Giving women total control

* Roger Short, Lachlan De Crespigny and Julian Savulescu

* August 15, 2008

Every birth should be a wanted birth. That must be the aim in Victoria.

AUSTRALIA in general and Victoria in particular have lagged far behind the rest of the developed world in their attitude to abortion. The United Nations International Conference on Population and Development, meeting in Cairo in 1994, affirmed that "all couples and individuals have the right to decide freely and responsibly the number and spacing of their children, and to have the means to do so".

Australia was a signatory to that declaration.

The 2007 Report of the World Health Organisation on Unsafe Abortion showed that of the 210 million women becoming pregnant each year, about 42 million would have an abortion, 20 million of which would be performed illegally, with a one in four risk of severe maternal morbidity or mortality. In 2001, safe abortion was available on request in 31 of 48 developed countries.

Because abortion in Australia still comes under the Criminal Code in most states, including Victoria, we do not have good figures on the annual abortion rate, but Tony Abbott recently suggested that it was about 80,000.

Therefore we should all welcome the report of the Victorian Law Reform Commission that recommended that abortion in Victoria should at long last be removed from the Criminal Code.

It presents three options. Model A is unacceptable. It does not achieve the Victorian Government's commitment to modernise and clarify the law. It merely decriminalises abortion, but fails to give the woman the final say in the matter.

Model B gives the woman the right to choose up to the 24th week of gestation, but after this it removes this right, and instead creates a potential medico-legal minefield around a very small number of women, at the most stressful time of their lives, when all they need is the spontaneous comfort, support and the advice of their doctor. Why exacerbate the situation and prolong the agony by inviting outsiders to add their conflicting political, moral, ethical, religious and legal opinions?

It is only Model C that rightly places the final decision solely in the hands of the woman throughout the whole of her pregnancy. What right have any people, other than the woman and her doctor, to intervene in such an intensely personal matter?

Back in 1965, before abortion was legalised in Britain, the late Sir Dugald Baird, regius professor of obstetrics and gynaecology at the University of Aberdeen, suggested that in addition to the four freedoms advocated by Franklin Roosevelt — freedom of speech and expression, freedom to worship God in your own way, freedom from want, and freedom from fear — we should consider a fifth freedom, freedom from the tyranny of excessive fertility.

The time has come to adopt his suggestion, and make it a uniquely female freedom; no person other than the woman and her doctor, least of all an outside male, should have the right to gainsay it.

The Catholic Church has been opposed to abortion since 1869, when Pope Pius IX declared abortion at all stages of pregnancy to be a sin punishable by excommunication. Pope Benedict XVI now has gone one stage further and added both contraception and abortion to his new expanded list of "deadly sins". So you are damned if you do, and damned if you don't.

But with respect, what can a celibate male clergyman know or understand about the inner workings of a woman's mind? Even today, 72% of Catholics support a woman's right to choose to terminate her pregnancy.

No woman happily chooses to have an abortion. It is chosen when it is the least bad option, often made with great sadness, and sometimes lifelong anguish. But abortion, like poverty, will always be with us, because there will always be contraceptive failures as well as human failings.

We should all agree on the need to lower Australia's unacceptably high teenage pregnancy and abortion rates, among the highest in the developed world, by improving sex education and contraceptive availability for our teenagers.

Australia has failed to live up to its promise to implement the Cairo recommendations by 2005, but at least Victoria can rejoin the developed world if it grants its women the freedom to control their own fertility by adopting Model C. Other jurisdictions will then need to reflect on whether to also modernise and clarify their laws. Only then can we ensure that every birth will be a wanted birth, which surely is what an already overpopulated world should wish.

Professor Roger V. Short, faculty of medicine, dentistry and health sciences, University of Melbourne. Associate Professor Lachlan de Crespigny, principal fellow department of obstetrics and gynaecology, University of Melbourne and honorary fellow, Murdoch Childrens Research Institute. Professor Julian Savulescu, Uehiro Chair in practical ethics and director Oxford Uehiro Centre for Practical Ethics, University of Oxford.

http://www.theage.com.au/opinion/giving-women-total-control-20080814 -3vnk.html?page=-1

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Support when it really counts

* Nicholas Tonti-Filippini

* August 15, 2008

Abortion is not a routine medical procedure: it must be regulated.

