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Reproductive Health Services for Women

3 May 2018

MATTER OF PUBLIC IMPORTANCE

Reproductive Health Services for Women

Ms O'CONNOR (Denison - Leader of the Greens) - Madam Speaker, we thought it was time this House had a serious debate about access to reproductive health services for women in Tasmania. This has been a matter of some controversy and significant public debate since Tasmania's private clinic in Hobart closed last year. Under the Liberals in Government, the rights of women in Tasmania have gone backward. Most affected by the ideological opposition of our Health Minister to women's reproductive rights are women living in rural and regional Tasmania, women living on our urban fringes and women who are living without significant financial means who find themselves in a position where they have an unwanted or unplanned pregnancy.

Today we are debating the Tasmanian Health Services Bill 2018 which lays out the functions of the Tasmanian Health Service. Anyone who has been watching parliament for a little while will know that this legislation has been put before the Address-in-Reply in order for the Government to try to end a disastrous parliamentary week for them by looking like they have an agenda.

It is relevant to the issue of this matter of public importance because for Tasmanian women, unlike women who live in many other parts of Australia, if you find yourself in a position where you have an unwanted or unplanned pregnancy, your options are limited. In other jurisdictions where these services are provided for in the public system, publicly funded, women's rights to choose and to have autonomy over their body are somewhat protected, but not here in Tasmania. There remains significant confusion within the community about what services are available to women who require a surgical termination.

We know that the number of women travelling interstate for a surgical termination has doubled. Rather than taking this issue seriously to the extent that you ensure these services are available in our public hospital system, public funds are being used to fly traumatised women interstate for an abortion. In 2018 that is simply not good enough. Five years ago in this place we passed the Reproductive Health (Access to Terminations) Bill 2013 which brought Tasmania significantly into line with the rest of the country so that we decriminalised what is a health procedure. Yes, it is a significant moral question but the moral question belongs to the woman concerned. It is a matter between her and her GP.

We now have legal protection for women seeking surgical terminations in Tasmania, legal protection for medical professionals and yet we have no readily accessible services in this state. I read to you from the diary of a woman who found herself in exactly this situation, an educated woman, a woman of means, a mother of three, who found herself pregnant with an unwanted and unplanned pregnancy. The difference with this woman is that she had the finances to make the trip to Melbourne because there were no services available to her here. This is what she said:

My story represents one part of the unspoken face of terminations. I am a mother in my late thirties that has a family and works hard in my career but does not always pay attention to my car and my body - I need to see a dentist, I need to get a pap smear, I need to not always drink as much over Christmas - that thinks about everyone else but forgets about what I need.

I am not reckless, as some often assign to those that end up in this situation. I am also a Tasmanian female who had to fly to Melbourne because I could not access affordable and available services in Tasmania. Even though the media releases tell me I am not disadvantaged because I live in Tasmania, that the services have been restored and that I have to see my GP, I have flown to Melbourne.

The cost to women who do not have the financial means is enormous. It is somewhere in the vicinity of $2500 to $3000 once you pay for your flights, the procedure and your accommodation. Let us not forget that for women who are in this situation, they are often doing it on their own, which is entirely unacceptable in 2018. I now quote from a highly respected GP, Dr Bastian Seidel, who says vulnerable women are being put through unnecessary stress at the hands of the Government's unclear policy. I quote -

A surgical termination really should be available in Tasmania for Tasmanian women and it is something the Royal Hobart Hospital can easily provide. If the service is available it needs to be made clear. It is a disaster to send a woman interstate when she is in a vulnerable position to undergo a surgical termination. Tasmanian women and their GPs deserve better than what they are experiencing now. 

This is not that complicated a situation. The law provides for legal surgical terminations. The law protects women in this situation. The law protects the medical profession. What we have here is a Dark Ages approach to women's reproductive choices, because there is an ideological opposition from the Health minister to making surgical termination readily available. He uses the term 'abortion on demand' as if this is a choice that women make lightly. It is not a choice that any woman makes without deep inner thought, and to describe the right of women to reproductive choice and autonomy over their body as abortion on demand says it all.

Women in Tasmania deserve better. They deserve to have access to the same services as their counterparts interstate. They deserve to be able to go to a GP and have a private conversation with them and be referred to an affordable public facility procedure. That is not happening. In order to avoid dealing with the issue, because there is this conflict in Cabinet obviously, now the Government is spending more money, causing more trauma and sending women in this distressing situation interstate for a procedure.

