Following is an edited version of an article appearing in this week's Green
Left Weekly (issue #460).
Tasmania's only free-standing abortion clinic closed in March this year,
exacerbating women's difficulties accessing abortion in the state. An
estimated 140 women annually fly from Tasmania to Melbourne to obtain
abortions they are unable to get in the state. I have written to the health
minister on July 22 urging her to consider funding a free-standing abortion
service and haven't yet received a response. You can see from the article
below the increasing urgency of this issue. Please write letters to Judy
Jackson (health minister) calling for government support for a dedicated
abortion service, and to Peter Patmore (attorney general) calling for repeal
of sections 134 & 135 of the criminal code which criminalise abortion.
c/-Parliament House, Hobart 7000. (Please send a copy to me at PO Box 115
North Hobart 7002.)
Resistance will be holding an open meeting 3.30pm Saturday 18th August to
discuss the issue and what action is required. Please come along - all
pro-choice people welcome. 225 Murray St Hobart. Ph 6234 6397.
A petition calling for repeal of the anti-abortion laws has been circulated
by Socialist Alliance. To obtain a copy, please email me or phone 6234 6397.
How and why abortion access is limited
BY KAMALA EMANUEL
Tasmanian abortion services may be set to improve, with health minister Judy
Jackson offering to investigate the possibility of public funding for the
establishment of a new abortion clinic. This is a significant victory for
Tasmanian women who, like many women around Australia, face numerous hurdles
in accessing abortion services. [At the time of writing this article, I
understood this to be the case, however, that has changed. Judy Jackson's
official position is unclear, however, unofficial indications are a lot less
promising now. It is definitely premature to talk of victory.]
Not all the hurdles result directly from the presence of abortion on the
criminal code but all have been exacerbated by it. The Tasmanian experience
highlights the need both for abortion laws to be abolished and for increased
recognition that reproductive choice is a woman's right.
In March, Tasmania's only free-standing abortion clinic closed. Since then
the public hospital system has struggled to manage the increased demand for
abortion services and more Tasmanian women have been forced to travel
interstate to access a confidential, timely and non-judgmental service.
Launceston General Hospital has continued to perform a fixed number of
abortions. However, at the Royal Hobart Hospital, while the number of women
seeking access to abortion has increased, the loss of a staff member in late
August has been expected to result in a decline in the number of abortions
performed.
In the 1970s, women couldn't obtain abortions in Tasmania. Feminist
activists ran a support network, enabling women to fly to Melbourne on
student concession fares and obtain abortions at the Fertility Control
Clinic where lower costs for Tasmanian women had been negotiated. In the
1990s the Women's Health Foundation (WHF) abortion clinic was established
near Hobart.
Isolated from Tasmanian medical personnel the clinic was forced to fly in
interstate doctors. The clinic's limited relationship with the specialist
community, combined with uncertainty about the legal status of abortion,
also meant that it required a much greater degree of experience for all its
proceduralists than interstate clinics.
This resulted in high fees for the clients — in the vicinity of $250-380 —
and financial uncertainty for the clinic. According to the 1996 National
Health and Medical Research Council's draft report on abortion in Australia
(since pulped by a hostile federal government) Medicare rebates for abortion
are not as high as for comparable procedures.
Non-surgical abortion
For a brief time medical abortion — non-surgical abortion induced by drugs
under medical supervision — was available in Hobart. This gave women another
(cheaper) option.
Methotrexate and misoprostol have been successfully tested for use in
medical abortion (provided surgical abortion is available for back-up). But
they are not licensed for this use. The manufacturer of one has tried to
stop it from being used for abortion, and the manufacturer of the other will
not seek to extend its licence to include abortion. So, despite being easily
prescribed in Australia (unlike the banned but even more reliable
mifepristone RU486), they are not in widespread use.
Multiple impediments exist for doctors wishing to prescribe medications for
abortion. Many anti-choice doctors would refuse to prescribe it, and other
doctors are unaware of this use for the drugs. Those who are, and do not
have "moral" objections, then have to face high insurance premiums.
At least one medical insurance provider currently refuses to indemnify
doctors who prescribe the drugs for abortion, on the grounds that it would
be "off-label" prescribing. But it is not illegal to prescribe medications
outside the manufacturers' recommendations. Misoprostol is widely used to
reduce damage to the cervix during surgical abortion, and methotrexate is
used to treat ectopic pregnancy (outside the uterus).
