[The following letter was sent by Dr Kamala Emanuel to the Tasmanian Premier Will Hodgman on August 8 in response to his government's decision not to allow public hospitals to provide abortion access from July 1. Emanuel sent it to Green Left Weekly in the wake of the public furore over Cricket Australia's decision to sack Angela Williamson because of her tweets campaigning for abortion access in the state.]
Dear Premier,
I lived for 9 years in Tasmania. My daughter was born at home in Glenorchy.
I'm a doctor and an abortion provider.
I was living in Tasmania when abortion services in the state ground to a halt in 2001. Some doctors had begun to provide medical abortion, and the Women's Health Foundation Abortion Clinic where I worked closed suddenly.
As women needing surgical abortion were referred to the public hospitals instead, the wait times started to blow out. Women started having to travel interstate to avoid the delays.
It all got worse when a medical student complained to the police about abortions being provided at RHH [Royal Hobart Hospital]. Although doctors had previously been given advice from the Attorney-General that procedures would be legal, new advice made the situation less clear, and pretty much all non-emergency terminations stopped.
The then Premier Jim Bacon recalled parliament and women in all parties led the push for legislative change that would provide legal certainty, something that would work to get abortion provision underway again.
I was critical of the shortcomings of that legislation, but welcomed the room it provided for women to be able to access safe legal abortion in Tasmania.
Fast-forward to 2018 and, all over again, there is service crisis and women and pregnant people are forced to travel interstate for essential healthcare.
The situation is a disgrace.
Breast cancer affects 1 in 8 women. We wouldn't accept a situation in which an oncology unit refused to treat breast cancer because it is a predominantly female disease.
Up to 1 in 3 or 1 in 4 women may undergo abortion. It is a common (if, for many, very unwelcome) part of our reproductive lives.
Why would you accept the notion that our public hospitals shouldn't provide care for women facing crisis pregnancy? We accept that care of women in labour, antenatal care and care of women experiencing miscarriage should be accessible in our public hospitals.
What — other than flagrant discrimination and lack of respect for women's agency and capacity in determining whether or when to continue a pregnancy — can justify the failure of public policy to ensure our public hospitals deliver safe care with dignity for women requiring abortion?
For several years I worked in the Sexual Health Clinic in Hobart. Like abortion services in South Australia, it offers the kind of model of care that would be suited to the care for women needing abortions. It was attached to the RHH (though not co-located with it), provided confidential care, and had dedicated staff recruited specifically for the sensitive nature of the work and the skills required to provide healthcare with discretion and dignity.
The notion that the law provides healthcare professionals with the option of refusing to participate in abortion care is a furphy when it comes to the establishment of public abortion services.
It doesn't absolve institutions of the need to provide services that are the public's right. It does mean they need to recruit and train staff who can conscientiously and safely provide appropriate care. All that takes is the will, a plan and a budget and, above all, the recognition that safe abortion is an essential component of reproductive healthcare, which is a basic right.
When I moved to Tasmania in the late '90s, a colleague told me of her university days in the '70s or '80s when students shared their Medicare and concession cards, forming a network to help pregnant women get to Melbourne for abortions they needed.
The interruptions to service provision over the decades show that there must be a commitment to service provision integrated into our public hospital system to guarantee continuity of services in the state.
Surely now is the time to establish safe, respectful, confidential, public services so that women can get the treatment that they need in Tasmania — close to their support networks and without the stress, delays and waste of resources involved in all that travel.
Ireland made it into the 21st century this year. What if you were to lead Tasmania in to the 21st century in this respect too?
Yours sincerely,
Dr Kamala Emanuel
Lutwyche, Queensland