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Lessons from the long fight for women’s access to safe abortion care

Introduction by Croakey: Women’s access to abortion in Queensland is likely to be contested following the election of a Liberal National Party Government led by Premier David Crisafulli.

Cross-bench MP Robbie Katter is planning a private member’s bill to wind back some elements of Queensland’s 2018 laws that decriminalised abortion, according to media reports this week.

While the incoming Crisafulli Government has said it has “no plans” to change the laws, The Guardian reports that if Katter brings a private member’s bill, the longstanding LNP practice is to hold a conscience vote.

In the article below, Adjunct Professor Caroline de Costa, a longstanding advocate for women’s reproductive rights, provides an overview of “the long struggle” of abortion law reform, and urges the Crisafulli Government to continue the steps taken by previous Labor governments to provide appropriate abortion care.

“I believe I speak for all of those who fought through many years to achieve these services when I say that I sincerely hope we will not have to come out onto the streets again,” she writes. “But if we do, we will be ready.”


Caroline de Costa writes:

At the beginning of the 21st century, abortion law in Queensland was unchanged from the wording of the 1899 Criminal Code, sections 224-226, which made abortion a crime for a woman undergoing a procedure, a person performing it and anyone assisting, although section 282 of the Code also provided a defence for the performance of abortion if the life or health of the woman was endangered by continuing the pregnancy.

Similar legislation applied in most other Australian jurisdictions.

From 1970 onwards, several legal cases, in Queensland, NSW and Victoria, in which medical practitioners were charged with abortion but acquitted, on the grounds of risks to the woman’s life or health, provided some measure of protection for doctors.

However, most doctors did not perform abortions, abortion practice and care was not taught to medical students or to trainee gynaecologists, and abortion was not written about in academic journals or discussed at scientific meetings.

The abortion drug mifepristone (RU486) was completely unavailable to Australian women under legislation passed in 1996 by the Howard Government. Abortion was stigmatised within the medical profession and in society generally.

Long struggle

Efforts to bring about change began in all states and territories from the late 1960s onwards, but real reform and in particular the decriminalisation of abortion has only taken place since 2008 (with the exception of ACT, which decriminalised in 2000).

It has been a long struggle, by many women, and some men, in all jurisdictions and all parliaments, but abortion is now decriminalised across the country, although there are some variations between states and territories around how abortions are provided.

The first attempts to decriminalise abortion and place its regulation in the health acts in Queensland were made by Rob Pyne in 2016-2017 when he was firstly Labor Member for Cairns and later an independent member of the Queensland Parliament.

His Bills were eventually withdrawn but prior to their withdrawal a Parliamentary committee conducted extensive and detailed consultations with the Queensland public, calling for written submissions and holding in-person inquiries across the state.

At the time of the Pyne Bills withdrawal, the matter of the reform of Queensland abortion law was referred by the then Premier, Annastacia Palaszczuk, to the Queensland Law Reform Commission.

The QLRC also consulted widely and in June 2018 presented their report to the Queensland Parliament. The report recommended decriminalisation of abortion, by repealing sections 224-226 of the Criminal Code and rewording section 282, and placing the provision of abortion care within healthcare regulations.

The Commission was guided in developing its report by principles of women’s bodily autonomy and women’s right to safe and accessible medical procedures.

The QLRC also sought consistency with contemporary clinical practice and with other Australian jurisdictions that had modified their abortion laws; by 2018 Victoria (2008), Tasmania (2013), and Northern Territory (2017) had done so, Western Australia and South Australia had done so partially. Complete decriminalisation was finally achieved in 2023.

Landmark

The Termination of Pregnancy Act was passed by the Queensland parliament in October 2018 and now applies to provision of abortion care in Queensland.

The purpose of the Act is to enable reasonable and safe access by women to terminations of pregnancy and to regulate the conduct of health professionals (doctors, nurses and midwives) in this regard.

Abortion up to 22+0 weeks is available to women upon request to one doctor. From 22+1 weeks the opinion of a second doctor is required. There are detailed requirements concerning where abortions may be performed; the right to conscientious objection by practitioners is acknowledged, and the provision of safe access zones around services providing abortions is included.

The six years since 2018 have seen major efforts on the part of Queensland Health to implement the requirements of the Act and make abortion care accessible to Queensland women.

