You are here

Full Debate - Access to Reproductive Health Services

Cassy O'Connor MP  -  Wednesday, 13 June 2018

Tags: Reproductive Health, Surgical Terminations, Australian Christian Lobby

That the House -

(1) Recognises Tasmanian women require full access to reproductive health services.

(2) Notes that international research has found that jurisdictions where terminations are difficult to access are associated with higher maternal mortality and unsafe abortion rates and barriers to abortion access in Australia particularly affect young women, rural women and women of low socio-economic status.

(3) Calls upon the Minister for Health to act immediately to ensure women are not forced to leave the state to access surgical terminations.

(4) Calls upon the Minister for Health to provide pregnancy terminations in the public hospital system, under all circumstances in which terminations are permitted by law, in accordance with Clause 4 and 5 of the Reproductive Health (Access to Terminations) Act 2013, by no later than 1 July 2018.

(5) Directs the Minister for Health to report on the implementation of this service to the House by 3 July 2018.

The matter before us today has commanded much state, national and international attention this year. Much has been said about why the minister has so far failed to act to ensure women can access this legal service in Tasmania. We have debated the same issue here in the last few weeks and many explanations have been floated. The reality is that we can only form our own personal opinions of whether it is influenced by his personal views on terminations, the power of the conservative right led by Senator Abetz in Tasmania, the incidence and behaviour around the infamous trolling incident, which came out of the Premier's office against a former colleague and friend and the dreadful way that Tasmanian woman was treated, including an attempt to undermine her professional position.

I have spoken of those issues here before and I hope we do not need to speak of them again. This House has an opportunity not to score points, not to argue our own deeply held views or prejudices, but to find a resolution and provide that today. In a previous debate on this issue, Mr Ferguson alleged that I disagreed with him because I do not like him. Minister, I assure you and other members of this House that is not my motivation in bringing this matter before us today. I cannot imagine having such a petty motivation on such a serious issue.

I disagree with this minister's action regarding access to reproductive health services in this state. That is my motivation today. That has been my motivation every day I have been told of doctors not knowing what advice to give as there is no clear referral pathway. It is my motivation when I have been faced with a distressing story of the pressure placed on women who feel they have been denied access due to an incapacity to pay or an inability to fly to Melbourne. It is my motivation every day I hear of the harrowing experience of women when they do fly away, far from their support structures.

The office of the UN Human Rights Commissioner clearly stated that women's sexual and reproductive health is related to multiple human rights. The Committee on Economic, Cultural and Social Rights and the Committee on the Elimination of Discrimination against Women have both clearly indicated that women's right to health includes their sexual and reproductive health. This means the states have obligations to respect, protect and fulfil rights related to women's sexual and reproductive health. The Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health maintains that women are entitled to reproductive health care services, goods and facilities that are available in adequate numbers, accessible physically and economically and accessible without discrimination and of good quality.

I am deeply passionate about a woman's right to choose and I am deeply distressed that women are being forced to leave the state to access these services. Under stress, they have to fly away. There is a genuine shock and distress about the fact that Tasmanian women are required to leave the state to access terminations. There is a sense of disbelief that our public health system would so fail them. It is important that service provision governing women's options around reproductive health supports access to positive sexual and reproductive health outcomes for Tasmanian women. As stated in the Beijing Declaration and Platform for Action -

Good health is essential to leading a productive and fulfilling life, and the right of all women to control all aspects of their health, in particular their own fertility, is basic to their empowerment.

Women's empowerment should not only be for those women that can afford empowerment. Access is merely privilege extended unless access is enjoyed and accessible by all.

How did we find ourselves here? It pays to recall the previous laws criminalising terminations and restricting access to terminations in Tasmania were based on the British laws of the 1800s. It was a law that was repudiated when women of this parliament, across the political divides, joined together. I offer my sincere appreciation to the many women and men who acted and advocated for laws and services that do the same, both today and in decades past. Many of those people are in the gallery today or are watching online. Such efforts recognise that women experience poorer health outcomes without the provision of a full range of safe, legal and accessible reproductive services. History clearly demonstrates this in Australia and overseas.

