Decriminalisation in the NT signals abortion is part of normal health care

The Northern Territory parliament this week passed a bill decriminalising abortion up to 24 weeks’ gestation, removing the requirement of parental approval for abortions in teenagers and providing early medical abortions with tablets.

Decriminalisation is important as it signals to the community that abortion is part of gynaecological care and should not be treated differently to any other form of health care. Abortion remains in the criminal codes of Queensland and New South Wales despite recent reform attempts.

A majority of countries have liberalised access to safe abortion as opposed to risky illegal abortion. The Centre for Reproductive Rights has a useful comparative map of abortion laws although it is not nuanced for Australia.

Data on abortion is poorly collected and analysed in the Northern Territory, but the new bill will ensure data will be collected for public health policy purposes.

Choices in women’s health

Previously NT women had no legal access to early medical abortion using the abortion medications mifepristone and misoprostol up to nine weeks and were only offered surgical abortions in three hospitals.

Early medical abortion has been legal in all other states and territories. The old Medical Services Act from 1974 that regulated abortion, stipulated that two doctors needed to be involved in the management, one of them being a specialist. This limited service was inadequate and out of step with modern gynaecology.

NT women and doctors will be able to use early medical abortion in general medical practices, health clinics and home settings. Women seeking termination services in regional, rural and remote areas face barriers to health care including finding a doctor, stigma, financial costs, and lack of privacy.

The bill enables significant improvements to women’s reproductive health, especially in a jurisdiction that struggles with health service provision and a challenging geography.

The bill also places safe access zones around clinics for health staff and women in a similar way to Victorian and Tasmanian legislation. The safe access zone will protect women and staff from intentional harassment, intimidation, obstruction or invasion of privacy. This also includes the recording of people leaving or entering health clinics and has penalties attached to this type of behaviour.

The bill also specifically references conscientious objection and the need for a health practitioner who holds anti-abortion beliefs to refer the woman to another health practitioner who does not. This is similar to Victorian and Tasmanian legislation and the national Australian Medical Association position statement.

Indigenous women’s health needs

The NT has a large minority (30%) of Aboriginal women who have higher maternal rates of death and illness than other women. During debate in parliament some members suggested that providing access to termination choices would be unsafe for Indigenous women in remote communities and that Indigenous women would not be able to understand aspects of their reproductive health.

The paternalistic and racist attitudes were called out by Mr Chansey Paech, Ms Selena Uibo and Ms Ngaree Ah Kit, Indigenous members of the legislative assembly who argued for legal equity.

This bill took four and a half years of public advocacy to be passed and there were several reasons for its success in 2017. The first is overwhelming public support for equity in health care and a strong community campaign.

The second reason is 50% of the members of the 13th Legislative Assembly are women. No state or federal parliament in Australia has this level of female representation. Women are better placed to understand women’s health needs and women in the NT were lacking this representation until gender parity in the lower house of parliament in 2016.

Addressing discrimination in health care

This legislation will reduce discrimination against women and go some way to meeting Australia’s obligations under the United Nations Convention of Elimination of all forms of Discrimination Against Women.

Termination of pregnancy enables women to manage their health and fertility, decreases maternal disability and death, and reduces unwanted motherhood. All of which are positive outcomes.

However, unwanted, mistimed and unviable pregnancies are not welcome events in women’s lives and may be indicators of poor health, genetic or contraceptive chance, social disadvantage, poor sexual and reproductive literacy, low reproductive autonomy, or lack of access to quality sexual and reproductive health staff and services. Some of these precursors to unwanted pregnancy need attention if abortion rates are to be reduced in Australia.