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Legislative Council - Fifty-Fourth Parliament, Second Session (54-2)
2020-11-12 Daily Xml
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Bills

Termination of Pregnancy Bill

Second Reading

Adjourned debate on second reading.

(Continued from 14 October 2020.)

The Hon. I.K. HUNTER (11:02): I rise this morning to support the second reading of the Termination of Pregnancy Bill. I note that this is a conscience issue for Labor members. At the outset, I advise that I am in strong support of decriminalising abortion, ensuring that it is treated as an issue of health care and of a women's bodily autonomy. I note that this bill does not substantially change current practice in relation to abortion in this state.

For more than 50 years now, many South Australian women have had safe and legal access to abortion. Like this bill, the abortion law reform of the 1960s was driven by women members of parliament and has resulted in long-lasting change for the benefit of South Australians. But this bill does make some key changes:

it finally removes abortion from the criminal code;

it simplifies access to abortion health care earlier in a pregnancy, which is particularly important for women in regional South Australia;

it recognises advances in medical abortion and telehealth, and ensures that South Australian women have access to those health services;

it allows medical practitioners to conscientiously object to providing abortion health care, so long as they provide a referral, as we would expect in any other healthcare situation; and

it strengthens safeguards against abortion coercion by ensuring that such coercion is considered abuse under the Intervention Orders (Prevention of Abuse) Act 2009.

So these, I believe, are sensible reforms, which bring our laws into modern practice. Importantly, these reforms are based on a strong body of evidence. The respected South Australian Law Reform Institute conducted an in-depth analysis of abortion law reform, receiving submissions from stakeholders on all sides of the issues. SALRI's recommendations are considered, they are detailed and they form a strong basis for the legislation we have before us.

Like all honourable members, I expect, I have received correspondence, again on both sides of the debate, on this legislation. I do acknowledge the deeply held views of many in the community and indeed in this chamber on the issue, but I am concerned about what I believe is some misinformation that has been circulating—I guess that is the best way to put it—about this bill, in my view at least.

I would like to place on the record my views on some of the issues raised in the correspondence that I have received. I guess chief amongst them is this concept or notion of abortion to birth which has been a strong theme—disingenuous, although probably honestly held by many people, but I think ill informed and incorrectly based on the evidence we have before us from SALRI and the legislation itself.

I suspect that some in the community have been promoting this idea that the bill will lead to a flood of women seeking abortions late in pregnancy on a whim. We hear that from time to time but it does not really stack up with the facts. It is inaccurate and it is offensive, I think, to the experiences of many women, because the decision to terminate a pregnancy at any stage is enormously difficult and a very personal one, but to terminate a pregnancy late in the term is even harder.

When I was reflecting on this issue, I came across a question and answer session from the US between a TV commentator who was taking to task a former Democratic presidential candidate, Mayor Pete Buttigieg of South Bend, Indiana. He was asked this very question about late-term abortions and his response was to express empathy for the person who might have to be facing such a decision. He asked people to put themselves in the place of women who are having to contemplate such a decision. He said:

Let's put ourselves in the shoes of a woman in that situation…

So we can better understand this issue. He continued:

If it's that late in your pregnancy, then almost by definition, you've been expecting to carry it to term. We're talking about women who have perhaps chosen a name, women who have purchased a crib, families that then get the most devastating medical news of their lifetime, something about the health or the life of the mother or viability of the pregnancy that forces them to make an impossible, unthinkable choice.

And the bottom line is as horrible as that choice is, that woman, that family may seek spiritual guidance, they may seek medical guidance, but that decision is not going to be made any better, medically or morally, because the government is dictating how that decision should be made.

If you look at the statistics in our state—as I said, briefing materials were provided to members by the Attorney-General's office, and I thank her for this information—in South Australia approximately 91 per cent of terminations are conducted within 14 weeks, and fewer than 3 per cent are conducted post 20 weeks. That very small number of terminations are overwhelmingly in circumstances of foetal abnormality or the unviability of the pregnancy or of some severe risk to the life of the mother.

As a member of parliament, a parliamentarian, particularly a male parliamentarian, I do not believe it is my place to tell these women in that extreme position, where they have been expecting to carry a child to term, making plans for the family, and are placed in such an impossible situation, that they cannot have access to the health care that they may decide for themselves they need. That decision should be made by the individual and her medical professionals that she consults.

In closing, I reiterate my strong support for the bill and, again for the record, I will be opposing amendments that have been filed to date. These amendments seek to undermine, in my view, the core objectives of the bill and I cannot support them.

I would like to commend the Attorney-General for leading this reform process and the Minister for Human Services for introducing the bill in our chamber. The advocacy of the Hon. Tammy Franks on this issue and that of the Hon. Connie Bonaros has been important and constant—and I emphasise constant. I would like to thank the many Labor women who have led this fight for so long, particularly the member for Reynell, the member for Hurtle Vale and the Hon. Irene Pnevmatikos.

I would also particularly like to thank the champions who are no longer with us in this parliament, who have been fighting on these issues and on these grounds for a long time: the Hon. Steph Key, the Hon. Anne Levy, the Hon. Carolyn Pickles, Gay Thompson, the Hon. Lea Stevens and the Hon. Gail Gago. Lastly, I would like to thank the South Australian Abortion Action Coalition and its predecessor organisations for hanging in there and for their forbearance and their persistence on this issue for so many years. I will be supporting the second reading.

The Hon. M.C. PARNELL (11:10): This bill is an important and long overdue reform, and I fully support it. I know that some of my colleagues in other parties are grappling with how they should exercise the rare opportunity to have a conscience vote, but this is not an issue for the Greens. Technically, we have a conscience vote on every issue. However, we also have a longstanding policy that providing access to affordable sexual and reproductive health care, including abortion and contraception, is part of every woman's right to control her own body.

I will be voting for the bill, not just because it is consistent with Greens policy, but because, according to my conscience, it is also the right thing to do. The Greens went to the last federal election with a policy to support decriminalisation of abortion under state law in New South Wales and Queensland and the removal of criminal provisions in South Australia and Western Australia, where they still exist. We know they still exist, and this bill removes them.

According to the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, one-quarter to one-third of all Australian women will have an abortion at some point in their life. You only have to do the sums: all of us know more than three or four women. There is a large number of women in my life, women whom I know, who have had terminations, and not one of them has fulfilled the stereotype that we hear in some of the items of correspondence, that they would wake up in the morning and just think, 'What will I do today? I know, I will go and have an abortion.'

In every one of the cases that I am familiar with, women who are friends and acquaintances of mine, all of them have gone into this with a great deal of soul-searching and often a great deal of pain, and the last thing they want to hear is that it is somehow a flippant, ill-conceived and ill-considered choice that they have made. The Greens agree, also, with the Public Health Association of Australia, which states in its abortion policy:

Abortion should be regulated in the same way as other health procedures, without additional barriers or conditions. Regulation of abortion should be removed from Australian criminal law.

It is a pretty simple position, that abortion is part of health care. Health care should be regulated in a health framework, and abortion has no right to be in the criminal law.

I also have received a large number of items of correspondence from all sides of this debate. It often surprises and disappoints me, when I read some of this correspondence, that people are not necessarily consistent in their views of life. We only have to look at, say, the American election we have just had, and there are many parallels in Australian politics as well. I struggle with the idea that someone can consistently and simultaneously be completely opposed to abortion in all circumstances but think that executing people in gaols—often young people, youth—is a reasonable response to whatever indiscretions they might have committed. I think it is a bizarre way to view the world.

I do not doubt for one minute the sincerity of those who are occupied in trying to prevent the rights of others. I understand that it is a strong religious view that many people hold, but at the end of the day my view, and certainly the view of my party, is that this is a matter for a woman and her healthcare providers to deal with. It is a matter that should be regulated in the healthcare system, it is not something that needs to be in the criminal law.

Along with the Hon. Ian Hunter, I would like to put on the record my thanks and congratulations to the people who have gone before in this debate, those who have actively advocated for the removal of abortion from the criminal code, not the least of whom my colleague the Hon. Tammy Franks, but also many of the other, sadly, mostly women, in state parliament on whose shoulders this task has fallen.

I am very pleased that we have now come to the pointy end of this and I am looking forward to the passage of the bill today. As I have said, my personal view and the view of the Greens is that legislation like this should be supported.

The Hon. T.A. FRANKS (11:15): I rise with great pleasure today to support the Termination of Pregnancy Bill 2020 and associate myself with the remarks of my honourable colleague Mark Parnell and the Hon. Ian Hunter in congratulating the Marshall government for allowing this debate to happen.

The mover, the Minister for Human Services, the Hon. Michelle Lensink, has brought this to us in private business time, but with the resources that have been afforded to this bill and the substantial body of work and research that have been afforded to this bill by ministers who did not stand in its way. Also, I particularly congratulate the leadership here of the Attorney-General.

The bill comes before us as a result of the SALRI recommendation, that SALRI report of October last year, which is an extensive tome and that we have all had at our disposal, couched—

The PRESIDENT: Order! There are a couple of conversations that are interrupting the honourable member and I ask that she be heard in silence.