In these efforts I include the collaboration of the Tasmanian women of the 2001 Parliament, including and led by former members of this House; Judy Jackson, the late Sue Napier and Peg Putt, who came together across political persuasions to amend the criminal code and introduce a legal exception to the crime of terminating a pregnancy when women and doctors meet specific criteria. At the time this was a significant step forward in what were urgent and extenuating circumstances. I commend these exceptional and compassionate women and all of the women of that Parliament for their cooperation and commitment to improving Tasmania's termination laws.

However, despite these efforts the passage of time showed the criminal law continued to be a restrictive and inappropriate vehicle to regulate access to terminations. Doctors in our public hospitals were frightened they would be sued. Such laws acted as a deterrent to the provision of safe and legal services and, in the absence of which, women seeking terminations were forced to continue a pregnancy against their will, travel to other jurisdictions for services or, frighteningly, to seek unsafe and unregulated services. All of those are an increased risk to their health and wellbeing.

That is why at the urging of youth and women's health organisations in particular, who were fundraising to send women to Melbourne, I introduced a private member's bill, not as the minister for health, but as a private member in this House who recognised this was not a legal issue but a health one. The Reproductive Health (Access to Terminations) Bill was debated in 2013. It acknowledged that access to pregnancy termination services is first and foremost a health matter and not a matter for regulation under criminal law. The bill affirmed women as competent and conscientious decision makers.

I noted at the time that improved services would not happen overnight and there were many conversations to come as we considered the best way forward. We were discussing provision in the public sector or through public funding, to ensure that having dealt with the legal barrier that cost was not a barrier as well. That should have been the end of it. We should have been developing better, more accessible and supportive services, but we find ourselves today with women being forced to travel and services being forced to fundraise to send them there.

What happened since then? The bill also allowed the provision of medical terminations. It allowed a medical termination under nine weeks, which is less invasive and is safe. Medical terminations are used to terminate early pregnancies within the first nine weeks of gestation, after which most clinics and most health professionals would recommend a surgical abortion. It involves taking two different medications:  Mifepristone RU486 and misoprostol, which  are TGA approved and have been since 2012.

The  Tabbot Foundation has made medical abortion more accessible for women in Tasmania by providing that service over the phone. The patient can contact a 1800 number, they are sent a request for a blood test and an ultrasound, which they then have. The results are evaluated and, if appropriate, arrange a consultation with a specialist over the phone. Women receive medication via express mail by the proposed date of the termination and on the day they have phone access to a 24-hour specialist and a nurse. Many Tasmanian women have accessed this service successfully and safely, but it does not meet the needs of all women. It did decrease, however, some of the patient demand for surgical terminations.

When the bill to decriminalise terminations was passed by both Houses of the Tasmanian Parliament in 2013 there were three clinics providing affordable access. The reasons for their closure vary, partly due to changes in service demand and partly the increased economic cost of maintaining and reaching standards that were altered nationally.

At each stage there was an opportunity for the Government to put in place measures to ensure that women were still able to access these services. When the first clinic closed at Moonah, it was not that big a concern. We had just decriminalised and there was a view that we would be able to manage this well, and we had still two services, one in the north and one in the south. When the second closed, the Government should have been acting to ensure provision. When the third closed, we should have had an acceptable model in place already. However none of this took place. When we decriminalised terminations we did not intend to reach this outcome. Denying access based on income is not and cannot be part of a broader strategy to improve the sexual and reproductive health of all Tasmanians, especially our vulnerable populations.