On behalf of all Tasmanian women and girls and the hundreds of people who rallied on the lawns of Parliament House this past weekend, I call on the minister to get into the twentieth century.

 

Ms O'BYRNE (Bass) - Madam Speaker, I will start my contribution on this very important matter of public importance by quoting the Minister, Mr Ferguson, on 2 February in a media report where he said, 'Surgical 
abortion services have been restored in Tasmania'. That statement was repeated by federal minister Greg Hunt later that week because he clearly believed when Mr Ferguson told him that women could get a surgical 
abortion in Tasmania, that these things were being provided. The minister was clearly being dishonest with the truth, as he often is on this issue.

You can get a surgical abortion in Tasmania, but only if there is a significant risk to the mother and child. These are the procedures that have always taken place in Tasmanian public hospitals. What we are not 
getting here is access to a legal service when women choose not to remain pregnant.

We brought in the Reproductive Health Services (Access to Terminations) Bill in 2013 because women in Tasmania were being denied access to services because access to terminations sat within the Criminal Code. 
That meant that our public hospitals did not have the comfort and safety to provide those services. That is why we decriminalised it. The Minister would remember that well because he voted against it.

What decriminalisation meant was that women would be able access services because we know that jurisdictions that do not provide public safe access to terminations increase the risk of mortality to the mother and decrease the overall health for outcomes for families. That is why terminations need to be provided legally and safely in jurisdictions.

The Minister made another comment to the media, saying, 'Oh well, other states do not provide public access to terminations'. That is because in some other states it is still in the Criminal Code. Every single time he 
has been asked a question about this he has not outright lied, but he has not told the truth either. At no stage has this minister told the truth about the fact that a week after this minister said surgical terminations 
were available in Tasmania, women like Bianca, the name given to the woman Ms O'Connor just discussed, could not access a surgical termination because they are not accessible in Tasmania.

Our women's health services are fund-raising to get women over. The only solution this Government came out with was that you can always make an application to the Patient Transport Assistance Scheme, but that does not cover the entire cost. It is also not appropriate for a women because they may not want to tell a complete stranger what they are accessing. They want to talk to someone in a supportive and healthy environment so they can access that health procedure.

When this Government came to power there were three clinics offering terminations in Tasmania. The first one in Moonah closed. The Government, at that stage, would have been put on notice if there was a significant risk to the continued supply of that service. Then the second one in Launceston closed. The Government was definitely put on notice then because Paul Hyland put them on notice that he was concerned about the ongoing viability of his services. Then the third clinic closed and this Government, once again, did nothing. At every stage, there was deliberate inaction that led to the circumstances we are in now.

We can access RU-486, or Mifepristone, but that is not suitable for all women and it is only suitable within a certain time frame. So particularly if you are a rural woman and you do not want to go to your local pharmacist or your local doctor because you might see someone you know, you wait till you get into town. By the time you get into town a lot of your time has gone. You are around 10 weeks potentially by then and you cannot access the postal service for RU-486. You cannot access Mifepristone. A surgical termination is your only option and if you cannot afford it you cannot have it. 

Two options occur. You either have to get into significant debt to get to Melbourne or undertake a significant risk of unsafe practices being performed in Tasmania. What else do women do when they are desperate? 
That is why decriminalisation of terminations services are happening around the world - to stamp out the appalling practices where women's health is put at significant risk because of unregulated backyard services. 

This is a legal procedure. This is a procedure that only the woman has the right to make a decision about. Only she has the right to make that decision. It should not be denied because this Government has decided 
either by intent or by inaction, and we could all draw our own conclusions around that, that they do not want women to have terminations. They do not approve of terminations so they will just make it harder and harder for women. 

Do you know what that does? It means that if you have lots of money, as distressing as it might be, you could probably still access it. If you do not have lots of money then you cannot. That is an appalling thing for 
women to be experiencing in 2018, nearly five years since we decriminalised. This Government has to take this responsibility.

I have been really concerned about the dishonesty that the minister has portrayed in the media every time he has spoken about this. I have also been similarly concerned about the trolling that occurred, which was 
clearly sanctioned by this Government. The woman who went to the media had to tell a story about how she had been trolled. It turns out it was by the Premier's own staff. Not only do they deny access to this woman to termination. They deny that they denied access to terminations, they then actually attack women in public - threaten them. They threatened her job. That is why they did. That was sanctioned by this Government. Frankly there is not a single thing that any member on that side of House can do to justify their behaviour. It has been the most appalling process.

