As an abortion provider, pro-choice advocate and a woman who has undergone abortion in New South Wales, I support the Reproductive Health Care Reform Bill.
Even with the best access to sex education, contraception and emergency contraception (which NSW does not have), there is no pro-active way for people engaged in potentially reproductive sex but not prepared for parenthood to guarantee they will not become pregnant. Sometimes, planned pregnancies become impossible to continue, whether for health or personal reasons.
Like contraception, miscarriage and childbirth, abortion is a part of reproductive life; between a fifth and a quarter of women and people with a uterus in Australia have undergone abortion.
(I use the terms woman, person with a uterus and pregnant person in recognition that while most people capable of becoming pregnant are women, some pregnant people are trans men or non-binary people.)
This legislation offers the chance to recognise that, remove the stigma of criminalisation and treat women and pregnant people seeking abortion care with compassion, dignity and respect.
It is my belief, however, that the restrictions in this bill are not warranted. I believe the strongest message of support for women making decisions about their healthcare would be simply to decriminalise abortion and reaffirm the principle that health care practitioners with conscientious opposition to abortion should not allow their personal views to interfere with a patients' right to care.
It would be better to not have legislation stipulating where an abortion can be performed, at what gestations it can be performed or who can perform it.
We do not need legislation to ensure doctors consider the need for counselling, any more than we need legislation to ensure doctors consider the need for counselling in any other situation where it may be needed: that is what training, registration, ongoing education and professional standards are for.
Finally, while abortion requests after 22 weeks are infrequent, several studies have identified many factors that can lead to delays in pregnancy diagnosis, decision-making, and requesting and obtaining abortion. The requirement for two specialists to agree that abortion is necessary after 22 weeks can only add to the delays and stress involved.
At the very least, if parliament is going to enact such restrictions, it should enact corresponding legislation to ensure no additional cost or delays are incurred, recognising that for a safe abortion, time is of the essence.
The prospect of high quality abortion care no longer being refused in the state's public hospitals is good for public health and equity.
Lawful abortion is performed in free-standing clinics across the state but at a cost that can be outside the means of disadvantaged women or pregnant people to afford and in metropolitan locations that can entail burdensome travel requirements for women from rural and regional communities.
Early medical abortion prescribed by GPs has the potential to fill some of that gap, but surgical abortion will continue to be needed and should be available in public hospitals.
The removal of abortion from the Crimes Act, recognition that abortion up to 22 weeks is a matter for a woman or pregnant person to decide and affirmation that those who refuse care on conscience grounds have a duty to assist their patients to access the safe abortion care they seek will pave the way for safe abortion to become accessible in public hospitals as a matter of course.
Gender-biased sex selection
I am also concerned about sections 14 and 15 of the bill, which relate to gender-biased sex selection. I believe it would be preferable for these sections to be removed.
Abortion opponents argue against sex selection abortion to establish a precedent that allows the state to determine that certain kinds of abortion are not permissible. If the state can override the decision of the woman or pregnant person in one instance, it undermines the central rights contention that the decision to continue or terminate a pregnancy belongs to the woman or pregnant person.
This argument only works if we accept the premise that a foetus with XX chromosomes or with ultrasonic evidence of female reproductive organs is a person with a right to life, a girl being killed because of her gender.
(I would point out that there is more to determination of sex than 2 combinations of sex chromosomes and more to determination of gender than anatomical sex.)
But female embryos do not have a right to life that trumps the right of the pregnant woman or person to determine whether or not to continue that pregnancy.
Gender-biased sex selection (which is different from abortion to avoid passing on sex-chromosome-linked diseases or conditions) is a problem. But it is not the problem opponents of all abortion would have us think.
It is a manifestation of the same devaluing of girls and women that underpins many aspects of discrimination and oppression of women and non-binary people. What this means is that to effectively confront it, the social context needs to be changed.
Including a statement of opposition to sex selection abortion in the legislation, without any reference to the structural changes needed to tackle it is, at best, posturing that is unlikely to make a positive impact and, at worst, a tool for opponents of abortion to use to undermine the exercise of abortion rights.
A statement of opposition to gender-biased sex selection and restrictive measures could also paradoxically make the risks of vulnerability and coercion worse by driving it underground.
Gender-biased sex selection is a concern. But it is a concern that merits its own discussion — not in relation to abortion and abortion law reform and not in an effort to undermine the overdue abortion rights of women and people with a uterus.
We should reject attempts to impose limits on abortion according to the reason for the abortion.
[This is an abridged and edited version of a much longer submission to NSW parliament regarding the Reproductive Health Care Reform 2019 bill. Dr Kamala Emanuel is a member of the Socialist Alliance.]