THE Victorian Government is soon to introduce abortion legislation. Given that decriminalisation has Opposition support, the current de facto availability of abortion may well become statute law.

A major effect of decriminalisation will be to bring abortion out of the shadows. That raises many other policy questions that have not been dealt with in the options proposed by the Victorian Law Reform Commission.

With abortion defined as an offence there is very little hard evidence of what happens, the frequency and the adverse events. The social policy section of the Australian Parliamentary Library, after researching the question, concluded that obtaining accurate information on even the number of abortions in Australia cannot be achieved given the nature of data collection.

In our community it is a taboo topic. Women seeking abortion enter a world of secrecy about which not much is published in the medical journals or anywhere else. Few doctors are willing to be involved with abortion, and the information available to women and their GPs is scant.

Whatever your views on when life begins — and only 42% of the community hold that a human foetus is not a person — abortion is not just a routine medical procedure. Yet it is unlikely that a woman in difficulty with pregnancy will have access to comprehensive and evidence-based information about abortion, because it is not available. The range and quality of information sources available for other elective procedures is not available for abortion.

While most people support making abortion lawful, most also think that it is a choice of enormous personal significance and most have grave moral reservations. Because it is the destruction of a nascent human life and because it involves a woman's motherhood, it cannot be regarded as ordinary or insignificant.

When a woman's partner says to her, "it's your choice", he is, in fact, withdrawing support. A woman under pressure to abort, such as from her family or by threat of loss of her relationship with her boyfriend, is unlikely to have someone to assist her to make her own decision who puts her needs first. There is no obligation

for the clinics or a referring doctor to ensure that she has access to independent counselling and support to assist her to make a decision that reflects her own values and sense of identity.

If she is a young person or has a developmental disability, she may be brought to an abortion clinic by the very person who has abused her.

Unlike other kinds of surgery, there is no requirement that the doctor who undertakes the surgery requires a referral from a GP. Abortion doctors can simply self-refer. The surgical risks and the personal significance of abortion warrant a proper referral structure for women experiencing difficulties with pregnancy and regulation to ensure that they receive advice that is impartial, informative and supportive of them and that the medical services have the specialist capacity to provide the assistance that they may need.

Late-term termination of pregnancy involves a child mature enough to be born alive, no different from the many premature children in neonatal care units. The commission's recommendations to the Government do not deal with the reality that late-term termination of pregnancy involves two decisions: the decision to end the pregnancy because it is a life or health risk, and the secondary decision to do so in a way that ensures that the child is delivered dead.

Clinics that offer abortion are able to do so with no more regulation than the day procedure regulations required for removing a wart. If abortion is to be brought out of the shadows then perhaps it ought at least be given the status that a surgical intervention warrants, including ensuring that providers have the on-site capacity to treat adverse events such as severe hemorrhage or severe reaction to anaesthesia. The practice of sending a woman who has a perforated uterus or is hemorrhaging badly to hospital by taxi could then be avoided.

Providers ought at least to have a fully fledged social work department providing support to women who are pregnant, including advice about access to economic support and material services in relation to continuing pregnancy and early infancy, should that be her choice, and follow-up if she later finds herself distressed by the experience.

The days of GPs doing major surgical procedures have long gone. Medical providers of abortion should at least have a diploma in obstetrics and gynaecology or its equivalent.

The Sexton Marketing research shows that Australians are clearly deeply conflicted on the abortion issue: 87% would like both to reduce the rate of abortion and retain the right of women to legal access to abortion. And 73% say outright that the rate is too high.

There is, however, no such conflict when it comes to wanting to ensure that women in difficulty with pregnancy are offered adequate support.

There is no reason to think that Victorians who support abortion also want women to be denied access to accurate information, professional decision-making support during a difficult time and a standard of medical services that parallels other areas of similarly invasive surgery.

Nicholas Tonti-Filippini is associate dean (teaching, learning and research) at the John Paul II Institute, East Melbourne.

http://www.theage.com.au/opinion/support-when-it-really-counts- 20080814-3vnj.html?page=-1