by John Williams, David Plater, Anita Brunacci, Sarah Kapadia and Melissa Oxlad, South Australian Law Reform Institute, Report 13, October 2019
The South Australian Law Reform Institute (SALRI), based at the University of Adelaide, recommended major changes to South Australian abortion laws in a 560-page report to the Attorney General with 66 recommendations. The report recommended that abortion be decriminalised and treated as a health issue, with a woman’s autonomy and best health care respected and promoted.
It proposed two alternative models. First author John Williams said: “The first model is that an abortion is lawful at all gestational stages with the woman’s consent and if it is performed by an appropriate health practitioner, which mirrors the law in ACT. This places decision-making responsibility with the woman and service availability with the medical or health professional. The alternative model, which reflects current clinical practice, is that if a woman requests an abortion after 24 weeks gestation the first medical practitioner is required to consult with at least one other medical practitioner – whilst still recognising the autonomy of the woman – and for both practitioners to agree that an abortion is medically appropriate. The second approach recognises that terminations at a later stage often involve complications, distress, complexities and higher risks to a pregnant woman.”
Other recommendations focused on establishing safe access zones around places where services are available, the roles of conscientious objection and referral for health practitioners, removing criminal liability for the woman involved and health practitioners, and a new offence for abortion services provided by unqualified parties.
The work benefited from wide-ranging consultation with the South Australian community and interested parties, including medical and health practitioners, professional bodies, legal experts and academics, faith groups, the disability sector, domestic violence services, Aboriginal health workers, and NGOs. People who were both supportive of and opposed to the decriminalisation of abortion were consulted. SALRI received a total of 340 submissions and 2,885 responses to its online survey.
In a 15-page response, published in November 2019, the Department for Health and Wellbeing accepted the great majority of recommendations, with 15 recommendations requiring deference to the Crown “for specific legal advice to ensure the intended outcome is achieved in any proposed new legislation”. Of the alternative models recommended by SALRI, the Department opted for the second one, putting the decision about abortions from 24 weeks in the hands of two medical practitioners. A summary of the clinical practice recommendations are:
- A suitably qualified and credentialed health practitioner should be allowed to provide a medical abortion up to 63 days into gestation. This could include medical practitioners, nurses or midwives. Legislative change will be required to allow prescribing of relevant drugs by nurses and midwives.
- Any surgical abortion at any gestation needs to be performed by a suitably qualified and credentialed medical practitioner with an appropriate scope of clinical practice.
- After 22 weeks and 6 days gestation, that an abortion be performed by a suitably qualified and credentialed medical practitioner with an appropriate scope of clinical practice only after consultation with a similarly qualified and credentialed medical practitioner with an appropriate scope of clinical practice (this most closely aligns with current clinical practice).
- In an emergency situation (to save a women’s life or the life of another fetus) an abortion should only be provided by a medical practitioner.
The expected impact on health services is:
- The legislative changes proposed are likely to result in greater equity of health services for women in South Australia.
- The recommendations are likely to result in a shift of abortion to occur earlier in pregnancy and for medical abortions, from hospitals to primary health care settings.
- Because the recommendations include provision for health practitioners other than medical practitioners to provide medical abortions, training and accreditation of nurses and midwives will be required, along with changes to the current legislation relating to prescribing rights.