Gender-biased sex selection and abortion rights

As an abortion provider and abortion rights advocate, I follow abortion news, which means sometimes links like this one¹, to an article decrying abortion for sex selection, appear in my inbox.

What I have noticed is that abortion opponents argue against sex selection abortion in order 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 pregnant woman in one instance, it undermines the central contention of abortion rights activists that the decision to continue or terminate a pregnancy belongs to the pregnant person².

Very often, arguments will be couched in feminist terms. Whether crudely³ or subtly⁴, they seek to use feminist language of opposition to discrimination to appear to take a feminist high ground - in a completely anti-feminist attempt to undermine support for women's and pregnant people's autonomy. Their arguments only work if we accept the premise that the 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. In passing, I will 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 even if, on the whole, embryos with XX chromosomes, or foetuses with female reproductive anatomy, would, if born, be girls, are they, in utero, girls with rights beyond the right of the pregnant person, rights that trump the right of the woman or pregnant person to determine whether or not to continue the pregnancy? Opponents of abortion don't (and can't) prove this - they just mobilise legitimate indignation and anger at discrimination against girls and women, in an attempt to get it to spill over into an attack on abortion rights.

Gender-biased sex selection⁵ is a problem. But it's 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 our oppression. In the societies where it is documented, the combination of influences on gender-biased sex selection usually includes deeply held values about the worth of sons over daughters, the role of sons providing for parents in their old age, women's relative exclusion from the paid workforce and lower pay where included, discriminatory inheritance patterns and (at least in parts of India) marriage customs such as the expectation brides' families will provide a dowry.

What this means is that if it is to be effectively confronted, the social context needs to be changed. Not surprisingly, measurable impacts on reversing son preference have been demonstrated by social measures affecting the underlying factors. Economic security in old age (in the form of savings or pensions), women's participation in the workforce, changes to the rights and responsibilities of women in relation to their family of birth, and media campaigns promoting the value of daughters have all had an impact.⁶

One important finding reported in a UN interagency statement on tackling gender-biased sex selection⁷ was that educational programs that stimulate discussion and allow for participants to share their experiences and thoughts in relation to conflicting values are more empowering and effective than those based on judgemental criticism of "bad" behaviour.

There is evidence of prenatal sex selection taking place in Australia, predominantly among women born overseas, most notably from India, China and South-East Asia.⁸ A 2018 study of births in Victoria found that in these populations, the male/female ratio at birth is significantly above the biological norm of 105:100.

Banning abortion performed for sex selection is only likely to put obstacles in the way of women and pregnant people seeking care and support, and risks harming already marginalised women.

The issues that should be of concern are not whether to ban abortion performed to enable sex selection, or to prevent women from undergoing blood tests or ultrasound examinations that may enable them to know about their pregnancy's chromosomal sex or reproductive anatomy. For healthcare providers in particular, the point at which a woman is making a decision to abort a pregnancy is not the point at which to refuse care or impose judgement. It is a point for promoting our patients' health and autonomy, including by the provision of safe abortion if that is the pregnant person's decision.

What we should be concerned about (healthcare professionals and wider society alike) is to identify and support women at risk of coercion into abortion, or facing harassment, violence or other kinds of pressure if they give birth to girls. We should support efforts, particularly efforts by young women of affected communities, to challenge and transform the culture of son preference.

We'll know we're succeeding when the sex ratio at birth returns to the biological norm - not by taking measures that undermine women's rights, but by implementing those with the capacity to enhance them.

1 https://caldronpool.com/researchers-say-discrimination-against-women-starts-in-the-womb. This one is particularly obnoxious, implying in its sub-heading that researchers who identified prenatal sex selection in a cohort of Australian women conclude that abortion is not beneficial to women, when that is, rather, the presupposition of the authors of the article and an opponent of abortion, nothing to do with the study, who they misleadingly quote.

2 I use the terms woman and pregnant person in recognition that while most people capable of becoming pregnant are women, some pregnant people are trans men and some are non-binary people or people with other gender identities.

3 E.g., https://caldronpool.com/researchers-say-discrimination-against-women-starts-in-the-womb

4 E.g., https://lozierinstitute.org/sex-selection-abortion-the-real-war-on-women

5 As distinct from abortion to avoid passing on sex-chromosome-linked diseases or conditions.

6 https://apps.who.int/iris/bitstream/handle/10665/44577/9789241501460_eng.pdf

7 https://apps.who.int/iris/bitstream/handle/10665/44577/9789241501460_eng.pdf

8 https://academic.oup.com/ije/article/47/6/2025/5057663

"Yes" victory in Irish abortion referendum

As the results of the Irish abortion referendum were announced on May 26th, scenes of celebration were shared around the world. The "yes" vote to repeal the constitutional ban on abortion had registered a smashing majority of 66.4%. Voter turnout was 54.51% - higher than for the 2015 marriage equality campaign and a record for any referendum in Ireland.

With 1,429,981 votes for repeal, campaign group Abortion Rights Campaign (ARC) Ireland points out, more votes were cast to remove the amendment than were cast to insert the ban into the constitution in 1983.

The 8th amendment, as it was known, recognised a right to life of the foetus equal to the right to life of the woman or pregnant person.

Under the ban, abortion has been subject to a comprehensive ban, even in cases of risk to the woman's health, conception from rape, and when fatal foetal anomaly have been diagnosed. Thousands of women travel abroad every year to obtain abortions in the UK and Europe, and thousands more risk the 14 year gaol term undergoing illegal abortion using imported medications without medical supervision.

