Despite existing guidelines and codes of conduct, many healthcare practitioners in Australia are failing to refer patients for abortion in a professional manner. This troubling trend is highlighted in a perspective published in the Medical Journal of Australia, which examines how these unprofessional practices pose a threat to person-centred abortion care across the nation.
Access to safe abortion care is recognized as essential healthcare and a fundamental human right. Practitioners who object to participating in abortion care are expected to refer patients to a willing provider. However, unprofessional referral practices continue to occur, causing harm and distress to abortion seekers through misinformation, judgment, and delays in care.
Guidelines and Professional Expectations
Medical guidelines, such as those from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, advise that referrals for abortion “must not impose delay, distress, or health consequences on a woman seeking an abortion.” Yet, evidence suggests a disconnect between these guidelines and real-world practices.
“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 co-authors wrote.
Dr. Makleff and her colleagues argue that strategies are urgently needed to ensure that practitioners refer patients for abortion in a professional manner. These strategies could help bridge the gap between current practices and the standards expected by professional bodies.
A Spectrum of Referral Practices
The perspective authors identified a spectrum of professionalism in referral practices, ranging from outright refusal to refer, to unprofessional referrals, and finally to person-centred referrals.
Refusal to Refer
Some practitioners refuse to refer patients due to conscientious objections, discomfort, stigma, or fear of repercussions. This refusal violates several professional codes of conduct and, in many jurisdictions, legal obligations.
Unprofessional Referral
Unprofessional referrals may involve rude, unfriendly, and judgmental communication with patients, delaying access to care through unnecessary tests, or referring patients to services that do not provide abortions.
Minimum Professional Standards
At a minimum, an abortion referral should be timely, communicated in a non-judgmental manner, and directed to a high-quality, willing provider. To support this, pathways for abortion care should be systemized, with clear and accessible information for health practitioners.
Person-Centred Referral
Beyond minimal standards, person-centred referrals focus on the needs and preferences of the abortion-seeker, supporting the patient’s right to dignity and autonomy in a friendly and empathetic manner.
Moving Towards Person-Centred Care
The perspective authors advocate for a person-centred approach to abortion referrals, which can be reinforced at various levels of the healthcare system.
“Professional bodies have a critical role in articulating and enforcing professional standards and codes of conduct — with a focus on regulating medical professionalism rather than over-regulating abortion,” the authors wrote.
Government regulators, such as the Australian Health Practitioner Regulation Agency (Ahpra), are urged to develop effective reporting and enforcement mechanisms for individuals who avoid their professional obligations for abortion referral. Health service policies can ensure that all staff are aware of their professional and legal obligations to refer respectfully for abortion.
At an individual level, practitioners are encouraged to reflect on whether their referral practices align with person-centred care principles, whether intentionally or unintentionally.
“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 concluded.
The full perspective is available in the Medical Journal of Australia.