There are options. An options could be the federal Labor offer. This Government could make the same approach to the federal Liberal Government for a significant investment in a stand-alone reproductive health service that puts wraparound services around women. That would be the most sensible decision and a fundamental human right. That would be a simple solution. You declare it a place that provides health services and therefore women can access under publicly funded processes with the state and Commonwealth sharing the money.

Or you could do what one doctor suggested. It would cost $180 000 to provide the service in public hospitals every year or you could just provide it in public hospitals because you are the minister and you could 
do it if you wanted to.

Time expired.

[11.23 a.m.]
Mr FERGUSON (Bass - Minister for Health) - Madam Speaker, everybody knows that the member who has just taken her seat does not like me, she does not like what I stand for, and she hates Liberals. What we have seen just now is a very political -

Ms O'BYRNE - Point of order, Madam Speaker. I feel that I have been grossly misrepresented and I do feel that that I have. I seek to make a personal explanation. Whilst the minister and I share very few values 
what I really object to is his behaviour as a minister. My individual dislike for him is irrelevant.

Madam SPEAKER - Your opportunity for doing this is on the adjournment.

Mr FERGUSON - The behaviour that everybody can see occurring does demonstrate that it is not just about the issue for the member. I also listened very carefully to the member for Denison's remarks. I will attempt as always to be not just honest but also sensitive and professional in the way that we respond to the issue that has been legitimately raised by the Leader of the Greens, Ms O'Connor. The fact is that there has been a hell of a lot of politicking played around this issue. Yes, we are - most of us anyway in this Chamber - on the public record as to our personal views when offered a conscience vote on this issue when it has come before the parliament. Yet that is being used very nakedly as a form of political attack.

We saw it being used in a political attack during the election campaign. Despite the significant politicking that has taken place around this issue, the fact is I want to acknowledge that not only is it a significant moral issue for the woman concerned, wherever she is facing that very difficult situation of an unexpected or unwanted pregnancy. It is a universally sad circumstance whenever a woman feels that she should contemplate or follow through with an abortion. That sensitivity ought to sit with all of us.

There was a time when there was no available provision in the private sector in Tasmania. Why is that? That occurred because of the law we had and the change in law that occurred - and no previous speaker has 
mentioned this - because of the very significant increase in the take up of medical abortions, which has led to a decrease in the demand for surgical abortions. The public hospital system is there to save lives. It is at times necessary to take action to save the life of a mother and that is exactly what occurs. 

Dr Woodruff - What? That is not the function of the hospital to save a life.

Mr DEPUTY SPEAKER - Order.

Mr FERGUSON - I wonder if I could be listened to in the same respectful way as I listened. These are very difficult circumstances where there are pregnancies with complications.

Dr Woodruff - Unless it is a life and death issue you do not go to hospital? It is not the job of a hospital -

Mr DEPUTY SPEAKER - Order. Conversations across the Chamber should be taken outside.

Mr FERGUSON - [Bookmark: OLE_LINK5] Ectopic pregnancies or other traumatic events, including sexual assault. As well, remember that there are times when a child is desperately wanted, but it is dangerous for the 
mother. That is where clinicians have to make, together with the woman concerned, those personal and difficult decisions. These are very trying, sensitive and difficult circumstances. Yes, I am male. Yes, I am the Health minister. Yes, I am white. Yes, I am well-off compared to many people. These cards being played are just frankly unhelpful and unprofessional.

I recognise the need for those services in those difficult circumstances. I am doing my best to demonstrate that this has to be handled sensitively. The policy that we have in our public hospitals is consistent with what 
was the case - and this is the hypocrisy in the way it has been raised - it has been consistent with the approach and the longstanding policy under successive governments of all colours. I believe we recognise that.

We have recognised the disruption in the system. It might have shocked the member for Bass, Ms O'Byrne, when this Government and I, and our Health Department, took the action to support women who were making the choice to fly to Melbourne who needed to and wanted to have that option with the support of their GP. A number of people who are strong supporters of mine have queried why we did that. You might spare a  thought for the fact that not everybody is on the same page here. 

Members interjecting.

Mr DEPUTY SPEAKER - Order.

Mr FERGUSON - We provided that additional support. If you would just listen to other people you might understand the point that is being offered, instead of constantly making this so political and nasty.

Ms O'Byrne - You are obliged to provide it when you don't provide a service in the state. That's how it works.

Mr DEPUTY SPEAKER - Order, Ms O'Byrne.

Mr FERGUSON - The Patient Travel and Assistance Scheme -

Ms O'Byrne - Go troll someone and see how nasty that feels.

