That the House -
(1) Recognises Tasmanian women require full access to reproductive health services.
(2) Notes that international research has found that jurisdictions where terminations are difficult to access are associated with higher maternal mortality and unsafe abortion rates and barriers to abortion access in Australia particularly affect young women, rural women and women of low socio-economic status.
(3) Calls upon the Minister for Health to act immediately to ensure women are not forced to leave the state to access surgical terminations.
(4) Calls upon the Minister for Health to provide pregnancy terminations in the public hospital system, under all circumstances in which terminations are permitted by law, in accordance with Clause 4 and 5 of the Reproductive Health (Access to Terminations) Act 2013, by no later than 1 July 2018.
(5) Directs the Minister for Health to report on the implementation of this service to the House by 3 July 2018.
The matter before us today has commanded much state, national and international attention this year. Much has been said about why the minister has so far failed to act to ensure women can access this legal service in Tasmania. We have debated the same issue here in the last few weeks and many explanations have been floated. The reality is that we can only form our own personal opinions of whether it is influenced by his personal views on terminations, the power of the conservative right led by Senator Abetz in Tasmania, the incidence and behaviour around the infamous trolling incident, which came out of the Premier's office against a former colleague and friend and the dreadful way that Tasmanian woman was treated, including an attempt to undermine her professional position.
I have spoken of those issues here before and I hope we do not need to speak of them again. This House has an opportunity not to score points, not to argue our own deeply held views or prejudices, but to find a resolution and provide that today. In a previous debate on this issue, Mr Ferguson alleged that I disagreed with him because I do not like him. Minister, I assure you and other members of this House that is not my motivation in bringing this matter before us today. I cannot imagine having such a petty motivation on such a serious issue.
I disagree with this minister's action regarding access to reproductive health services in this state. That is my motivation today. That has been my motivation every day I have been told of doctors not knowing what advice to give as there is no clear referral pathway. It is my motivation when I have been faced with a distressing story of the pressure placed on women who feel they have been denied access due to an incapacity to pay or an inability to fly to Melbourne. It is my motivation every day I hear of the harrowing experience of women when they do fly away, far from their support structures.
The office of the UN Human Rights Commissioner clearly stated that women's sexual and reproductive health is related to multiple human rights. The Committee on Economic, Cultural and Social Rights and the Committee on the Elimination of Discrimination against Women have both clearly indicated that women's right to health includes their sexual and reproductive health. This means the states have obligations to respect, protect and fulfil rights related to women's sexual and reproductive health. The Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health maintains that women are entitled to reproductive health care services, goods and facilities that are available in adequate numbers, accessible physically and economically and accessible without discrimination and of good quality.
I am deeply passionate about a woman's right to choose and I am deeply distressed that women are being forced to leave the state to access these services. Under stress, they have to fly away. There is a genuine shock and distress about the fact that Tasmanian women are required to leave the state to access terminations. There is a sense of disbelief that our public health system would so fail them. It is important that service provision governing women's options around reproductive health supports access to positive sexual and reproductive health outcomes for Tasmanian women. As stated in the Beijing Declaration and Platform for Action -
Good health is essential to leading a productive and fulfilling life, and the right of all women to control all aspects of their health, in particular their own fertility, is basic to their empowerment.
Women's empowerment should not only be for those women that can afford empowerment. Access is merely privilege extended unless access is enjoyed and accessible by all.
How did we find ourselves here? It pays to recall the previous laws criminalising terminations and restricting access to terminations in Tasmania were based on the British laws of the 1800s. It was a law that was repudiated when women of this parliament, across the political divides, joined together. I offer my sincere appreciation to the many women and men who acted and advocated for laws and services that do the same, both today and in decades past. Many of those people are in the gallery today or are watching online. Such efforts recognise that women experience poorer health outcomes without the provision of a full range of safe, legal and accessible reproductive services. History clearly demonstrates this in Australia and overseas.