The Hon. T.A. FRANKS: That SALRI report will be a great resource for us as members of parliament on what is a difficult conscience issue and what, for many members, will be the first time they have had to consider a bill in great detail that is actually quite a substantial piece of legislation and that will have an impact on many lives in South Australia. I thank the leadership of the Marshall government for getting us to this place.

It will come as no surprise to members of this council that, given I brought a decriminalisation bill for abortion to this place in 2018 following the state election with the hope that it be referred to SALRI for that extensive work and research to take place, I am very supportive of the intention to decriminalise abortion in this state. The bill before us does that: it removes abortion from the criminal law. It also removes the gestational limits for surgical termination, which is in line with the SALRI recommendations. It removes the requirements for unnecessary and obstructive barriers to access abortion in this state.

Should you not be a resident of this state, you have to wait two months before you qualify for that medical care. That is an extraordinary imposition on people's lives when they are making a very difficult decision. For those who say they do not want abortion to happen later, the removal of the two-month barrier, that waiting time, should be warmly welcomed by those people, but I have yet to hear them warmly welcome that great initiative and move forward.

Very simply put, the bill ensures that we treat abortion as health care and regulate it in health legislation where we have lawful access to abortion, rather than keep it in the criminal code. Quite proudly, we have public funding and excellent health services in this state. The doctors, the medical professionals and the people who are pregnant have to tread lightly around a series of lines drawn by parliament 50 years ago, which put barriers in their way such as that two-month waiting period for non-residents and such as having to be in a prescribed hospital to receive early abortion medication of two pills over a series of two or three days, forcing rural and regional women in particular to travel hundreds, if not thousands, of kilometres simply to access something that, should they live just the other side of the border, they could potentially access via telehealth or at their local clinics.

In South Australia, we make those people travel inordinate amounts of distances unnecessarily, putting them at risk as they miscarry on their return home, requiring them to find care for other children, requiring them to take time off work, potentially booking hotel accommodation, indeed putting those financial barriers in their way as well. It is not good enough that we have allowed this 50-year-old law to exist, preventing the access to termination that we have deemed by this parliament to be lawful and to be worthy of public support. When it comes to bureaucracy, we are happy to make individuals' lives as difficult as possible.

This bill draws a line. Often in debates about abortion there is much debate about where the line is to be drawn, and this bill does draw a line at 22 weeks and six days. The line I would like to talk about today is not that line where at that point it would be on medical grounds and require that two doctors sign off. I would like to talk about the line that we have drawn as members of parliament that it is us who know best, that it is us in this parliament, rather than that woman and her medical team, who should make that decision.

The line that I would like to draw today is that this parliament cannot anticipate every single experience that medical team and that pregnant person might find themselves in. Somebody carries a, most likely, much-wanted child to the third trimester. She has chosen a name, painted the nursery and picked out baby clothes and is then faced with a medical decision, due to the advanced technology that we have—the scans and medical reports she may have received—that is probably the worst decision of her life. The idea that this parliament can understand and anticipate every single situation somebody in that terrible situation might find themselves in is quite offensive.

The line I want to draw today is that we finally start to trust the medical profession and we start to trust women. They are the experts in their own lives. They are the experts in that particular experience. They are the only ones able to make that decision. The decision we make with this bill is to empower the doctors and the pregnant person to make that decision given their set of circumstances.

Quite simply, this is a bill that updates our 50-year-old laws that were once progressive, when South Australia had a reputation for respecting women's reproductive rights and trusting doctors. I hope that today is the first step in bringing us into the 21st century and for us becoming the last place in Australia to decriminalise abortion and drawing that line that we do trust women and their medical teams.

The Hon. D.G.E. HOOD (11:23): I rise to address the Termination of Pregnancy Bill. Before I get to the speech I have prepared, I would like to address two matters that have been raised this morning, which I think are significant and need to be said.

The first is that, if this bill was simply a matter of removing abortion from the criminal code and placing it as a freestanding bill and that was all it did, it would have my support. In fact, I have not yet come across anybody who has argued against that; that is, that it should remain in the criminal code. I want to make that absolutely crystal clear because it has been suggested, potentially, that even that level of change would not get support. Well, it certainly would get mine.

As I said, my understanding is that it would pass, possibly unanimously, so we need to be clear about that. The reason that I will oppose this bill is because it does many more things than that, which I will go into in some detail in a moment.

The other thing is that I am not of the view, as has been suggested this morning, that passing this bill will necessarily result in a rush or an increase in the number of abortions. I do not know what the impact will be. I am not arguing that. I have not had anyone argue that to me. I just want to be clear about that. That is not one of the central reasons that I will be opposing the bill either. I think there needs to be some clarity around that.

I guess the meat of it for me is that members know where I stand in terms of so-called life issues. I am in the pro-life camp and always will be. I realise other members, as we have heard this morning, are what we might traditionally call the pro-choice camp, and I acknowledge that abortions are a genuinely difficult subject to discuss for many people. I have personally known people who have gone through abortions.

I acknowledge that abortion is genuinely difficult. In my experience, few people will ever change their mind on their view on that matter. However, I believe that common ground is possible and that most people can agree that it is good public policy to both reduce abortion numbers where possible and to reduce the numbers of so-called unwanted pregnancies. I say 'unwanted pregnancies' because a particular woman may not want to be pregnant or may not want to have her child or the child she is carrying, but of course there are literally thousands of South Australians couples who would move heaven and earth to adopt that child if it were to reach this stage of birth, potential mums and dads who desperately want a child.

Indeed, I reflect on my own experience, when my wife and I tried—and I do not think I have ever mentioned these issues in this place before—for many years, I think it was about eight years or thereabouts, to achieve pregnancy but we were unable to. Fortunately, after a long period of IVF and other sorts of interventions, we were able to conceive and my wife gave birth to a beautiful baby girl, our daughter. We are very proud of her, I assure you.

During the pregnancy at the 20-week scan, though, despite the very long length of time we took to finally get my wife pregnant, we were told that there was an increased risk of abnormality and that we should consider an abortion. We did not consider it, and I am pleased to say that she was born perfectly healthy. Indeed, sir, call me a biased father, but in my view she is absolutely perfect.

During our journey of seeking a pregnancy, which I can assure you was probably the most difficult time of our lives, we would have gladly adopted at any time if it was a realistic option; in fact, we explored it. As members are probably aware, in addition to that both my wife and my father are actually adopted themselves. It is a fact to say that if they had been born post the passage of the abortion legislation that currently exists, there is a fair chance, at least it is possible anyway, that they would have been aborted and they would not exist today.

Of course, that also means that I would not have existed, nor my daughter or any of her potential descendants. Perhaps that paragraph alone sums up my strong view that adoption should be a realistic and a viable option in use today, but the truth is it is very, very difficult to adopt a child under the current legislative regime, whether it be local, because they are basically none available, or from overseas.

In 2009, former US President Barack Obama, in a seminal speech on abortion at the University of Notre Dame, spoke of the common ground between the pro-life and pro-choice movements. He was absolutely clear in his position that he is in the so-called pro-choice camp. With his usual eloquence, he said, and I quote directly:

Maybe we won't agree on abortion, but we can still agree that this [is a] heart-wrenching decision for any woman [to make, with] both moral and spiritual dimensions.

So let's work together to reduce the number of women seeking abortions [by reducing] unintended pregnancies [and making] adoption more available [and providing] care and support for women who do carry their child to term.

I wholeheartedly agree with that sentiment. In forming part of that common ground that President Barack Obama mentioned, I hope that we as legislators can work to reduce the number of abortions carried out in South Australia and provide the necessary information and resources to promote and facilitate adoptions, foster care or other options.

I say to members, whether you sit in either of the so-called pro-choice or pro-life camps, that I hope we can agree that it is good public policy to reduce the number of abortions being carried out in South Australia. Each year, we have approximately 4,300 to 4,400—around that—abortions in this state, which works out to roughly 17 per working day or around about 85 each week. How many more will be performed if these measures are passed?

As I said in my opening, I just simply do not know. I do not know, but one could hardly expect that these measures will result in a reduction in abortion numbers, and that will not help adoption numbers either. I ask members to consider if this bill is genuinely the right way forward, given that circumstance. Should other options, like a genuine attempt to encourage adoption, be considered?

I submit that adoption and foster care are sometimes viable alternatives to abortion, and it is important that women seeking abortion have a clear understanding of these alternatives. Of course, individual circumstances need to be considered, but surely women should at least have the opportunity to consider the possibility of adoption and foster care and how it may work in their circumstances.

When former Attorney-General Robin Millhouse introduced and implemented abortion law reforms in South Australia about 50 years ago, his intent was for a qualified doctor to be able to perform an abortion to preserve a woman's life or her mental or physical health, actual or reasonably foreseeable, or in cases of possible foetal abnormality. He would go on to lament the broad interpretation of the law by the medical and legal professions. Millhouse was quoted in SA Weekend,published on 15 August 2014:

I deeply regret that the medical profession—and the lawyers—interpreted the law too widely…We've got abortion on demand. I have taken the rap for it. It is something I regret.

