AUSTRALIA – Abortion is no longer a crime but legal hurdles remain

The 31 March edition of Repro Wrap, the newsletter of Children by Choice Australia, included four different articles about the fact that abortion is no longer a criminal act anywhere in Australia. The differences in perspective across the four articles are notable, however.

As abortion has only very recently been decriminalised in South Australia, the last state where this has happened, it was a very upbeat report, thanking the legislators who passed the law, and giving the details of the law reform – “It can be performed (sic) by one medical practitioner up to 22 weeks and six days gestation. After that time, a medical practitioner can only perform an abortion if they consult with another practitioner and if both are of the view that the procedure is medically appropriate. Those circumstances could include if a life is at risk, if there’s a serious foetal anomaly or a serious risk to a patient’s physical or mental health.” Those who opposed the reform nevertheless succeeded in obtaining a ban on sex-selective abortion and a requirement that every patient be provided with information about counselling, regardless of their situation. (SBS News, 3 March 2021)

The Brisbane Times (by Lydia Lynch, 10 March 2021) reports that the number of abortions in Queensland has not increased since they were decriminalised in 2018. The article says the Queensland law now “allows abortion on request up to 22 weeks gestation, and introduced safe access zones of 150 metres around clinics to protect women from harassment. Abortion after 22 weeks is also not a crime, but women must gain consent from two doctors. There is no requirement for mandatory counselling for women considering an abortion in Queensland.” Oddly, although the article is about abortions not increasing, the annual abortion figures it provides show the number of abortions decreasing year on year since 2013: “In 2013 we saw over 12,000 terminations. There were over 11,000 in 2014, 10,800 in 2015, over 10,400 in 2016 and… 9,445 in 2017 and 9,308 in 2018.” And in the first half of 2019, it is noteworthy that there were only 35 abortions after 22 weeks.

Things are not perfect in Australia, however, as two further articles show. In an interview with Dr Magdalena Simonis, a GP, she calls for Australia to take the next steps after all this law reform – increased education of the public around sexual and reproductive health, training of doctors, funding of services, increasing capacity and accessibility for all women and adolescent girls, and better alignment with World Health Organization guidelines. She calls for training of more GPs in provision of medical abortion, pointing to estimates that only around 1,500 of Australia’s 35,000 GPs are registered prescribers of medical abortion pills. Moreover, while surgical methods are rebatable under Medicare, medical abortion is not, even though the medications are listed on the Pharmaceutical Benefits Scheme. Moreover, she says, access to services outside the main cities can be very restricted. (RACGP, by Morgan Liotta, 3 March 2021)

Hurdles to access not only remain but come with a lot of complications, as the fourth article explains in depth (The Conversation, by Erica Millar and Barbara Baird, 3 March 2021). The authors are academics and members of the South Australia Abortion Action Coalition. First, with the exception of the Northern Territory, where abortion remains a medical practitioner’s decision regardless of the gestation, and the Australian Capital Territory, where no gestational limits apply, Australian jurisdictions now permit abortion on request up to varying points in pregnancy.

The gestational limit for an “on request” abortion is 22 weeks and six days in South Australia and between 16 and 24 weeks in other states. Beyond these on request limits, though, women generally require two doctors to approve an abortion on psychological, physical or, in most instances, social grounds (for example, the inability to afford another child, or intimate partner violence). In Western Australia, after 20 weeks, however, two doctors from a panel of six must determine the abortion is necessary because “the mother, or the unborn child, has a severe medical condition”, while in the Northern Territory, abortions after 23 weeks are prohibited, unless it is deemed necessary to save the woman’s life.

Millar and Baird argue that “by adopting a model of law reform that regulates abortion differently after [specified] gestational limits, governments have failed to prioritise expanded abortion access”. They point out that the purpose of criminal laws was to prevent unqualified people from performing abortions – a historical problem that no longer exists – and that by creating special new regulations these new laws prevent abortion being fully integrated into normal health law. Instead, they call for broadening of the rules on who can provide abortions in Australia in line with WHO guidelines, not just restricting it to doctors. It is only in South Australia and the Northern Territory that trained nurse practitioners and Aboriginal and Torres Strait Islander health workers are also allowed to provide abortion pills.

Conclusion: “decriminalisation” does not necessarily mean the law will no longer be used to continue to restrict access to abortion

And they describe other restrictions and barriers as well. Thus, it turns out that “decriminalisation”, that is, removing abortion from the criminal law, although a major step forward, does not necessarily mean the law will no longer be used to continue to restrict access to abortions in potentially many other ways. Yet another hurdle revealed, to overcome on the long road to “the right to choose”!!

INFOGRAPHIC: at the top of this report is from Junkee, 4 September 2015, so it’s out of date, but you get the point!