In these efforts I include the collaboration of the Tasmanian women of the 2001 Parliament, including and led by former members of this House; Judy Jackson, the late Sue Napier and Peg Putt, who came together across political persuasions to amend the criminal code and introduce a legal exception to the crime of terminating a pregnancy when women and doctors meet specific criteria. At the time this was a significant step forward in what were urgent and extenuating circumstances. I commend these exceptional and compassionate women and all of the women of that Parliament for their cooperation and commitment to improving Tasmania's termination laws.
However, despite these efforts the passage of time showed the criminal law continued to be a restrictive and inappropriate vehicle to regulate access to terminations. Doctors in our public hospitals were frightened they would be sued. Such laws acted as a deterrent to the provision of safe and legal services and, in the absence of which, women seeking terminations were forced to continue a pregnancy against their will, travel to other jurisdictions for services or, frighteningly, to seek unsafe and unregulated services. All of those are an increased risk to their health and wellbeing.
That is why at the urging of youth and women's health organisations in particular, who were fundraising to send women to Melbourne, I introduced a private member's bill, not as the minister for health, but as a private member in this House who recognised this was not a legal issue but a health one. The Reproductive Health (Access to Terminations) Bill was debated in 2013. It acknowledged that access to pregnancy termination services is first and foremost a health matter and not a matter for regulation under criminal law. The bill affirmed women as competent and conscientious decision makers.
I noted at the time that improved services would not happen overnight and there were many conversations to come as we considered the best way forward. We were discussing provision in the public sector or through public funding, to ensure that having dealt with the legal barrier that cost was not a barrier as well. That should have been the end of it. We should have been developing better, more accessible and supportive services, but we find ourselves today with women being forced to travel and services being forced to fundraise to send them there.
What happened since then? The bill also allowed the provision of medical terminations. It allowed a medical termination under nine weeks, which is less invasive and is safe. Medical terminations are used to terminate early pregnancies within the first nine weeks of gestation, after which most clinics and most health professionals would recommend a surgical abortion. It involves taking two different medications: Mifepristone RU486 and misoprostol, which are TGA approved and have been since 2012.
The Tabbot Foundation has made medical abortion more accessible for women in Tasmania by providing that service over the phone. The patient can contact a 1800 number, they are sent a request for a blood test and an ultrasound, which they then have. The results are evaluated and, if appropriate, arrange a consultation with a specialist over the phone. Women receive medication via express mail by the proposed date of the termination and on the day they have phone access to a 24-hour specialist and a nurse. Many Tasmanian women have accessed this service successfully and safely, but it does not meet the needs of all women. It did decrease, however, some of the patient demand for surgical terminations.
When the bill to decriminalise terminations was passed by both Houses of the Tasmanian Parliament in 2013 there were three clinics providing affordable access. The reasons for their closure vary, partly due to changes in service demand and partly the increased economic cost of maintaining and reaching standards that were altered nationally.
At each stage there was an opportunity for the Government to put in place measures to ensure that women were still able to access these services. When the first clinic closed at Moonah, it was not that big a concern. We had just decriminalised and there was a view that we would be able to manage this well, and we had still two services, one in the north and one in the south. When the second closed, the Government should have been acting to ensure provision. When the third closed, we should have had an acceptable model in place already. However none of this took place. When we decriminalised terminations we did not intend to reach this outcome. Denying access based on income is not and cannot be part of a broader strategy to improve the sexual and reproductive health of all Tasmanians, especially our vulnerable populations.
Research shows that restrictive laws and restrictive access does not reduce the incidents of terminations, but instead negatively impacts on the health and wellbeing outcomes for women. When faced with an unplanned pregnancy, women make deeply considered decisions based on multiple and contingent factors. Whether the woman ultimately chooses to continue or end a pregnancy, she is considering factors such as her age, her physical and mental health, her cultural background, her personal beliefs and values, the circumstances of conception - which may have been traumatic and have been a result of abuse and assault - the extent to which she is in a supportive relationship, the stability of her living circumstances, whether she has sufficient financial and other resources to feed, clothe, educate and provide shelter for a child, and whether she can continue to meet her existing obligations to herself, her partner, her existing children, her parents and her community.
