Bills

Statutes Amendment (Abortion Law Reform) Bill

Second Reading

Adjourned debate on second reading.

(Continued from 5 December 2018.)

The Hon. T.A. FRANKS (16:48): I rise to conclude my comments on the second reading of this most important bill. I do so because best quality abortion care is enabled when abortion is a woman's decision, affordable to all and accessible regardless of a woman's location. In South Australia abortion remains a crime punishable by up to life imprisonment. Where we once led, we now lag. It is time to again move forward.

While each woman's experience of abortion is unique, all women seeking an abortion in South Australia will encounter the laws that now constrain the possibilities for medical practitioners and health services to provide them with that best care. These barriers do not necessarily prevent women in our state from seeking abortions. They do, however, place unnecessary limits on the capacity of the doctors and the health professionals who seek to provide them with that abortion care. That is why the South Australian Abortion Action Coalition formed three years ago and mounted the case for law reform. They were formed from a basis of medical and legal professionals concerned with these barriers to care that they observed day to day and documented through academic analysis.

At this point, I seek leave to table the document Abortion in the Shadow of the Criminal Law? The Case of South Australia, authored by Mary Heath and Ea Mulligan.

Leave granted.

The Hon. T.A. FRANKS: I continue. From those beginnings, the South Australian Abortion Action Coalition has grown in number and in breadth, and the growing list of supporters now includes (I note this because the list has grown since I last spoke to this bill, so I update the council now for the public record): the Aboriginal Health Council of South Australia, the ALP Women's Network, the Australian Clinical Psychology Association, the Australian Greens South Australia, the Australian Medical Students' Association, the Australian Nursing and Midwifery Federation (SA Branch), the Australian Psychological Society (SA Branch), the Australian Society for Psychosocial Obstetrics and Gynaecology, the Australian Women's Health Network and Business and Professional Women Adelaide.

It also includes: Children by Choice, the Coalition of Women's Domestic Violence Services, EMILY's List Australia, Family Planning Alliance Australia, Flinders University Student Association, the Human Rights Law Centre, Marie Stopes Australia, the National Alliance of Abortion and Pregnancy Options Counsellors, the National Council for Single Mothers and their Children, the Public Health Association of Australia (SA Branch), Reproductive Choice Australia, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the South Australian Council of Social Service, the South Australian Council for Civil Liberties, the South Australian Rainbow Advocacy Alliance, SA Unions, the SA Unions' women's standing committee and SHINE SA.

Finally: Support After Fetal Diagnosis of Abnormalities SA, The Tabbot Foundation, the Union of Australian Women, the Women's Electoral Lobby, the Women's International League for Peace and Freedom (SA Branch), the Women Lawyers Association of South Australia Incorporated, the Working Women's Centre South Australia and the YWCA Australia (formerly the YWCA Adelaide, that organisation now having amalgamated).

These many organisations backed this law reform because the 1969 statutory amendment to the 1935 act allowed abortion only when the woman had resided in South Australia for some two months, two doctors determine the abortion necessary on either mental or physical health grounds or for foetal abnormalities and before the woman is 28 weeks pregnant; thereafter, only to preserve the woman's health and to be performed in a prescribed hospital.

Our current law is from another time when abortion was banned. Much as elsewhere in the world, times gone by are no longer the framework for this particular law. Back then, when abortion was banned, sometimes it was safe and a lot of the time it was not. Those unable to find a doctor or midwife would have to go secretly to gain an abortion. It was not always a safe option. They often relied on self-inducing with dangerous and unreliable methods, or with patent medicines featuring not so subtle 'will cause miscarriage in pregnant women' warnings or by using knitting needles, coathangers or falls downstairs.

In fact, in 1930, illegal abortion was listed as a cause of death for some 2,700 women in that year alone in the United States. The risk of an unsafe abortion continues to stalk women globally. Even now, recent figures from the World Health Organization estimate that nearly half of the 56 million abortions given worldwide every year are unsafe. However, banning abortion does not make abortions go away. Women who have the means to travel or the desperation to go underground have always found a way. As was said at last year's Youth Parliament in their debate on a similar bill: you cannot ban abortions, you can only ban safe abortions.

That is why we reformed this law 50 years ago and that is why we should now further reform our laws so that our abortions in this state are safe. Safe abortion means that abortion is treated as health care, publicly provided wherever possible and accessible. Yet we know already that there are delays due to our current laws pushing women further back in their pregnancy. Safe also means protecting—protecting women seeking that health care as well as protecting those who provide that health care.

That is why this bill contains a 150-metre safe access zone, as almost all other states and territories have now included in their laws. I note the recent, very welcome announcement made by Bill Shorten at the ALP National Conference to support such safe access zones and indeed to support publicly provided accessible abortions across our nation.

Unfortunately, however, we do not provide that safe workplace to those who work in South Australia. Indeed, as a Pregnancy Advisory Centre staff member commented to me last year when we first introduced the bill, in that instalment of my second reading explanation, she noted afterwards that she was grateful because she had had a quiet day down at the clinic in Woodville as the protestors had been here in parliament for a change and not outside the Pregnancy Advisory Centre.

For that reason, I am glad protestors are on the steps weekly and are here today. It means that they are not outside the clinic at Woodville and are safely far away from the women who today seek the health care they deserve and need, again giving those hardworking, compassionate and professional staff the break I imagine they gratefully appreciate.

We have come a long way since a time when only women of means were able to access abortion, where backyard butchers preyed upon the vulnerable, and quite rightly that activity needed to be stamped out. But given that our once progressive law that was designed to protect women now harms them, and that those who work in providing abortion care suffer the harassment of regular protests and threats, we must now move so that abortion is not treated as a crime. In fact, it should be regulated as any other health service, and for this to happen we need informed debates.

However, the public debate so far has not necessarily been informed. I, like many others in this place, and no doubt in the other place, have received an avalanche of missives and misinformation. There has been murder rhetoric, noting that:

The Tammy Franks abortion bill is the worst in the western world, allowing babies to be killed right up until birth, for no medical reason.

We have 'open-house slaughter of the innocents', noting that this must not be allowed to happen or it would be 'mass murder', stating that abortion is the 'hands that shed innocent blood', blatant misinformation such as saying that the bill would allow sex selection abortions to be carried out and would allow paedophiles and sex traffickers to do away with the evidence of the child they fathered and not be convicted of any offence.

Other emails and letters state that this bill would approve a 'children's Holocaust' and that it would also 'betray the values for which every martyr in history fell and, more importantly, the values for which our own Anzac soldiers died defending, that is, the freedom to live', and quoting the J.R.R. Tolkien character, Gandalf, when he said:

Do not be too eager to sort out matters of life and death for even the wisest cannot see all ends.

This, no doubt, was prompted by some of the misinformation that has gone out from more formal sources, which I will get to soon. Some of the missives have just been odd, noting:

Please reconsider the Bill. I believe some of the proposed provisions are as extreme as the Nazi bombing in Sheffield.

Another stated:

We should not have a task force to hunt terrorists if we are allowed to do this to our own.

