Real question on SA abortion care is who decides?
As a controversial anti-abortion lobbyist announces she is taking SA police to court, academic Dr Judith Dwyer AM says the real question about abortion care is “who gets to decide”?
Anti-abortion lobbyist Joanna Howe has filed a $5000 claim against SA Police in Adelaide Magistrates Court over being told to leave a voting booth during the state election. Following a recent, controversial third attempt to pass legislation to restrict later-term abortions in this state, Dr Judith Dwyer recognises the issue won’t go away but says the real question at the heart of this debate is not ‘should there be more restrictions on abortion care?’.
Last month when members of the Legislative Assembly voted overwhelmingly (36 to 9) to defeat the most recent bill seeking to restrict abortions later in pregnancy, it wasn’t mostly about conscience.
Almost everyone in the chamber knew that the vote was about preserving the 2021 abortion law. The Bill was a rearguard action against that law, arising as part of a collection of right-wing populist campaigns that make up the current ‘culture wars’.
The seven men and two women who voted to restrict access to care that night were reflecting their personal beliefs about the moral status of abortion, although for the four One Nation members it was a party position not a conscience vote.
The 36 who rejected the Bill so convincingly (most of the ALP, all the independents and three Liberals) were clear that the law as it stands provides a fit-for-purpose framework within which decisions about abortion and abortion care are made.
Meanwhile, the advocates for treating abortion as what it is – an essential component of women’s health care – are focused on improving access to care, particularly for regional and rural residents, and those with complex health care needs. (I am one of those advocates and have been for what feels like about 100 years.)
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In spite of the noise and dust, the matter is pretty settled in Australia – there is strong support for treating abortion care as health care. This is true whether you are old enough to remember what prohibition of abortion care was really like (Hansard records that a woman died from one and was buried at West Terrace during the first round of reform debates in 1969) or young enough to simply assume that having a child is everyone’s own decision to make.
The real question at the heart of this debate is not ‘should there be more restrictions on abortion care?’. It is really ‘who gets to decide?’ And Australians generally agree that it is the patient and their health care team who must decide, as it is in relation to all health care.
Whatever we think about the moral status of abortion, we can be reasonably comfortable with that position because there is an elaborate framework of laws, policies, procedures, training, ethical codes, accreditation requirements and practice standards that regulate the health system and shape those decisions.
It’s a human system, it has flaws, but it mostly works. As citizens, and as law makers, we don’t need to decide if we support person x getting a lung transplant, or person y having the best possible treatment for their kidney disease, or even person z being admitted to a psych ward without their consent in extreme situations. It doesn’t matter whether you personally approve of particular procedures or their use for particular patients.
We have collectively decided that those decisions are best made by the people in the room, working within a rigorous set of rules, regulations and guidance.
However, the heat and dust are not over yet. The campaign of misinformation about what abortion care actually is will go on. There will be more fake photos, more lies about ‘abortion up to birth’, more efforts to intimidate members of parliaments and health care workers. Hopefully, the more despicable tactics will rebound on their proponents.
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The people who provide abortion care do so because it is essential, and they respond with compassion and professionalism to their patients’ needs. Those whose moral position is incompatible with providing this care do not have to do so.
"It is grossly misleading to suggest that ‘healthy babies are left alone to die’."
The protocols for safe and compassionate abortion care provide either for feticide, under anaesthesia, to ensure there is no pain; or sometimes, when the patient wishes to hold their baby, death is allowed to occur naturally, with comfort care being provided.
Later abortions (after 23 weeks gestation) are always provided in hospitals, each is endorsed by two doctors, and they are needed for complex, sometimes heartbreaking reasons. The law specifies those reasons: fetal abnormality or serious risk to the patients’ life and health from continuing the pregnancy. There were just 48 in 2024 (one per cent of the total).
The current focus by anti-abortionists on later abortions is just a foot in the door, and it is vital that these efforts are defeated for two reasons. Firstly, the real patients involved in the real situations are facing terrible diagnoses, or serious illness or injury, or great risk to their lives and future health for reasons not of their making, and compassionate skilled abortion care is essential.
The second reason why attempts to wind back access to abortion care must be defeated is that if they succeed, further attempts to impose more legal restrictions will be made. It is not thinkable in modern Australia that we could return to the bad old days of illegal abortion, when patients were regularly admitted to hospital for treatment following illegal abortions, and sometimes they died.
Those patients were often interrogated at the bedside by police officers. The current experience in some states of America shows clearly that mortality and health risks for pregnant people and babies go up when abortion care is restricted, and surely nobody is arguing for that.
Later abortion is tough enough, let’s not make it worse. The House of Assembly has resoundingly voted on who decides. It is surely time for the rest of us to leave the decision-making about this essential care to patients and their health care teams.
Dr Judith Dwyer AM is an adjunct professor in the Flinders College of Medicine and Public Health, and a former health care executive and board director. The views expressed in this article are hers.
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