Women's accounts of this decision making process reveal the very complex and personal social constructs in which reproductive health events must be understood. However in Tasmania we then ask women to make yet another decision, a decision not required by women in jurisdictions where terminations are legal. The woman must then consider whether she can afford to access the private services or whether she can afford to fly to Melbourne.
I will now read something written by a woman who had to travel. The actual full document is deeply personal and distressing. I cannot read it now. I struggled reading it the first time I saw it, but I can tell you that this woman and her doctor struggled to find a referral pathway. Due to the timing, she was not eligible for a medical termination and due to the delay in accessing an appropriate referral pathway she could not use the private facility in Tasmania because she was beyond their cut-off limit. She paid over $3000 to navigate our health system, fly to Melbourne and have the procedure she should have been able to access here. I quote:
I started to type this sitting in a waiting room in Melbourne while waiting for the first part of my second trimester termination to take place.
This is the first time I've thought about who I am, and I've not started with my work CV. I'm a confident, educated and able woman. Yet, I'm sitting here feeling beyond vulnerable, I'm feeling less of a person. I'm feeling invisible. I'm feeling alone. I'm feeling ashamed.
I just turned 39, I have 3 beautiful kids, I've been a mum since I was 21. My kids are 17, 10 and 7. I'm divorced. I'm into the second year of a beautiful relationship with someone I love unconditionally. We have a beautiful life.
My story represents one part of the unspoken face of terminations - I'm the mother in my late 30s that has a family, that works hard in my career, that does not always pay attention to my car ... and my body (I need to see a dentist, I need to get a pap smear, I need to not eat and drink as much over xmas, I need to work out what my regular cycle is ... regular
???), that thinks about everyone else, that forgets about what I need.
I'm not reckless, as some often assign to those that end up in this situation.
I'm also the Tasmanian female who had to fly to Melbourne because I couldn't access affordable and available services in Tasmania.
Even though the media releases tell me I'm not disadvantaged because I live in Tasmania, that the services have been restored, that I just have to see my GP, I've flown to Melbourne.
I'm an advocate and I've never been an activist. I'm now both.
I know politics, especially Tasmanian politics. I worked in Premier Hodgman's Office (after working for Labor and Liberal federal ministers, including our now federal Health minister, Greg Hunt) and I've worked in the Australian Government for 13 years.
I don't think of myself as the typical social advocate, but I had the same desire that all advocates share - we want action.
The health portfolio has hardly impacted on my life, I have private health insurance and I'm fortunate to have a healthy family - so this is my first true intersection with a health policy that fails Tasmanians.
That failed me.
She then details the costs. Her first visit to the GP, where the GP had no idea what to do, cost $82.50, with a $37 Medicare rebate. Blood tests were bulk-billed. An ultrasound cost $265, with $102.50 returned by Medicare rebate. Her second visit to the GP, when they were still struggling to find out exactly what they should do and who they should talk to, cost $82.50 with a $37 Medicare rebate. The specialist consultation with the local provider was $190, with a Medicare rebate of $72.75, but it was too late to access that service. Her flights to Melbourne cost $411.50 and accommodation was $507.45. For incidentals, such as Uber food, taxis, train, Skybus, she has a million receipts in her bag across two accounts and has not counted them all up. The procedure itself cost $2750.
There are many of these stories. I have heard a number of comments saying that we should not provide terminations in the public system because that would lead to abortion 'on demand'. Quite frankly, the use of such language as 'on demand' is judgmental, offensive and does not treat terminations as a legal medical procedure but implies it is somehow a lifestyle issue. A woman can no more demand a termination than any man or woman can demand any medical procedure.
The framework is based on consent, which is exactly the same legal framework that regulates all other medical procedures. Consent of the patient is the legal authority for the doctor to act. Consent takes its usual meaning within the medical context, that is, voluntary consent by a patient after receiving proper and adequate information about the proposed treatment, including potential risks and benefits and alternative options. These requirements exist for all medical procedures and are imposed by professional medical standards.
