Alabama has voted to ban abortions. Could the same happen here?

The US state of Alabama is making headlines after its legislature voted to outlaw all abortion procedures, even in cases of rape or incest. Any doctor who performs an abortion could go to prison for 99 years.

Alabama is just the latest US state to sign off on “heartbeat” bills, so named because they ban abortion once a fetal heartbeat can be detected, which is at about six weeks. Mississippi, Georgia, Kentucky and Ohio have all instituted their own versions.

These states are attacking the standard established by the US Supreme Court in its 1973 Roe v Wade decision, which ruled that states could restrict abortion only after fetal viability (about 24 to 28 weeks).

The new laws will be challenged in the courts and may be blocked. In the meantime, both pro-life and pro-choice supporters have taken to the streets over the bills, and the more progressive state of Nevada has just moved to make abortion more accessible.

It is estimated that one in three Australian women will have an abortion in their lifetime; there are up to 80,000 abortions in Australia every year.

What are our laws on abortion and could they be eroded?

Should Australian women be worried?

"In Australia, there isn't really a mood to ban abortion, although there are sections of the population that would be interested in restricting access," says Dr Sasha Callaghan, lawyer and lecturer in health law and ethics at University of Sydney.

Abortion in Australia is under the jurisdiction of state law. While several federal ministers (such as Cory Bernardi) have previously expressed a desire to restrict access to terminations, their power is limited.

A rare conscience vote was held in Federal Parliament in 2006 over whether to lift a ban on the abortion drug RU486, with the result of the vote stripping then health minister Tony Abbott of his power over the pill.

This had been an indirect exercise of power over abortion access: the health minister was given the power to approve the importation and listing of abortion drugs under the federal Therapeutic Goods Act. This was a result of a political deal with conservative Tasmanian senator the late Brian Harradine, who then held the balance of power in the Senate.

I would like to think we wouldn’t find ourselves in the position that US states find themselves in but I would never want to be complacent.

Marie Bismark, University of Melbourne

Until 2012, no pharmaceutical company had successfully applied to import and distribute RU486 in Australia and only a small number of doctors were authorised to give it, but the drug eventually became available on the Pharmaceutical Benefits Scheme in 2013.

Marie Bismark, associate professor of public health at the University of Melbourne, says we shouldn't take rights such as abortion for granted.

"History teaches us that human rights can quickly be eroded," she says.

In the US, abortion was decriminalised by Roe v Wade, but this doesn't mean it will never be reversed.

"What the US constitution actually protects is a right to privacy, and Roe v Wade was a Supreme Court decision that extended the right to privacy to a woman's right to choose what she does with her body," says Professor Bismark.

"That interpretation of the constitution was made by certain judges at the time and now that there are different judges in court [including the conservative Brett Kavanaugh], there is a chance they could reinterpret that decision.

"I would like to think we wouldn’t find ourselves in the position that US states find themselves in, but I would never want to be complacent."

Prime Minister Scott Morrison has stated that abortion services are "rightly dealt with by the states and territories".

"I don't find that debate one that tends to unite Australians, and I certainly am not going to engage in the political elements of that discussion because, frankly, I don't think it is good for our country," he said in March.

What are the laws in Australia?

Medical abortions, which involve taking two tablets to end a pregnancy of up to nine weeks' gestation, are allowed at home or in a clinic when prescribed by a certified doctor in Queensland, NSW, Victoria, Western Australia, the Northern Territory and Tasmania.

Overall, it's a low-risk option for early termination with a success rate of up to 98 per cent. In some circumstances, such as for women living in rural areas, the tablets can be posted.

Teleabortions, where a woman has a phone consultation with a doctor and is then sent the medications required, are available everywhere but South Australia and the ACT. In WA, it requires a referral from a doctor.

In the ACT, the law requires pills for a medical abortion to be taken in a hospital or approved medical clinic, although new laws will soon allow medical abortions through a GP or telehealth provider.