There has been a lot of mother blame, pleading to not support this bill with accusations such as:

Hard questions need to be asked, and society needs to support these women more so that the life in their womb is not sacrificed to avoid discomfort for them or those around them.

Also stating:

Has life become so cheap that we are to set a precedent that an innocent baby nearly at full term can be exterminated practically at the whim, of its mother?

Another states:

I can only imagine the heartache and trauma of women who deliberately choose to end the life of their own flesh and blood, especially through this barbaric act of mutilation and callousness.

Hell, Satan and Isis have all been mentioned, with one missive noting:

Ms Franks is in the pagan ancient world, there was always human sacrifice to the false God's Baal, Ishtar, Isis, ('$atan'.)

I note Satan is spelled with a dollar symbol instead of an 's'. It continues:

Involving children also, the Babylonians, Incas, Mayas.. Ms Frank, abortion is just a 'human sacrifice' to Satan, as was done in the ancient pagan world, all who are against God's Commandments, the teachings of Jesus Christ your Lord 'God' and Saviour. Hell is real and many unsuspecting souls go there….don't be one of them…For those who end up in the eternal lake of fire 'there is no return..' Ms Franks Many will not inherent the kingdom of God, please consider this 'satanic late abortion' bill.

Further calls that this would lead to ritual sacrifice, and stating that abortion is just another name for child sacrifice:

…tragic to see you pushing for child sacrifice, as with the pagans 3,500 years ago, & pretending your [incorrectly spelt] 'liberating' women from their 'burden' with some 'modern philosophy'!?

Another goes on to say:

I have heard my teachers tell me of Aztec's and Inca's who sacrificed newborn babies and children to 'Sungods'. And yet that is exactly what would be happening if we were to pass this law; we would be sacrificing the babies to the god of 'Self'.

Then some personal attacks: 'Is this woman (Tammy) a mother or an auntie?' The answer is yes to that person, but I will not be writing back to them. 'Is she despairing that her own mother never aborted her?' I must say that my mother is a strong supporter of choice, and indeed worked at Family Planning Queensland. Back when she had me, of course there was no choice of a legal abortion, and certainly she and I have had many discussions about how that failed so many women of the time, particularly with the forced adoptions that resulted from them.

Some more personal attacks, which I will not go into, but being called a murderer on a regular basis I have to say will not deter me, because it is not true. The misinformation and fear campaign simply fuels my desire to have this debate in an informed way. Those organisations that have put their name to some of this claptrap should be ashamed of the lies and misinformation that they have spread about, often willingly, certainly recklessly. With that, I seek leave to table the three letters initiated on 14 February this year from the Catholic Archdiocese of Adelaide.

Leave granted.

The Hon. T.A. FRANKS: In that letter of 14 February from the Catholic Archdiocese of Adelaide, signed off by the apostolic administrator, Gregory O'Kelly, is an attachment from Dr Elvis Seman, and a form letter for people to send off to their local MP, but I note that the letter states:

This bill treats abortion simply as a medical procedure without moral significance.

I would agree if they had said that this bill simply treats abortion as a medical procedure. I disagree that any woman contemplating an abortion does not place some moral significance upon it. However, it then goes on to completely lie and say:

There is no need for a medical opinion or a doctor's involvement, and no reason need be given for an abortion. It will be the most radical abortion law in the country.

Totally false to say that, by taking abortion out of the criminal code and treating it as a health procedure, there will be no medical opinion or doctors' involvement. That is the point of this bill: that there will be medical opinion and doctors' involvement.

The letter goes on to advise people to send missives that no doubt everyone in this place has now received, stating such things as, 'The Franks bill', according to Dr Elvis Seman, 'when carefully analysed', as he claims, 'aims to radically deregulate abortion and outlaw two important things: conscientious objection to abortion and the freedom to pray and offer pregnancy support near abortion clinics.' The bill, of course, does not allow babies born alive to be left to die.

In my second reading explanation I have also already noted that I would actually continue the public reporting of abortion statistics in this state. My bill does not preclude that. The claim that it will radically deregulate abortion and allow conscientious objection and the freedom to pray are simply wrong.

I will not be lectured to by the Catholic Church on issues of abortion or, indeed, child abuse—certainly, and in particular, not this week. I draw members' attention to the recent revelations that nuns who were raped had the Catholic Church oversee abortions because that rape was conducted by priests and sanctioned by the church. It seems that sometimes abortion is appropriate, but not all times. This bill would ensure it is the woman's choice, and would certainly not sanction rape.

I also go on to note a very common misunderstanding, that decriminalisation somehow means deregulation. I fear this is something I may have to say a thousand times over the next six months: decriminalisation does not mean deregulation. The Marshall government's announcement this week that the debate will now be assisted by reference to the South Australian Law Reform Institute (SALRI) is most welcome, not least because I would back Professor John Williams and his team's understanding of the law any day over many of those making these extraordinary claims about my bill.

I am pleased to see the Marshall government allow for some informed insight and reflection to counter the shrill voices that are currently claiming all of the space. I believe the SALRI will report back to the parliament on this area and ensure, as MPs with a conscience vote and as we debate a woman's choice, that our own choices on how we exercise that vote will be better informed as we progress to a vote.

Before we get to the SALRI report, which is some months away, I think now is as good a time as any for a little truth telling. Contrary to the fear campaign that has been launched in our streets, on our airways, across many churches and even on the back of a truck, as I said, decriminalisation does not mean deregulation. They are five simple words and an even simpler concept, but I feel we will have to repeat this ad nauseam, as it is being so wilfully misunderstood.

Health care is highly regulated in our nation, and will remain so with the Health Practitioner Regulation National Law (South Australia) Act 2010, the Consent to Medical Treatment and Palliative Care Act 1995, and the Therapeutic Goods Act 1989 being just three of the most obvious of the many relevant statutes that will continue to regulate abortion care. Currently, in the case of abortion care, women and their healthcare teams are constrained in their healthcare decisions by the Criminal Law Consolidation Act 1935.

Repeal of the criminal law in relation to abortion will remove the stigma and the chilling effect of criminality on clinicians and healthcare organisations, and it will require only minor amendments to existing standards and guidelines for the overwhelming majority of abortions—some 98 per cent of them. Once abortion is removed from the criminal law it will be regulated according to the normal standards and practices that govern all other health services. These include specific clinical guidelines for each area of care.

All health procedures, practices and services are closely controlled and regulated by government, industry and professional bodies, and breaches are dealt with very seriously. In this way existing health law regulations, codes of practice, clinical protocols and institutional policies and procedures provide a comprehensive regulatory framework that protects patients, promotes good quality and safety in health care and ensures accountability.

Under these arrangements women who need abortion care will be afforded the same safe, good quality care as all patients should be able to expect, and healthcare professionals will be able to deliver that care within a framework of health laws, standards and regulations, not with the criminal law looming over their practice. I remind members that there are some 20 South Australian and about 70 commonwealth health statutes.