As international evidence has demonstrated, restricted termination practices do not decrease the incidence of terminations. Research conducted by the Guttmacher Institute and WHO demonstrates this. Forcing women to travel to Melbourne will not prevent them from having terminations but it runs the very real risk of preventing them from having safe ones. No women who has made the decision to either continue or terminate her pregnancy should face that risk, nor should they be subject to criticism, disapproval or attempts to dissuade her, and never should she be limited by capacity to pay.
Article 12 of the International Covenant on Economic Social and Cultural Rights, which commits parties to protect, promote and fulfil the right of everyone to the enjoyment of the highest attainable standards of physical and mental health, includes the right to appropriate health care, including reproductive health services. It does not mean forcing women to travel or preventing them from accessing services due to cost.
This Government says that women can access the Patient Travel Assistance Scheme. That is not an answer, nor is it timely enough, private enough or indeed actually enough to cover the cost. The Government has talked of a private low-cost provider. I am open to any conversation and any proposal that provides access. Federal Labor has a similar plan for a holistic reproductive health service that is designated as a health service that could access the activity-based funding model. But even if that was agreed today, it would not always meet the needs of every women, particularly rural women, and even if it was announced today, it could not be implemented immediately. We need a solution that helps women today, not in six or 12 months or longer.
That is why federal Labor's plan was multi-layered. It talked about a stand-alone wrap-around reproductive health service, but also recognised that we need the public provision of termination services to meet the needs of women in the short term and the needs of women for whom travelling to Hobart is just as hard as getting to Melbourne.
That is something the minister can do immediately. He can stand in this House today and commit to providing services in public facilities and then he can leave this House as minister and ensure that it is done. We ask in our motion for him to come back to the House and update us on the implementation. We ask this because all year the minister has said that access is provided, that women are not disadvantaged, that they just need to see their GP, and in more recent months that he is working on a solution, and yet women are still forced to fly.
In January, a spokesperson for the Tasmanian Department of Health told BuzzFeed News that the Government was investigating options regarding the provision of surgical terminations. The Health minister, Michael Ferguson, told BuzzFeed later that surgical abortion services had been restored in Tasmania. The situation he said, in a statement, is now exactly the same as it was prior to the recent closure. Federal Health minister, Greg Hunt, said on a Sky News interview that he had spoken to the state minister that day and that services were available. None of this is true. Bits of it are true. It really depends on what you are trying to tell the media and clearly they were not trying to admit what they were doing.
An amount of $2500 to a private service which operates on a limited basis cannot be equated to a restored service. Since then, the Government continues to say that they are working on a plan time and time again, yet these women continue to leave our state.
Tasmanian women have waited for that plan to be realised. We need a resolution. There has been plenty of time to find that resolution. I look forward to a holistic service but we also need to make sure that women are taken care of now.
We no longer have confidence that the minister and his department have acted immediately to provide this service. We know the Government says services are not provided in every state. Of course they are not. The procedure is not legal in every state and where it is legal they are accessible in the public hospital system.
We know the Government says the system has not changed in terms of public hospital provision. Actually everything else has. The decriminalisation of terminations removes the concern of a medical practitioner so that they can perform them in hospitals. The legal ramifications are removed but we have also had the closure of the affordable private clinics. There is a capacity and a need for the Government to take and we need to know that they are going to fix it. It has been six months already.
This House, this parliament, needs to put a deadline on it because at every opportunity this issue has been fobbed off. We need a deadline so that the safety net of public access is provided, and provided urgently. That is what this motion delivers. Not just more words but a provision of accessible service in Tasmania and a report back to this House. The pre-eminent part of this role in this state reports back to us to ensure that it is done: to provide the legal service that this parliament voted for in 2013, to provide the service that was intended when women from across the parliamentary divide from each political party joined together in that first bill in 2001 to deliver. We need action now and we need to enforce a deadline on its provision. We have to have confidence that this circumstance that impacts so badly on Tasmania women will end.