Looking at the broader picture, I think it is important that we consider the context in which we find ourselves in modern Australia. Fertility rates are on the decline in our nation and have been for many years. Australia has a fertility rate of 10.2 per 1,000 teenage women and girls aged 15 to 19, and that rate continues to fall. Further, Australia still has a marginally higher rate of unintended pregnancy than is found in some similar countries within the OECD.

As we are all aware, unintended pregnancy has been dealt with in recent decades in large measure, though not exclusively, through abortion, and to some degree that number largely accounts for the approximately 17 or so abortions carried out in South Australia every working day.

While we have declining fertility rates, perhaps counterintuitively, we also have currently plummeting adoption figures. In fact, today one in six couples is considered infertile for one reason or another. Very many of them would wish to parent a child. The sad fact is that, despite the large number of couples who are unable to conceive a child—about one in six—and the fact that many of them would love a child to adopt, the number of local adoptions in South Australia has fallen dramatically in recent decades. I say it is a sad fact because adoptive families provide children with the permanence and security they need to develop and thrive. There are many parents who are desperate to adopt and have a family.

As I have already stated, in my own family both my father and my wife were successfully adopted and have gone on to lead successful, productive lives. Just as a point of interest, neither has ever sought to meet with their biological parents, incidentally. As far as they are concerned, their adoptive parents are their parents, full stop. As people with lived experience of being adopted, they are advocates for it and reject the argument sometimes used that adoption is overly difficult for the child. As my father has sometimes said to me jokingly, it is much better than the alternative.

That said, adoption is a very difficult process in South Australia. This is reflected in the steady decline in adoption numbers. In 1970-71, there were some 879 children legally adopted in South Australia. In 1987-88, there were 416 adoptions in South Australia. In 2008-09, there were only 35 finalised adoptions in South Australia and only one—just one—local child was placed for adoption in South Australia in that year. In 2011-12, there were just 24 adoptions in total. Of those 24 adoptions, 23 were from overseas and the other one—again, just one—was adopted by a relative locally in South Australia.

In both of these years, there was just one single adoption. There are several others; I am not cherrypicking the data. Members who are across this data would know that the numbers of adoptions in South Australia are very low every year, almost always for local babies below 10 and often below five. In both of these years that I have quoted there was just a single adoption, but of course in all of those years there would have been thousands of abortions in South Australia.

Despite the very low numbers of adoptions in total, the overwhelming majority of these low numbers of adoptions now occurring are from overseas and, in many cases, are prohibitively expensive for many of the prospective parents involved or those who simply want to adopt. I am told that parents who want to adopt a child from overseas often find the application process too costly. In addition, the process does not always lead to a successful adoption anyway, despite a significant financial commitment regardless of the outcome.

Simply, the barriers are seen as too difficult to proceed by many prospective parents, and thus the low number of adoptions of overseas children that we see as well. I can testify to that from personal experience. During that time, my wife and I looked into a local adoption, which was our first consideration, but we were told that there were no children available. Then, when we looked at overseas adoption, the costs easily ran into many tens of thousands of dollars, but our calculation was that it was going to be closer to $60,000, $70,000, $80,000. I am told that that may be slightly reduced today.

It is important to recognise that, as well as the social benefits of having a family and the social benefits that adoption would provide to our community, there are also significant economic benefits to the state and nation in promoting childbirth. It is significant to note that in the early seventies, 31 per cent of the population was 15 years or younger. Now it is approximately 19 per cent—so it was 31 per cent and now it is 19 per cent.

Over the same period, the percentage of those aged 65 or over has climbed from 8 per cent to 16 per cent and is projected to reach 25 per cent of the population before 2040, so one in four people at or beyond retirement age in just 20 years' time from now. The economic implications of this are obvious. Without question this has profound economic implications. Indeed, I understand that our health budget is nationally increasing by around 7 per cent per annum now and in no small part due to the much higher costs of our ageing population. This can only be exacerbated as the population continues to age.

The fact is that Australia's population will age markedly over the next decades without a substantial increase in the birth rate. This is due to both the increased longevity of life—that is, people are living longer—and lower birth and fertility rates. Consequently, there is relatively little that can now be done to avoid the population dynamics currently unfolding unless we have fundamental change. More babies born and fewer abortions, in my view, form part of that solution. It would decrease the average age of South Australians and increase our population numbers.

The Australian Bureau of Statistics estimates that the resident population of South Australia as at 31 March this year—and they are very precise with their estimates—is 1,767,247. That is an increase of 17,882 since the exact same day the previous year, at an annual growth rate of just over 1 per cent—1.02 per cent. Australia's growth rate over the same period was 1.41 per cent, so South Australia continues to be a declining percentage of the nation's population.

Population growth is driven by natural increase; that is, births and net migration, both overseas and interstate. Net migration contributed 72 per cent of South Australia's population growth in the 12 months to March 2020, and strong positive overseas migration has helped to counter South Australia's interstate population losses. With declining fertility rates and an ageing population, as I mentioned before, we are heading for economic consequences that will have implications. Former federal Minister for Immigration Arthur Calwell's catchcry, 'Populate or perish', I believe still rings true today.

Against this backdrop, since 1970 there have been approximately 220,000 abortions in South Australia. Based on the 2015 ABS data, had these 220,000 babies been born this would have equated to around 2,530 additional births in just that year—that is, 2015—alone. Clearly, thousands more births every year over nearly 50 years results in literally hundreds of thousands of extra and, importantly, younger South Australians.

Our population would, in those circumstances, well exceed two million people. Rough statistics indicate that in the order of 2.1 million to 2.4 million people would be the population figure for South Australia today, depending on how many children those children had. The average age of South Australians would also be substantially reduced, thus reducing the impact on the health system.

The resulting demographic shift would be compelling, heavily reducing the percentage of our ageing population and resulting in a substantially younger average age of South Australians, with a resulting increase in younger, productive, taxpaying South Australians, as well as a substantial decline in associated health costs. There are many positives.

This would also contribute significantly towards the government's policy objective of population growth. South Australia has consistently had the lowest level of population growth of all mainland states for many years now. Although this has shown improvement in recent times, the long-term solution, or at least part of it, is more adoptions and less abortions. I have laboured that point so I will turn to the bill itself and some of the details of the bill, and the difficulties I have with it.

If the intention of the bill, as I stated at the outset, was simply to move all provisions regarding abortion away from the Criminal Law Consolidation Act, as has been stated and argued, then as I said I would likely support it. I would need to see the detail but in principle I would support it. But the bill in its present form goes much further than that and way too far, in my view.

What concerns me greatly is there is no specific upper limit for gestation. The current act, as it stands, does have an upper limit of 28 weeks, and regarding that 28 weeks there are certain circumstances where abortions can be performed beyond it, but in practice they rarely happen. But there is what you might call a soft limit—perhaps is the best way of putting it—at 28 weeks, but in this bill there is no upper limit for gestation.

I will get to some of the details in a moment, but I am also deeply concerned that this bill does not rule out private providers operating abortion clinics in South Australia. If abortion is to become a profit-making industry in South Australia via the entry of private, non-government operators, it surely realises Robin Millhouse's greatest concern. I believe it must remain under the jurisdiction of government, and this bill does not ensure that it does, and that, for me is a significant issue.

There are amendments, which I have noticed have been filed, to deal with a number of issues, and I believe that they give the bill a better balance, and I intend to support them. I will touch on two in particular. The first one deals with prescribed hospitals and outlines the meaning of what a prescribed hospital should be. As I understand it, this amendment will provide that all abortions performed on a woman who is more than 22 weeks and six days pregnant are performed in a hospital.

This is a measure that will go part of the way to ensuring that abortions do not become a business where profits are derived with an abortion industry formed in South Australia. I would respectfully suggest that even those members who are inclined to support this bill consider supporting this amendment in order to prevent the access of private abortion providers to South Australia and the creation of an active market where private operators have a financial incentive to increase abortion numbers.

I will read the other amendment. It is amendment No. 3 and states:

(a) the medical practitioner considers that, in all the circumstances—

(i) the termination is necessary to save the life of the pregnant person or save another foetus; or

(ii) there is a case, or significant risk, of serious foetal anomalies associated with the pregnancy that are incompatible with survival after birth; and

(b) a second medical practitioner is consulted and that practitioner considers that, in all the circumstances—

(i) the termination is necessary to save the life of the pregnant person or save another foetus; or

(ii) there is a case, or significant risk, of serious foetal anomalies associated with the pregnancy that are incompatible with survival after birth; and

(c) the termination is performed at a prescribed hospital.

I believe this is a critical amendment, as it will ensure abortion will only take place in clearly defined circumstances. It ensures abortions can only be carried out on a woman who is more than 22 weeks and six days pregnant to save the life of the pregnant woman or to save another foetus or if there is a case or significant risk of serious foetal anomalies associated with the pregnancy that are incompatible with survival after birth. I also support that amendment.