Law and professional practitioner regulatory boards already ensure that only qualified professionals provide health care and that they are held accountable for compliance with standards. Health care is provided in accordance with those specific clinical standards and in appropriate facilities, with hospitals and day surgery centres regulated primarily by SA Health. Early medication abortion in the primary care setting is closely regulated under commonwealth laws and regulations. Patients must, of course, give informed consent for all healthcare services, and healthcare providers who fail to secure that informed consent are subject to heavy penalties.

Standards and guidelines for the very small number of abortions that would be needed later in pregnancy—less than 2 per cent of all abortions—will likely be revised once the criminal laws are repealed. Revisions will ensure that appropriate clinical decisions are made for these patients, who are typically faced with a decision of whether to keep or terminate their pregnancy in distressing and complex situations, such as the diagnosis of foetal abnormality, serious maternal illness or in the context of family violence.

Regulation under health law will help to ensure that patients can be treated promptly and that care is affordable. Importantly, health professionals are already not required to provide abortion care if they have a conscientious objection. They are always required to refer patients to others who can provide care. This will not change. Indeed, assaults on a woman that also harm her foetus would still be punishable under the criminal law of assault. Where coercion is used, that would certainly not have ever been a matter related to sections 81, 82 and 82A of our current criminal code. Indeed, these provision would be far more likely to punish the victim of that coercion and domestic violence rather than the perpetrator of that violence. I remind members that there is a life imprisonment penalty associated with some of these clauses.

The Health Practitioner Regulation National Law applies in South Australia to all health professionals. The national law provides for the protection of the public by ensuring that only health practitioners who are suitably trained and qualified to practice in a competent and ethical manner are registered. The national law also establishes the Australian Health Practitioner Regulation Agency and national health practitioner boards, including the Medical Board of Australia, the Nursing and Midwifery Board of Australia, the Pharmacy Board of Australia and the Psychology Board of Australia, among others.

These national boards set registration and accreditation requirements, including standards and programs of study, to ensure practitioners are suitably qualified and competent. They also establish mandatory performance and professional standards, as well as policies and guidelines. Each board has extensive investigatory and disciplinary powers, including suspension or withdrawal of registration and maintenance of national registers. The national law also allows for the minister to make further regulations and define offences for unqualified persons practising inappropriately. Health practitioners can be disciplined for misconduct and unsatisfactory professional performance. The national law is administered in South Australia by the South Australian Health Practitioners Tribunal.

With regard specifically to conscientious objection, health professionals are already not forced to provide care they are not willing to provide, and nothing in this bill will obligate them to defer from that. However, under the current system they are obligated to assist patients to gain access to care. Doctors, nurses and others are specifically protected from being required to provide care for which they are not skilled or have a conscientious objection. Protection for conscientious objection is specified in mandatory national codes of conduct for doctors, nurses and midwives and others, as well as in the AMA code of ethics.

The provision of abortion in appropriate facilities will, of course, continue to be in accordance with the relevant clinical guidelines and standards. Surgical abortions are provided in hospitals and day surgery centres. The Health Care Act 2008 of South Australia governs the incorporation of public hospitals and the licensing of private hospitals and private day procedure centres. SA Health specifies mandatory standards and procedures for these facilities.

With regard to early medication abortion care, it is used extensively throughout our country and internationally, and its safety is proven. Following decriminalisation, early medication abortion care would be provided in primary care, including by telemedicine, as well as in outpatient services. Medications for early abortion are regulated under the Therapeutic Goods Act 1989, and this controls the quality, safety, efficacy and timely availability of therapeutic goods. It covers the regulation of manufacture and standards for those therapeutic goods, establishes the Australian Register of Therapeutic Goods and creates a criminal offence for importing, supplying or exporting goods that do not comply with these standards.

The TGA approval of early medication abortion medicines was issued in 2012 and it specifies the conditions under which they can be prescribed, including gestational length, dosage, training requirements, follow-up and access to emergency care and support. Pharmaceutical benefits schedule regulations require that authority is requested from the commonwealth Department of Human Services for each prescription for early medication abortion. Two large studies of the Australian experience have found that early medication abortion (EMA) is safe and effective, with the most common complication being incomplete abortion in about 5 per cent of cases. For that, surgical abortion is the backup procedure.

Patients, of course, must give informed consent, and currently all patients must give that informed consent for medical treatment, including for abortion care. This bill does not change that. The potential problem of coercion of a woman to terminate a pregnancy is addressed by the informed consent requirement as legislated in the Consent to Medical Treatment and Palliative Care Act 1995 of South Australia. It aims to ensure that patients decide freely for themselves on an informed basis whether or not to undergo medical treatment of any kind.

Medical practitioners are required to explain the nature, consequences and risks of treatment and alternatives. These provisions act to protect patients from coercion by parents, partners and others, because treating health professionals must rule out coercion in order to reach and meet their obligations. The Health and Community Services Complaints Act 2004 enables patients who are not satisfied with any aspect of their care to complain to the Health and Community Services Complaints Commissioner.

Grounds may include that the health practitioner acted unreasonably, inappropriately, without due skill, contrary to applicable standards or in an unprofessional manner. In particular, patients may complain that a health practitioner failed to provide sufficient information to enable them to make an informed decision, or failed to provide the patient with a reasonable opportunity to make an informed choice concerning treatment and services provided. The commissioner does have extensive investigative and disciplinary powers.

Ensuring proper consent on behalf of minors and other people unable to give their own consent is also regulated under both the Consent to Medical Treatment and Palliative Care Act 1995 and the Guardianship and Administration Act 1993. Informed consent must be sought from the parent or guardian. There are some exceptions, but the medical practitioner must satisfy a number of conditions, with serious penalties for failure to do so.

Institutional requirements ensure that abortions later in pregnancy are provided in accordance with those clinical and professional standards, as I have mentioned, and professional ethics and the health professional regulation national law require that all health professionals act in the best interests of their patients and that all health care is provided on the basis of need, in the interests of the patient's health, wellbeing and quality of life, and within clinical standards and guidelines. That need is determined by patients and their healthcare teams.

Women facing the question of an abortion above 20 weeks are always in distressing and complex situations. About half are confronting a diagnosis of foetal abnormality. A small number face serious maternal illness or injury, and others are in a range of complex social personal circumstances. These include reproductive coercion and other forms of family violence. They include rape, facing pregnancy as children or when very young, or experiencing an undiagnosed pregnancy, mental illness or substance abuse.

Patients with these complex needs are currently treated in specialised centres by multidisciplinary teams, in compliance with institutional protocols and professional standards. This bill would not change that. The current criminal law, however, does cause several problems for patients and their care providers in these situations, most commonly the pressure to make a decision quickly because of a looming cut-off time, which varies across services.

One story that I would like to share today is of a friend of mine. Her oldest daughter is of a similar age to mine and I remember talking to her in the playground when both of our daughters had just started junior primary school. Prior to that day, she had been incredibly happy: she was pregnant and expecting their second child. Seeing my friend Sandy in the playground that day in tears, stressed, was not what I had expected. That day, she had found out that at her 21-week scan her now daughter Tess had a severe heart condition.

