Table 2

Summary of participants’ perspectives on the intended and unintended consequences of abortion law reform in Victoria, Australia

Section 1. Intended and achieved
Position abortion as a health issue rather than a legal issueThe climate, or the culture, the philosophical or moral background is clearer and very positive. [P01]

The intent of the law reform as I understand it was to validate and make legal the current experience. So it was to acknowledge that women are having terminations and that they're requesting termination of their own volition and that that's not illegal. [P12]
Shift the power in decision making from doctors to womenIt has taken away that difference about abortion and the doctor being the one who decided if it was in the patient's right interest … it's made it much more of a conversation rather than a decision making on the part of the doctor – if that makes sense. [P12]
I think it was to put reproductive rights back in the hands of the women, but it is primarily to get it out of the criminal code. And it did do that, I think it has done that. [P10]
Increase clarity and safety for doctors providing abortionWas it achieved? Yes. I feel very comfortable now doing what I do, as prior to the reform I felt a bit uncomfortable doing what I was doing. You had to look over your shoulder every minute. [P18]

The immediate change unexpectedly was that I felt a huge sense of relief … When the decrim went through I really felt something go off my shoulders in terms of ‘well no one can ever call me a criminal’. It made me realise that that ambiguity was actually at play for health providers. [P05]
Section 2. Hope (or intent) of law reform and not achieved
Increase access to abortionWell the intent of the Law Reform was to take it away from the criminal code, and it achieved that. Did it make abortion more accessible? Of course not. [P09]

I think the intent hopefully was accessibility, but I don't think it's been achieved. [P11]
Decrease stigma (for doctors and women)I guess what I hoped though was that it would over the years feed into destigmatising the area, feed into abortion being considered a normal aspect of women's reproductive health care and fertility choices and be seen as just part of a normal gamut of people trying to be in control of their fertility…. Yes, so I'm hoping that that destigmatisation – I think that will be kind of a slowish process. [P05]

The reason I felt that that was done was so that there wasn't sort of that stigma attached to having an abortion …. But I still believe that there is that, you know sort of that stigma attached to having an abortion, and that's why a lot of practitioners won't or don't, sort of aren't interested in becoming providers for medical terminations as well. [P13]

I still think there's as much stigma around it. No one wants to say they're having an abortion or tell people. [P03]
Section 3. Unintended negative consequence
Section 8 increased the legitimacy of ‘opting out’ of abortion provisionOne of the things in the abortion law reform is the ‘opt out’ clause and institutions have taken that on board. There's nothing that says an institution can opt out but institutions have grasped it to say there's the ‘opt out’ clause so we don't have to provide a service. It doesn't say that. It just says that if the clinician doesn't want – yeah. [P12]
Section 4. Coincidences
Reduced public provisionSince abortion law reform access to public services has shrunk. It's not getting better. It's shrunk. [P12]

If you live 4 hours from Melbourne it doesn't matter, the legality of your reasoning of why you need a termination does not matter at all when you can't get one. [P11]
Reduced provision of late abortionI suppose I've seen a narrowing of services. A few years ago women were able to privately access post-24­week abortions but they can't anymore unless it's – like I'd say it's extremely rare and it would be for a severe fetal abnormality. [P03]
Introduction of medication abortionI suppose the shift has been the availability of medication abortion which I suppose is unrelated to the legislation. [P03]

I think the thing that's probably made it a little bit more accessible is the availability of the medical termination I think rather than the actual law itself. [P06]
Section 5. Unfinished business
Presence of protesters at abortion clinicsI was very aware that sadly it would not change many of the issues that are big issues in terms of abortion provision. So it would not deal with the access issue of being harassed and intimidated by extremists. [P05]
Lack of a state-wide strategy for abortion provisionWhat is happening now is because the health department or the government doesn't have a strategy, and there has been no change to the development of abortion services from a state perspective. Then it has to be up to individual practitioners and organisations and that's what's happening now … The context has lifted a bit and that has made it more feasible but there's still no overall strategy so it's very slow. [P01]
Sustaining the workforceThere's no new providers or anything popped out of the woodwork, nothing whatsoever. And the providers that there are, are getting very old. [P09]

One of our main problems is trying to recruit practitioners to work for us. It's incredibly difficult to get somebody – general practitioners, specialists, anybody, to join the service, to see it as something that they want to do… None of us are getting any younger, and a lot of practitioners are in their late 60s, early 70s … so at some stage there's going to be a problem. [P19]