Turning to other issues, the potential and indeed in some cases actual impact on the mental health of women experiencing abortion has been outlined in 2018, when Cambridge University published online the findings of quantitative synthesis and analysis by peer-reviewedmedical journal The British Journal of Psychiatry. This looked at extensive research into abortion and the mental health implications from 1995 to 2009.

This review cannot be easily dismissed, as it is published in what is widely regarded as one of the world's leading psychiatric journals, and it is the largest ever quantitative estimate of mental health risks associated with abortion in worldwide literature, full stop. The review found that 10 per cent of the incidence of mental health problems were shown to be attributable to abortion, and women who had undergone an abortion experienced an 81 per cent increased risk of mental health problems. I quote directly from their paper:

This review offers the largest quantitative estimate of mental health risks associated with abortion available in the world literature. Calling into question the conclusions from traditional reviews, the results revealed a moderate to highly increased risk of mental health problems after abortion. Consistent with the tenets of evidence-based medicine, this information should inform the delivery of abortion services.

As I said, this is a highly reputable publication and one that no doubt has gained significant attention worldwide. Those are not my words, of course, but those of a highly credible medical publication outlining the biggest work ever of its type. At the very least I would argue that this requires reflection.

I appreciate that this is not a pleasant subject for me to be outlining, and I do not do it to sensationalise the issue in any way, but I believe it is legitimate to argue that a woman seeking abortion must be provided with this information. After all, it is their body, and they should fully understand what is being done and the possible implications.

What I am saying is that a greater emphasis should be placed on information, and details about adoption and foster care options should also be provided, information that could be provided by the Department for Health in an impartial manner. Surely with more information in general better decisions will be made.

My submission is that the very act of providing information such as I have just outlined, and about alternatives, can open a valuable dialogue between the doctor and the pregnant woman during the process. Any coercion or any other unfair influence on the woman can be discovered, addressed and dealt with appropriately.

Indeed, one very troubling statistic I have come across from research in preparing for this speech today was in the United Kingdom, carried out in May 2008. That study stated that over 50 per cent of British women felt that they had, in their words, 'no choice' in deciding to have an abortion. I believe this should almost never be the case, and an open dialogue about options would surely help those women who feel in their own words that they have no choice. They should be given a choice.

These are some salient facts about the unborn child, revealed by recent scientific developments, which I also believe cause pause for thought for all of us. According to the well-known and I would say well-regarded Cleveland Clinic in the US, in the stages of pregnancy—and they are looking specifically at weeks nine to 12—quoting directly from their website, they say:

Your baby's arms, hands, fingers, feet and toes are fully formed. At this stage your baby is starting to explore a bit by doing things like opening and closing its fists and mouth. Fingernails and toenails are beginning to develop, and the external ears are formed. The beginnings of teeth are forming under the gums. Your baby's reproductive organs also develop by the end of the third month, your baby is fully formed [by the end of the third month]. All the organs and limbs (extremities) are present and will continue to develop in order to become functional. The baby's circulatory and urinary systems are also working and the liver produces bile.

That is just at 12 weeks. As I mentioned previously, abortion is an issue that brings out substantial levels of passion in people, not surprisingly. You do not meet many people who are genuinely on the fence on this issue, if I can put it that way. Generally, people tend to have strong feelings either way. Nevertheless, I believe that, rather than encouraging the option of abortion and passing laws to make it more accessible, an emphasis on the benefits of avoiding abortion, where possible, is appropriate. These benefits are far-reaching and can facilitate the possibility of adoption, resulting in strong population growth and an increase in family numbers, while reducing the pressure on our health system by reducing the average age of South Australians.

In an environment of declining fertility rates, ageing populations and it being almost impossible to adopt a locally born baby, this not only has personal costs for those involved but it can be argued that the economic costs alone of high abortion numbers are substantial, in addition to the personal and human costs, which can also be very significant. For the reasons I have outlined, I will not be supporting the bill.

The Hon. C. BONAROS (11:47): I rise to speak in support of the second reading of the Termination of Pregnancy Bill 2020. I quote:

The moral and physical wellbeing of people should be the fundamental basis of all law making. Party considerations, class interests and self seeking should have no place in the creed of the true politician.

With the best interests of the nation at heart he should legislate with justice to all, though that justice might not be unanimously demanded or might be in some cases received with indifference.

It frequently happened that those suffering from injustice were the last to assert their rights. A long period of oppression blunted even the keenest sense of justice.

If they believed the artist, lawyer, and physician were each the best judges of their own craft, were we not obliged to admit that the woman was the best judge of the legislation which related particularly to herself?

These words were spoken in this place on 8 November 1894, during the landmark debate on legislation enabling women to vote and stand as members of parliament, a first in Australia. They are still as pertinent today as they were 125 years ago because, as we have said in this place time and again, so often the more things change the more they remain the same.

I want today to speak about the role we play in this debate, that professionals play in this debate, because by their very nature professions like the legal profession, that of MPs and the medical profession generally are held to a higher standard than many other workplaces. We take oaths, we promise to adhere to high standards and enforceable codes of ethics that require behaviour and practice beyond the personal moral obligations of an individual, and we demand high standards of behaviour in respect to the services provided to the public and in dealing with our own professional colleagues.

We hold ourselves out and are accepted by the public as possessing special skills and knowledge based on years of education and training, and we use those skills in the interests of others. Those standards that apply to our medical profession, our doctors and our clinicians armed with the task of providing health care, with preventing illness and saving lives, and with watching lives lost each and every day, are amongst the highest of all. Any suggestion, any implication or any inference that somehow this bill will seek the very same doctors and clinicians who dedicate their lives to their patients to suddenly move away from those standards and ethics and treat the termination of a pregnancy with any less importance is frankly offensive.

As a legally trained professional, I too have undertaken to adhere to similar standards, and I take those undertakings seriously. As I have said in this place previously, I do not consider my role in this place as one that requires or expects me to vote according to any personal beliefs, whatever those personal beliefs might be. It saddens me that this is even contemplated and discussed in the community, because by its very nature my legal training expects differently of me, just as it requires differently of my colleagues who practise in the law.

You do not refuse to represent a client because they have committed a crime; you do what the law requires of you to do, you do what you signed up to do. You represent your client to the best of your abilities without judgement, without bias and without the imposition of any personal, religious or moral beliefs. My personal views, whether supportive or otherwise, are irrelevant.

I accept and I appreciate the very strong views of all members of this place. I appreciate and can relate to stories like the one that was just told to us by the Hon. Dennis Hood regarding the difficult position men and women are often put in when it comes to much-wanted pregnancies. I have no doubt that many of us have experienced those very similar sorts of situations, but it is precisely for these reasons that I, like other members of this place, supported the referral of the bill to SALRI.

As a legally trained legislator, I will be guided by that body of work in terms of the vote that we have on the bill. There is no question, absolutely no question, that the termination of a pregnancy is a public health issue. That has been well established by the experts. It does not matter what we think. Our decision-making should and must be guided by the professional views of those experts who are in the know. We are not the experts here but we do have a responsibility to listen to those experts.

This bill is consistent with SALRI's recommendations, namely that the termination of a pregnancy should be largely removed from the criminal law jurisdiction and be placed in public health law and practice. That does not mean that an abortion or a termination of pregnancy that is undertaken in a way that is not fitting with the law will not be treated or dealt with under our criminal law provisions.

If an abortion is illegal, if it is conducted in a means that does not adhere to those laws, then of course our criminal law will have a role to play. As I said yesterday, the decision of whether or not to bear a child is central to a woman's life, to her wellbeing and to her dignity, and nothing in this bill, absolutely nothing in this bill, will prevent a woman to carry through with a safe and wanted pregnancy—nothing.

By the same token, choosing to terminate a pregnancy is never an easy decision. It can be heartbreaking. As I said yesterday, it can mean the end of a much-wanted pregnancy. It can mean the difference between life and death for a woman. It can mean a life of emotional turmoil. It can mean having no choice at all. And of course it can mean mental health implications. In fact, it is inevitable that in many cases—maybe even most cases—it will result in such implications. It is hard to fathom that it would not have these implications when there is a much-wanted pregnancy in question.

We know when a foetus is fully formed; we do not need to be advised. Any person in this place who has given birth to a child or who has experienced pregnancy up to any stage knows what it feels like from day one to day dot. We know what it feels like at one month and two months and three months and four months and five months and six months and seven months and eight months and nine months, if that is the choice that we make.

It can mean so many different things for so many different women. The bottom line is, and will always be, that these are not easy decisions and they are not easy choices, and sometimes you will feel like you have absolutely no choice at all. However, they are choices that are afforded to us, and they should be done so as fairly and equitably as possible. In this instance, treating the termination of a pregnancy and abortion as a public health issue aims to achieve just that.

The Hon. N.J. CENTOFANTI (11:56): I rise today to speak on this bill and to indicate that I will not be supporting it in its current form. As a woman and a mother, there are several elements of the bill that I find very concerning, first and foremost the removal of gestational upper term limits on the termination of a pregnancy.

