SOUTH AUSTRALIA – Abortion: A Review of South Australian Law and Practice

Abortion: A Review of South Australian Law and Practice

by John Williams, David Plater, Anita Brunacci, Sarah Kapadia andMelissa Oxlad, South Australian Law Reform Institute, Report 13, October 2019

Department for Health and Wellbeing Response to SALRI reportAbortion: A Review of South Australian Law, November 2019

The South Australian Law Reform Institute (SALRI), based at theUniversity of Adelaide, recommended major changes to South Australian abortionlaws in a 560-page report to the Attorney General with 66 recommendations. The reportrecommended that abortion be decriminalised and treated as a health issue, with a woman’s autonomy and best healthcare respected and promoted.

It proposed twoalternative models. First author John Williams said: “The first model is thatan abortion is lawful at all gestational stages with the woman’s consent and ifit is performed by an appropriate health practitioner, which mirrors the law inACT. This places decision-making responsibility with the woman and serviceavailability with the medical or health professional. The alternative model,which reflects current clinical practice, is that if a woman requests anabortion after 24 weeks gestation the first medical practitioner is required toconsult with at least one other medical practitioner – whilst still recognisingthe autonomy of the woman – and for both practitioners to agree that anabortion is medically appropriate. The second approach recognises thatterminations at a later stage often involve complications, distress,complexities and higher risks to a pregnant woman.”

Other recommendationsfocused on establishing safe access zones around places where services areavailable, the roles of conscientious objection and referral for healthpractitioners, removing criminal liability for the woman involved and healthpractitioners, and a new offence for abortion services provided by unqualifiedparties.

The work benefitedfrom wide-ranging consultation with the South Australian community andinterested parties, including medical and health practitioners, professionalbodies, legal experts and academics, faith groups, the disability sector,domestic violence services, Aboriginal health workers, and NGOs. People whowere both supportive of and opposed to the decriminalisation of abortion wereconsulted. SALRI received a total of 340 submissions and 2,885 responses to itsonline survey.

In a 15-page response, published in November2019, the Department for Health and Wellbeing accepted the great majority ofrecommendations, with 15 recommendations requiring deference to the Crown “forspecific legal advice to ensure the intended outcome is achieved in anyproposed new legislation”. Of the alternative models recommended by SALRI, theDepartment opted for the second one, putting the decision about abortions from24 weeks in the hands of two medical practitioners. A summary of the clinicalpractice recommendations are:

  • Asuitably qualified and credentialed health practitioner should be allowed toprovide a medical abortion up to 63 days into gestation. This could includemedical practitioners, nurses or midwives. Legislative change will be requiredto allow prescribing of relevant drugs by nurses and midwives.
  • Anysurgical abortion at any gestation needs to be performed by a suitablyqualified and credentialed medical practitioner with an appropriate scope ofclinical practice.
  • After22 weeks and 6 days gestation, that an abortion be performed by a suitably qualifiedand credentialed medical practitioner with an appropriate scope of clinicalpractice only after consultation with a similarly qualified and credentialedmedical practitioner with an appropriate scope of clinical practice (this mostclosely aligns with current clinical practice).
  • Inan emergency situation (to save a women’s life or the life of another fetus) anabortion should only be provided by a medical practitioner.

The expected impact on health services is:

  • Thelegislative changes proposed are likely to result in greater equity of healthservices for women in South Australia.
  • Therecommendations are likely to result in a shift of abortion to occur earlier inpregnancy and for medical abortions, from hospitals to primary health caresettings.
  • Becausethe recommendations include provision for health practitioners other thanmedical practitioners to provide medical abortions, training and accreditationof nurses and midwives will be required, along with changes to the currentlegislation relating to prescribing rights.

ADDITIONAL SOURCES: Universityof Adelaide Newsroom, by Crispin Savage, 5 December 2019 ;Government of South Australia, Abortion Legislation Reform, n.d.