The death of migrant dentist Savita Halappanava in 2012 from septic miscarriage was attributed to the ban, as legal uncertainty led to delays emptying her uterus while the foetal heartbeat was detected, even though her miscarriage was deemed inevitable and became the cause of her overwhelming infection.

Her death became the trigger for legislative reform and the push to repeal the constitutional ban.

After a series of public mobilisations, the issue was referred to the Irish Citizens' Assembly, which recommended a referendum to repeal the constitutional amendment and allow the government to make laws to regulate abortion.

Before the referendum, the government announced that if the amendment was repealed, they would introduce legislation to allow abortion freely up to 12 weeks of pregnancy, for medical reasons (with two doctors' agreement) up to 24 weeks, and for fatal foetal anomaly after that. They have pledged to introduce the legislation this year, and plan to establish services in Ireland in 2019.

The No campaign mobilised with images of foetuses, attempts to equate foetal life with the lives of children and pregnant women, misleading advertising claiming the government's proposed legislation would allow abortion up to six months, and claims to "love both" - arguing for adoption instead of abortion.

A statement issued by the Adoption Rights Alliance noted the offensive irony of the No camp slogan "Love Both". As advocates for those adopted under Ireland's closed, forced adoption system, they pointed out that none of the adopted people they are in contact with over two decades have ever been offered support by anti-abortion organisations. Similarly, it was anti-abortion crusaders who persecuted pregnant women and gave cover to the forced incarceration of unmarried pregnant women and girls (and those considered "at risk" of pregnancy outside marriage) in the Magdalene Laundries and other institutions - where they were forced to give birth and relinquish their babies for adoption.

Adopted People for Yes was one of the 97 groups that joined the umbrella group "Together for Yes," by the time the referendum was held. It emphasised compassion and care for women and pregnant people facing crisis pregnancy.

The Yes campaign was marked by stalls, fundraisers, rallies, public statements and social media outreach. Perhaps most striking was the scale of mobilising of volunteers to doorknock canvassing for votes. The Yes volunteers knocked on 500,000 doors, or about a third of all households in the country.

In public and in private, people facing crisis pregnancy told their stories of stigma and isolation traveling for abortion care; of taking medications to induce abortion without medical assistance; and of being denied care in their home country, when faced with a diagnosis of severe foetal health problems that would inevitably result in stillbirth or the death of the baby if born.

“Today’s results show what we in ARC have seen around the country for the last 6 years – that the people of Ireland were hungry for change. The grassroots community-led organising at the heart of ARC has been a huge part of the campaign’s appeal across all groups and communities. We especially acknowledge the work of migrants who did not have a vote and who were disproportionately affected by the Eighth, as well as the many trans and non-binary people affected.”

“This result is bigger than Ireland: we know the world watches us as abortion access is being eroded in other places. Ireland now has the opportunity to be a beacon to the world in terms of respect for people who can get pregnant.”

Close to the republic, calls have already been made for the UK to liberalise abortion access in Northern Ireland, where the issue has been devolved to the parliament of the six counties, and remains banned by an 1861 law. With the power-sharing agreement in a shambles and no executive government in Belfast for over a year, the demand is being made for the UK government to bring abortion law into line with the rest of the UK. A rally of hundreds launching the campaign was held in Belfast on May 28.

Another rally was held the same day in Brisbane. Buoyed by the victory in Ireland, sixty people gathered to call for repeal of Queensland's abortion laws - also modelled on the UK 1861 Offences Against the Persons Act.

Vigil for Savita Halappanavar, outside Irish consulate, London, 28 October 2017

Ireland: Abortion Referendum to be held May 25

Campaigning for abortion rights in Ireland has stepped up since the announcement of the date and wording of a referendum on constitutional change to allow abortion. The referendum will be held on May 25. It will ask voters whether to repeal the section of the Irish constitution that bans abortion, and to allow parliament to make laws to regulate abortion.

Currently, abortion is banned by the Irish constitution under an amendment (the Eighth Amendment) adopted by referendum in 1983. According to the amendment,

‘The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.’

According to Shauna Stanley of the Melbourne Irish Abortion Rights Campaign, the impetus for the amendment was the Roe v Wade ruling in the US. Anti-abortion activists in Ireland wanted to prevent similar judicial intervention from making abortion accessible to women in the republic.

Abortion rights campaigners have waged a campaign for over 30 years, beginning with the "No" campaign in that referendum, and continuing efforts that have borne fruit in a change in public attitudes, constitutional and legal change and now the growing call to repeat the Eighth Amendment.

Attempts by the state to restrict pregnant women's access to information about abortion and right to travel to obtain abortion were overturned by successive referenda, which added two further amendments to the constitution:

‘This subsection shall not limit freedom to travel between the State and another state.’

‘This subsection shall not limit freedom to obtain or make available, in the State, subject to such conditions as may be laid down by law, information relating to services lawfully available in another state.’

While the later provisions give people needing abortion some protection, it means (as many abortion rights campaigners point out) abortion is a problem that Ireland exports. As a result of the ban, an estimated 4000 women and non-binary or trans people travel abroad (mostly to the UK, but also the Netherlands and France) each year to obtain abortion. Up to 2000 risk a 14 year gaol term by taking medications obtained online, to induce abortion. The number who are unable to obtain abortion and simply continue a crisis pregnancy, with all the impacts that has, is unknown.