The initial prognosis was that the condition was so severe that it was incompatible with life. The doctor's advice was that a late abortion would be the best emotional and health outcome for Sandy and her baby, but as an urgent priority they needed to get more tests and more scans and gather more information. They then had a terrible realisation that they only had 10 days before the medical professionals would be unable to perform abortion surgery due to the legal uncertainty around abortion care in this state. This position was concerning.

All of the doctors were apologetic, but there was this unhelpful and arbitrary deadline to a very traumatic decision. All were clear that the best medical advice would be not to rush a decision and to give Rob and Sandy the time to grieve the situation. They were also clear that the health outcomes for Sandy and her baby would not change between 20 and 23 weeks. The heart diagnosis was essentially fatal and time would not change that.

But a week later new scans and medical technology did not medically change the outcome, it provided them with vital, clearer information. The part of the heart that had appeared to be missing was transposed, located 180 degrees in the wrong place. This changed everything and the life chances turned from incompatible with life to a serious and challenging heart condition. It was certainly not easy for them from there on in, but that did change everything. They were so relieved and felt it was the best news they could have received, but they were two days away from the date where they would have had to undergo the termination surgery. That arbitrary and unhelpful legal deadline could have caused them to make what would have been, in this lucky case, an unnecessary rushed and tragic decision.

Prenatal screening is a means to an amazing amount of information for foetal health. We must remove the legal uncertainty so that our medical experts can give the very best care to our community. These instances are, of course, rare. They are definitely traumatic and the information technology that provides us with this information improves day by day. The law, of course, now though, is a reverse clock working against the best medical information being obtained before medical advice is given.

Now, six years on, young Tess has had two open-heart surgeries and so many other procedures. She is brave and strong and Rob and Sandy love her dearly and they are so glad that she was not lost to them by this unnecessary law, but it was so close that it almost took Tess's life. They say that most of all they wish for other parents and doctors to be able to avoid the trauma of those arbitrary dates in the future and to remove abortion from the criminal law.

This is the situation for far too many families in our state currently who face that distressing diagnosis of an abnormality in a very much wanted pregnancy and are sometimes required to make a very difficult decision within even as little as 24 hours, a requirement that rules out the further diagnostic assessment that may have enabled them to make a different decision. For some women, access is also denied in Adelaide and they travel interstate or overseas to get the health care they need. Women who are not able to travel are forced to continue the pregnancy and birth a baby that they did not necessarily choose to. There are immediate consequences for a woman's mental health, affecting their capacity to bond with that baby and generally poor outcomes for both the woman and the child.

Critically, leading health bodies, including the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal Australasian College of Physicians and the Public Health Association of Australia, do not—I repeat: do not—support legislatively-prescribed gestational limits that set out different laws for different stages of pregnancy.

That is because the health system and health professionals working with individual patients are equipped to make appropriate decisions in the best interests of patients regarding later terminations. Once the criminal law is repealed, amendments will be required to the two existing SA Health clinical standards for abortions that are undertaken later in pregnancy, and governing the termination of pregnancy and foetal loss. The corresponding hospital policies and procedures will then be amended accordingly.

Regulation in other jurisdictions in Australia and internationally provides potential models for amending these standards for South Australia to follow. The standards will then need to guide decision-making about care for each individual patient within a framework of appropriate principles and processes. Healthcare professionals are never forced to provide the care that they are not willing to provide, and certainly the scuttlebutt that has been put out about this bill taking abortion care out of the realm of doctors and medical professionals and medical opinion is just that: it is absolute rubbish and it belongs in the bin.

In terms of the most recent debates, I would reiterate that claims that we have seen in this most recent day or so, that removing abortion from the Criminal Code will somehow result in more coerced abortions and increase domestic violence, is mischievous at the very least and wilfully destructive at worst. Is it not time that we stopped punishing victims of domestic violence? Rather than leave a law in the Criminal Code that would punish the victim herself of that abortion rather than the perpetrator of violence against her, we should put that political agenda to one side. If people are serious about addressing issues of domestic violence and coercion then bring forward legislation to this place to increase our progress in that area. Do not use abortion law reform as a stalking horse with the pretence that you are supporting those who are victims of domestic violence.

We have heard a lot of claims so far and we have heard a lot from those who are not involved in the provision of abortion or, indeed, later abortion. Someone who I would urge all members to pay heed to, who is a doctor, who has performed later abortions for many years and has become somewhat of a Twitter sensation, is obstetrician and gynaecologist Dr Jennifer Gunter. Incensed by the recent comments of Donald Trump at the State of the Union Address, she took to Twitter and it certainly was an education.

At the time she wrote that she noted only nine states in the District of Columbia allow abortions after 24 weeks without restrictions, and that the number of those was incredibly rare, some 0.3 per cent. She went on to state:

Normally they are only done because the mother is sick or the baby is so deformed it won't live. With a sick mum after 24 weeks they would normally induce labour and once born the baby would be in the care of the neonatal intensive care unit to help it survive.

She cautioned the general public and especially our political leaders not to confuse the abbreviation of 'term' with term meaning a fixed or limited period for which something lasts, and stated:

Late term abortion is in fact redundant because termination is the medial word for elective abortion. It should either be late term or late abortion.

She went on to state:

The only abortion of an unwanted pregnancy at 37 to 42 weeks of pregnancy is in fact inducing labour, normal birth of a live baby and adoption to new parents.

She knows because she has worked in this field for many, many years. She knows because she has had to perform a late abortion for a woman whose ultrasound showed anencephaly. Be glad that you do not know this word. I did not know it before now. It means missing most of the brain and part of the skull. The only case that she could think of in her knowledge and experience of many years of work in later abortions was that of a 12-year-old girl who was raped by her stepbrother and then dragged through the courts as she sought to gain an abortion, and that court process pushed her into that later abortion framework.

That girl was failed by her family and failed by the courts. The doctor was there to provide the abortion health care that she needed. And if you do not think that 12 year olds in this country are raped by stepbrothers, I draw your attention to the young girl in WA who was impregnated by her brother and gave birth in her own lounge room last month. She did not even know she was pregnant.

There are so many stories we have yet to hear in this debate. I would urge MPs to start to listen to the quieter voices in this debate, the voices of those people that I imagine none of you would care to walk in the shoes of, those of later abortion patients. In fact, they have started to speak up in America because of President Trump using the opportunity of the State of the Union Address to divide his country.

In response to his fake news of a so-called nine-month abortion, a signed letter from dozens of Americans—an open letter—was penned. These Americans were from Illinois, Indiana, Idaho, Arizona, Maine, Pennsylvania, Washington, South Dakota, California, Oregon, Michigan, Virginia, Georgia, Tennessee, Connecticut, Massachusetts, Florida, Oklahoma, New Jersey, Iowa, Missouri, Colorado, Alabama, Wisconsin, Maryland, New York, Kansas and Texas, and they stated:

Recent legislation regulating abortion in New York and the fervour around a similar proposed bill in Virginia have ignited a national conversation around later abortion.

