A pervasive stigma, hard-to-find information, scarcity of providers, and denial of care on religious grounds.
These are all part of the maze regional people who are seeking abortions must navigate in modern Australia.
"One woman left her town because of her experience of being turned away from the local GP," University of Sydney rural pregnancy researcher Anna Noonan told ACM.
"That was the deciding factor in leaving that town because she knew that GP ... and just couldn't deal with, not so much the shame, but the fact that the system and the people working within the system weren't willing to help her."
There are two types of abortion. Medical abortion, where the patient takes medication that will induce a miscarriage, and surgical abortion, when a doctor performs a surgery to end a pregnancy.
Each state and territory has different regulations on abortion, but both medical and surgical abortions are legal nation-wide.
A PhD candidate, Ms Noonan's research has focused on a group of 20 women from various remote or rural locations in NSW managing an unintended pregnancy from July 2021 to February 2022.
The study participants' experiences paint a distressing picture of access to abortion care for regional Australians, finding the women not only had difficulty locating where - and if - services were offered, but that they struggled to find a professional to speak with about their options.
"When people did finally get to wherever they wanted to go, or chose to go, they often found that providers would turn them away," Ms Noonan said.
"Or providers would say, 'oh, I can't help you but someone else might,' or 'ring this telehealth number,' or 'I don't really know, you probably have to go and see a female GP,' and in rural areas at the moment wait times to see a GP particularly a bulk bill or female GP can be three to five weeks."
One of the participants, Ms Noonan said, had a doctor tell her they could not offer care because of their faith.
And abortion healthcare is time-critical.
One woman from the study described her situation: "I'd kind of used up about a week ... it may have been even like two weeks in between seeing that first GP, not really knowing what to do, going and doing the test, confirming that I was pregnant and then finding out about the women's health clinic and then getting an appointment there."
"So, by this point I was kind of already at like six weeks, so it was starting to get quite time critical," the participant said.
READ MORE:
Another woman said she had to wait until she was eight weeks pregnant before she received medication for a medical abortion.
"It gets really desperate... the further along that you get, you can't have a medical termination by a certain point, you have to go and have a surgical [one]," she said.
According to national sexual and reproductive health research centre, SPHERE, 703 out of 34,000 practising GPs in Australia are certified to deliver a medical abortion.
The centre also reports one in four women had an unintended pregnancy in the past 10 years and about 30 per cent of unintended pregnancies ended in abortion.
Rural women are 1.4 times more likely to experience an unintended pregnancy.
Monash University chair of general practice Professor Danielle Mazza said limited public access to abortion services was another major contributor to the gap in regional abortion health care.
"We're in this place because we've had ... abortions stigmatised for so long. It hasn't been part of general training for health professionals, because it was always done in the private sector," she said.
"So when you train you don't train generally in the private sector, you train in hospitals, and if you don't see it, you can't [provide the service]."
Research by Monash published this month, which reviewed 17 of 34 referral portals used by GPs over a six-month period in 2022 across all states and territories except Tasmania and South Australia, found almost half, at 47 per cent, had no public services listed for surgical abortion, and 35 per cent had no public services for medical abortions.
It also found most emphasised that public services should be "used as a last resort".
Professor Mazza said not every patient would be suitable for both types of abortion and the lack of public options pushed people to private providers.
A private surgical abortion can cost anywhere between $400 to $700.
"It's pushing all of the cost and all of the burden onto the individual woman to bear because the public hospital system is not stepping up in this area," Professor Mazza said.
"Its not just the cost of an abortion [for rural women], it's travel, transport and accommodation and childcare, because, you know, a significant proportion of women who have abortions already have children."