Ireland's abortion ban is among the strictest in the world. It is extensive, with few exceptions. The impact of the ban on abortion in Ireland is not only felt by women who are simply not ready for parenting, or who can't manage for socioeconomic reasons, but also those who have conceived from rape, are in coercive or violent relationships or have serious but not life-threatening health problems. Although the constitution refers to the "equal right" to life of the mother, the chilling effect of the abortion ban on healthcare providers and institutions is so extreme that in 2012 it led to the death of a woman, Savita Halappanavar, who was miscarrying. Although she was told her miscarriage was inevitable and requested medical intervention to empty her uterus, it was refused on the basis that there was still a foetal heartbeat - and despite her condition deteriorating as she developed overwhelming infection as a result of the miscarriage.

Savita's death galvanised the growing community opposition to the abortion ban, with massive and growing annual marches for choice calling for abortion to be legal. In a quirky twist, the appearance in around 2012, of insensitive graphic billboard advertising publicising opposition to abortion, itself sparked a renewed enthusiasm for organising and mobilising for abortion rights among a layer of the community.

A 2013 law, the Protection of Life During Pregnancy Act, subsequently codified that threats to the woman's life (as distinct from health), including the risk of suicide, would constitute grounds for abortion.

Attempts by the parliament to widen eligibility of people who could become pregnant have been struck down by the courts, because of the constitutional protection of the foetus. According to Stanley, this has also led to a strengthening of the pro-choice movement and its focus on calls to repeal the Eighth Amendment.

According to Stanley, in 2016, the campaign started to gain more momentum. Recognising the centenary of the Dublin Easter Rising, the Abortion Rights Campaign ran a campaign under the slogan "Rise and Repeal," linking the campaign for abortion rights to republican struggle and Ireland's historical context. The campaign drew out the proclamation of the republic's founder that the it was to be one in which Irish men and Irish women would have equal rights - something clearly absent in an Ireland where half the population is denied reproductive justice.

In the same period, the Repeal Project apparel campaign took off. Black jumpers with the word "repeal" on them spread the message and sparked conversations among people who might not have identified with more traditional political campaign activism.

During the Polish "Black Friday" women's strike of 2016, when the Polish government threatened to wind back what little space there is for legal abortion in that country, members of the Polish diaspora within Ireland mobilised in solidarity. Inspired by this action, on International Women's Day in March 2017, the abortion rights movement in Ireland held a women's strike - wearing black and staying away from work.

In line with the rising activism and campaign visibility, opinion polls in recent years have shown majority support for liberalising access to abortion.

As the campaign for reform continued to gain traction, the issue was referred to the Irish Citizens' Assembly, an exercise in deliberative democracy involving a random selection of citizens, tasked with making recommendations about a range of issues. In April 2017, they voted to recommend a referendum to repeal the Eighth Amendment and allow the government to legislate to regulate abortion.

In response, Leo Varadkhar, the Irish prime minister (Taoiseach), announced in September that the referendum would be held in mid-2018.

Announcement of the exact timing and wording of the referendum was delayed while the government awaited a Supreme Court ruling on whether the constitution provides for any foetal rights other than the right to life. The March 6 Supreme Court ruling that there are no other foetal rights under the constitution than the right to life paved the way for the decisions to be made on the referendum.

The Irish cabinet marked International Women's Day (IWD) 2018 by introducing the legislation to hold the referendum, and on March 25th, the May 25th referendum date was announced. The government has pledged that if the referendum is passed, it will introduce legislation to replace the Protection of Life During Pregnancy Act, decriminalising abortion for the pregnant person and introducing laws that make abortion readily available in the first 12 weeks of pregnancy, with restrictions as to reason thereafter.

Together4Yes, a coalition of over 70 groups from across Ireland, launched its campaign - modelled on the successful marriage equality campaign - on March 22. In the lead-up to the launch, member organisations have been training canvassers and recruiting volunteers from across the country to undertake the task of doorknocking and engaging people across the country, with a focus on those who are undecided.

The breadth of support for the campaign is evident in the packed calendar of campaign activities around Ireland, from art installations, public meetings and campaign stalls to punk gigs, singalongs, story-telling and comedy events.

And the campaign isn't limited to Ireland. In 2016, the online campaign Repeal Global was initiated to call and coordinate solidarity actions to coincide with the major annual marches for choice. Just like during the marriage equality campaign, there are campaign committees in the Irish diaspora around the world. The London Irish Abortion Rights Campaign launched a #hometovote campaign urging eligible voters around the world to make plans to travel back to vote in the referendum.

In Australia, campaign events have been held since 2016, with rallies in Melbourne in solidarity with the marches for choice in Dublin in 2016 and 2017, and other actions in Sydney, Perth and Darwin. The Melbourne Irish Abortion Rights Campaign formed a contingent calling for repeal of the eighth amendment to march in Melbourne's IWD march in 2017.

In the countdown to the referendum, Stanley says, the campaign focus is on fundraising. "Living in Australia, it would cost $2000 to return to Ireland to vote. Irish citizens who have been out of the country for 18 months aren't allowed to vote. And the laws about donations to electoral campaigns are quite strict. Only citizens can donate. Many of us are going to return to Ireland some day. And we want to return to an Ireland that has proper healthcare. If you need an abortion, you should be able to get it in your home country. We want to do something. Even if we can't vote, we can raise money to support the campaign. We want to reach out to members of the Irish diaspora in other cities, to support them to be part of the campaign - whether it's organising fundraisers, or participating in the social media campaigns, or encouraging to talk with their grandparents back home."

