Women's right to choose under attack
By Tuntuni Bhattacharyya
There is a stealthy war being waged against women in Australia, a war that threatens to erode most of the reproductive rights and choices that women have won in past years.
The first shot fired after the election of the Howard federal government was the amendment in May of the federal Therapeutic Goods Act, initiated by Tasmanian Senator Brian Harradine. This act applies to anti-progestogen drugs such as RU486 and anti-pregnancy vaccines. It ensures that, prior to being released in Australia, all new drugs are screened and approved by an independent panel of scientists.
Harradine's amendment places RU486 and other abortifacients into a class of their own. Now all uses of RU486 require approval from the minister for health and subsequent tabling in parliament. This politicising of RU486 has been condemned by both the Australian Medical Association and the Family Planning Association (FPA).
RU486 blocks the action of progesterone, the hormone that stimulates the lining of the uterus to encourage implantation of the fertilised ovum or, if the ovum is already implanted, it provides continued support of the lining. RU486's blocking action causes the lining to come away as occurs in a period. It can therefore act as either a morning-after pill to prevent pregnancy or as an abortion-inducing drug.
The National Health and Medical Research Council (NHMRC) draft review of pregnancy termination services in Australia states that RU486 plays an important role in completing "a range of options" which "enhances choice in women's control of reproduction". It reports that RU486 appears not only to have fewer side effects, but also to be a more effective form of morning-after pill than the currently available methods. When used in conjunction with a prostaglandin, RU486 is 95% effective as an abortifacient.
Harradine's amendment ensures that RU486 cannot be used as either an abortifacient or a morning-after pill: the current health minister, Dr Michael Wooldridge, who now has the power to authorise RU486's importation, evaluation and registration, was "endorsed" by Right to Life in 1990 and is openly anti-abortion.
Family planning
Another attack under way targets family planning services. On May 23, Senator Jocelyn Newman, the minister assisting the prime minister on the status of women, responded to a question in parliament about future funding for family planning services by saying that, while the government "clearly believes in family planning ... the details of [the future of the services] are not able to be discussed at this stage in fine print because they relate potentially to decisions made in the budget context". A fortnight later, Wooldridge is quoted in the Australian as saying that he has "no plan or desire to shut down family planning clinics although ... you might look and see if the need existed as much as it did two decades ago".
It is ludicrous to think that women do not require the same contraceptive services as they did 20 years ago. The services provided by family planning clinics include reproductive health information, contraception and education for general practitioners about already existing forms of contraception and newer technologies.
The benefits of the FPA's provision of reproductive health care and contraception services are reflected in falling abortion rates over the past 20 years, despite the population increase.
While there has been a reduction in adolescent pregnancies, a 1994 NSW study found that, amongst women having second trimester or late abortions, there was still a disproportionately high number of adolescents. This may reflect a tendency among young women to delay seeking help due to fear of parents' and doctors' reactions to their pregnancy. Second trimester abortions are more difficult to perform and have a higher rate of complications. Reduced family planning services would particularly affect women who may already be disinclined to seek out relevant information.
The importance of easily accessible reproductive health care is illustrated by a study reported in the June 15, 1996, issue of the medical journal Lancet, which found that the Netherlands, which has one of the worlds most liberal abortion laws and freely available family planning services, has one-fifth the rate of unintended pregnancy and abortion of the USA.
The advances in family planning service provision in Australia over the last two decades would also be set back by Wooldridge's plan to devolve health service delivery to the states. Such a system exposes women's health services to ad hoc funding; the Victorian Kennett government abolished funding to family planning services in 1993, only reinstating it after public outcry.
Medicare rebate
Also under attack is the Medicare rebate for abortion. The government currently provides a rebate of $136. By comparison, the NHMRC review cites the example of a "diagnostic arthroscopy [a knee operation] ... a surgical procedure comparable to abortion in terms of complexity and duration", which gets a rebate of $326 (1994 figure).