Whilst it is a slight extension to the terms of the motion I will explain where it fits. I congratulate those men and women in New South Wales last week who joined together to introduce access zones. In 2013, in the same legislation, we introduced the first access zones establishing a 150 metre zones around premises at which terminations are provided. We included the creation of an offence for a person to engage in prohibited behaviour in an access zone defined in the bill as 'harassing, intimidating or interfering with a person accessing a service', which I am sure no member in this House would support. There is nothing peaceful about shaming complete strangers about private decisions made about their bodies.
I respect each of us are entitled to our views. What I do not respect is the manner in which some people choose to express them. Standing in the street outside a medical facility with the express purpose of dissuading or delaying a woman from accessing a legitimate reproductive health service, to my mind, is quite unacceptable. It is not protesting, it is bullying. I raise it in today's motion because of the fact that people from both sides of the parliament, of both political divides, joined together to vote in that. In New South Wales they joined together. In Victoria they joined together. In the ACT they joined together. It is only here when the issue of access zones is brought before the parliament that any parliament voted against it. It was just the lower House, the Liberal members in this lower House.
In relation to today's motion, you can be a Liberal Party member and support matters that go to delivering and achieving the rights of women and not be acting in any opposition to conservative policies. In the end our decriminalisation bill passed because despite not a single lower House Liberal member voting for it. In the upper House people like the late Vanessa Goodwin did vote for it. In the upper House people like Paul Harriss who came down and sat in this parliament as a Liberal Party member did vote for it. This is not Labor versus Liberal. This is not progressive versus conservative. It is not even me versus Mr Ferguson. This is saying that the procedure is legal and should be accessible. It is saying that we should not provide access only to those who can afford it. It is about saying we will not force Tasmanian women to fly to Melbourne when they should be with their supporters, with their families and their friends accessing the service in the least traumatic way possible.
Today members are asked quite simply to give effect to the decisions that this House made in 2001 and in 2013, to accept that women are competent and conscientious decision-makers and recognise that a woman is in the best position to make decisions affecting her future and health. When this competent agent forms the decision that she will terminate her pregnancy then she will neither be financially penalised or prevented from accessing a termination due to cost or limited access.
Madam Speaker, I seek leave now to move a minor amendment which will ensure that if it is passed that this motion will not just call upon the minister to provide the services but to adequately resource those services. I do have the right to speak to that but I have taken a lot of the time of the House and I want to ensure that other members get the opportunity to speak.
The amendment to motion 32 moved in my name refers to paragraph 4, after the words 'to provide' and before 'pregnancy terminations' insert the words 'and adequately resourced'.
I will not take much more time allocated speaking to the amendment as I genuinely want there to be time for full contributions from other parties in this House or any member who might be using their right for a conscience vote, who might be using their right to join across the parliament to deliver what this House voted for in 2013.
The intent of the amendment is self-evident. It seeks to ensure there is not a failure to deliver the outcomes this House seeks to achieve through a funding shortfall. Being Tasmanian should not be a barrier to accessing legal reproductive health services. Being poor should not be a barrier to accessing legal reproductive health services. Being a member of this House should mean that when we pass laws to ensure access to terminations are legal, safe and affordable, that it actually happens.
This minister can ensure services are provided and he can do so today. I commend this motion and the amendment to the House. I call on all members to remember this is not about whether terminations should be legal; it is about ensuring Tasmanian women are not disadvantaged and shipped off to other states for services that are legally available in this state. It is about ensuring women can make choices about their own lives and not be forced into financial stress or unsafe practices because we failed them, because our health system has failed them and because our parliament ultimately fails them.
Ms O'CONNOR (Denison - Leader of the Greens) - Madam Speaker, the Greens will be supporting this notice of motion as we strongly supported the Reproductive Health Access to Terminations Act 2013. We do so because we believe nobody - not the state, not any other person - should have the power to tell a woman what to do with herself in the circumstances where she becomes pregnant.