The average cost of a medical abortion in Australia is $560 (after the Medicare rebate), and $470 for a first trimester surgical abortion, according to a 2017 study in The Australian and New Zealand Journal of Public Health.

For women who are more than nine weeks pregnant, surgical abortion is a day-surgery procedure at a specialist clinic.

The cost increases to $1500 for procedures at 13 to 19 weeks (with the rebate) and $7700 for procedures beyond 19 weeks.

Some women also have to factor in travel and accommodation costs, GP referrals, medical tests, out-of-pocket costs and lost wages due to travelling.

How is abortion still a crime in NSW?

Under the New South Wales Crimes Act, abortion is criminal if performed unlawfully and it can carry a maximum penalty of 10 years’ jail. Both women and doctors can be caught by the law.

In 2018 a Sydney woman was prosecuted for taking a drug to induce an abortion after she bought pills on the internet; while In 2006, a doctor was placed on a two-year good behaviour bond after being prosecuted for the first illegal abortion in the state in 25 years.

Under the law, exceptions can be made when a doctor believes a woman’s physical and/or mental health is in serious danger. Social, economic and medical factors may be taken into account when deciding if the abortion should take place.

NSW legislated last year to create safe zones around places where abortions take place, but the government still faces a campaign from groups – ranging from the Human Rights Law Centre to the Royal Australian and New Zealand College of Obstetricians and Gynaecologists – which say the state's criminalisation of abortion is archaic.

NSW Premier Gladys Berejiklian and the Labor opposition have both confirmed their MPs would be given a conscience vote on the issue should a bill come before the next Parliament.

Which state has the most progressive laws?

Victoria, where abortion is accessible and legal up to 24 weeks, and legal after 24 weeks with the approval of two doctors. It is illegal to protest within 150 metres of an abortion service in the state. (Even that last aspect of the law has recently been challenged by anti-abortion advocates, but the High Court dismissed two appeals against safe access zones in Victorian and Tasmanian laws.)

In 2017 the Andrews government launched the state’s first sexual and reproductive health strategy. Since then it has started funding such initiatives as eight new sexual and reproductive health hubs, including in regional areas.

A new service, 1800 My Options, allows women to call a helpline to find out about sexual health, contraception and termination.

What about the other states?

If you’re a woman living in South Australia, Tasmania or Queensland, obtaining an abortion, despite being legal, is still difficult.

Whether it’s being unable to access a provider, having to jump through hoops to gain the approval of multiple doctors before proceeding, or even having to show proof of state residency, there are many examples of women’s struggles to access abortion.

In South Australia, abortion is legal up to 28 weeks only if two doctors agree that a woman's physical or mental health is endangered by pregnancy, or if that there’s a risk the baby will be born with a serious abnormality.

All abortions there must also take place in a hospital or a prescribed facility, and the pregnant woman must be a state resident. In an emergency, these provisions may be waived. Under South Australian law, a woman can still be charged for obtaining an "unlawful" abortion.

Access to surgical abortions is woeful in Tasmania following the closure of the state’s only dedicated abortion clinic in 2018.

The Liberal government – which, when in opposition, opposed the decriminalisation passed in 2013 – has ruled out funding elective abortions through the public system, and will only offer financial assistance in some circumstances to women travelling to other states for a termination.

For many women, the cost of travelling to another state is so prohibitive – for example, between $1500 and $2000 to travel to Melbourne for an abortion – that it is forcing some women into proceeding with an unwanted pregnancy, says Women’s Legal Service Tasmania.

Until 2018, not even rape, incest and fetal abnormality were grounds for a lawful abortion in Queensland. Since 2018, a woman has required the approval of a doctor for abortions after 22 weeks. Protesters are not allowed within 150 metres of a clinic.

Termination is legal up to 14 weeks in the Northern Territory, and 23 weeks with the approval of two doctors. Medical abortion, however, was legalised only in 2017. A women does not have to be a resident of the NT to access abortion. The territory mandates safe-access zones.