Labor’s reproductive health pledge a win for activism

On International Women’s Day, March 8, 57 countries signed on to a United Nations’ statement calling for universal sexual and reproductive healthcare, including access to safe abortions, and comprehensive sexuality education.

Australia was not one of the signatories.

Two days before, federal Labor announced its national reproductive and sexual health strategy. If elected in May, it has committed to improve public hospital access to abortion services; support general practitioners to provide medical abortion; fund an abortion referral line and a public hospital reproductive health hub (including abortion services) in Tasmania; expand availability of contraception; and work with states to decriminalise abortion where it currently remains a crime.

It followed that up on March 8 with a promise to the Catholic sector that it would not withhold funding from hospitals that refuse to perform abortions.

The contrast with Prime Minister Scott Morrison, who condemned Labor for its plan to decriminalise abortion in NSW, could hardly be more stark.

Labor’s shift comes after decades of feminist abortion rights activism and several years of significant abortion law reforms across states and territories, with decriminalisation (depending on gestation) in Victoria (2008), Tasmania (2013), the Northern Territory (2017) and Queensland (2018), and clinic harassment protection zones now in most jurisdictions.

For years, Labor told activists “now isn’t the right time” for abortion law reform. When it was in government, it was never the right time because its MPs had a conscience vote. Now, that seems to be changing. Its commitment to guarantee near universal service provision is a victory for grassroots campaigners in and outside the party.

It is problematic that Labor will allow Catholic-run hospitals to refuse to perform abortions, but its promise to make abortion available in public hospitals is an important reform we must hold it to.

If implemented, it will meet a key outstanding demand of the women’s liberation movement of the 1970s: free, safe, accessible abortion on demand. That Labor feels compelled to promise this now is testament to the power of activism.

The reforms will take planning and training in the procedural and professional skills required to ensure that abortion is provided with compassion and dignity and without judgement and stigma.

There is a cultural change taking place in society, as well as in health care: medical, nursing and midwifery bodies have publicly backed legal reform. But genuine recognition of autonomy when it comes to sex, sexuality, contraception, abortion and birthing is still far from universal.

The plan to use Commonwealth funding agreements with the states to ensure abortion services are rolled out in “all public hospitals” was clarified by shadow health minister Tanya Plibersek. On March 8 she assured Catholic hospitals with public funding that if they refuse to perform abortions they will not have their funding cut.

For decades the outsourcing and privatisation of public services has been accompanied by cuts and a squeeze on jobs. This is bad enough. But it is worse when religious-based organisations receive public funding for women’s health services and then refuse to provide them all.

Other elements of Labor’s plan also fall short and need further scrutiny.

A professional, all-options referral line is an essential service. There are several “pregnancy help lines” that provide false information and try to steer women away from abortion.

A publicly-funded legitimate service could help connect pregnant women to the services they need. It should be run as a public service. If it is outsourced, the selection process must be transparent, and not merely awarded to any service provider with an interest in self-referral.

While federal Labor pledges to work with states where abortion remains a crime (South Australia and NSW) to progress decriminalisation, Labor MPs in those states will still have a conscience vote. In 2017, three NSW Labor MPs joined government MPs to vote down the Greens’ decriminalisation bill. In 2016–17, Queensland Labor, while in government, opposed a bill that would have decriminalised abortion.

In a concession to the stigma still surrounding abortion, NSW Labor has promised to push for the Law Reform Commission to review the law instead of simply saying it has to be removed from the Crimes Act and regulated by the health profession.

While the Law Reform Commission approach did, finally, deliver significant reforms in Victoria, Tasmania and Queensland, the amended laws maintained criminal provisions covering gestational limits and doctors’ oversight, instead of the whole procedure being determined by the pregnant woman.

In some parts of the world, early abortion is safely provided by midwives. A scenario where midwives undergo appropriate training in the safe provision of abortion and expanding the number of practitioners willing to support women undergo the procedure would be precluded by the criminal sanctions that remain in many states.

The inclusion of abortion in criminal law has left a bad legacy as the situation in South Australia today shows. While the 1969 law allowing abortion in certain circumstances paved the way for safe medical procedures in a prescribed hospital means all abortions performed in the state are free, access is still a problem. Unlike the rest of the country, in SA those wanting to have a medical termination (taking abortion pills) at home are banned under law from doing so.

A 2008 survey of women of reproductive age indicated that half had experienced an unintended pregnancy. About half of these continued the pregnancy (a small proportion relinquishing the baby for adoption), a third underwent abortion and a fifth experienced miscarriage.

Like childbirth and miscarriage, abortion and contraception are reproductive health care needs. Cost and location are obstacles to care. We don’t know how many women give birth because they cannot obtain contraception or abortion. But we do know that the lack of public provision of services is unfair.

In this context, federal Labor’s promise is great news. If implemented, it will make a difference to the sexual and reproductive health of millions.

They say if something seems too good to be true, it probably is. If the past is anything to go on, the only way to be sure Labor delivers is to keep the pressure up until these long overdue reforms are delivered.