And in the spirit of the solidarity that connects the Polish and Irish struggles, she added, "and we want to support the campaigns in Australia, in NSW and Queensland. We'd like to support organising solidarity in the states where abortion is legal, to help the campaigns in NSW and Queensland, where it's not."

Connect with the Melbourne Irish Abortion Rights Campaign on Facebook at "Irish Pro Choice in Oz."

International Women's Day rally Brisbane/Meanjin

Over 300 people took part in the Brisbane/Meanjin International Women's Day rally and march at Emma Miller Place on March 10.

According to the information provided by the rally Working Group and rally speaker, retired academic Diane Zetlin, Emma Miller Place itself is of historical significance - for the Aboriginal community, the feminist movement, the trade union movement and numerous other social justice struggles, with countless public demonstrations being held there. It was named after labour and women's movement leader Emma Miller who famously led women textile workers defying a mounted police attack on a general strike for union rights in February 1912. The women charged police lines, defending themselves with the hatpins they stuck into the horses' rumps. Again the women's liberation movement faced off against the police, in 1978 defying Joh Bjelke-Petersen's ban on street marches as they attempted to leave the site (then known as the Roma St forum).

The 2018 march was led by a group of '78ers - veterans of that rally.

A range of pressing issues for women were addressed by other rally speakers. Ros McLennan, secretary of the Queensland Council of Unions, spoke of the need to address the gender pay gap. She slammed the federal government and employers for their attacks on penalty rates, set to get worse when new legislation takes effect in July. Owing to the concentration of women in low-paying, part-time, casual and precarious work, the impact of cutting penalty rates will be disproportionately borne by women.

Yamatji woman Janine Kelly spoke of the injustices facing Aboriginal women. She relayed a message from her auntie Carol Roe, Aboriginal elder and grandmother of a young woman killed by medical neglect in WA's South Hedland lock-up, calling for justice for Ms Dhu and an end to the racism that kills Aboriginal people in custody. She played a powerful song for Ms Dhu by rappers The Cat Empire; a new recording of it is to be released in the coming week.

Deb McLoughlin, a '78er from the Women's Abortion Rights Campaign, spoke passionately for abortion law reform and for access to abortion in the state's public hospitals. Erin Cameron from Sisters Inside recounted the marginalisation and discrimination facing incarcerated women. Griffith University Senior Law Lecturer Zoe Rathus outlined the difficulties women face in dealing with family law, debunking myths about women's preferential treatment in custody matters, and describing the bind women leaving violent relationships can be placed in: if they try to protect their kids, they may be in violation of court orders; if they comply with court orders, they'll be treated as not believable if they subsequently raise the issue of violence. And Sia Carolyn of the Brisbane Rape and Incest Survivors Support Centre highlighted the ongoing crisis of violence against women. A Palestinian woman spoke in solidarity with imprisoned young woman Ahed Tamimi. A group of Latin American women sang Spanish songs raising awareness of violence against women, and the Women's International League for Peace and Freedom performed a piece commemorating Emma Miller's contribution to the struggle against conscription.

The otherwise excellent rally was marred by a small group with transphobic signs (one of whom had been invited onto the platform as an entertainer). A large number of rally participants responded by expressing their support for trans inclusion in various ways. Some stood near and in front of them, holding signs affirming that trans women are women; many cheered when speakers expressed support for trans women's inclusion. On the march, chants were raised in solidarity with ending transphobia. And when the slated entertainer took to the platform, many left, some turned their backs, and others held signs expressing support for trans women.

#IWD #InternationalWomensDay #IWD2018 #feminism #women #StopViolenceAgainstWomen #AbortionRights #abortion #ProChoice #EndWomensPoverty #ChangeTheRules #JusticeForMsDhu #StopBlackDeathsInCustody #TransInclusion #TransWomenAreWomen #AusPol #Brisbane #QldPol

Abortion rights: unfinished business

As women and their allies around the world prepare to strike, rally and march on International Women's Day, abortion rights are once again placed on the agenda in many countries. And in Australia, a new movement for abortion rights is emerging. It's a movement that sits within the broader struggle for reproductive justice that includes the right to have and keep children, the right to contraceptive information and healthcare, the right to respect and autonomy when we're giving birth, the struggle against forced sterilisation, and more. It's part of the wider struggle for the rights of all women - including trans women. But it's still unfinished business.

In some ways, the movement never went away. In the heyday of the second wave of the women's liberation movement, the struggle for abortion rights was one of the central demands around which women rallied across Australia. Nineteenth century laws made abortion a crime. Protests for law repeal morphed into service provision and advocacy, but although in the 60s and 70s, law reform in South Australia and liberal court rulings in Victoria and NSW paved the way for safe abortion services to be established in many states, abortion access is still a postcode lottery. Nowhere is this more apparent than Western Australia, where abortion was mostly decriminalised almost 20 years ago, but access to publicly funded abortion services depends on whether or not you live in the postcode-determined catchment area of the small number of hospitals or hospital-contracted private providers that provide abortion in accordance with the principle established in the law - that it be by "informed consent" - not exactly on demand, but almost.