Before outlining my opposition to this bill in its current form, I would like to state for the record that I am not against the move of the abortion legislation away from the Criminal Law Consolidation Act and into its own standalone health act. It is my understanding that in the last 50 years no woman has ever been prosecuted for accessing an abortion. What I am against are the changes to allow lawful abortion up to birth. I also have concern with some of the early medical abortion legislation changes, particularly around rural and regional women and duty of care.

Current legislation allows for termination up until proof of foetus or viability of a foetus, which is defined in the act as 28 weeks. This can be done on grounds of physical or mental health of the mother or if the baby has such abnormalities that it is deemed to be severely handicapped. At over 28 weeks of gestation, abortion is illegal, except in circumstances where it is done in good faith to preserve the life of the mother. This is because society recognises that the baby is viable, feels pain and is capable of living externally, independent of its mother.

Over a number of decades we have reached the point where, due to advances in medical technology, the threshold of viability has shifted from 28 weeks to 22 weeks and six days. In fact, according to the Department for Health, the chance of survival in a baby born between 23 and 24 weeks of age who receives intensive care is 50 per cent. The new legislation correctly identifies the fact that the viability of a foetus occurs not at 28 weeks but at 22 weeks and six days. I commend the Attorney-General in the other place for acknowledging and recognising this important factor.

The bill also removes subsection 7, which states that it is illegal to abort a child after proof of foetus or viability, except to save the life of the mother. It will no longer be an offence to have an abortion at any stage up until birth for reasons that a medical practitioner deems as medically appropriate. This broad term poses significant risks that medical practitioners may be pressured to perform late-term abortions due to psychosocial reasons. The reality is that, although the percentage of terminations in South Australia post 20 weeks is small, in 2017 a total of 49.5 per cent of these were for psychosocial or mental health reasons.

When speaking on the radio about the bill, the Attorney-General spoke about possible situations when late termination is required. I would like to bring this to the attention of the chamber, as I feel there needs to be some clarification on the definition of pregnancy termination and I feel the bill does not address this appropriately. The bill defines termination as:

an intentional termination of a pregnancy in any way, including, for example, by—

(a) administering or prescribing a drug or other substance; or

(b) Using a medical instrument or other thing,

What this bill does not define or rather fails to recognise is that there are two clinically and ethically distinct ways of terminating or ending a pregnancy. The first method is abortion, where the mother and baby are separated with the intention of producing a dead baby. The second method is early delivery, where the mother and baby are separated with the intention of producing a live baby. Both of these methods are terminating a pregnancy, but one produces a very different outcome from the other.

When asked about whether late-term abortion can occur if necessary for the physical and mental health of the mother, the Attorney-General said:

It is possible…the medical practitioners are the ones who identify whether there's risk to the health of the mother…there are two exceptions where occasionally this is called upon, one is where the life of the mother is at risk and that will be maintained in this legislation and if the life of another foetus is at risk and I think what people don't always appreciate it's not women who go along to say suddenly I realise I don't want to have a child and I'm seven months pregnant, it's actually a circumstance for example they might have…twins and the medical assessment is that one's at risk and therefore [to] save one [a] termination needs to be at least considered…

I do know that this situation does occur from time to time. As a mother who has carried twins previously I am aware of the number of risks that twin pregnancies can have, such as Twin to Twin Transfusion Syndrome. However, I would argue that in this situation there are several advanced medical procedures that can be effected to assist one or both foetuses or an induction of labour would be the likely resolution, where both babies can be delivered by caesarean and cared for in the appropriate medical setting.

I think we need to be very careful in the use of our language when debating this bill because the early induction of labour or preterm delivery via caesarean to be able to care for these children in a controlled, safe and outside environment is very different from the termination of the life of a child by means of lethal injection before dilatation and evacuation of that child.

However, I do understand that there may be very tragic circumstances that can occur in a pregnancy, circumstances in which an abnormality may be picked up, particularly between weeks 20 and 26 of pregnancy, with twins that may mean that it is necessary to terminate the life of one baby in order to save the life of another.

The current legislation already allows for this up to 28 weeks. However, as the bill identifies that foetal viability begins at 22 weeks and six days, I think there needs to be provision for this. My understanding is that this is not common and there are usually advanced medical procedures that can be attempted in utero, but I do think there needs to be a specific provision for this for those cases that are perhaps at 23 weeks of pregnancy, where a medical condition provides significant risk for one or both of the babies and which cannot be helped in utero.

That is why I will be moving an amendment to section 6 of the pregnancy termination bill to allow for termination of a pregnancy for a person who is more than 22 weeks and six days pregnant if two medical practitioners are consulted and consider that in all the circumstances the termination is necessary to preserve the life of the mother or to save another foetus. When abortions are performed to save a woman's life or the life of another foetus, there needs to be a distinct intention that one life must be saved to prevent the loss of both lives.

I also acknowledge and understand that there are some terrible, awful situations where congenital or other anomalies may be picked up at a later time during gestation, say in the second trimester, anomalies or abnormalities that are not compatible with life. In these such situations, parents may need to make a heartbreaking decision to terminate the pregnancy. I understand that these are tragic circumstances and this is also acknowledged in my amendment to section 6 that allows for a termination after 22 weeks and six days if there is a case of significant risk of serious foetal anomalies associated with the pregnancy that are incompatible with survival after birth.

Whilst in some extenuating medical circumstances late-term abortions are necessary, they should never become routine. Many members in this chamber claim that they will not become routine. I reply: let's ensure they do not by legislating for those situations that require it but maintaining the protections for those situations that do not.

Twenty-two weeks and six days is five months through a pregnancy and I would argue that that is plenty of time for a woman to make a decision as to whether they want to continue on with the pregnancy or not, and for those circumstances where that does not occur before 22 weeks and six days, there are other options for these women, such as adoption.

There are many published risks to a woman associated with late-term abortions, including uterine perforation; Asherman's syndrome, where there is scarring inside the uterus and cervix leading to reduced future fertility; retention of the placenta or foetus, known as incomplete abortion; excessive bleeding or haemorrhage, leading to the requirement for a blood transfusion; infection or sepsis; and general anaesthetic and operative complications, not to mention the studies published on the post-traumatic stress disorder associated with late-term abortions in women.

Two large-scale quantitative research papers, S.V. Faufberg's paper, 'Abortion complications' and L.A. Bartlett, C.J. Berg, H.B. Shulman et al.'s paper, 'Risk factors for legal induced abortion-related mortality in the United States', have revealed that second trimester and third trimester abortions pose the most serious risks to women's physical health compared to first trimester abortions. The abortion complication rate is 3 per cent to 6 per cent at 12 weeks to 13 weeks gestation and increases to 50 per cent or higher as abortions are performed in the second trimester.

Another significant quantitative study was done entitled 'Late-term elective abortion and susceptibility to posttraumatic stress symptoms' by Priscilla Coleman, Catherine Coyle and Vincent Rue. The purpose of this study was to test the hypothesis that women who undergo second and third trimester abortions would be more traumatised than their peers who experience first trimester abortions, as evidenced by significantly higher rates of PTSD symptoms.

After instituting statistical controls for race, marital status, formal education, number of abortions, number of years since the abortion, mental health counselling and hospitalisation for emotional problems before the abortion, meaningfulness of the respondent's religion and a childhood or adult history of physical or sexual abuse, all of the group differences were in the hypothesised direction but only a few were statistically significant.

Specifically, the difference in intrusion sub-scale scores was statistically significant. Intrusion involves an increased tendency to have persistent or unwanted re-experiencing of the traumatic event in the form of recurrent or distressing memories, flashbacks and hyperreactivity to any stimuli associated with trauma.

In addition, when individual PTSD items were examined, the late-term group was found to report more disturbing dreams, more frequent reliving of the abortion and more trouble falling asleep. The study also found that 52 per cent of those women who had had early abortions had PTSD, while 67 per cent of those who had late-term abortions, defined as second and third trimester abortions, had the disorder, thus, those women having late-term abortions were more likely to experience severe anxiety.

There is also the psychological impact on the healthcare team in the provision of a late-term abortion involving foeticide. A recent article about foeticide and late termination of pregnancy in the magazine of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists stated:

One infrequently discussed aspect of late abortion is feticide, where specific interventions occur to ensure the death of the fetus prior to expulsion. Unintended live birth after abortion can be emotionally difficult for many (although not all) women and poses difficulties for health professionals, both in terms of process and emotion.

In general, feticide is performed by ultrasound specialists who have skills in accessing the fetal circulation to instill intracardiac potassium chloride…or intrafunic lignocaine, resulting in cessation of fetal cardiac activity prior to the commencement of the termination procedure.

It goes on to say:

Little consideration has been provided to the psychological impact on the healthcare team in the provision of a feticide service…

The bill does have a clause relating to registered health practitioners being able to conscientiously object to performing or assist in performing a termination, as does the existing legislation. However, I have concerns about regional or remote medical practitioners who are already under pressure to perform additional procedures, given their locations.