They condemned President Trump's words that these were easy decisions, and they stated:

We know because we are the families who have gotten them.

We are the later abortion patients and their partners who are concerned with the politicisation of this issue at the expense of both truth and compassion. While we do not speak for every later abortion patient and do not pretend to represent everyone who seeks this care, we can speak for ourselves and our families.

The stories we hear being told about later abortion in this national discussion are not our stories. They do not reflect our choices or experiences. These hypothetical patients don’t sound like us or the other patients we know. The barbarous, unethical doctors in these scenarios don’t sound like the people who gave us compassionate care.

Our cases, the ones that would be affected by the legislation in question, constitute a relatively small number of abortions. So while these cases are incredibly rare and specific to each patient’s unique circumstances, they are being broadly misrepresented and are playing an outsized role on the national stage.

The decision to terminate a pregnancy is never a political one, it is a personal one. Later abortions stories are often ones of tragedy and loss. For others they are stories of relief. They feature struggles with hope, women betrayed by their bodies and the incredible complexity of pregnancy. Many stories are ones of overcoming the many obstacles and restrictions our states have placed on these procedures.

We are not monsters. We are your family, your neighbours, someone you love. We are you, just in different circumstances. Due to ignorance, many of us may not have supported later abortion access before facing a crisis ourselves, accepting restrictions on healthcare we never imagined needing. Now we recognise that our laws may not be able to draw neat lines around each of our stories, allowing these procedures in certain, hyper-specific circumstances and not in others, because we know people will be left outside those lines. As people privileged enough to speak up, that is unacceptable to us.

I applaud their courage for speaking up. They all put their names to that letter, not just their locations. I repeat that it has stuck with me, their words and how they must be feeling, having already suffered such devastating circumstances and loss. They state:

We are not monsters. We are your family, your neighbours, someone you love. We are you, just in different circumstances.

None of us here would want to be them, but all of us here should be willing to support them. To do that we must start having a more nuanced conversation about later abortion that reflects the experiences of patients and the expertise of physicians. We need to start listening to people with that firsthand experience. They will tell you their stories if you can muster the compassion necessary to hear them. Talking about later abortion is uncomfortable. It requires us confronting the terrible reality that pregnancy, even the most wanted one, is not always blessed. It means we have to consider decisions being made with imperfect information.

When we talk about later abortion, concepts we thought were simple become very complicated. Therefore, we must weigh the restrictions on later abortion against real stories, not the hypothetical cases that are fabricated to win political points. With the manufactured crises over later abortion, opportunistic politicians will seek to exploit an already stigmatised, marginalised group of people. Over and above the loss of those much-wanted pregnancies, they will suffer also from the loss of their dignity, being reduced to demons and being denied their voice.

There must be space in this debate for education and empathy, but this is only possible if it includes the stories of real patients. Real women, not mythical ones, must guide this debate—real women, not mythical women, must guide this debate, placing trust in women to control their own health, with compassion and understanding, not with stigma, assumption and impugned motives, and by making a good-faith effort at a conversation on later abortion that includes them. However, abortion stigma runs very deep in this debate, and it is running very deep right now in this state. That is why I will today also include the voices of some of those who have experienced later abortion in this conversation. Listen now to the voice of Kate Carson:

I had a later abortion because I couldn't give my baby girl both life and peace.

No-one loves my baby more than I do. Her death was a gift of mercy. Now, women like me will always be a scapegoat for policies limiting women's rights.

People are talking about me again, loudly, unkindly. Even the President of the United States has had his say about families like mine. I have told this story so many times, but I will tell it again as many times as it takes.

I help run a support group for families who have ended pregnancy after poor prenatal or maternal diagnoses. If you're wondering, 'Who are these women who get abortions in the third trimester?' We are. I am. Parents who love our babies with our entire hearts. Desperate acts like an abortion in the 36^th week of pregnancy are brought about only by the most desperate circumstances and are only available to those [in certain, limited certain situations].

I know, I've been there.

My daughter, Laurel, was diagnosed in May 2012 with catastrophic brain malformations (including Dandy-Walker malformation) that were overlooked until my 35^th week of pregnancy. I did not know much about brain disorders at that point. I imagined developmental delay, special education classes, financial pressure, an overhaul of expectations for Laurel's life and my motherhood. Here were the doctor's real expectations for Laurel: a brief life of seizures, full-body muscle cramps, and aspirating her own bodily fluids.

When I heard the list of all the things my beloved daughter would not do—talk, walk, hold her head up, swallow—I grasped for what she would be able to do.

'Do children like mine just sleep all the time?' I asked.

The neurologist winced. Children like yours, he told me—slowly—are not often comfortable enough to sleep.

Our choice was sad but clear.

Let me answer some questions you might be thinking: Yes, we were sure that these problems were severe. No, there is no cure, nor any on the horizon. Yes, we were counseled in-depth on our options, including adoption. Because we wanted to spare our daughter as much suffering as possible, our choice was very sad, but crystal clear: abortion.

I imagined an abortion at eight months would be grisly. But no matter how violent my imagination, it surely could not compare with the suffering Laurel would have endured in her own broken body.

In Massachusetts, my home state, a later abortion can be obtained only if the life or health of the mother is at risk. So I set off on a 2,000-mile journey from Massachusetts to Colorado to access this abortion. I landed, not in the nightmare I had imagined, but in the safest, kindest, most dignified hands I have ever encountered as a patient anywhere. Dr. Warren Hern at his Boulder Abortion Clinic is one of the few doctors in the country performing this procedure. After a single injection and a couple of hours, my baby was laid to rest in my womb, the purest mercy that I knew how to give my Laurel…

Mercy means something different to each family…

Nobody loves Laurel more than I do. Her death was a gift of mercy. Mercy means different things to different loving families, and that has to be okay. To all the families who face similar circumstances and made a different choice, I honor you. I trust your wisdom. I celebrate your child's brief and beautiful life.

We must treat each other with love, tenderness and respect.

It is horrible, as a parent, to choose between life and peace for our children, especially when we want to give our children both beautiful and precious gifts.

It is devastating to lose a child. But, unlike most bereaved parents, women like me will live out the rest of our lives as scapegoats, fuel for an agenda that seeks to strip women and families of our reproductive freedoms.

When I think of my baby Laurel, I feel love and peace. Unfortunately, I cannot be with that peace because there are fresh wounds in the way, the throbbing pain of being hated and misunderstood.

Gretchen Voss has also shared her late-term abortion story, which started so happily, as so many do:

Way too excited to sleep on that frigid April morning, I snuggled my bloated belly up to my husband, Dave. Eighteen weeks pregnant, today we would finally have our full-fetal ultrasound and find out whether our baby was a boy or a girl. I had no reason to be nervous, I thought. I was young (if 31 is the new 21), healthy, and had not had so much as a twinge of nausea. Well into my second trimester, I was past the point of worrying about a miscarriage.

