By Lynette J. Dumble
The Therapeutic Goods Amendment Bill of 1996 claims to be about protecting women from harmful drugs, but the rhetoric that ushered the bill through both houses demonstrates that this legislation was more specifically about restricting women's access to abortion.
Unlike antibiotics, antidepressants, anti-cancer drugs and so forth, medications that induce abortion are already classed as restricted goods. However, as pointed out by Senator Dee Margetts for the Greens, this bill intensifies the discrimination against abortion drugs. Henceforth, the importation, testing, registration and listing of an abortifacient are controlled by the health minister. A safety clearance from the Therapeutic Goods Administration's panel of drug experts is sufficient to legitimise the prescription of non-abortion drugs, but similarly cleared abortion drugs remain prohibited until a written authorisation by the minister is tabled in the parliament.
A series of inaccurate and exaggerated claims about RU 486, the French abortion pill, misled the House of Representatives, but proved the point made by Democrat Meg Lees in the Senate, that parliamentarians are not "the best people to determine what the risk [of a drug] really is".
RU 486 can be seen as inferior to conventional suction curettage and vacuum aspiration without overstating the case: RU 486 drags an abortion out for, on average, a week; it involves three to five medical consultations which turn a private event in a woman's life into one that is instead very public; it has a higher failure rate (5%) than conventional methods (1%) even when a second medication, known as prostaglandin, is co-administered; and it imposes more pain, nausea and bleeding than conventional methods.
Instead, parliament was told that: RU 486 protocols include two courses of the prostaglandin, when only one is administered to achieve a 95% complete abortion rate; injectable prostaglandin medications are involved, when tablet forms have superseded the injectables for the past six years; women are hospitalised for 12 hours in case of any prostaglandin side effects, when medical monitoring amounts instead to four hours; and one woman has died following an RU 486 abortion, when the solitary death from 500,000 RU 486 abortions pales in terms of the two to three estimated fatalities each year amongst Australia's annual 70,000 abortions by conventional methods.
The rhetoric continued as the Creutzfeldt-Jakob disease legacy of the 1967-1985 human pituitary hormone program was cited as an example of the drug risks imposed on women when government authorities stand back. How short some memories, or perhaps how shallow the understanding! The human pituitary hormone program had full government sponsorship, and enjoyed government resources, first at CSIRO, and later at CSL, throughout its entire 18-year history. It was a perfect illustration that parliamentarians are less than expert to recognise drug risks, even when manufactured under their very noses.
The legislation's agenda becomes more transparent in the context of the federal government's plan to hand the funding of family planning services to the states. In defence, Dr Michael Wooldridge protested that he is the minister for health, not the minister for family planning, reflecting either a glaring ignorance of the wide range of women's health issues addressed by family planning clinics, or a willingness to further shrink abortion access by dismantling family planning operations.
On this background, the enactment of the unsuccessful 1989-90 Abortion Funding Abolition Bill is practically all that is required to extinguish altogether Australian women's abortion rights.
In addition to singling out abortion drugs, the new bill places similar restrictions on anti-fertility vaccines, even though such vaccines are clearly contraceptive rather than abortifacient. Does this mean that other, or indeed all, contraceptives are to be classified as abortion drugs?
If so, perhaps the minister and his "pro-life" allies might take action on the long-acting contraceptive Depo Provera, which is being over-prescribed to marginalised women — the indigenous, women from non-English speaking backgrounds, blue-collar workers, and the intellectually and physically disabled — around the country. Perhaps the minister might come up with a response to the national campaign against Depo Provera launched by Women in Community Health and Industry (WICH) and myself on International Women's Day 1996 and its hitherto unanswered demand for a parliamentary inquiry into Depo Provera's contraceptive approval by the TGA in 1994.
The risk to women during the brief abortion exposure to RU 486 pales when compared with their risk from a single injection of Depo Provera, which is guaranteed to last for at least 12 weeks and has 80-odd inherent acute and chronic ill effects.
Repressive legislation and rising fundamentalisms incrementally diminished abortion rights in the 1980s and were blamed for the uncritical welcoming of RU 486 by pro-choice groups. An anti-RU 486 critique which I co-authored with Janice Raymond (University of Massachusetts) and Renate Klein (Spinifex Press) caused a split between pro-choice allies back in 1991.
My position remains unaltered, but the RU 486 ban I seek must come from women speaking for themselves after they have been informed of the pros and cons of methods on offer. The Canberra alternative amounts to patronising prohibition, and it contravenes the 1996 Amsterdam Declaration on Abortion which calls on all governments "to advocate and defend legal, voluntary, safe and humane abortion provision to all women in need of it, as an integral part of reproductive health care".
[Dr Lynette J. Dumble is senior research fellow in the University of Melbourne's Department of Surgery, at the Royal Melbourne Hospital.]