LATE TERM ABORTION IN AUSTRALIA

Some of the recent debate on abortion has focussed on late-term abortion with even representatives of the Women's Electoral Lobby expressing briefly the view that it was a time for a new debate on this issue.

In this context it is useful to examine some recently published data on late-term abortion in some Australian states.

WESTERN AUSTRALIA

When abortion was legalised in Western Australia in May 1998, the amendments to the Health Act 1911 provided that:

If at least 20 weeks of the woman's pregnancy have been completed when the abortion is performed, the performance of the abortion is not justified unless

(a) 2 medical practitioners who are members of a panel of at least 6 medical practitioners appointed by the Minister for the purposes of this section have agreed that the mother, or the unborn child, has a severe medical condition that, in the clinical judgment of those 2 medical practitioners, justifies the procedure; and (b) the abortion is performed in a facility approved by the Minister for the purposes of this section.

King Edward Memorial Hospital is the only facility which has been approved under this provision. The names of the medical practitioners on the panel have never been officially released but it is known that Drs Jack Goldblatt, Jonathon Rampono, Harry Cohen and Jan Dickinson are on the panel.

Dr Dickinson, without disclosing her membership of the panel, has authored an article "Late pregnancy termination within a legislated medical environment" which was published in the Australian and New Zealand Journal of Obstetrics and Gynaecology (2004: 44:337-341). From this article we learn something of the otherwise secret work of this panel.

From June 1998 to December 2003,there were 219 abortions at 20 weeks or more carried out at King Edward. Dickinson reveals that when a woman wants an abortion at 20 weeks or more she is first referred for counselling which "includes information on the conduct of the termination in addition to the alternative management options available". If she wants to proceed with an abortion her obstetrician will refer the case to the chairman of the panel which will consider the case, usually at a single meeting.

Abortion methods

"Feticide using intracardiac potassium is used for all non-lethal anomalies beyond 24 weeks gestation, prior to the commencement of the abortion process. Misoprostol is the principal abortifacient used for medical pregnancy termination.... all women undelivered after.48h of misoprostol therapy received ... extra-amniotic prostaglandin or intravenous oxytocin."

The killing of the unborn child in his mother's womb by stabbing poison in his heart is no doubt done to avoid the occurrence of live born babies such as Jessica Jane, who in 1998 survived for 80 minutes after an induced abortion in Darwin, and the aborted baby found alive in the bin at Sydney's Westmead hospital the same year.

Reasons for abortion

All abortions approved by the panel were for "a severe medical condition" in the child. These "severe conditions" that the panel believe warrant the killing of the child include Down's Syndrome and spina bifida.

The panel did refuse 11 applications for approval of post-20 week abortions. These included 7 for "psychosocial reasons" and 4 for minor or correctable disabilities.

Given that the law explicitly provides for post-20 week abortion on the grounds that the mother has a "severe medical condition ... that in the clinical judgement of those medical practitioners justifies the procedure" it is revealing that there was not even a single application, let alone an approval, for a post-20 week abortion on these grounds. This indicates that in approximately 145,000 pregnancies there has not been a single case where the pregnancy, post-20 weeks, has proved a severe threat to the mother's health.

SOUTH AUSTRALIA

There were 377 late-term (post-20 weeks) abortions performed in South Australia from 1998 to 2002. Of these 171 were for fetal abnormalities, 10 for a medical problem with the mother and 196 (52%) on "mental health" grounds. The "mental health" ground, provided for in South Australia's abortion law which dates from 1969, is generally accepted to cover any psychosocial reason that is to allow effectively for abortion on request.

VICTORIA

The Consultative Council on Obstetric and Paediatric Mortality and Morbidity's Annual Report for the Year 2003 incorporating the 42nd Survey of Perinatal Deaths in Victoria (http://www.health. vie, aov.au/peri natal/down I pad s/ccopmm. annrepO3.pdf) released on 21 sl December 2004 gives statistics relating to abortions performed at 20 weeks gestation and later in Victoria.

There were 219 post twenty week abortions (0.345% of all births) in Victoria.

Of these 103 were carried out for maternal psychosocial reasons. The report gives no further information about these "psychosocial reasons" so they amount to no more than a request for an abortion. 53 of these abortions were carried out on women whose usual residence is outside Victoria.

Significantly there is no mention in the report of any post 20 week abortions carried out due to maternal physical health or threat to maternal life.

The remaining 116 post twenty week abortions were performed because a congenital abnormality was diagnosed. In 41 (35.3%) of these abortions the baby survived outside the womb for some time less than 6 hours. These abortions were classified as neonatal deaths rather than stillbirths. The report notes that there has been an increase in the number of babies surviving after abortion due to the use of vaginal misoprostol to induce labour. The note indicates that this also occurs with pre 20 week abortions but the numbers are not given in this report and it appears that these live births are not officially recorded.

