Essential information for understanding abortion care in South Australia:
1 – Best care and how to extend it
2 – Public opinion
3 – Health professionals’ opinion on abortion
4 – Understanding the need for late gestation abortion
5 – Barriers to best care
6 – Early medication abortion (EMA)
7 – How the current law affects services
8 – Enabling legislation to support access
9 – Rural and remote access
10 – Myths and realities
11 – Regulation of abortion care
You also can download these fact sheets as a single document.
PLUS: Information Brief on the Safety of Abortion Care in Australia (published by SPHERE)
Abortion Law Reform Fact Check
The opponents of abortion law reform are making incorrect claims about abortion and the Bill to remove abortion from the SA criminal code.1
What the Bill WILL do:
- Stop abortion being a crime punishable with life imprisonment for women and their doctors, as has already been done in most Australian states/territories.
- Improve access to abortion for women in rural and remote areas by enabling women to receive Early Medication Abortion (RU486) from their GPs (within strict clinical guidelines).
- Enable all abortions to be covered by health law and regulations in accordance with modern care standards, including the very small number required after 20 weeks gestation.
- Protect the privacy of women and staff outside abortion clinics.
What the Bill WON’T do:
It won’t allow abortion ‘up to birth’, ‘for any reason’, or mean that babies born alive will be left to die. Later gestation abortions happen now for a tiny proportion of women and for very serious reasons, and this will continue when the Bill passes. Health law and regulations will ensure that later gestation abortions are only undertaken when they are necessary, by skilled health care teams in appropriate facilities. Clinical protocols and practices are designed to ensure that fetuses are not aborted, born alive and left to dies, and that will not change. It is absurd to suggest that removing abortion from the criminal law will mean that hospitals, doctors and other health professionals will cease to be guided by the normal clinical or ethical standards that ensure safe practice. This is not possible under health law and hasn’t happened in states that have decriminalised abortion.
It won’t give women breast cancer or make them infertile or increase their risk of pre-term birth. There is no evidence of increased risk of breast cancer as a result of abortion. Medical experts repeatedly and definitively reject this proposition.2 3 While infertility is caused by unsafe, illegal abortion,4 abortion provided in accordance with modern medical standards does not cause infertility.5 Similarly, abortion provided in accordance with modern medical standards does not increase the risk of premature birth in future pregnancies.6 7
It won’t cause an increase in the number of abortions. The abortion rate in South Australia has been steadily declining since 1998.8 Decriminalisation has not increased the number of abortions in other states,9 rather it has improved the standards and circumstances of abortion care.
It won’t harm the mental health of women who have an abortion. There is no evidence that abortion leads to mental illness.10 11 For women with existing mental illness, the risk of pregnancy making it worse is the same whether the woman has an abortion or continues the pregnancy.12 For most women, legal abortion is accompanied by feelings of relief and reduced stress.13 As would be expected, a small number of women experience grief and regret,14 and support services are available to assist them.
It won’t harm the physical health of women who have an abortion. Abortion is one of the safest surgical procedures according to relevant statistics,15 and Early Medication Abortion is likewise of very low risk.16 17 18 In the past when abortion was not provided by qualified professionals in regulated health facilities, women were sometimes harmed or killed by illegal abortion. After safe abortion was made available in 1970 in South Australia, deaths from abortion declined quickly, as did other serious harms, and they have remained at virtually zero ever since (there has been one associated death since 1980).19
It won’t increase domestic violence and reproductive coercion. Reproductive coercion (women being forced by partners whether to have an abortion or not to; or to get pregnant or not to) is a significant part of domestic or family violence.20 There is no sense in which decriminalisation of abortion could contribute to this problem.
It won’t stop women being offered alternatives to abortion. There is an explicit requirement under the Consent to Medical Treatments and Palliative Care Act 1995 for doctors to discuss all treatment options with patients as part of obtaining informed consent and there are significant penalties for failure to do so. Women facing unplanned or unwanted pregnancy are routinely advised about all their options in the South Australian health system, and this will continue.
It won’t remove the right to conscientious objections for doctors and other health care professionals. All health professionals have the right to conscientious objections under the national codes of practice of their registration boards21 22 set up under the Health Practitioner Regulation National Law.
It won’t allow unqualified providers to do abortions. Under health law, standards, policies and professional ethics, it is unlawful for anyone other than a registered medical practitioner to conduct surgical abortion, and regulation of the medicines for EMA under the Therapeutic Goods Administration requires it to be prescribed and managed by a registered medical practitioner. There is nothing in the Bill that would remove or reduce these protections.
It won’t result in backyard abortion. Women are protected from unqualified abortion providers as explained above. When abortion is legal and safe, there is no market for unqualified providers. The suggestion that consolidating safe legal abortion care by removing abortion from the criminal code would somehow lead to women choosing unsafe abortion is absurd.
It won’t stop people from praying or supporting women in pregnancy. The creation of a 150-metre safe access zone around clinics will prevent protesters from confronting women and clinical workers with verbal abuse and false information about abortion. This will bring abortion care into line with all other health care services.
It won’t allow sex selection ‘for social reasons’. All health procedures can only be undertaken for good reason considering medical risks – so health professionals must be satisfied that the intervention they propose is necessary. The Bill will not change this.