Mr FERGUSON - By your conduct, you are illustrating my earlier point.

Ms O'Byrne - No, you are. You are absolutely illustrating our concerns. You cannot put your personal views away from this.

Mr DEPUTY SPEAKER - Order.

Ms O'Byrne - You are the minister. You won't listen.

Mr FERGUSON - It is incessant.

Mr DEPUTY SPEAKER - If we could, please. Ms O'Byrne, you have already had your opportunity. You have made your contribution to this debate. The Minister is on his feet. Minister, if you could direct your contribution 
to the Chair that would be much appreciated.

Mr FERGUSON - For all the disruption I just have a few moments to continue. I want to say that extension of the Patient Travel and Assistance Scheme was not offered previously and we have done that. 

Ms O'Byrne - We didn't need it; there were clinics. He is misleading the House.

Mr DEPUTY SPEAKER - I warn you, Ms O'Byrne.

Mr FERGUSON - If I could be heard. It is incessant, disruptive and it is discourteous when I am trying to make a respectful contribution. 

For the record, it has to be said since the issue has been raised by Ms O'Connor, there has been interest shown from an interstate provider. Despite the accusations, which I have responded to, the Department of Health and Human Services has acknowledged that expression of interest from an interstate provider. The department is the appropriate regulatory body. The secretary is the statutory officer responsible for deciding if a licence application meets requirements and it would be the secretary that would make that decision as to the granting of a licence. 

Mr Deputy Speaker, if you could indulge for one moment more, this is the role for the department. I support that. I want to see less politicking on this while we work through that potential outcome. In all cases, the 
Government will respond to this professionally and under the law.

Time expired.

[11.30 a.m.]
Dr WOODRUFF (Franklin) - Mr Deputy Speaker, I take the minister's point that this is a serious matter and it should be discussed in a considered manner. I listened carefully to the minister's words and I am concerned 
that they came dripping with moralism. The comments that the minister made reveal he is actively working to disrupt the legal right of women in this state to exercise choice over their bodies and to make the decision 
to have a surgical termination if they find themselves in that situation and they make the personal decision that is what they need to do. 

The minister could intervene right now instead of waiting for another possibly fictional provider to come down to Tasmania in a fictional future. It would be a good thing if that happened. We cannot wait because 
women are sitting around today, possibly waiting with an incredible amount of tension in their life to make a decision that, if they do choose to have a surgical termination, would be one of the hardest decisions they 
have to make. It is hard and shameful for many women to have to go through so many steps in order to receive that surgical procedure when they ought to be able to, in a decent society in the twentyfirst century, 
to a one-stop shop information service that can direct them to the single place they need to go to have that procedure.

At the moment, if you live in Dover or in Queenstown, you have to go to a GP. Family Planning Tasmania is not nearby, so you have to go to your local GP. That GP ought to, under your direction, refer you to the nearest hospital for a surgical termination. There has not been a clear directive. No clear directive has been given to the general practitioners in Tasmania; information to general practitioners about how to act in this situation has been actively silenced. The GP must provide a medical reason for termination. A woman in a situation of making a choice about her own body, her own life, must seek a medical reason from a doctor. 
That would be for mental health reasons or physical risk. If the woman is at 10 or 12 weeks and has nothing physically wrong with her, she is labelled a mental health risk. 

This is the twenty-first century. It is disgusting that a woman would have to go through that process and have that label attached to them, for want of a simple directive being given by this minister. This is the same 
minister who cut funding to the Scarlet Alliance; $67 000 paltry for the only sex worker support service in Tasmania, the service we are required to provide as part of our commitments under the national AIDS and 
communicable diseases obligations, and under our commitments to the Australian Hepatitis Council. We are required to support a sex worker organisation in Tasmania. This Christian minister could not bring himself 
to find 67 000 paltry dollars. Minister, I use that word -

Mr Ferguson - Wow. You are offensive.

Mr DEPUTY SPEAKER - Order, Ms Woodruff, through the Chair, please.

Dr WOODRUFF - It is not offensive. I take the minister's point. There is nothing offensive about saying things the way they are. This minister has conservative Christian values that mean if another such person was in that role, who did not have those values, a woman, white or any other race or creed without that particular value about how women's bodies should be used, we would have a directive to general practitioners in Tasmania telling them how they could forward women immediately to the Royal Hobart Hospital, the North-West Regional Hospital or the Launceston General Hospital to have a surgical termination, if that is what they decided they needed to do in their own life.