The past 3½ months had been a time of pure bliss—dreaming about our future family, squirreling away any extra money that we could, and cleaning out a room for a nursery in our cozy, suburban home, then borrowing unholy amounts of stuff to fill it back up. From the day that we found out we were expecting a baby—on New Year’s Eve 2002 —we thought of ourselves as parents, and finding out whether the 'it' was a he or she would cap the months of scattershot emotions and frenetic information-gathering. I just couldn’t sleep. I invited our 105-pound yellow Labrador 'puppy' into bed with us and snuggled even closer to Dave.

Later that morning, at quarter past 9, Dave held my hand as I lay on the cushy examining table at the Beth Israel Deaconess Medical Center office in Lexington. As images of our baby filled the black screen, we oohed and aahed like the goofy expectant parents that we were. 'Can you tell if it’s a boy or a girl?' I must have asked a million times. The technician was noncommittal, stoic, and I started feeling uncomfortable. Where I was all bubbly chitchat, she was all furrow-browed concentration.

Then, using an excuse about finishing something on her previous ultrasound, she left the room. Seconds passed into minutes while we waited for her to return. Staring at the pictures of fuzzy kittens and kissing dolphins on the ceiling, I knew something was wrong. Dave tried to reassure me, but when the ultrasound technician told us that our doctor wanted to see us, I started to shake. 'But she doesn’t even know we’re here,' I said to her, and then to Dave, over and over. That’s when I started crying. I could barely get my clothes back on.

The waiting room upstairs, usually full of happy pregnant women devouring parenting magazines, was empty. Our doctor, who usually wears a smile below her chestnut hair, met us at the front desk. She was not smiling that day as she led us back to her cramped office, full of framed photos of her own children.

As we sat there, she said that the ultrasound indicated that the fetus had an open neural tube defect, meaning that the spinal column had not closed properly. It was a term I remembered skipping right over in my pregnancy book, along with all the other fetal anomalies and birth defects that I thought referred to other people’s babies, not mine. She couldn’t tell us much more. We would have to go to the main hospital in Boston, which had a more high-tech machine and a more highly trained technician. She tried to be hopeful—there was a wide range of severity with these defects, she said. And then she left us to cry.

We drove into Boston in near silence, tears rolling down my cheeks. There was no joking or chatting at the hospital in Boston. No fuzzy kittens and kissing dolphins on the ceiling of that chilly, clinical room. Dave held my hand more tightly than before. I couldn’t bear to look at this screen. Instead, I studied the technician’s face, like a nervous flier taking her cues from the expression a stewardess wears. Her face revealed nothing.

She squirted cold jelly on my belly and then slid an even colder probe back and forth around my belly button, punching it down every so often to make the baby move for a better view. She didn’t say one word in 45 minutes. When she finished, she looked at us and confirmed our worst fears.

Instead of cinnamon and spice, our child came with technical terms like hydrocephalus and spina bifida. The spine, she said, had not closed properly, and because of the location of the opening, it was as bad as it got. What they knew—that the baby would certainly be paralyzed and incontinent, that the baby’s brain was being tugged against the opening in the base of the skull and the cranium was full of fluid—was awful. What they didn’t know—whether the baby would live at all, and if so, with what sort of mental and developmental defects—was devastating. Countless surgeries would be required if the baby did live. None of them would repair the damage that was already done.

I collapsed into Dave. It sounds so utterly naive now, but nobody told me this pregnancy was a gamble, not a guarantee. Nobody told me what was rooting around inside me was a hope, not a promise. I remember thinking what a cruel joke those last months had been.

We met with a genetic counsellor, but given the known, as well as the unknown, we both knew what we needed to do. Though the baby might live, it was not a life that we would choose for our child, a child that we already loved. We decided to terminate the pregnancy. It was our last parental decision.

So this is our story—mine, my husband's and our baby's. It is not a story I ever thought I'd share with a mass audience, because, frankly, it's nobody's business. But now it is…

But lost in the political slugfest have been the very real experiences of women—and their families—who face this heartbreaking decision every day [and are not heard].

I don't know what was worse, those three days leading up to the procedure (I have never called it an abortion), or every day since. I clung to Dave. He was always the rock in our relationship, but now I became completely dependent on him for my own sanity. Though abortion had never been part of his consciousness, he was resolved in a way that my hormones or female nature or whatever wouldn't let me be. But I worried about him too. The only time I saw him crack was after his brother—his best friend—left a tearful message on our answering machine. Then I found Dave kneeling on the floor in our bathroom, doubled over and bawling, his body quaking. That nearly killed me.

I don't remember much from those three days. Walking around with a belly full of broken dreams, it felt like what I image drowning feels like—flailing and suffocating and desperate. Semiconscious. Surrounded by our family, I found myself tortured by our decision, asking over and over, 'Are we doing the right thing?' That was the hardest part. Even though I finally understood that pregnancy wasn't a Gerber commercial, that bringing forth life was intimately wrapped up in death—what with miscarriage and stillbirth—this was actually a choice. Everyone said, of course, 'It's the right thing to do'—even my Catholic father and my Republican father-in-law, neither of whom was ever 'pro-choice'. Because, suddenly, for them, it wasn't about religious doctrine or political platforms. It was personal—their son, their daughter, their grandchild. It was flesh and blood, as opposed to abstract ideology, and that changed everything.

I was surprised to find out that I would no longer be in the care of my obstetrician, the woman who had been my doctor through my pregnancy. It turned out that she only dealt with healthy pregnancies. Now that mine had gone horribly wrong, she set up an appointment for me with someone else—the only person who was willing to take care of me now. I felt like an outcast. As we drove to his private office, I could not shake the feeling that we were going to meet my executioner. I had never met this doctor, but I did look him up online.

With thick, mad-scientist like glasses, he looked scary. In person, though, he reminded me both in looks and the manner of Dr Larch in The Cider House Rules. He had the kindest, saddest eyes I have ever seen, and he sat with us for at least an hour, speaking to us with heartfelt compassion, an understanding that I had never encountered from any doctor before. His own eyes teared as Dave and I cried.

He explained the procedure to us; at least the parts we needed to understand. Unlike a simple first trimester abortion, which can be completed in one quick office visit, a second trimester termination is much more complicated, a two-day minimum process. He started it that day by inserting four Laminaria sticks made of dried seaweed into my cervix. It was excruciating, and he apologised over and over as I cried out in pain. When I left the examining room my mum and my husband were shocked. I was shaking and ghostly white. The pain lasted through the night as the sticks collected my body's fluids and expanded, dilating my cervix just like the beginning stages of labour.

The next morning Dave and my mother took me to the hospital in Boston. I was petrified. I had never had any sort of surgery, and I fought the anaesthesia, clinging to the final moments of being pregnant—as I lay in that stark white room and I started to drift off, my doctor held one of my hands and an older female nurse held the other, whispering in my ear, 'You're going to be okay, I've been here before, lean on your husband.' It was my last memory, and when I woke it was all over.

