical scenarios. This study presents participants’ responses to three clinical scenarios of women presenting with a fetal chromosomal abnormality after 20 weeks’ gestation.

Results: Of the 22 medical practitioners in this study, 18 reported that access to late-term abortion in their state was restricted. The two key factors perceived to affect the decision to terminate a pregnancy in this context were the legal status of abortion and Department of Health policies mandating that applications for abortion be presented to clinical ethics committees. Practitioners reported that committees were slow to convene and inconsistent in their decisions.

Conclusions: Ethics committee involvement for late-term abortions is required by state health policy in NSW and Queensland, where abortion is still a criminal offence. This process is seen by abortion providers to hinder timely access to services and excludes women from the decision-making process.

Keywords: clinical ethics, fetal anomaly, induced abortion.

JEL Classification: K00