If a woman presents to a rural medical practitioner for a late termination procedure, who has a conscientious objection to abortion and perhaps is the sole doctor in the region, and she says to that doctor, 'I have no mode of transport. I cannot afford to travel. You are my only hope,' what is the medical practitioner supposed to do? Is he or she not bound by a duty of care? These are questions I would like answered in this bill. In the AMA's statement of conscientious objection, they state under point 2.4, and I quote:

The impact of a delay in treatment, and whether it might constitute a significant impediment, should be considered by a doctor if they conscientiously object, and is determined by the clinical context, and the urgency of the specific treatment or procedure. For example, termination of pregnancy services are time critical whereas other services require less urgency (such as IVF services).

This highlights the significant pressure on rural and regional GPs, as it seems to suggest that, if there is not a convenient, timely alternative option for a patient, the GP should reconsider his or her conscientious objection.

My other concern with this bill is its ability to allow a registered health practitioner, who is not a doctor, to prescribe the drugs Mifepristone and Misoprostol—or the MS-2 Step, as it is so often referred to—for at-home abortions without the clear need for a medical practitioner's input. Part 2, section 5(1)(b) states:

(1) A termination may be performed on a person if—

(b) in the case of a termination performed by any other registered health practitioner acting in the ordinary course of the practitioner's profession—

(i) the termination is performed by administering a prescription drug…

(ii) the termination is performed on a person who is not more than 63-days pregnant; and

(iii) the registered health practitioner is authorised to prescribe the drug under section 18 of the Controlled Substances Act 1984.

When you look at who is able to prescribe a prescription drug within the Controlled Substances Act 1984, it states that this person may be a medical practitioner but also can be a nurse practitioner or a pharmacist. I have concerns with a nurse practitioner or a pharmacist being able to prescribe these drugs without the requirement for a medical practitioner to deem it safe to do so.

The Hon. Tammy Franks, in her first reading speech of the Statutes Amendment (Abortion Law Reform) Bill, spoke about the lack of access to medical abortions for rural women and the barriers to their health care. I wholeheartedly agree with the honourable member: when it comes to regional health care, it is well-known that those of us in the country face challenges with distance when accessing health care. However, it would be irresponsible for members in this place to support convenience over best medical practice for rural women.

Under the proposed legislation, there are no safeguards to ensure that a medical practitioner has deemed a pregnancy termination to be safe. This is paramount. According to the TGA, there are a large number of situations or contraindications when the MS-2 Step should not be prescribed, which requires obtaining a thorough medical history. These situations include: if there is a suspected or confirmed ectopic pregnancy, if there is an intrauterine device present, if there is an uncertainty in gestational age, in a situation where the mother may be suffering from chronic adrenal failure, if the mother is on long-term corticosteroid therapy, and if the mother has a coagulopathy or haemorrhagic disorder or is taking anticoagulants for another condition—to name a few.

Therefore, for the health and wellbeing of these rural women, it is critical that a medical practitioner performs a thorough examination of these women and performs or assesses an ultrasound to ensure that there are no complicating factors before the prescribing and administration of both mifepristone and misoprostol.

This is why I will be supporting an amendment to the legislation to ensure that any termination by a registered health practitioner is done only after a medical practitioner has determined that the termination is safe to do so, because this really is about the duty of care to these women and ensuring that medical procedures are conducted in a safe manner. Importantly, the TGA guidelines for the MS-2 Step state:

MS-2 Step should only be prescribed by doctors with the appropriate qualifications and certified training. Ectopic pregnancy should be excluded, an IUD…must be removed, consent must be obtained and patients must have the ability to access 24-hour emergency care if and when required for incomplete abortion or bleeding.

In addition, the current recommendations from SA Health on termination of pregnancy in the first trimester is that women should not undergo a medical abortion if they live more than one hour away from emergency services such as an ambulance service or a hospital. I believe this is sensible and should be stated in the legislation to avoid any doubt.

Many rural and remote communities have limited access to emergency services. Being a woman and mother living in the country, I am acutely aware that, whilst we must look to provide better services in the regions, we must also ensure that these services are safe. We, as members of parliament, have a duty of care to ensure the safety and wellbeing of our citizens and communities.

SA Health also currently advise that the woman needs to have adequate support for the process, including a support person to drive her home and/or return to the hospital via car or ambulance in the case of profuse bleeding necessitating urgent treatment. They also state that the woman must be advised that, if she has heavy bleeding, she must present to the emergency department for urgent assessment and that urgent dilatation and curettage may be required. Whilst I understand that these complications are not common, they can and do occur and, again, it is why it is necessary that we legislate that a woman should not undergo a home abortion if they are more than 50 kilometres away from a hospital or ambulance service.

During commentary about this legislation before us, much credit was given to the then Attorney-General, the late Hon. Robin Rhodes Millhouse QC, on his so-called progressive reform of abortion laws in 1969 in South Australia. Whilst at the time the reform was popular, I would like to quote the late Mr Millhouse from an article written in The Advertiser from 2014, entitled 'Robin Millhouse's regret'. After 45 years of carrying a growing burden, the Hon. Mr Millhouse QC confided:

I deeply regret that the medical profession—and the lawyers—interpreted the law too widely. It has become abortion on demand. I did not intend it to be that…I have taken the rap for it. It is something I regret.

This interview is pertinent, as it is a direct admission of how the intent of legislation is often not the reality. It is our job as members of parliament but particularly as members of the Legislative Council to scrutinise the legislation to ensure that the practical outcomes of a bill are what is expected and intended.

Most of us know someone who has been confronted with the decision of whether to terminate a pregnancy. It is an incredibly difficult decision. But the decision facing the parliament is not about access to early terminations which are currently provided in a safe medical environment and should continue to be done as such; it is a decision about the ethical and moral implications of late-term abortion not associated with specific extenuating medical circumstances. Whilst I agree that the abortion laws need reform to reflect the advances in medicine, we must as leaders always remain focused on protecting those who do not have a voice.

The Hon. S.G. WADE (Minister for Health and Wellbeing) (12:19): I rise to speak on the Termination of Pregnancy Bill 2020. I thank the Attorney-General and the Minister for Human Services for their hard work in developing the bill and bringing it before the parliament. This bill is a conscience vote for the parliamentary Liberal Party; accordingly, I do not speak for any other member.

As a Christian, I know that many Christians and people of other faiths consider abortion to be the taking of a human life and a grave moral offence. However, other citizens, including other Christians, hold dramatically different moral perspectives. We live in a pluralist society, and in 1969 our state decided that, despite the diversity of moral perspectives, abortion would be legally available in this state.

Since 1969, successive state and federal governments have provided funding to make abortions widely available through public health services. My assessment is that there is minimal public support to step away from this pluralist position on abortion to impose a single world view on the issue. I see minimal support to legally prohibit abortions or to withdraw funding from termination of pregnancy services. In the context of this broad consensus, parliament needs to ensure that, given that termination of pregnancy services will be broadly available, they should be available on an equitable basis to all citizens.

South Australia was the first Australian state to liberalise abortion laws. In the 50 years since, abortion services have changed dramatically; our laws have not. As a result, South Australian abortion laws are the most out of step with current healthcare practice than any other Australian jurisdiction. The Termination of Pregnancy Bill before us both reflects current best clinical practice and removes unnecessary barriers to access.

Within health care 'access' is defined as access to a service, a provider or an institution, and it is one of the overarching principles that is central to the performance of healthcare systems the world over. The current South Australian system for termination of pregnancy restricts women's access to health services, in particular that of women who live in regional South Australia. As the Minister for Health and Wellbeing in South Australia, I am committed to enabling all South Australians to achieve good health and overall wellbeing so as to maximise their potential and to live their lives with dignity and lives of their own choosing.

The present law in South Australia relating to abortion is founded within the Criminal Law Consolidation Act. In February 2019, the Attorney-General commissioned the South Australian Law Reform Institute to inquire into and report on South Australian abortion law. SALRI put 66 recommendations for modernisation of the law, and this bill reflects the SALRI report recommendations and was introduced into this place on 14 October.

The bill seeks to do several things. The key change proposed is to remove abortion from the criminal law and to treat it as a healthcare issue. As Minister for Health and Wellbeing, I consider that abortion needs to be regulated but I do not think that it is appropriate that the regulation should be under the criminal law. A person seeking a health service permitted by law and funded by the state, or a person providing a health service permitted by law and funded by the state, should not be at risk of being declared a criminal. The state needs to provide abortion as a health service and to regulate it as a health service in health law not criminal law.

Secondly, the bill significantly improves equitable access to health services by removing the requirement for terminations to be carried out in a prescribed hospital. Currently, South Australian laws do not distinguish between surgical and medical abortions and require both to be provided in a prescribed hospital. When the current legislation was enacted, surgical termination of pregnancy was the only available method and was only available in hospital facilities. In that context, the law supported safety by imposing a legislative requirement that terminations could only occur in prescribed medical facilities.

Now, 50 years later, women have the option of terminating a pregnancy medically. Medical terminations involve taking two medications orally, 24 to 48 hours apart. The medications used are Mifepristone and Misoprostol. The procedure is more commonly referred to as MS-2 Step. There is no healthcare need for a medical termination to occur in a prescribed hospital.