Dave had to return to work the next day. He didn't want to leave me, and he certainly didn't want to return into the furtive stares of his co-workers, all of whom knew we had 'lost the baby'. I really don't know how he did it. My mother stayed with me at home for the next week, trying to glue my shattered pieces back together with grilled cheese sandwiches and chicken noodle soup. I had no control over my emotions. I felt like a freak in a world of capable women having babies, and I couldn't stop whimpering: Why did my body betray me?

For months, I hid from the world, avoiding social outings and weddings. I just couldn't bear well-meaning friends saying, 'I'm so sorry.' So I quarantined myself, and would try to go about my day—but then, bam, heartbreak would come screaming out of the shadows, blindsiding me and leaving me crumpled on the floor of our house. It wasn't that I was questioning our decision. I knew we did it out of love, out of all of the feeling in the world. But I still hated it. Hated it.

The doctor who performed my termination talks about the women he has helped through the years—the pregnant woman who was diagnosed with metastatic melanoma and needed immediate chemotherapy, the woman who was carrying conjoined twins that had only one set of lungs and only one heart, the woman whose baby had a three-chambered heart and would never live.

I wrote my doctor a long thank you note on my good, wedding stationery. I thanked him for his compassion and his kindness. I wrote that it must be hard, what he does, but that I hoped he found consolation in the fact that he was helping vulnerable women in their most vulnerable of times. He keeps my note, along with all the others he's received, in a really large bundle. And he keeps that bundle right next to his stack of hate mail [that he also receives]. They are about the same size.

Listen now to those from the medical profession. The aforementioned Dr Jennifer Gunter is an obstetrician-gynaecologist and a pain medicine physician. She is the author of a book, The Preemie Primer: A Guide for Parents of Premature Babies, and her website (and I recommend all members visit this) is drjengunter.wordpress.com. She is, of course, on Twitter @DrJenGunter. Members may know her as the doctor who recently schooled Donald Trump. She starts with:

Dear Donald Trump: I'm an OB-GYN. There are no 9-month abortions.

She then continues:

I'm a doctor who was trained to do late-term abortions. I did them for five years in residency and for 10 years in practice and I have no idea what Trump is talking about. I have even practised in states with no gestational age limit for abortions. So while I no longer perform abortions, I know much more about this subject than Donald Trump or any of his advisers can ever hope to know.

Focusing on late-term abortions is always an interesting strategy. And certainly, if one really wanted to reduce abortion, it is the wrong strategy, as only 1.3 per cent of abortions happen at or after 21 weeks. We know this because the Centers for Disease Control conducts annual abortion surveillance. The majority of abortions, 91 per cent in fact, happen before 13 weeks, and we know how to prevent most of them: easily accessible, free, long-acting reversible contraception.

But since we can't count on Trump—

and certainly today I would add the Catholic Church—

for facts about abortion, let's set the record straight on later abortions, meaning those on or after 21 weeks.

According to Dr Gunter:

There are three reasons women seek later abortions: health of the mother, personal reasons, and fetal anomalies (birth defects). Late abortions are rare—and women tend to seek them for [those] three reasons.

Abortions for the health of the mother only happen before 24 weeks, which is the generally accepted cut-off for fetal viability. After 24 weeks, if a pregnant person is sick enough that she needs to deliver for her health, obstetricians either induce labour or perform a C-section, and the baby is attended by the neonatal intensive care unit. Anti-abortionists would apparently have you believe, and perhaps he believes himself, that in these situations doctors do a delivery and then commit infanticide.

Health of the mother abortions absolutely do happen—in circumstances of ruptured membranes with infection or deteriorating heart disease, for example—but they happen before 24 weeks. No OB/GYN is doing third trimester abortions for the health of the mother. We simply practise obstetrics and deliver the baby by the most appropriate method.

A small percentage of late term abortions (i.e., at or after 21 weeks) are for personal reasons. These procedures also don't happen in the 'ninth month' or one or two days from delivery. When a woman presents for an abortion and she is past 24 weeks, she is told she is far too far along for the procedure. There is even a medical term for this—

Dr Gunter goes on to say—

'turnaways'.

I note at this point that there is also a report on those turnaways available via the University Of California, 'Advancing New Standards in Reproductive Health', online.

Sadly, however, this debate has not listened to the doctors and it has not listened to the patients. I hope that the SALRI reference will allow some much-needed sense and facts to be brought into this debate, but I do think we also need the compassion and the willingness to be open, to have those facts and those stories guide our decisions and to not come back to this place with another blunt tool based more on politics than on the personal experiences of those who seek health care.

Indeed, it is possible for people to change their minds on this issue, and I will finish with one final story. That is the story of Dr Parker. Dr Parker, in America, is a Christian. He is from Birmingham, Alabama, and he initially refused to even consider doing the procedures of abortion. However, about halfway through his 20-year career he changed his mind and now he is one of the rare doctors who is willing to push the limits and provide abortions at 24 weeks of pregnancy. He wrestled with the morality of it. He had grown up in the south with fundamentalist Protestantism and was taught that abortion is wrong. Yet he pursued his career as an obstetrician/gynaecologist and there he saw the real and heartbreaking dilemmas that women found themselves in.

He found he could no longer weigh the life of a pre-viable or lethally flawed foetus equally with the life of the woman sitting before him. In listening to a sermon by Dr Martin Luther King he came to a deeper understanding of his spirituality which places a higher value on compassion. King said that what made the good Samaritan good is that, instead of focusing on what would happen to him by stopping to help the traveller, he was more concerned with what would happen to the traveller if he did not stop to help.

With that, Dr Parker stated, 'I became more concerned about what would happen to these women if I as an obstetrician did not help them.' He goes on to say that they lack access to health care or they do not have an understanding of their body changes and often figure out later on that they are pregnant, or they find out early enough that they are pregnant but their lack of access to health care or volatile dysfunctional relationships delay them seeking help.

The women most likely to be in these situations are trapped in poverty. They are often women of colour or poor socio-economic backgrounds, less education, and women and girls of the extremes of reproductive age: women beyond that age where they think they can become pregnant or young girls who have infrequent and irregular sexual activity and are not conscious of it. Starting with those women as the ones that you would cut off is kind of ironic because they have the most compelling reasons to consider abortion in the first place. The reality is that unplanned or unwanted pregnancies occur to women in all walks of life and in all demographics. One in three will terminate a pregnancy in her lifetime.

The doctor goes on to note that he had a patient who was a 32-year-old attorney, a senior staffer for a prominent US senator. She and her husband had their first pregnancy and were very excited about it, only to find out in the 21^st week that there was a lethal, severe developmental abnormality. They waited until the 23^rd week because it was a rare disorder and they did not want to have an abortion unless that rare condition was absolutely confirmed. Another patient was a 13-year-old girl with a very quiet demeanour, which her parents had perceived as model behaviour, but in fact she had an uncle staying with the family who had been sexually molesting her and she had kept quiet about it. It only came to light after he left.

Dr Parker is a lesson in education, empathy and understanding. These examples he has cited are typical circumstances for later abortions. Doctors do not deliver babies and then kill them. The central concept behind that claim is that women will somehow seek out late-term abortions for cavalier reasons and that doctors will perform them, with the indulgence of craven politicians. It is the stuff of fantasy and it shows distrust of both women and our medical system.