Another insurance provider covers medical abortion under the costly rate
associated with surgical "procedures", despite the fact that it doesn't
involve the use of any surgical instruments.
It is hard to escape the conclusion that these insurance providers are more
worried about litigation resulting from the quasi-legal status of abortion
than about safe medical practice. This makes it much harder for women to
find doctors to perform the procedure, and pushes the costs up when they do.
The availability of medical abortion in Hobart, although briefly opening up
more opportunities for women, contributed to a decline in women attending
the WHF clinic. Financial pressure soon forced the clinic's closure, and at
around the same time access to medical abortion was severely reduced.
Previously employed at the clinic, since its closure I have been involved in
searching for ways to maintain Tasmanian women's access to abortion. In the
process I have become convinced that mainstream acceptance of anti-choice
ideas and the crimes act provisions prohibiting abortion are the two biggest
intertwined factors undermining women's access to abortion services.
Boycott
Even many of those who pay lip service to access to abortion being a woman's
right do not acknowledge that this means there is a duty on the part of
health services to provide it. Currently, staff can boycott the procedure.
For years abortion hasn't been available in northwestern Tasmania because
the anaesthetists at the local public hospital refuse to be involved. New
gynaecology staff who will be taking up positions in the Royal Hobart
Hospital have indicated that they refuse to perform abortion. The hospitals
haven't been obliged to try to recruit staff who will.
Despite the fact that abortion is one of the 10 most performed surgical
procedures, and can be performed by GP's, medical training does not
routinely include it. Worse, it may not even be available as an option.
When I was a student in NSW, abortion wasn't carried out in the hospital
where I was attached for gynaecology; as an intern and resident, I was
unable to be trained in the teaching hospital where I worked. When I finally
trained at an abortion clinic, I was still unable to work in a teaching
hospital under gynaecologist supervision to up-grade my skills or achieve
some kind of accreditation to work alone.
In the last few months I have participated in a series of meetings with
service providers, referral agencies and the health department. While
hospital management has ensured the short-term continued provision of
abortion, its repeated message is that this is "not sustainable", and that
an out-of-hospital "solution" must be found.
Surgical abortion is a relatively simple procedure. For the majority of
women requiring it, it can be safely performed in a consulting room or
outpatient department facility.
The advantages of a free-standing clinic are that abortion can be provided
in a private, non-bureaucratic and non-judgmental environment by
specifically recruited staff. The advantages of hospital provision are the
presence of back-up facilities in case of a medical emergency and the
relative protection from anti-choice attacks that a mainstream public
institution can provide.
The recent murder of Steve Rogers, a security guard at Melbourne's Fertility
Control Clinic, has shown how vulnerable free-standing clinics can be to
anti-choice activity. Protests, anti-choice hate mail, harassment of clients
and staff, and violence all hinder women from accessing abortion services
and even information and referral services.
The presence of abortion on the criminal codes of most states adds
legitimacy to the calls to close down services, to prevent them receiving
government funding (through Medicare or grants), and to suppress information
about abortion availability.
Only a large, visible public campaign supporting women's right to decide can
strengthen access to abortion. We need to abolish the laws that currently
prohibit women from inducing abortion, and assisting others to do so and we
need to get rid of all practical barriers to the provision of abortion.
The struggle for reproductive rights is broader than just abortion
provision. It includes strengthening contraceptive and fertility services
(including conception assistance to lesbian and single women), pregnancy
care (including midwife care) and child care. But securing the option to
terminate a pregnancy remains a touchstone for feminist campaigning.
There is an opening now for women to run such a campaign. We should continue
the struggle that women started in the `70s, to make abortion free, legal,
safe and available on demand. And I would add, provided in non-judgmental,
geographically accessible facilities.
There has been little public discussion in Tasmania of abortion services
since the clinic's closure. There is a danger in the lack of public input
that other health services may be traded off or cut. State government
figures released on August 3 show a budget surplus of $3.5 million, up from
an expected $2.6 million. The money exists to adequately fund all health
services, but for it to be allocated will require a united public political
campaign.
The Denison branch of the Socialist Alliance has produced a petition calling
for repeal of all abortion laws in the criminal code. This will be presented
to the state attorney general in late August. The socialist youth
organisation Resistance will be holding a public meeting about the abortion
rights campaign on August 18 [see pages 30-31 for details].
[Dr Kamala Emanuel is the convenor of the Denison Socialist Alliance branch
and a member of the Democratic Socialist Party.]
--
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