Despite well-established guidelines and codes of conduct, numerous healthcare practitioners in Australia are reportedly failing to refer patients for abortion in a professional manner. A recent perspective published in the Medical Journal of Australia highlights how these unprofessional practices pose a significant threat to person-centred abortion care across the nation.
Access to safe abortion care is not only essential healthcare but also a recognized human right. Practitioners who opt out of participating in abortion care due to personal beliefs are expected to refer patients to a willing provider. However, the reality often falls short of this expectation.
The Disconnect Between Guidelines and Practice
Medical guidelines, such as the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Clinical guideline for abortion care, explicitly advise that referrals for abortion should not impose delays, distress, or adverse health consequences on women seeking an abortion. Yet, unprofessional referral practices continue to prevail, causing harm through misinformation, judgmental attitudes, and unnecessary delays.
“There is ample evidence of a disconnect between real-world abortion referral practices and the principles outlined in professional codes of conduct and clinical guidelines,” Dr. Shelly Makleff and her co-authors assert.
The authors of the perspective call for urgent strategies to ensure that practitioners adhere to professional standards when referring patients for abortion.
A Spectrum of Referral Practices
The perspective outlines a spectrum of referral practices, ranging from outright refusal to refer, to unprofessional and minimally professional referrals. Each of these practices has distinct implications for patient care.
Refusal to Refer
Some practitioners refuse to refer patients due to conscientious objections, discomfort, or fear of repercussions. Such refusals violate professional codes of conduct and, in many jurisdictions, legal obligations as well.
Unprofessional Referrals
Unprofessional referrals are characterized by rude, unfriendly, or judgmental communication, unnecessary tests that delay care, or referrals to services that do not provide abortions. These practices undermine the quality of care and patient trust.
Minimum Professional Standards
At a minimum, abortion referrals should be timely, non-judgmental, and directed to a high-quality, willing provider. Systemized pathways for abortion care, with clear and accessible information, are essential to support professional referrals.
Person-Centred Referrals
Going beyond minimum standards, person-centred referrals prioritize the needs and preferences of the abortion-seeker, supporting their right to dignity and autonomy in a compassionate manner.
Towards Person-Centred Care
The perspective authors advocate for a shift towards person-centred abortion referrals at various levels of the healthcare system. Professional bodies are urged to articulate and enforce standards focusing on medical professionalism rather than over-regulating abortion.
“Government regulators, such as the Australian Health Practitioner Regulation Agency (Ahpra), have a responsibility to develop effective reporting and enforcement mechanisms for individuals who avoid their professional obligations for abortion referral,” the authors note.
Health service policies can play a crucial role by ensuring all staff are aware of their professional and legal obligations to refer for abortion respectfully. At an individual level, practitioners are encouraged to reflect on their referral practices to align with person-centred care principles.
“In this perspective article, we have argued the importance of encouraging all health practitioners, regardless of objector status, to move along the spectrum towards person-centred referral,” the authors conclude.
The full perspective can be accessed in the Medical Journal of Australia.