There are so many stories, such as that of Lindsey Paradiso of Virginia, who discovered that her foetus had a severe abnormality that was almost certainly lethal but did not want to abort until it was absolutely confirmed. But then, because she had waited, hers was a later abortion—but can you blame her? Or that of Darla Barar of Texas, who was devastated to learn that one of the twin girls she was carrying had a neural tube defect and brain matter was being leached out. That meant that she would be severely disabled, if she was not a vegetable. Ending half the pregnancy of the twin girls meant that the other baby had a better prognosis.

These choices are heartbreaking, but Danielle Deaver had no choice at all. The Nebraska woman was forced to watch her baby choke to death moments after giving birth because of a strict law in her state that banned abortions after 20 weeks. If her doctor had been allowed to induce labour and analyse her condition earlier, she would have learned something that would have helped her have a future healthy birth. Instead, she had to wait out a worsening infection and go through a painful delivery and then the agony of the baby's death.

Another woman facing an unmistakably dire prognosis might not want her baby to suffer and then die, or live in that vegetative state. What sense did it make to put her own health at risk or that of the twin foetus? These are the situations that we are talking about when we talk about the supposedly wanton women who will simply seek abortion on demand. These are the most heartbreaking stories that you will hear in this place, and yet they are such a small number and they are so often silenced. We must stop using them as political pawns and listen to the realities of their experiences.

If we want to prevent late-term abortions, the answer is to provide early, affordable, safe access to abortion wherever possible, along with easy access to contraception, but also to ensure that our laws are not a blunt tool that puts those families in the most precarious and difficult positions, with those terrible choices with the reverse clock that we currently have and the unrealistic boxes that we will place them in. We must let women and their doctors handle it and respect the fact that they are actually going to be more concerned about that foetus than any politician in this place will ever be, than any priest will ever be. Unless it is our body, recognise that it is not our choice.

Like Dr Parker, you might even find that you change your mind when you not only trust women but you listen to their voices. This is a South Australian Abortion Action Coalition bill, not a Greens bill, as I have stated, but as a Greens member of this place I am proud to bring it forward. I am proud that my party has the courage to take on this debate, and I certainly look forward to more members in this place having the courage to listen to the true stories—not to the rhetoric and not to the rubbish that we see put into our letterboxes in the dead of night without any authors—and to start ensuring that this debate is informed by that compassion and understanding and that we move from the shrill voices that have so far dominated the debate. With those words, I commend the bill.

There being a disturbance in the gallery:

The PRESIDENT: Order! Black Rod, remove that man from the gallery.

The Hon. I. PNEVMATIKOS (18:03): Today, I also rise to speak on the Statutes Amendment (Abortion Law Reform) Bill 2018. South Australia has a long proud history of being the most progressive state in the nation, especially when it comes to gender equality. In 1879, South Australia opened the first state secondary school for girls in Australia. In 1881, we were the first to admit women to degrees, and of course in 1895, South Australia was the first Australian colony to grant women the vote and allow women to stand for parliament.

These are achievements that we can rightly be proud of, but I fear we may have lost touch with our progressive and groundbreaking heritage and we are starting to fall behind other states and territories. The way we treat abortion is one example. Interestingly, South Australia was also the first Australian state to liberalise access to abortion through legislation but, according to most experts, our laws now are out of step with modern advances in medicine. We can and should do better.

South Australia's abortion laws were introduced in 1969. They state that South Australian women are only able to access an abortion if they have been examined by two doctors and if they believe there is a risk to the woman's life or that the child would be seriously disabled. This not only means that women are denied the freedom to determine their reproductive choices, it also entails an expensive and unnecessary use of medical resources.

Importantly, it can also contribute to a delay in access where two doctors might not be available. It must be remembered that these laws were introduced at the time to protect women from receiving surgical abortions from unregulated facilities, but with our world-class healthcare system and great advances in medical services and technologies, South Australia is vastly different today from what it was in 1969.

Not only are our laws out of step with medical advances but also with moves from other states and territories to decriminalise abortion. A look at the time line from other jurisdictions shows just how far behind we are lagging. Western Australia decriminalised abortion way back in 1998, the ACT in 2002, Victoria in 2008, Tasmania in 2013, the Northern Territory in 2017 and Queensland took the step in 2018.

That leaves just South Australia and New South Wales as the only two states to include abortion in the criminal code. South Australia has gone from leading the way in such reforms to seriously being out of step with modern advances and practices. It is commonly recognised that at present South Australia has the most restrictive laws of all the states and territories. We should care about this; after all, it can affect us all.

Statistics show that one in three Australian women will have an abortion in their lifetime, meaning that all of us will likely know someone who has faced this decision. It is also an issue that Australians feel strongly about. Studies conducted have consistently shown that around 80 per cent of Australians support the statement, 'A woman should have the right to choose whether or not she will have an abortion.' Keeping abortion in the criminal code truly appears to be out of touch with the general sentiment of the majority of South Australians.

Abortion should be regulated like other health care. This is important because we know that the best quality abortion care is enabled when abortion is a woman's decision, is available free of cost and is accessible regardless of a woman's location. This brings me to another issue that is very close to my heart, namely the disadvantage faced by women in rural and remote areas when trying to access abortion services.

Advances in medicine and technology mean that under certain circumstances women today can access EMA termination using prescription medication. EMA has been commonly available in Australia since 2013 as an alternative to surgical abortion and it is widely regarded as safe and effective for early pregnancy up to nine weeks. In every other jurisdiction, this treatment can be accessed from GPs or community health centres or by telemedicine.

However, under South Australia's current abortion laws, this is not possible because we have a prescribed hospital requirement. This means that women who qualify for an EMA must still complete two visits to a prescribed hospital 48 hours apart. There is no doubt that this further disadvantages women in regional or rural South Australia and is yet another area where South Australia is clearly lagging behind other jurisdictions.

Once abortion is removed from the criminal code, it will be regulated according to the normal standards and practices that govern all other health services, which include specific clinical guidelines for each area of care. Regulation under health law will help to ensure that patients can be treated promptly and that care is affordable.

This is very much in keeping with the recommendations published by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in 2016 that clearly states that access to termination of pregnancy should be on the basis of healthcare need and should not be limited by age, socio-economic disadvantage or geographic isolation. The changes proposed in the bill will ensure that South Australian laws correspond to most other jurisdictions as well as no longer disadvantaging certain groups in our society.

Since this bill was introduced, I have met with many groups and stakeholders of all persuasions because I believe it is important to hear all views. I continue to receive phone calls, emails and letters from many groups sharing their feelings about this bill. While I appreciate this input, I wish to make it explicitly clear that I will not be responding any further at this stage until I have received and had the chance to review the South Australian Law Reform Institute report. I am still waiting on further contributions on specifications of the proposed bill. I look forward to considering this matter further when in committee.

Debate adjourned on motion of Hon. I.K. Hunter.