By HEATHER GRIDLEY
Women living in urban areas may take for granted their relatively easy access to family planning services that provide information and ways to freely determine the number, timing, and spacing of their children. For women in rural areas, the picture can be very different.
Recent research in rural Victoria found these women face extra hurdles and feelings of “judgement” when seeking out these services. The project I worked on with Dr Julie Kruss investigated the barriers for women seeking emergency contraception, pregnancy termination or pregnancy-related options counselling in rural western Victoria. Options counselling refers to services that explore available alternatives regarding an unplanned pregnancy.
We conducted in-depth interviews with health professionals and others whose current employment was connected to the issue of family planning, including nurses, doctors and counsellors. These frank discussions focused on issues they had witnessed for women accessing family planning services.
The study highlighted an overall lack of women’s health services in rural communities, as well as some alarming patterns in reported barriers to accessing them.
A significant issue was the feeling of being “judged” by health professionals, with some doctors refusing to make referrals based on their own moral judgement. Other doctors were suspected of deliberately delaying women’s access to abortion, for example by sending them for multiple ultrasounds, and withholding information about how to access appropriate services.
As time is of the essence in reaching decisions about an unwanted or unplanned pregnancy, delays can obviously compromise timely decision-making. The experience of being blocked produces distress and reduced self-efficacy, but can also turn women off accessing these and other health services altogether.
There were also examples of doctors who agreed to perform an abortion but then warned the patient that it wouldn’t be carried out if there was a “next time”. Threatening to withhold a health service on the basis of what is acceptable to the doctor’s moral judgement breaches medical ethics. The doctor starts to “play God” in more ways than one by assuming the power to provide or withhold a service (or information), and by imposing a moral judgement on a patient’s behaviour.
While these issues could arise anywhere, the problem is compounded in rural areas where there might only be one doctor in a town and limited opportunity for a second opinion.
There were also examples of misleading information being provided to women in rural areas. One pharmacy distributed scary pamphlets on emergency contraception that were not evidence-based.
Elsewhere, myths about abortion leaving women infertile were still being spread, despite declarations by medical bodies such as the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (2005) that there’s no proof of such links if abortion is conducted by a medical professional in a medical facility.