Thirdly, the bill improves equitable access by allowing the use of modern healthcare pathways. The current legislative requirement for in-person examination of women seeking a termination is inconsistent with contemporary developments in current medical practice and precludes the use of telemedicine. Clinical studies have shown that telemedicine is not inferior to in-person provision for non-surgical terminations of pregnancy.

Fourthly, the bill improves equitable access by allowing early medical terminations to be approved by a single health practitioner. Currently, South Australia is the only Australian jurisdiction that requires two doctors to examine a woman prior to the termination of pregnancy at any gestation. The bill removes this barrier to access, as it is unnecessarily onerous in the context of modern healthcare practice. In addition, this requirement prejudices women in regional South Australia, where there are fewer doctors available to provide termination of pregnancy services.

Data from 2017 highlights this issue: 99.3 per cent of women residing in metropolitan Adelaide region had their termination in a metropolitan hospital, either private or public, yet only 16.3 per cent of women residing in country South Australia had their termination in a country hospital, with most rural-dwelling women travelling considerable distances to metropolitan Adelaide.

Women in rural areas experience significant emotional cost and are further burdened by monetary costs of travel and accommodation away from home. These hurdles for women in non-metropolitan areas can lead to delays in accessing early medical termination and result in otherwise avoidable surgical terminations. Removing the need for a prescribed hospital, allowing alternative pathways and removing the need for a second doctor collectively make services significantly more accessible for women.

I want to be clear that, as health minister, I consider that termination of pregnancy should be regulated to protect the safety of health care for women. The bill provides a solid legislative framework, anchored by appropriate safeguards that ensure that only appropriately qualified and registered health practitioners can perform early medical—that is, non-surgical—terminations. It further provides that the practitioner must be acting in the ordinary scope of their profession and be authorised to provide medical termination of pregnancy under the Controlled Substances Act 1984.

It is noteworthy that this legislation will operate in the context of other pertinent legislation providing oversight of clinical practice. The bill will also be scaffolded by robust policy and guidelines for practice that are embedded within the public health system and health professional colleges. These additional frameworks will continue to provide guidance on what constitutes a medically appropriate termination and ensure the delivery of the highest quality of medical services.

Additionally, the Australian Health Practitioner Regulation Agency, commonly referred to as AHPRA, in implementing the National Registration and Accreditation Scheme verifies that only practitioners meeting the required standards are able to provide termination services and would therefore be permitted to deliver new healthcare pathways, such as telemedicine for termination services.

I appreciate that later term terminations cause significant concern. Under the bill, a termination of pregnancy may only be performed after 22 weeks and six days where two medical practitioners consider that in all the circumstances the termination is medically appropriate. It is important to note that over the last 20 years only 0.1 per cent of all terminations in South Australia have been after the 22 weeks and six days' gestation. In that period, the latest gestation termination was a single case in 2009 that occurred at 27 weeks as it was deemed medically appropriate.

Later term procedures are therefore very rare, and among the desperate circumstances in which one may be undertaken are cases of rape, which includes sexually abused minors, or women in violent and abusive relationships, as well as those dealing with mental illness or addiction issues. Additionally, many foetal congenital abnormalities can only be detected in the second trimester, which can lead to a woman having to make the incredibly difficult decision to seek a later term termination.

Later term termination may occur surgically or by induction of labour and delivery, with the woman counselled about the options available. For some women, where appropriate to the circumstances, palliative care support is offered prior to the termination. In all circumstances a later term termination would take place only after careful consideration by all parties. While counselling is not mandatory in South Australia, several services are available to assist women and their families in making a well-informed and considered decision. It is considered best practice for women to be offered counselling, and this would certainly continue under this bill.

I think it is important to recognise that a later term termination in South Australia will be the subject of significant oversight. It would occur at an SA Health tertiary institution, where it would be in the hands of a multidisciplinary team. While two medical practitioners need to formally determine that the termination is medically appropriate, the determination is made in the context of a collaborative team bringing a range of perspectives, collectively supporting robust decision-making and quality care.

Section 5 of the bill provides scope for registered nurses, nurse practitioners and midwives to administer MS-2 Step, as is currently the case in the Australian Capital Territory and Victoria. This would increase access to safe, early medical termination of pregnancy, which is a less invasive procedure for the woman. The bill is responsive to a clear need for women in South Australia, a third of whom seeking termination services in 2017 in fact obtained medical terminations.

The bill also seeks to modernise the language in the legislation to reflect societal advancement and expectations, with removal of references such as medical practitioners being male, in addition to addressing language that is inconsistent with contemporary health terminology.

Three Australian jurisdictions have reformed their abortion laws in recent years: Queensland, the ACT and New South Wales. None of the three reported increased demand for termination services after the laws changed. While there has been no increase in service demand, they have reported a trend showing a movement away from surgical and towards early medical termination as a result of the reform. That represents a significant reduction in the risk of harm to women seeking termination services.

When South Australia led the nation in reforming its abortion laws, there was concern that the law would establish abortion as a key family planning measure. That has not been our experience. South Australia's termination rate is amongst the lowest in the world. The rate has been decreasing since 2001, plateauing in 2017 at 13.2 terminations per 1,000 women aged 15 to 44. Of the 2017 terminations, 91.2 per cent were conducted in the first trimester.

Termination of pregnancy is a polarising issue. The development of a legislative framework to allow abortion requires a sensitive and considered approach. The time and effort that has gone into this bill's development demonstrates a clear commitment to prioritising and respecting a patient's bodily autonomy and individual choice, while providing appropriate safeguards.

In closing, I would like to emphasise that good health and wellbeing encompasses all aspects of the life experience: physically, mentally and socially. Health and wellbeing is a shared responsibility of the government, the wider community, as well as the individual. In my view, this bill presents us with an opportunity to develop our health services in a way that is caring, sustainable and responsive to the productive healthcare needs of the women of South Australia. I indicate that I will be supporting the bill.

The Hon. E.S. BOURKE (12:33): Before speaking to this bill I thank the mover of the bill in this chamber, the Hon. Michelle Lensink, the Hon. Tammy Franks and also the member for Bragg, Vickie Chapman, in the other chamber, along with the many women who have come before them to put issues about women's health on the record and to support them.

In doing so, I ask whether any act that is undertaken in accordance with the current health guidelines within a public hospital, at no cost to a patient, be deemed a criminal act. I am not here to bring the emotion of the journey one goes through when considering an abortion. By law, abortion has given as a medical consideration a choice a woman in South Australia has had the right to consider for over 50 years.

The key word here is 'choice'. For over 50 years the termination of a pregnancy has sat within the Criminal Law Consolidation Act. The bill before us today takes what is already a medical choice out of the Criminal Law Consolidation Act and creates a new standalone act to regulated the termination of a pregnancy as a lawful medical procedure.

I understand this standalone act removes any current uncertainties by decriminalising abortion for women and doctors, an essential outcome that would enable a choice to be made without fear or the burden of an unlawful abortion being seen as a criminal act. I acknowledge that this is a sensitive health policy, and I appreciate and respect the varying views that will come before this chamber today and over the coming weeks.

It is for this reason that I also appreciate this bill is a conscience vote for Labor and Liberal members, if not for all members in this chamber. I have mentioned in this chamber on a number of occasions that I believe in the power of regulations that provide necessary protections and therefore strengthen the intent of policy reform.

The bill before the chamber, I feel, has found a balance between choice and considered regulations, regulations that have resulted from a comprehensive consultation process run by SALRI, and I would like to take this moment to thank the many involved in this report, particularly the AMA, which has been willing to provide further information since the bill was introduced.

I believe the bill has found a balance that leaves the choice to the woman, their partners and qualified medical and health professionals, but it is a choice that is guided by incorporating specific professional standards and ethics critical to reaching this choice. Just like members within this chamber, doctors hold differing views regarding abortion, an opinion that is their choice, a choice that is acknowledged within this bill.

The bill regulates that a practitioner may refuse to perform or assist in a termination, giving health practitioners also the choice to object to performing a termination or providing advice. But in doing so, they must immediately inform the person of their conscientious objection and provide an appropriate transfer to a registered practitioner who can provide the advice a patient is seeking.

Importantly, this bill carries criminal offences that further seek to protect women from abusive relationships that may result in women being pressured against their will to keep or terminate a pregnancy. Further, an unqualified person who performs a termination on another person commits an offence—an offence which carries a penalty of seven years' imprisonment—as does any unqualified person who assists in the performance of a termination of another person. This would be an offence that carries a maximum penalty of five years' imprisonment.

This is a medical procedure that is time sensitive. Time is critical for the patient and medical professionals when performing terminations, and it is time that both practitioners and patients are seeking so they can determine the best health outcomes that can be achieved when considering the circumstances. We rightfully put trust in our medical practitioners and health providers to make decisions within our healthcare system and this bill is an extension of that trust.