Earlier today out on the lawns there was a prayer gathering which I happened to walk into. Unfortunately, I had exchange with a well-known member of the Australian Christian Lobby and it was a frustrating exchange but it is a conversation women have endured for centuries. It went something like this. 'That's a very unfortunate piece of legislation you will be debating today, isn't it, Cassy?' I said, 'It is a notice of motion because the legislation passed in 2013. Access to terminations is legal in Tasmania'. 'That is very sad still, it is not good, all life is sacred.' I said, 'Are you saying that women should be forced to incubate babies in all circumstances?' The answer was, 'Every life is sacred and important.' I said, 'If only the church you purport to represent spoke as strongly for the children after they are born. If only the church advocated for action on climate change, on inequality and all the other challenges children face as they come into this world. If only the churches - and I say that in a broad sense of the word because I have enormous respect for many of the aspects of the church and have numerous friends who are Christians - but if only the churches did not have such a poor record, such an appalling record on the treatment of children, going back centuries.'
I pointed out to this gentleman the church was no position to tell us anything about how to deal with our bodies in the circumstances where we become pregnant, and the church should keep its nose out of women's business.
I thank Ms O'Byrne for bringing on this notice of motion today. As Ms O'Byrne has said, 'Women must be viewed as competent and conscientious decision-makers.' The notion that people who purport to represent the church and the majority of people who were at that prayer meeting today were males. The notion they should be able to dictate to a women what she should do in this situation is offensive to human autonomy and to the right of every woman to choose what happens to her body.
I do not know how many members in this place have watched or read The Handmaid's Tale. It is that dystopian future that we could dismiss out of hand as something that is fiction or happened in times past, but with women and for feminism and our human rights it often feels like one step forward and two steps back. There is a need for constant vigilance. I believe The Handmaid's Tale is particularly relevant to this debate because at the core of this, and at the core of the conversation I had with the gentleman saying the prayers for the fallen women of this parliament and the world today, is a strong desire and practice to control women's bodies. That has been part of the culture of male-dominated religions, whether they be Christian, Muslim, Hindu or otherwise going back centuries and millennia. It is about control over women's bodies. I will read a review of The Handmaid's Tale in the Sydney Morning Herald -
In the world of The Handmaid's Tale, women's lives are only contingent on their ability to produce babies and a group of rich, religious white men decide the fate of female bodies. The Commander has perfunctory sex with Offred, held down by his wife, Serena Joy, who can't get pregnant, and the women are rounded up to watch a handmaid called Ofwarren, who's bullied for having an abortion, give birth.
Sure, it sounds absurd - until you remember that we live in a culture in which a Texas judge recently referred to pregnant women as "hosts", abortion is still a criminal offence in Queensland and New South Wales, and the Australian Christian Lobby is fighting to reinstate the global gag rule which denies women from Pacific Island nations rights to reproductive health services and abortion access.
The Handmaid's Tale takes the culture's motherhood fetish to its chilling endpoint and reminds us that we need to fight for autonomy over our lives and bodies at every turn.
It is evidenced again today by the protest out the front and a very clear belief, of those who would tell women what to do with their body, in enforced incubation. That is the flipside of not respecting the rights of women to make their own difficult choices. The flipside of that is enforcing incubation on women. That is the story of The Handmaid's Tale, the beliefs are hardly that different. I saw on social media there is a revolting reference from a well-known, purportedly Christian leader in the north of the state, at Legana. He makes it clear that even in circumstances of rape, women and girls should not be able to legally access terminations. Again, enforced incubation.
As Ms O'Byrne said, this is not about whether abortion is legal in Tasmania. The services are simply not available to women. The service system has not responded to the fact that women in Tasmania, and young women, have the right to legally access surgical terminations. That is the law out there. It is a law resoundingly passed by this parliament in a very moving and significant debate. I acknowledge the enormous amount of work Ms O'Byrne has put into this issue. I know you put your heart and soul into it and worked with people such as the wonderful recently retired Glynis Flower, and Susan Fey - extraordinary, wonderful, good women who understand that this is an issue of human rights.
We are not here to debate the law.