A lot of abortion law reform has been reactive. From the 1960s to the 1990s in Victoria, NSW and Qld, court rulings in cases of prosecutions under anti-abortion laws recognised (more or less stringently) circumstances when abortion could be legal. In WA and Tasmania, reform of anti-abortion laws was triggered by charges or police investigations into doctors performing abortion. In each case, rallies and other grassroots public actions were organised to give visibility to public support for abortion rights. Similarly, when a restrictive court ruling in NSW threatened to undermine the previously recognised legality of abortion in a wide range of circumstances. But starting with SA and the NT, and more recently, ACT, Victoria, Tasmania and again the NT, legislative reforms came about as a result of more pro-active processes, including legislators working with abortion rights groups and parliamentary responses to law reform commission reports.

Now, the momentum for change keeps growing.

In South Australia, abortion is accessible in designated hospitals - but only there, and only for women who meet the residency provisions. This is a problem for accessing abortion, which in other states can be completed at home.

In the Northern Territory, those who spearheaded last year's breakthrough decriminalisation that still retained some restrictions on abortion after 14 and even more, after 23 weeks have pledged to campaign for the full right to abortion.

At the time of writing, a crisis grips abortion service provision in Tasmania. In 2001, the feminist-run free-standing abortion clinic closed its doors after medical termination (ie, taking medications to induce miscarriage-like abortion) began to be offered by some doctors. This led to bottle-necks in the public hospital system. Services stopped completely after a medical student complained to the police that unlawful abortion was being carried out in Hobart's public hospital. In response to the crisis, Labor premier Jim Bacon recalled parliament, and minimal law reform providing clarity allowed services to recommence and new clinics to be established with legal protection.

Now, after years of private clinic provision of abortions, the much-expanded availability of early medical abortion has again led to a closure of the state's free-standing private abortion services. As a consequence, and in the absence of on-request public hospital services, women unable to obtain early medical abortion once again have to travel interstate for surgical terminations.

The state LNP government refuses to intervene.

By contrast, state and federal Labor have pledged public funding to establish a hospital-affiliated service to meet the need. If Labor wins the March 3 state election, they must not wait for the election of a federal Labor government to make sure public hospitals provide this needed reproductive healthcare. If the LNP maintains power, the crisis and hardship for women and people needing abortion will be set to continue. As former AMA head and Sydney city councillor, Professor Kerryn Phelps put it on ABC's "The Drum," there's no reason why hospitals can't be required to provide the service tomorrow.

In Western Australia, the state government is considering moves to create protective zones around abortion clinics, in line with similar protections in Tasmania, Victoria and the ACT. The need for this is most obvious around this time of year, when some people decide that for Lent, the best thing they can do to show their adherence to the guy who said "Don't judge, so you won't be judged," is to "give up" letting people enter abortion clinics without being confronted by "sidewalk counsellors" who want to convince women to continue their pregnancies, and clinic staff to find another job. In the words of one such group of zealots, they want to end abortion "from the inside out" - to reduce the number of people willing to be involved in abortion services, until "then there were none."

NSW and Queensland remain the only Australian states to keep abortion a crime without spelling out exceptions in the law. In the last two years, both states have seen a number of public rallies and creative actions to build support for abortion law reform. In 2017, both state parliaments failed the test when given the chance to recognise women's and pregnant people's rights to decide about this health matter for themselves.

In NSW, the state upper house voted down a bill to take abortion out of the criminal code and protect women from anti-abortion harassment at clinics. Opinion polling shows majority support for these measures. The bill was introduced by Greens MLC Mehreen Faruqi, and had wide-ranging support, from doctors and public health groups to anti-violence and civil liberties. Just not politicians elected to represent the community.

In Qld, independent MP Rob Pyne withdrew his bills to decriminalise and regulate abortion when Labor wouldn't bind its members to support them and the LNP announced its members would all exercise their "conscience" vote to vote against. In return for withdrawing the bills, Labor referred the issue to the Queensland Law Reform Commission (QLRC).

Women's Abortion Rights Campaign, a grassroots independent feminist activist group, has organised numerous rallies, pickets, petition campaigns and other activities aimed at building and expressing public support for change. It has initiated a rally on May 26 to mark the global day of action for women's health, under the slogan "Abortion rights: it's time." The rally will call for abortion to be decriminalised and for safe abortion to be free, safe and accessible "on demand and without apology." The rally will be held at King George Square, from 11am and will come a month before the QLRC is due to report.

Including the call for abortion to be free is an important component of the struggle for abortion rights. The law as it stands in Qld is a serious obstacle to the exercise of the right to determine whether or not to continue a pregnancy. But the lack of services won't be solved by decriminalisation without a commitment by governments to ensure that the public hospital system - funded to provide the range of healthcare needs - meets the needs for reproductive healthcare, including safe abortion.

We must insist that Qld Labor match the pledge of its Tasmanian counterpart and establish reproductive healthcare hubs throughout the state to meet the unmet need for abortion that remains an obstacle to the full exercise of women's rights.

While a lot changed with the rise of organised feminist campaigns for abortion rights in the 70s, and activism has continued in a range of forms since then, legality and free access to abortion in our communities remains to be won. The right to decide whether or not to continue a pregnancy is a prerequisite for determining the course of our lives. This IWD, we again raise the cry, "our bodies, our lives, our right to decide."

Abortion referred to Queensland Law Reform Commission

In a move similar to the one that preceded abortion law reform in Victoria and Tasmania, Queensland state attorney-general and justice minister Yvette D’Ath has referred abortion to the Queensland Law Reform Commission (QLRC). It has been tasked with drafting legislation to modernise abortion law in Queensland. The current laws date back to 1899 and haven’t been amended since.