This is about choice and it is about women's bodies. Men without those values and women without those values, as the minister, would simply do the job because we live in decent society. Women have fought, and with the support of men and friends, for this right to have choice and make decisions about our own bodies. I speak for all the women in rural Tasmania who cannot easily do this themselves. They cannot reach the 
Family Planning Association. I speak for all the women who cannot afford to fly on a plane to Melbourne, and all the women who do not want to have to leave the state to have a surgical termination. I call on the Minister to make a clear directive that any women can use the hospital services of Tasmania for this incredibly important procedure.

Time expired.

[11.37 a.m.]
Ms HADDAD (Denison) - Madam Speaker, we heard the Minister for Health tell us he wants to see less politicking around the issue of termination of pregnancy and that each MP has previously had the opportunity to express their personal views. He then expressed many of his own personal views: that medical terminations should be available to women in certain circumstances such as ectopic pregnancies, and he talked about sexual assault and when there was a risk to the mother. That is right. Those circumstances are serious health circumstances and termination services should be available, but it is politicking, pure and simple. This is an expression of the minister's own personal view of this legal health service.

The time to debate on morality or ideology over people's personal views on termination services has passed. It happened in a previous parliament and one I did not form a part of. It was done when terminations were 
decriminalised in Tasmania. I congratulate the former health minister for achieving that when that legislation was debated.

What we are talking about now is access to a legal health service. It is not about morality and it is not about ideology. It is about access to a legal health service as with any other health service, either in private 
clinics or in our private health system. If any other health service was not available in Tasmania, if hip replacements were not available in Tasmania or if heart surgery was not available in Tasmania, would any 
other health minister drag their feet on such health services? We are told a private provider has made an application. That was made in January this year. Why has the time ticked by since January? If that is when the 
application was made, what is the delay?

Those circumstances the minister talked about, yes, surgical terminations should be available in those circumstances. What is so important is to recognise that termination of pregnancy is an incredibly emotional and 
difficult decision for any woman and any family to make. It is not fair to suggest it is only in the circumstances of ectopic pregnancies, sexual assault or risk to the health of the mother that it is an emotional 
decision. 

I find it particularly personally galling and abhorrent that the Health minister has referred to any other type of abortion as abortion on demand. There is no such thing as abortion on demand. It is offensive to talk 
about it in that way. It is an emotional decision for any family. At the moment 10 families per week are travelling to Melbourne to access services that they should be able to access right here in Tasmania. That is a huge financial and emotional cost to those families. I do not know about you, but if I was sitting on a plane being asked why I was travelling to Melbourne I cannot imagine the emotional turmoil I would feel in having to explain or make up an excuse about the real reason I was travelling to Melbourne, which is because those services are not accessible here in Tasmania.

I was proud during the recent election campaign to stand with Michelle O'Byrne and Rebecca White along with our federal colleagues, Tanya Plibersek and Catherine King, to announce that federal Labor in government 
would commit $1 million for the establishment of a reproductive health hub and Rebecca White committed to public access to medical terminations in the public health system in government.

The Liberals can do this and I encourage the Health minister and the Premier to approach their federal Liberal colleagues for a similar commitment. The minister can intervene here. The minister can make this 
right. Be in no doubt that the minister can intervene and allow for this legal health service to be provided in this state, and if he will not, the Premier has the power to intervene to make this right, to stand up to the 
conservative elements in his party and to make sure these services can be provided to Tasmanian women here in Tasmania.

[11:41 a.m.]
Ms ARCHER (Denison - Attorney-General) - Madam Speaker, it is disappointing that each member keeps getting up and saying put the politics aside, and we just heard that as well from shadow attorney-
general. We had a grossly political contribution from the member for Franklin, Dr Woodruff.

Dr Woodruff - This is about politics.

Ms ARCHER - Let us just put this aside. The service that is offered by this Government is the same. There has been no change in what was provided under previous governments when Labor was in power when the 
Greens were in power. For those on the other side of the House now to basically say we are basing this on personal views on a medical issue is the height of hypocrisy. We have all acknowledged in the House today that it is a very trying a very sensitive and a very difficult experience for any woman. Nobody doubts that, so please remove the politics from this debate and acknowledge the services that are provided and the fact that terminations are provided for certain circumstances in our public hospitals.

The Minister for Health was also shot down when he said that public hospitals were there to save lives. That was just making a factual comment and he could not even get that out in this whole contribution. 
They are there to save lives and that is the overarching principle of our public health system, and it is largely supported by our private sector as well and often in partnership, and that is what we see in this arrangement.

Time expired.

Matter noted.