In Melbourne in 2000 a 32 week old baby girl was aborted after her mother threatened to kill herself because her baby may have been a dwarf. Hospital notes indicate that "On delivery the baby doesn't look small."

PARTIAL BIRTH ABORTION

Dr. David Grundmann, the medical director for Planned Parenthood of Australia, has written a paper in which he explicitly states that he uses the partial-birth abortion procedure (he calls it "dilatation and extraction") as his "method of choice" for abortions done after 20 weeks (4 1/2 months), and that he performs such abortions for a broad variety of social reasons. ["Abortion After Twenty Weeks in Clinical Practice: Practical, Ethical and Legal Issues" ]

Dr. Grundmann himself described the procedure in a television interview as "essentially a breech delivery where the fetus is delivered feet first and then when the head of the fetus is brought down into the top of the cervical canal, it is decompressed with a puncturing instrument so that it fits through the cervical opening."

In the 1994 paper, Dr. Grundmann listed several "advantages" of this method, such as that it "can be performed under local and/or twilight anesthetic" with "no need for narcotic analgesics," "can be performed as an ambulatory out-patient procedure," and there is "no chance of delivering a live fetus." Among the "disadvantages," Dr. Grundmann wrote, is "the aesthetics of the procedure are difficult for some people; and therefore it may be difficult to get staff." Dr. Grundmann also wrote that "abortion is an integral part of family planning. Theoretically this means abortions at any stage of gestation. Therefore I favor the availability of abortion beyond 20 weeks."

Dr. Grundmann wrote that in Australia, late-second-trimester abortion is available "in many major hospitals, in most capital cities and large provincial centres" in cases of "lethal fetal abnormalities" or "gross fetal abnormalities," or "risk to maternal life," including "psychotic/suicidal behaviour."

However, Dr. Grundmann said, his Planned Parenthood clinic also offers the procedure after 20 weeks for women who fall into five additional "categories": (1) "minor or doubtful fetal abnormalities," (2) "extreme maternal immaturity i.e. girls in the 11 to 14 year age group," (3) women "who do not know they are pregnant," for example because of amenorrhea [irregular menstruation] "in women who are very active such as athletes or those under extreme forms of stress i.e. exam stress, relationship breakup...," (4) "intellectually impaired women, who are unaware of basic biology...," (5) "major life crises or major changes in socio-economic circumstances. The most common example of this is a planned or wanted pregnancy followed by the sudden death or desertion of the partner who is in all probability the breadwinner."

MEDICARE FUNDING

Items covering abortions were added to the Medicare schedule from 10 April 1974 without any public announcement or parliamentary debate or vote.

On March 22nd 1979 a motion introduced by National Party MHR Stephen Lusher to curtail Medicare funding of abortion was defeated 62 votes to 52.

The Abortion Funding Abolition Bill introduced by Liberal MHR Alasdair Webster as a private member's bill in 1989, 1990 and 1992 was given atotal of 2.5 hours of debate and never came to a vote.

Australian taxpayers have been funding abortions through Medicare for over 30 years.

On the 2004 Medicare General Medical Services Table there are two items under which abortions are funded.

Item 35643 is defined as "Evacuation of the contents of the gravid uterus by curettage or suction curettage". This abortion method can generally only be used in the first trimester (up to 13 weeks) of pregnancy. Note that the Table includes a note that this item is not to be used when Item 35640 applies. This is the item covering a curette after an incomplete miscarriage. A "gravid" uterus means a uterus that is pregnant or "with child". In the 2003/04 financial year taxpayers paid abortionists $10,428,730 to perform 72, 554 abortions by curettage or suction curettage.

Item 16525 is defined as "Management of second trimester labour, with or without induction, for intrauterine fetal death, gross fetal abnormality or life threatening maternal disease". This item would cover abortions by misoprostol or prostanglandin induction as well as the partial birth abortions performed by Dr David Grundmann. The second trimester is defined as weeks 14-26 of pregnancy. While there may be a small number of non-abortion procedures included under this item (intrauterine fetal death in the second trimester is rare) the majority of the 637 "services" funded at a cost of $116,031 are likely to be abortions at 14-26 weeks.

Medicare funding does not apply to procedures carried out on public patients in public hospitals. Abortions in public hospitals, including late term abortions, are funded through the general block grants given by the Federal Government to each state or territory under the regular 5 year duration Australian Health Care Agreements. The current agreements last from 2003-2008.

THE CURRENT DEBATE

In March 2004 the Hon Tony Abbott, Minister for Health first raised publicly his strong discomfort at presiding over a Medicare system which funded 73,000 abortions annually. Since then, and particularly since the return of the Howard Government to a fourth term of office, there has been an escalating debate on abortion among Federal MPs and other commentators.