The terms of reference for the report and draft legislation appeared quietly on the QLRC website on 20^th June. The referral had been awaited since February 28 when Independent MP Rob Pyne withdrew from parliament his bills to decriminalise and regulate abortion. Those bills had been due to be debated the following day. In a February 28 media statement, state Labor premier Annastacia Palaszuk, deputy-premier Jackie Trad and attorney-general Yvette D’Ath pledged to refer the issue to the QLRC and that in the next term of government, Labor would introduce legislation, based on the QLRC recommendations, to “modernise” the state’s abortion laws.

At the time the promise was made to seek the commission’s advice and legislate in the next term of government, campaigners and doctors pointed out that putting it off until then introduced uncertainty, as the make-up of the next government is not yet known.

Over 1000 people signed a change.org petition calling on the Labor leaders to refer the issue immediately to the QLRC, have it report quickly and then move to make abortion legal in Queensland in 2017.

However, under the referral, the QLRC is not required to make its report until June 30, 2018, after the latest time for the next state election (May 5).

While the terms of reference for the QLRC report fall short of requesting advice on simple, complete decriminalisation of abortion, it does request advice on removing abortion performed by a medical practitioner from the criminal code, and for clarification of abortion law in the state.

Most abortions in the state are performed or prescribed by doctors, so removal of these from the criminal code would be an immense advance for the provision of abortion in Qld to be legal.

However, because of the lack of access to abortion provision by doctors, some Queensland women induce their own miscarriages without medical support.

An ABC report on 21 June quoted the manager of the state’s central pregnancy counselling and abortion referral agency Children by Choice, who said she saw “about one woman a fortnight who was considering” inducing her own miscarriage.

"We have women who either tried, or have asked how to do it," she said.

The most recent prosecution for abortion under the state’s criminal code was in relation to an abortion obtained by a woman with her partner’s help, without a doctor’s authorisation.

The narrowness of the terms of reference means that such pregnancy terminations (and help from non-medical support people) will potentially remain crimes. It’s not illegal for someone to manage their own healthcare needs without trained professionals, and separate legislation already prohibits people who are not health practitioners from providing healthcare that needs training. Making abortion by a medical practitioner legal is likely to reduce the number of women seeking to induce their own miscarriage, but singling out self-induced miscarriage as a crime threatens to punish women (and anyone who helps them) for the failings of a system that currently lets them down.

Furthermore, in some countries, trained health practitioners apart from doctors perform abortion. Given the refusal of many doctors to perform abortion, if the proposed bill only decriminalises abortions provided by doctors, it closes the door to other health practitioners – with proper training and qualifications, within their scope of practice – legally stepping in to fill the gap left by doctors refusing care.

On the other hand, the terms of reference instructs the QLRC to have regard to existing practices and services in Qld, existing legal principles, the government’s commitment to modernise and clarify the law, the recent parliamentary enquiries into abortion (held in consideration of Rob Pyne’s bills), the views of experienced clinicians, the views of the Qld community, and the laws in other jurisdictions.

Within such a scope, it will no doubt be possible to put forward arguments that a modern criminal code has no room for provisions that make abortion a crime.

Health (Abortion Law Reform) Amendment Bill

The Queensland Health, Communities, Disability Services and Domestic and Family Violence Prevention Committee has been tasked with looking into the Health (Abortion Law Reform) Amendment Bill, put to Qld parliament in August 2016 by MP Rob Pyne. It's a private member's bill, and can be found at. It followed his introduction of a simple bill to decriminalise abortion, which the committee recommended against passing alone.

A summary of the second bill from the committee's website shows it includes provisions to legislate that:

• only a doctor may perform an abortion: a person who is not a doctor (or a registered nurse administering a drug to perform an abortion under the direction of a doctor) would commit an offence.
• a woman does not commit an offence by performing, consenting to or assisting in an abortion on herself
• an abortion on a woman who is more than 24 weeks pregnant may be performed only if two doctors reasonably believe the continuation of the woman’s pregnancy would involve greater risk of injury to the physical or mental health of the woman than if the pregnancy were terminated
• conscientious objection: no-one is under a duty to perform or assist in performing an abortion; however a doctor has a duty to perform an abortion if it is necessary to save a woman’s life or prevent serious physical injury. Also, a registered nurse has a duty to assist in such circumstances.
• patient protection or ‘safe zones’: a protected zone of at least 50 metres must be declared around an abortion facility; certain behaviour, e.g. harassment and intimidation, is prohibited within a protected zone. Publishing images of a person entering, leaving or trying to enter or leave an abortion facility is prohibited.

Below is the submission I made (half at the deadline, and half, just afterwards in the hope that it would be considered).

Submission to the Queensland Health, Communities, Disability Services and Domestic and Family Violence Prevention Committee regarding the Health (Abortion Law Reform) Amendment Bill

Dear committee members,

I am writing as a woman who grew up on the Sunshine, Gold and Tweed Coasts, and as a doctor who has worked as a junior doctor in obstetrics, gynaecology and paediatric emergency, and as a general practitioner with over 20 years' experience working in women's health, sexual health, family planning and abortion services, in NSW, Tasmania and Western Australia.

