"We have to make sure you meet certain criteria": exploring patient experiences of the criminalisation of abortion in Australia.

Abstract

Nine different sets of laws govern abortion in Australia, and the criteria for an abortion to be considered lawful varies considerably by jurisdiction. We explored how the criminal status of abortion affected patients' experiences in accessing care in a country where abortion services are widely available. We conducted qualitative, in-depth interviews with 22 people who had an abortion in Australia since 2009 across a variety of legal contexts. We audio-recorded all interviews and transcribed them in their entirety. We carried out content and thematic analyses of the interviews using deductive and inductive techniques. At the time of their procedures, more than half of our participants (n = 13) obtained their abortion in a state or territory that had criminal sanctions associated with procuring an abortion and required abortion seekers to meet strict legal requirements to access care. In general, participants reported confusion about the legal status of abortion. Participants who had an abortion in criminalised settings described significant negative emotional impacts that were directly linked to the law. They were often required to fit their abortion story into a state-mandated narrative. Further, the criminalisation of abortion meant that some participants felt they could not be honest with clinicians for fear of being denied care. The participants were overwhelmingly in support of decriminalisation of abortion and increased consistency of the legal status of the procedure across Australia. The criminalisation of abortion in some Australian states negatively impacts patients' emotional wellbeing, undermines the patient-clinician relationship, and perpetuates abortion stigma. In the absence of legislative reform, training for clinicians - including abortion providers and general practitioners - to explain the implications of the legal status to their patients appears warranted. Patient-centred resources, such as a website with state-specific information, could fill an important knowledge gap for the public.