When Kitty Grozdich interviews a patient for the first time, they sometimes say things such as "I don't want to do this", and so she'll ask why they're there.
They might say their mum or their boyfriend is making them see her, which is a clear-cut reason to stop the procedure going ahead. But patients who say "maybe I'm making a mistake", Grozdich tells them: If you're saying "maybe", for me that means "no".
Grozdich is a nurse at an abortion clinic. She has seen "maybes" change to "Yes, yes, yes, I didn't mean maybe. I'm sure, I'm sure".
But once they say "maybe", they'll have to come back another time; the clinic won't proceed with anyone who isn't certain they want an abortion.
The Marie Stopes Westmead clinic, where Grozdich works, has up to 60 patients in a day. The priority is to protect, to put at ease, to hold a patient's hand while the cannula is inserted in their arm. A visit to the clinic may be highly emotional for the patient, who may have travelled 10 hours with whoever has come to support her, both of whom may have taken days off work; they may have arranged it all covertly, and be relieved to finally talk about it with someone else. "They realise that we're having this non-judgmental conversation about a normal, medical procedure," Grozdich says. "There's no gossip; there's no digging."
Sometimes, patients don't want to talk, a potential sign they need decision-based counselling. Other times, patients want to talk a lot, and in their talking Grozdich can hear they, too, might need counselling. But the majority of patients she nurses are comfortable with their decision, and for them it's a straightforward process.
Sometimes, she helps women in desperate situations - women who have been raped; women fleeing domestic violence.
About twice a month, a patient doesn't have money for the procedure, and the clinic won't perform it. Grozdich wonders whether, if a woman can't afford to have an abortion, she can afford to have a child. She has no idea what these women go on to do, and it scares her to think about it.
Sometimes, long-distance patients - often from the Northern Territory - are in their first trimester when they find out they are pregnant and can't get an appointment in Darwin. If they can't immediately find the funds to fly down and cover the cost of the abortion, overnight accommodation for themselves and the person with them, and sometimes childcare, their situations will escalate. Depending on how far into the pregnancy the woman is, one minor procedure can become two procedures that happen over two days, and at three times the price.
"It drives my frustration with the system," Grozdich says. "You just think, Why is this happening? How could so many things have happened to bring this person to us, today?"
Except for South Australia and the NT, abortions mostly take place in specialist clinics, set apart from public hospitals, and often run by large not-for-profits such as Marie Stopes International. Women can also access an over-the-phone service, through which supplies for a medical abortion are posted to you after a phone consultation - a practice the medical director of the Tabbot Foundation, which provides the service, says helps women avoid judgment from doctors and pharmacists.
After all, getting an abortion is a crime in NSW, and women qualify only if their doctor believes that continuing with their pregnancy poses serious danger to their physical or mental health, or life.
The first openly run abortion clinic in Australia was founded in 1972, in Melbourne, by doctor and campaigner Bertram Wainer. Two years earlier, he forced the Victorian government to hold an inquiry into abortion protection rackets run by the police, which focused public attention on the corruption and exploitation permeating underground practices. This was also a problem in NSW, where the first legal clinic opened in 1974. The following year, a rebate for abortions became available through Medibank, the forerunner of Medicare, and now roughly half the cost is covered for abortions at nine weeks' gestation or less. At Marie Stopes, which provides about one-third of abortions in Australia, the average out-of-pocket cost at this stage of pregnancy is $500, and prices rise after the first trimester: up to $3800 at 20 weeks. The Medicare rebate amount stays the same.
In a study of barriers to accessing abortion in NSW, Dr Frances Doran of Southern Cross University and Julie Hornibrook of James Cook University, who specialise in health research, distinguished between internalised stigma, which stems from secrecy, and external stigma, which is foisted on people by society. While keeping an abortion secret may be a way of avoiding external stigma, they write, this can lead to internalised stigma, and perpetuate a cycle of shame.
Telling people about having an abortion can be unexpectedly revealing. As one woman told the researchers: "It was an eye-opener when everyone I had disclosed to had also told me they've had at least one, so why is it so difficult?"
In May, the NSW Upper House voted down a Greens' bill put forward to decriminalise abortion, which required protest exclusion zones outside clinics, placed no upper time limit on when an abortion could be performed, and didn't mandate for it to be performed by a clinician. More than 100 law academics in NSW signed a letter in support of the bill, stating that abortion was a "health and welfare matter, not a criminal issue" and that women and doctors "should not face the risk of criminal prosecution" for it.
Yet society's attitudes are shifting: the proportion of Australians who think women should be able to obtain an abortion, readily when they want one, has risen from 55 per cent to two-thirds over the past 20 years, while the minority who think it should be banned has reduced from 6 per cent to 4 per cent, according to the Australian Election Study. The procedure itself is common and, from a medical perspective, simple. It's been estimated that one in four women in Australia will have an abortion in their lifetime, according to figures from SA Health, the only jurisdiction that collects and publishes the data.
Jill, from Queanbeyan, NSW, was a 24-year-old undergraduate of science and psychology when she had an abortion in 2014. (She didn't want her real name in this article to protect her family's privacy.) She has never regretted the decision, which allowed her to pursue the life she imagined for herself. Though she thought her boyfriend of five months was wonderful, it was too early to know if they wanted to spend their lives together. She was studying part-time, working full-time, lived with an alcoholic father and an imperious mother who fought constantly, and had no desire to raise a child.
The moment after her pregnancy test came back positive, Jill was searching online and calling clinics. "I actually thought that in Australia, there was no issue with getting an abortion, and it wasn't until I started Googling it that I was like, 'Oh, okay - there's not that many providers'."
On Wikipedia, she saw that abortion laws varied significantly between states and territories.
"I was like, What the hell? What's going on? I started to become a little bit worried and concerned: Am I actually going to be able to do this?"
Her local clinic had told her that she would be questioned on the grounds she had for getting a termination, which made her feel like something was wrong. She drove to Canberra, instead, where abortion is decriminalised.
She discovered that clinics had fast approaching close-down periods over Christmas, and that, if all went smoothly, she would be out-of-pocket by at least $400. On the drive to the clinic, she said to her partner, over and over: "Thank goodness we live so close."
If she hadn't been able to access a legal abortion, she says would have tried to induce a miscarriage some other way. "I would have tried some dangerous things."
What she remembers most was the relief when it was over, and the sympathy of the nurses and doctor, who treated her like a person capable of sound judgment. She talks often about her experience, but she didn't tell her mum, who is fiercely religious. For years, it was easier not to bring it up - and when she did, her mother was silent. She clearly didn't want to talk about it, and Jill hasn't raised the subject with her again.
It's a type of discomfort that Kitty Grozdich is used to. Family members make jokes about coat hangers, and friends call her "the arborist" because they don't want to say "abortion". She thinks her job garners less respect than other jobs. But she is proud of her work.
She considers herself a "social advocate", and thinks that getting an abortion should be talked about in the same straightforward way one would talk about having wisdom teeth removed.
Of the moment of conception, she says: "If we break it down, we're talking about cellular division. But at the end of the day, that's not really worth it ??? People who say that conception matters are obscuring the point. They're getting lost in the detail and not actually looking at the person in front of them."
Years after having had an abortion, Jill is happy to be living with a friend in western Sydney, with a full-time job that gives her the opportunity to travel. "If I was to fall pregnant again - even though I could, potentially, take care of a child at the moment - I still wouldn't want one," she says. "I think that's a decision that I've made for my life in general, and I think that's a decision I should be allowed to have."