I am not a medical professional and I have no qualifications in what is best for women confronted with this decision. I have personal views but I am not qualified. I am not a medical professional and, as I am not a medical professional, I feel I am not equipped to provide what is the best medical practice for the termination of a pregnancy or heart surgery or cancer treatment. But I am an elected member of parliament and, as such, I must consider the legislative framework that provides all professionals the safeguards to perform their role.

This bill is a result of comprehensive consultation run by SALRI, which has considered extensively the views of medical practitioners who are qualified to provide that medical advice. This is a heavy burden on decision-makers in this chamber, but I am sure it does not compare to the heavy weight this decision has on medical professionals or, most importantly, on women when considering a termination. For me, this is a medical issue and must be considered in what provides the best legislative framework for women and doctors.

I have foreshadowed in forums outside this chamber my intention to further consider an amendment to section 2(c) under Confidentiality. While I understand these regulatory requirements have been carried over from another act and inserted into this bill to provide clarification, I feel the intent of this section could enable unintended circumstances to arise and potentially breach patient confidentiality.

As with this section of the bill, I will consider any amendments put forward by other members, but I have stated that I will be relying on medical advice. I support the right for choice but a choice that is guided by the appropriate regulations that support the best outcome for a woman.

The Hon. I. PNEVMATIKOS (12:39): I rise today to support this historic bill. Although abortion practices are liberalised in South Australia, having the practice within the criminal code has severe social, ethical and health implications. I would like to begin by thanking the Hon. Tammy Franks for bringing the Statutes Amendment (Abortion Law Reform) Bill 2018 to this place, marking the beginning of legislative change. After her bill was put to this parliament, the Attorney-General requested SALRI to complete a report into abortion law reform. The 553-page comprehensive report covers every aspect of abortion law reform in South Australia and is an extraordinary piece of reference.

Extensive independent and multidisciplinary research and consultation with interested parties and the community formed the basis of the 66 recommendations. Some members yesterday in another debate insinuated that the report was flawed. They made comments about anti-abortion supporters not being sought to contribute. No individual or group was targeted or identified, and many did respond to the open submission process. SALRI received 2,885 submissions from members of the public via the YourSAy platform.

They received 340 written submissions and conducted a series of targeted expert forums with representatives across the board, which also included faith-based and civil libertarian groups. We are aware that Children by Choice, FamilyVoice Australia, Genesis Pregnancy Support, Maternity Choices Australia and Right to Life, to mention a few, have been extensively involved from the outset in terms of the consultation process.

So if those representative groups did not provide evidence or submissions based on the individuals or the groups they claim to represent, then that is not a failing of SALRI. It was their responsibility to ensure that they put their views up and they had every opportunity to do so. In any event, the report considered their submissions and found them wanting in terms of the scope of the exercise. Funnily enough, we live in a democratic society. SALRI undertook the same democratic approach when gathering submissions and recommending reform.

Further to these responses, SALRI looked at the extensive research that has been undertaken regarding reform in other jurisdictions. The report not only provided recommendations but also analysed current practices and sought the expertise of medical professionals and the experiences of women. Overwhelmingly, SALRI supported the notion that abortion be removed from the criminal code and placed within health care.

The extent of consultation done in this report far exceeds any other research done for a piece of legislation that I have seen of late. Like the SALRI report, this legislation does not consider the question of when life begins. The argument is redundant not only in this debate but in current practice and in the medical professionals' opinion. Since the report's release, many of us have been eagerly awaiting this legislation, and I am happy to see it before this parliament.

I would like to thank the Deputy Premier, Vickie Chapman, from the other place for introducing this bill. Her department and staff have worked tirelessly to draft this bill and offered every opportunity for members to educate themselves through briefings. I would like to also extend my thanks to the Hon. Michelle Lensink for bringing the bill to this place, and the Hon. Stephen Wade for his expertise in the area of health and contributions to the bill.

Unlike other pieces of legislation that have been promulgated in this place, the bill briefing sessions that were conducted by the Attorney-General were extensive. It is highly offensive that some of those members who claim to have concerns about the bill did not see it necessary that they should attend. Their absence was noticed. For members who did attend the briefings and took the anti-abortion rhetoric to the forum, I personally found it quite taxing and no doubt the health professionals and the medical staff providing the briefings would have found the same. In spite of that, they utilised every endeavour to provide information and responses.

Dominating the discussion and what I would categorise as bullying the staff who valiantly tried to respond to every issue raised was highly inappropriate. More importantly, some members do not accept women are smart, or smart enough to make their decisions. They challenge the science and the experts. For me, these briefings further highlighted the deficits in the current legislation and the benefits of the new bill.

The current requirement for two doctors to examine a patient does not account for current clinical practices, including telehealth and other remote forms of consultation. Abortion care must also be able to be provided outside a prescribed setting, meaning that these practices should be able to happen outside a hospital. This means that potentially a pharmacist and local GPs would be able to assist in abortion health care.

The current criteria for an abortion to take place also limits one's ability to receive appropriate health care. It is essential that this be made in line with general health law and practice, which this bill before us does. Late-term abortions are a reality. The Termination of Pregnancy Bill allows for late-term abortions to occur with the approval of two doctors. We know that in practice today abortions after 16 weeks necessarily involve a multidisciplinary medical model. That is the reality. I support this measure.

Consistent with the SALRI recommendations, gender selection provisions are not required within the bill. Conscientious objection is also something that has been appropriately measured within the bill. If doctors do hold a conscientious objection, it is essential that they pass on the care of a patient to someone who will provide the required and adequate care. As we saw last night, debates around the topic of abortion can be highly sensitive and emotive. Everyone in this chamber, even if they are not aware of it, most likely know someone who has had an abortion. It is a fact that one out of three women will have an abortion in their lifetime.

These decisions are not made lightly or frivolously or without deep consideration. The notion that women are not capable of making their own decisions regarding their health care is not only archaic but deeply rooted in patriarchy. This is an important issue for me. As a feminist, believing in feminist values and theories, I am guided by ethics, the expertise of professionals and the research, which all support decriminalisation.

We need to heed and note the science, and I will refer to the study that was referred to by the Hon. Nicola Centofanti, in terms of Priscilla Coleman's study. Much like the current act that we have, which this new bill hopes to reform, that occurred 50 years ago. Priscilla Coleman's study happened in 2009. That study has actually been debunked and it has been debunked for a number of reasons: the conclusions were found to be invalid, the facts were wrong, it was based on inaccurate facts, and there were serious methodological errors in the study. That is today.

We need to trust the science and follow the science. It is not enough to just dig up a research paper from the past and present it as fact and solid research today when it has already been debunked. I have concerns about the agenda of religious groups claiming they are saving women and protecting women's rights when it comes to abortion. It is completely contradictory. You cannot claim to be progressing women's rights if you are controlling them. By not acknowledging women have bodily autonomy, you deny all women the ability to be equal citizens.

The moral and religious arguments against abortion are misguided at best. Willie Parker, an American reproductive rights doctor and activist, as well as a devout Christian, states:

In the world of the Bible, bearing many children was a woman's most important [role]…in that ancient cultural context, however, abortion is never mentioned…The death of a fetus is regarded as a loss but not a capital crime. Throughout Jewish scripture, a fetus becomes human when—and only when—its head emerges from the birth canal. The new testament doesn't mention abortion at all.

These pro-life groups have labelled themselves incorrectly. If these groups were pro life, they would have regard for the woman's life too. Simply, these groups who claim to be pro life are just anti-abortion and anti-woman. I am disappointed—no, sorry, I am angry—and offended by being made out by those opposing the bill to be some sort of ogre for relying on the science, the experts and the views of the community who overwhelmingly support reform.

In case there is any doubt, I am not anti-baby or anti-children. I have two amazing daughters and a beautiful grandson, but this debate is not about my personal choices. It is about everyone's personal choices and the right for everyone to have those and to make those personal choices. Law reform has come about by the tireless work of the women's movement, the rallying of pro-choice supporters and those standing up for women's reproductive rights.

Health professionals, community groups and activists collectively have brought us to this point in time. It is time we listened to the experts. It is time we listened to the community. It is time we stood up for human rights and remove abortion from the criminal code.

The Hon. K.J. MAHER (Leader of the Opposition) (12:52): I rise to speak in support of this bill. To terminate a pregnancy is not, I imagine, an easy decision to make and it is not a decision any man in this parliament will ever make for themselves. However, many of us will experience the extraordinary wonderment that is seeing a new life born, a life develop and the hope of potential being fulfilled. Therefore, to suggest, as it has been in some of the correspondence that I have received, that a woman would take such a decision lightly or frivolously I think is particularly disrespectful.

To terminate a pregnancy is not, I imagine, an easy decision to make, and to have it governed by the criminal law makes a difficult decision unnecessarily more difficult. I support it being regulated as a health issue, not a criminal one. For me, to vote against this bill would be to fundamentally disrespect the experience and teachings of so many women whose profound effect on me has helped shape the views that I hold. For the many medical, science and evidence-based reasons and for the many legal opinions that have been expressed in this debate, I support the bill and I support it wholeheartedly.

Debate adjourned on motion of Hon. D.W. Ridgway.

Sitting suspended from 12:54 to 14:15.

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