It won’t allow doctors to use ‘any method’. The current criminal law does not specify any particular method of abortion, and neither does the reform Bill. Like all other medical procedures, abortion can only be provided lawfully when it is clinically indicated, risk is minimised and informed consent is given.
It won’t remove accountability through reporting on abortion care. Abortion procedures will continue to be closely regulated and reported in the same way as other medical procedures. Surgical abortions will continue to be reported in the normal data collections applying to both public and private hospitals and day-surgery clinics. EMA is closely regulated under the TGA ACT and regulations, and individual approval is required for each prescription.
1 The errors cited in this Fact Check have been published in a leaflet titled Imago Dei and in a letter written by Dr Elvis Seman and circulated by Bishop Greg O’Kelly, Adelaide Catholic Archdiocese.
2 Beral V, Bull D, Doll R, Peto R, and Reeves G, 2004, ‘Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83,000 women with breast cancer from 16 countries’ Lancet, 363:1007 – 16.
3 World Health Organisation, Induced abortion does not increase the risk of breast cancer Fact Sheet 240, June 2000. Reproduced on the Australian Women’s Health Network website http://awhn.org.au/policy-statements-and-fact-sheets.
4 Safe abortion: technical and policy guidance for health systems, World Health Organisation (2nd ed) Geneva 2012, p17.
5 Royal College of Obstetricians and Gynaecologists, 2011, The Care of Women Requesting Induced Abortion: Evidence-based Clinical Guideline No. 7, (p44). London: RCOG.
6 Oliver-Williams C, Fleming M, Monteath K, Wood AM and Smith GC, Changes in Association between Previous Therapeutic Abortion and Preterm Birth in Scotland, 1980 to 2008: A Historical Cohort Study. PLoS Med, 2013 Jul;10(7):e1001481. doi: 10.1371/journal.pmed.1001481. Epub 2013 Jul 9.
7 Ke L, Lin W, Liu Y, Ou W and Lin Z, 2018, Association of induced abortion with preterm birth risk in first-time mothers, Scientific Reports Vol 8: 5353.
8 Pregnancy Outcome Unit, SA Health, Pregnancy Outcomes South Australia 2016, September 2018.
9 De Costa CM and Douglas H, 2015, Abortion law in Australia: it’s time for national consistency and decriminalisation. Med J Aust, Vol 203, Issue 9, pp 349 –350. doi: 10.5694/mja15.00543.
10 American Psychological Association, Task Force on Mental Health and Abortion. Report of the Task Force on Mental Health and Abortion. Washington, 2008. http://www.apa.org/pi/wpo/mental-health-abortion-report.pdf
11 Royal College of Obstetricians and Gynaecologists 2011, op cit pp45 –46.
12 National Collaborating Centre for Mental Health, 2011, Induced abortion and mental health. A systematic review of the mental health outcomes of induced abortion, including their prevalence and associated factors. London: Academy of Medical Royal Colleges.
13 Rocca C, Kimport K, Gould H and Foster DG, ‘Women’s emotions one week after receiving or being denied an abortion in the United States’. Perspectives of Sexual and Reproductive Health, Vol 45 No 3, September 2013. http://www.guttmacher.org/pubs/journals/4512213.html.
14 Steinberg JR and Russo NF, 2009, Evaluating research on abortion and mental health. Contraception Vol 80: 500 –3.
15 Safe Abortion: Technical and Policy Guidance for Health Systems, World Health Organisation (2nd ed) Geneva 2012 p21. http://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241548434/en/
16 Kulier R, Kapp N, Gülmezoglu AM, Hofmeyr GJ, Cheng L, Campana A. Medical methods for first trimester abortion. Cochrane Database of Systematic Reviews 2011, Issue 11 Art No: CD002855. DOI: 10.1002/14651858.CD002855.pub4.
17 Goldstone P, Walker C and Hawtin K, 2017, Efficacy and safety of Mifepristone-buccal misoprostol for early medical abortion in an Australian clinical setting. Australian and New Zealand Journal of Obstetrics and Gynaecology, 57(3), 366– 371. doi: 10.1111/ajo.12608.
18 Mulligan E and Messenger H, 2011, ‘Mifepristone in South Australia: the first 1343 tablets’, Australian Family Physician, 40.5, 342–345.
19 Pregnancy Outcome Unit, SA Health 2018, Maternal and Perinatal Mortality in South Australia 2016, Adelaide: Pregnancy Outcome Unit, p10.
20 Children by Choice, 2016, Pregnancy, Domestic Violence and Reproductive Coercion, Healthed Clinical Articles. http://www.healthed.com.au/clinical-articles/pregnancy-domestic-violence-and-reproductive-coercion/
21 Medical Board of Australia 2014, Good medical practice: A code of conduct for doctors in Australia (clause 2.4.6 and 2.4.7). https://www.medicalboard.gov.au/Codes-Guidelines-Policies.aspx
22 Nursing and Midwifery Board of Australia 2018, Code of Conduct for Nurses (clause 4.4.b). http://www.nursingmidwiferyboard.gov.au/documentsdefaultaspx?record=WD17%2F23850&dbid=AP&chksum=L8j874hp3DTlC1Sj4klHag%3D%3D.