Very comprehensive guidelines have been developed, published and updated, most recently in September 2024, as to how abortion care should be provided both in the public sector and in private practice by general practitioners and specialists.

RANZCOG, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, has also published comprehensive guidelines for best practice in abortion care.

All Queensland public Hospital and Health Services have or will have a Senior Medical Officer with appropriate expertise to oversee the provision of abortion care.

The Miles Government in August 2024 announced the Termination of Pregnancy Action Plan 2032, allocating $41 million over five years to extend and improve abortion services across Queensland, with particular emphasis on services for women and pregnant people in rural and remote areas.

Essential healthcare

Fifty percent of all pregnancies in Australia are unintended, and Queensland is no exception. Around 14,000 Queensland women seek abortion care each year.

Accessible safe affordable abortion care is an essential part of women’s healthcare that needs to be equally appreciated by Queensland men.

The steps taken by the Palaszczuk and Miles governments to provide appropriate abortion care must be followed with ongoing action by the incoming Government.

Much misinformation concerning abortion has abounded in Queensland in recent weeks. Most abortions, around 95 percent, take place in the first trimester, the first 12 weeks of pregnancy.

They may be performed surgically or with the use of medication, the drugs mifepristone and misoprostol, now widely available although still often only in the private sector. These abortions must remain a matter purely for a woman and her doctor.

About five percent of abortions take place in later pregnancy. Most women with a continuing pregnancy in Australia undergo some form of antenatal screening for fetal anomalies. This includes ultrasound scanning for fetal structural anomalies and combined first trimester screening and/or non-invasive prenatal screening (NIPT) for certain chromosomal or genetic conditions.

Most severe fetal anomalies are detected by 20 weeks’ gestation, and most parents choose to terminate pregnancies in which they are identified at that point in the pregnancy.

However, a small number of very severe anomalies and an even smaller number of maternal conditions are not always diagnosable by 20 weeks, and sometimes not until the third trimester, and can therefore be reasons for requesting a termination in the latter part of the second trimester, or rarely even later.

Such late termination of pregnancy is performed in only a very small number of Queensland hospitals, by obstetricians with particular expertise, supported by midwives, nurses, psychologists, counsellors and other experts who choose to take part in such care.

The diagnoses in these cases are discussed fully with the parents and the ultimate decision made by the woman or by both parents, together with the doctors. Explanation around whether the infant will be stillborn or born alive will be provided to the parents.

Where an infant is live-born that infant will be kept warm and comfortable, with the parents if desired, until the death, which is the inevitable consequence of a lethal anomaly, occurs.

This practice is consistent with Queensland Health guidelines, and with the respect and dignity displayed by the relevant health professionals towards all their patients.

Obviously parents and other family are distressed by the diagnoses and necessary procedures in these situations; criticism from poorly informed non-medical politicians or members of the public is unhelpful.

Abortion services in Queensland are evolving and improving every year. They are being provided in response to the important needs of all Queensland women for access to safe abortion if they have to make that decision for themselves.

The stigma of abortion is lessening, and medical students and junior doctors are now learning about abortion.

I believe I speak for all of those who fought through many years to achieve these services when I say that I sincerely hope we will not have to come out onto the streets again. But if we do, we will be ready.

Author details

Caroline de Costa, Professor of Obstetrics and Gynaecology at James Cook University’s College of Medicine and Dentistry in Cairns from 2004 to 2021, is now an Adjunct Professor of The Cairns Institute at the Smithfield Campus of JCU, where she supervises postgraduate students and conducts research in the area of women’s reproductive health, with numerous recent publications in peer-reviewed journals. She is also an author of fiction with six novels published since 2015.


PostScript from Croakey

Advocates for women’s reproductive health rights have been delivered a helpful resource: a speech by Michelle Obama in support of United States presidential candidate Kamala Harris (which you can watch in full here).

Obama’s message to male voters resonates with Professor Caroline de Costa’s point that “accessible safe affordable abortion care is an essential part of women’s healthcare that needs to be equally appreciated by Queensland men”.

https://edition.cnn.com/2024/10/26/politics/michelle-obama-harris-rally/index.html?cid=ios_app

See Croakey’s archive of articles on abortion

 

 

 

 

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