As well as Tony Abbott a number of Coalition MPs have expressed their concern at the high rate of abortion in Australia, continued Medicare funding of abortion and particularly the performing of late term abortions. Those who have spoken out include: The Hon John Anderson, Deputy Prime Minister; the Hon De-Anne Kelly, Minister for Veterans' Affairs; the Hon Eric Abetz, Special Minister for State; Alan Cadman, Member for Mitchell; Christopher Pyne, Parliamentary Secretary for Health; newly elected Member for Hastuck, Stuart Henry and Senator-Elect Barnaby Joyce.

THE PRIME MINISTER

The Prime Minister, John Howard, has made it clear that there will be no Government- sponsored change at a federal level to current arrangements. However he has also stated that "It is always open, if somebody wishes to on an issue like this, to bring forward a Private Member's Bill and the Liberal Party for its part, and I'm sure also the National Party, would allow all of its members a free or open vote as we have in the past."

Mr Howard has also dismissed "the rather odd proposition that in some way abortion can't be talked about because there was a debate 20 or 30 years ago. That is self-evidently a negation of a free and open society, people are entitled to raise these issues."

The Prime Minister has also stated that he is personally repelled by late term abortions.

The most important precedent in the current situation is the Euthanasia Laws Bill 3996 which was introduced as a private member's bill by the Hon Kevin Andrews to deal with the problem of legalised euthanasia in the Northern Territory. The Prime Minister, while allowing a conscience vote to all Liberal MPs and making clear that this was not a Government bill, nonetheless ensured that parliamentary business in both the House of Representatives and the Senate was managed so as to allow adequate debating time on the bill. This resulted in its successful passage in both houses.

It is timely for all those concerned about abortion, including later term abortion, and the Federal Government's role in funding it with taxpayers' money through Medicare, to make their views known to the Prime Minister and their own local member of Federal Parliament.

ABORTION STATISTICS IN AUSTRALIA

1. Medicare funded abortions

In the 2004 Medicare General Medical Services Table there are two items under which abortions are funded.

Item 35643 is defined as "Evacuation of the contents of the gravid uterus by curettage or suction curettage". This abortion method can generally only be used in the first trimester (up to 13 weeks) of pregnancy. Note that the Table includes a note that this item is not to be used when Item 35640 applies. This is the item covering a curette after an incomplete miscarriage. A "gravid" uterus means a uterus that is pregnant or "with child".

In the 2003/04 financial year taxpayers paid abortionists $10,428,730 to perform 72,554 abortions by curettage or suction curettage. [Those doctors asserting that many of these are curettes after miscarriage are almost certainly wrong. For Western Australia, one of the two states that requires notification of all abortions, the Medicare figures reconcile with the notification figures. This would not be the case if the Medicare figures included a large number of curettes for miscarriage. These should be claimed under Item 35640 which has a lower scheduled fee. Any doctor claiming these under Item 35643 would be defrauding Medicare.]

Item 16525 is defined as "Management of second trimester labour, with or without induction, for intrauterine fetal death, gross fetal abnormality or life threatening maternal disease".

This item would cover abortions by misoprostol or prostanglandin induction as well as the partial birth abortions performed by Dr David Grundmann. The second trimester is defined as weeks 14-26 of pregnancy. While there may be a small number of non-abortion procedures included under this item (intrauterine fetal death in the second trimester is rare) the majority of the 637 "services" funded at a cost of $116,031 are likely to be abortions at 14-26 weeks.

2. Abortions on public patients in hospitals

Medicare funding does not apply to procedures carried out on public patients in public hospitals. Abortions in public hospitals, including late term abortions, are funded through the general block grants given by the Federal Government to each state or territory under the regular 5 year duration Australian Health Care Agreements. The current agreements last from 2003-2008.

Using data from Tables 8.8; 8.9; 8.10; 8.13 and 8.17 from Australian Hospital Statistics 2002-03

(Australian Institute of Health and Welfare) there appear to have been 73,686 abortions of private patients in private hospitals (including free standing day clinics which covers most of the stand alone abortion clinics), This matches the Medicare data. These include 322 abortions with a two or more day hospital stay. These statistics also report 14,259 abortions of public patients. Of these 1,592 include a two or more day stay. This gives a total of 87,945 abortions with 1,914 of these involving a two or more day stay. The latter would correspond to second trimester abortions involving induced labour. Partial birth and D&E abortions would usually be day surgery.

There may still be some uncounted abortions - those performed in GPs offices for which Medciare is not claimed; those claimed as Item 35640 to avoid recording an abortion on a woman's Medicare recrod; those abortions performed in hospitals which are not coded as ICD-10-AM Code O04 Medical Abortion as the principal diagnosis.

It seems the number of abortions in Australia is probably closer to 90,000 abortions than to 100,000.