I did not make a submission to the committee regarding the associated Abortion Law Reform (Woman's Right to Choose) Amendment Bill. However, I read the committee's report with interest and was disappointed with the decision not to recommend immediate passage of the bill to decriminalise abortion.

My daughter and I will be moving to Queensland next year, and these two bills, important for all Queensland women of reproductive age, will have a bearing on us, on my patients and on my medical practice.

Like so many who gave written and oral presentations to the committee, I am in favour of immediate complete decriminalisation of abortion.

I am writing this submission to give qualified support to the passage of the Health (Abortion Law Reform) Amendment Bill 2016, only in conjunction with passage of the Abortion Law Reform (Woman's Right to Choose) Amendment Bill.

I believe this bill is too restrictive, however, I believe that on balance it would be better to be passed (in conjunction with passage of the Abortion Law Reform (Woman's Right to Choose) Amendment Bill), rather than having the Abortion Law Reform (Woman's Right to Choose) Amendment Bill not pass at all. I believe this bill makes substantial concessions to alleviate concerns raised in the committee's report, and should be seen as an attempt to introduce legal reform that will be generally workable, introducing legal protection for Queensland women seeking abortion and for health care professionals providing abortion-related services to women in good faith.

I would like to address each of the key elements of the bill in turn.

Only qualified health practitioner may perform abortion

This section of the legislation must be understood to be intended to protect women from unsafe procedures, and as such, is laudable.

Read in conjunction with the conscientious refusal provision, however, this section restricts abortion provision (apart from medication administration) to doctors only, while allowing doctors to refuse to perform a service that a substantial number of women in Queensland require (whatever figures we rely on for that estimate).

Experience from abroad indicates that first trimester aspiration abortion can safely be performed by appropriately trained nurse practitioners, physician assistants and nurse midwives¹. Although I am not aware of any jurisdiction in Australia where first trimester aspiration abortion is carried out by nurse practitioners or nurse midwives, there is no reason why, if proper training were introduced for willing clinicians, such an initiative should be ruled out in Queensland by a ban with a ten-year imprisonment penalty. Many women in remote and regional centres are unable to access first trimester abortion close to home. A new law shouldn't make it impossible to implement an initiative to reduce the number of late abortions by improving access to early abortions.

It has taken over a hundred years of the operation of criminal law restricting abortion for abortion law to be seriously revisited in Queensland. Medical, nursing and midwifery practice is continually evolving. It makes most sense for regulation of who can perform abortion, to ensure public safety, to be overseen by the medical and nursing/midwifery boards and by existing general laws restricting health care practice to only those who are properly qualified.

It would be preferable for this section to be amended to include reference to other appropriately trained clinicians, or to be omitted altogether, on the understanding that Queensland already has effective laws prohibiting untrained people from providing health care for which they have not undergone proper training.

Those objections notwithstanding, if this section is passed as it is, it would not restrict existing practice and would provide legal protection to doctors and nurses currently providing abortion-related services. If it's the best that can be achieved, I support it.

Abortion on woman more than 24 weeks pregnant

The notion that decriminalising abortion without restriction as to reason and gestation will result in a rash of third trimester abortions overtaking Queensland is an invention of those who are opposed to abortion on non-scientific grounds.

The experience of the ACT, where there is no gestation limit in law bears this out. The only free-standing clinic where abortion is available in the ACT provides procedures under 16 weeks' gestation only.²

In Canada, where there is also no legal gestation on abortion, it is estimated that abortion after 20 weeks makes up 0.86% of all abortion.³

The vast majority of pregnant women seeking abortion do so as early as they can. Reasons for presenting late for termination have been explored in the medical literature and may be complicated. They represent a tiny minority of abortions, but the women undergoing abortion late are no less competent to make decisions about their pregnancies than women requiring abortion who are able to present for medical care early. Late abortion is generally harder for women to undergo and clinicians to perform; no-one directly involved in the decision-making process does so lightly. There is no need for the additional restriction of law, in the way of restrictions as to reason beyond 24 weeks' gestation. If a woman 24 weeks pregnant or later determines that she requires an abortion – whether because in the opinion of her doctors it is necessary for her physical or mental health – or whether she determines it is in the best interest of the foetus, or for some other reason or set of reasons – there shouldn't be a legal restriction preventing her doctors from performing it for her.

As with the previous section, if the law will only be passed with this proviso, it is better than not decriminalising abortion. However, it represents an unnecessary interference in a woman's right to decide how and whether to proceed with her own pregnancy.

Patient protection

I support this section of the bill. I believe the protection zone should be greater, probably 150m, in keeping with the ACT legislation.

Protesting and expressing minority views about the morality of abortion can have a place in a democracy, but there is no absolute right to such political communication that outweighs women's right to privacy in seeking medical care. I have witnessed the impact of distressing, hostile protest actions outside abortion facilities on women seeking care and am in favour of measures to prevent harassment of patients and staff.

Duty of care

Most health professional codes of conduct recognise a right to conscientious refusal of care. The impact of this on restricting reproductive health care is not well documented, though an attempt to begin this work has been undertaken.⁴

What is important to note is that in general, where a right to refusal of care is acknowledged, it is not considered to outweigh the right of women to access needed healthcare. This generally includes an obligation of practitioners refusing to perform abortion to refer women to others who will provide services.

Again, it seems to me unnecessary to include this assertion of the right to refuse care in the law when it is already accepted in practice, but particularly without the inclusion of the complementary obligation to refer to a practitioner who will provide care. As I outlined in the section on who can perform abortion, when only doctors may lawfully perform or prescribe abortion medication, but they may refuse, if this is not combined with a safeguard obliging referral to a practitioner who will provide services, it could operate as a practical barrier to access.

