This month, the Australian Capital Territory has made medical and surgical abortions up to 16 weeks gestation free for all its residents, regardless of visa status. This is a huge step forward for reproductive justice in Australia. It makes the ACT the first and only state or territory where temporary visa-holders without Medicare have a no-cost option to terminate a pregnancy.
For many pregnant people around Australia, abortion services and pregnancy care are unaffordable and unattainable. In particular, people on temporary visas face multiple barriers to accessing sexual and reproductive health services, starting with their exclusion from Medicare. Pregnancy, whether wanted or unwanted, planned or unplanned, entails significant costs: the cost of pregnancy care itself, of childcare and child raising, education and children’s health care, all of which migrants on visas must pay full fees for. Due to the gendered burden of care, women usually must add, or rather subtract, the substantial costs of foregone income and superannuation.
Structural discrimination and gendered caregiving norms mean pregnant people and primary caregivers experience significant barriers to workforce participation many years after having a child. Such barriers are reflected in the gender pay gap, since women are much more likely than men to take a workforce break to birth and care for children. Women are also more likely to be working in underpaid care and service roles, experience pregnancy-related workplace discrimination, and be overlooked for promotion. What results is a system of gendered economic inequality which limits women’s financial independence and their ability to make important decisions for themselves and their families. We know that men's control of decision-making and limits to women's independence in public and private life, are some of the key drivers of violence against women.
For migrant and refugee women, girls, trans and gender diverse people, the structural drivers of gender inequality are compounded by systemic racial and political exclusion and disadvantage. We do not have reliable data in Australia to estimate the rate of surgical and medical abortions. We do know, however, that migrant and refugee women are amongst the highest population groups to access MSI Australia’s Choice Fund, a bursary service set up for women and pregnant people who are experiencing financial hardship, in addition to other healthcare barriers.
International students and their partners are one cohort who are structurally excluded from pregnancy and termination services and often in need of such financial assistance. Currently, their insurance does not cover pregnancy or abortion care if they fall pregnant within the first 12-months of migration. This means if they experience an unintended pregnancy during this time, they are faced with limited reproductive choices and may feel coerced into making a decision, whilst simultaneously negotiating financial and settlement difficulties. This is an example of how migration related policies impact reproductive choice and ‘universal’ access to care in Australia.
The good news is that we can achieve gender, racial and health equity by promoting universal access to sexual and reproductive health (SRH) and justice. SRH is often sidelined by governments in lieu of health issues that are more explicitly linked to mortality (for instance, cancer, heart disease and most recently, COVID-19). Yet SRH is fundamentally about empowering all of us by promoting and securing our autonomy over our own bodies. When we are empowered to control our bodies – when we are supported and enabled to make decisions about whether to continue or terminate a pregnancy, for instance – we are empowered to take control over our own lives.
If we are serious about achieving gender equality and preventing violence against women, girls and gender diverse people, we must become serious about reproductive justice. Any person who is pregnant should be able to access safe, free or low cost, culturally appropriate, and publicly-funded pregnancy and abortion care. It is time for the rest of Australia to follow the ACT’s lead and take transformative steps in achieving gender, racial and health equity.
First published in edition #120 of The WRAP on 28 April 2023.