While Wooldridge has said that the government will not cut the rebate, he told the Australian in early June that if a private member's bill to change the rebate was moved, he would probably support it.
At present, in NSW public hospitals, if the obstetric staff are not prepared to do abortions (for whatever reason), the service is not provided. This erratic provision, combined with long waiting lists, means that getting an abortion in a public hospital is not an option for most women. Seventy-five per cent of abortions in NSW are therefore carried out in private clinics.
However, the NHMRC review found that the out-of-pocket cost of an abortion in a private hospital is up to $600. It concluded that this was unacceptably high and recommended that "the level of remuneration for termination of pregnancy services be reviewed to ensure parity with equivalent surgical procedures".
If the rebate was abolished, women's access to safe abortion services would be set back 20 years. The demand for abortion would not lessen, but women would be driven back to the cheaper option of backyard clinics where the risks of haemorrhages and infection are very real. Yet, as the Lancet review of abortion states: "the empirical record is clear — the combination of good quality family planning and safe abortion will result in far fewer embryos being destroyed and far fewer women will experience ill-health or death".
Already, on a global scale, the number of deaths every year as a result of unsafe abortions is greater than the total number of people killed in the bombing of Hiroshima. While there is more access to safe abortion services in Australia than in many countries, the situation is still far from ideal.
Because of the persistent stigma attached to abortion, even within the medical establishment, abortion clinics often find it difficult to attract suitably skilled personnel. As a result of staffing and financial difficulties, there is now only one non-profit, feminist abortion clinic left in Australia.
Church control
The attack on women's reproductive rights is also occurring at the state level. The Labor state government in NSW recently announced plans for the inner-city St Vincent's Hospital, run by an order of Catholic of nuns, to take over control of St George public hospital in Sydney's south. The merger was part of the government's plans to "rationalise" health service delivery.
St Vincent's Sisters of Charity are opposed to all forms of contraception, in-vitro fertilisation and abortion, all of which are available at St George. The public outcry by St George staff and the local community forced the government to shelve the proposal, for the moment at least.
Women in the Hawkesbury district, north-west of Sydney, were not so fortunate. Under the previous Liberal state government, the provision of publicly funded health care in that district was contracted out to a subsidiary of the Australian Catholic Health Care group. As a result, services such as abortion, tubal ligation and contraception, which were previously provided by the Hawkesbury hospital, were no longer available.
To assuage outraged residents, the NSW Department of Health guaranteed that a reproductive health service would be provided by the area health authority. As noted in the July issue of the Women Lawyers Association newsletter, however, the current state health minister, Andrew Refshauge, supported the health authority in reneging on this promise. Women in the Hawkesbury region must now travel to hospitals outside the area to access reproductive services.
Backlash
All of these attacks on reproductive services are part and parcel of governments' general austerity drive. Many of the hard-won gains in living standards of all working people — employees and the unemployed, migrants, Aborigines, young people and women — are under attack as governments drive to cut public spending, and reduce wages and working conditions, so as to shore up the profit levels of the private sector.
The war against women's rights has been multi-pronged — wages and conditions, reproductive health and child-care facilities have all been targeted. All of these attacks, if successful, will result in some budget savings for the government. They also serve another, equally essential purpose, however.
In order to roll back the gains made by the women's movement over the last few decades — gains which forced governments and business to bear some of the costs of maternity leave, child-care, health, education and welfare services — the powers that be must push forward with their drive to strengthen the ideology of the family and women's "proper" role as mothers and wives, individually responsible for the unpaid domestic labour and super-exploitable in the paid work force as a result.
By moving to restrict women's access to information and services which will assist them to make life choices other than perpetual pregnancy, motherhood and poverty, the government is moving to entrench women's exploitability as both unpaid and waged labourers.
Only a revitalised women's movement which wins the active support of other progressive movements and broad sections of the community for women's inalienable right to control their own bodies can stop these attacks.
[Dr Tuntuni Bhattacharyya is a women's liberation activist and works in health services.]