In Western Australia where I currently practice, and where there is a restriction requiring a woman seeking abortion to be given information by a doctor not participating in the abortion, it is not unusual for women to see more than one practitioner; I have had patients who've needed to see 3, 4, even 5 doctors before being appropriately assisted to obtain an abortion. This clearly results in delay and later procedures. It is not known whether it ever results in women being unable to obtain abortion at all, but this possibility can't be discounted. I am concerned that the uneven emphasis on the right to conscientious refusal of care in the bill, if not balanced with the internationally recognised obligation to refer to a practitioner who will provide care, will result in unnecessary and unfair difficulties for women seeking abortion services, depending on the availability of clinicians who support women's access to the full range of reproductive healthcare services.

These are the concerns I have about the Health (Abortion Law Reform) Amendment Bill. I believe the bill should only be passed in conjunction with the passage of the bill to decriminalise abortion, that its provisions don't represent the best for the women of Queensland, but that they should be supported as concessions to enable recommendation of decriminalisation of abortion, which would certainly be a step towards the 21^st century.

1 Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants Under a California Legal Waiver

Tracy A. Weitz, Diana Taylor, Sheila Desai, Ushma D. Upadhyay, Jeff Waldman, Molly F. Battistelli, and Eleanor A. Drey. American Journal of Public Health 2013 103, 3, 454-461

2http://www.shfpact.org.au/sexual-health/pregnancy-options accessed 6/10/2016

3http://www.arcc-cdac.ca/backrounders/statistics-abortion-in-canada.pdf accessed 6/10/2016

4http://globaldoctorsforchoice.org/wp-content/uploads/GDC_White-paper-on-CO-in-reproductive-health_ENG.pdf accessed 6/10/16

Qld pro-choice bill faces set-back

Pro-choice activists in Queensland have expressed disappointment at the release of a parliamentary report on August 26^th that failed to support the bill before Qld parliament to decriminalise abortion.

In a public statement, advocacy group Pro Choice Queensland said, “the bi-partisan Health, Communities, Disability Services and Domestic and Family Violence Prevention Committee’s report into abortion law reform concludes reform is needed, but is unfortunately indecisive about what that reform should be.”

The bill was introduced into parliament in May this year by independent MP for the Qld seat of Cairns, Rob Pyne. It was referred to a parliamentary health committee to consider.

After reviewing over 1400 submissions and hearing over 31 hours of evidence and perspectives, the committee compiled a comprehensive report on current abortion law in Qld, laws in other Australian jurisdictions, regulation of abortion by medical professional bodies and the Qld health department, and relevant international human rights law. It describes current abortion practice in Qld, community attitudes towards abortion, approaches to reducing the need for abortion, the health effects of abortion, abortion and young people, counselling, conscientious objection to providing abortion, and other issues.

Key findings of the report include that the current law, which makes abortion a criminal offence except in the case of serious medical or psychological risk to the woman, is out of step with current medical practice in Queensland. It points out that there is majority support for abortion to be readily available to women who seek it, although that support declines with advancing pregnancy duration. The report found that decriminalising abortion would bring Qld into line with Australia's international treaty obligations regarding the rights of women and children. The report described the existing codes of medical conduct that both affirm the right of conscientious refusal to participate in abortion, while balancing it with the duty to ensure that that refusal doesn't interfere with patients' right to care by practitioners who don't have such objections. It also outlined existing codes of conduct and guidelines for performance of abortion late in pregnancy.

It outlined a number of possible approaches to the law, not arguing in favour of any of them directly, but merely against the adoption of the decriminalisation bill.

It seems that they lost their nerve at the point where it mattered.

In summarising their objections to the bill, the committee highlighted community concerns about the need to regulate late gestation abortion, even though acknowledging the existence of existing regulations, parallel to the current law. They also referred to concerns about protecting conscientious objectors. In light of existing regulations and codes, they don't stack up as reasons to maintain the existing criminal status of abortion.

“These regulations would not suddenly disappear because abortion was no longer a crime. Medicine, and particularly abortion, is heavily regulated by Health and Hospital Service Boards, professional standards and clinical guidelines, licensing, and medical insurers to name a few. Doctors need clarity, and we have been waiting too long for someone in Parliament to do something about it,” says Dr Caroline de Costa, Professor of Obstetrics and Gynaecology of the College of Medicine at James Cook University.

The report argues that decriminalisation alone would do nothing to improve access to abortion for children considered unable to provide consent for themselves (whose parents are not allowed to provide consent – not because of the criminal law, but other case law), and that it would leave the issue of protests outside services where abortion are offered unaddressed. These are important, and should be addressed. But without providing a clear way forward, these don't seem so much reasons not to pass the bill before parliament as reasons to support any additional legislation that may be put forward to address them – now, or at any time.

The bipartisan report's recommendation against the bill's passage makes it less likely to be passed at this time, however, an additional bill, which addresses some of the concerns about gestation raised by the committee – including gestational limits, safe access zones around abortion facilities and conscientious objection – was introduced by Pyne on August 17 and is yet to be considered by the committee.

Regardless, pro-choice activists are planning on continuing their campaign to ensure women in Qld have equitable access to legal abortion.

Published at Green Left Weekly, Sept 1, 2016