Research shows that restrictive laws and restrictive access does not reduce the incidents of terminations, but instead negatively impacts on the health and wellbeing outcomes for women. When faced with an unplanned pregnancy, women make deeply considered decisions based on multiple and contingent factors. Whether the woman ultimately chooses to continue or end a pregnancy, she is considering factors such as her age, her physical and mental health, her cultural background, her personal beliefs and values, the circumstances of conception - which may have been traumatic and have been a result of abuse and assault - the extent to which she is in a supportive relationship, the stability of her living circumstances, whether she has sufficient financial and other resources to feed, clothe, educate and provide shelter for a child, and whether she can continue to meet her existing obligations to herself, her partner, her existing children, her parents and her community.
Women's accounts of this decision making process reveal the very complex and personal social constructs in which reproductive health events must be understood. However in Tasmania we then ask women to make yet another decision, a decision not required by women in jurisdictions where terminations are legal. The woman must then consider whether she can afford to access the private services or whether she can afford to fly to Melbourne.
I will now read something written by a woman who had to travel. The actual full document is deeply personal and distressing. I cannot read it now. I struggled reading it the first time I saw it, but I can tell you that this woman and her doctor struggled to find a referral pathway. Due to the timing, she was not eligible for a medical termination and due to the delay in accessing an appropriate referral pathway she could not use the private facility in Tasmania because she was beyond their cut-off limit. She paid over $3000 to navigate our health system, fly to Melbourne and have the procedure she should have been able to access here. I quote:

I started to type this sitting in a waiting room in Melbourne while waiting for the first part of my second trimester termination to take place.

This is the first time I've thought about who I am, and I've not started with my work CV. I'm a confident, educated and able woman. Yet, I'm sitting here feeling beyond vulnerable, I'm feeling less of a person. I'm feeling invisible. I'm feeling alone. I'm feeling ashamed.
I just turned 39, I have 3 beautiful kids, I've been a mum since I was 21. My kids are 17, 10 and 7. I'm divorced. I'm into the second year of a beautiful relationship with someone I love unconditionally. We have a beautiful life.

My story represents one part of the unspoken face of terminations - I'm the mother in my late 30s that has a family, that works hard in my career, that 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 eat and drink as much over xmas, I need to work out what my regular cycle is ... regular
???), that thinks about everyone else, that forgets about what I need.

I'm not reckless, as some often assign to those that end up in this situation.

I'm also the Tasmanian female who had to fly to Melbourne because I couldn't access affordable and available services in Tasmania.

Even though the media releases tell me I'm not disadvantaged because I live in Tasmania, that the services have been restored, that I just have to see my GP, I've flown to Melbourne.
I'm an advocate and I've never been an activist. I'm now both.

I know politics, especially Tasmanian politics. I worked in Premier Hodgman's Office (after working for Labor and Liberal federal ministers, including our now federal Health minister, Greg Hunt) and I've worked in the Australian Government for 13 years.

I don't think of myself as the typical social advocate, but I had the same desire that all advocates share - we want action.

The health portfolio has hardly impacted on my life, I have private health insurance and I'm fortunate to have a healthy family - so this is my first true intersection with a health policy that fails Tasmanians.

That failed me.

She then details the costs. Her first visit to the GP, where the GP had no idea what to do, cost $82.50, with a $37 Medicare rebate. Blood tests were bulk-billed. An ultrasound cost $265, with $102.50 returned by Medicare rebate. Her second visit to the GP, when they were still struggling to find out exactly what they should do and who they should talk to, cost $82.50 with a $37 Medicare rebate. The specialist consultation with the local provider was $190, with a Medicare rebate of $72.75, but it was too late to access that service. Her flights to Melbourne cost $411.50 and accommodation was $507.45. For incidentals, such as Uber food, taxis, train, Skybus, she has a million receipts in her bag across two accounts and has not counted them all up. The procedure itself cost $2750.

There are many of these stories. I have heard a number of comments saying that we should not provide terminations in the public system because that would lead to abortion 'on demand'. Quite frankly, the use of such language as 'on demand' is judgmental, offensive and does not treat terminations as a legal medical procedure but implies it is somehow a lifestyle issue. A woman can no more demand a termination than any man or woman can demand any medical procedure.

The framework is based on consent, which is exactly the same legal framework that regulates all other medical procedures. Consent of the patient is the legal authority for the doctor to act. Consent takes its usual meaning within the medical context, that is, voluntary consent by a patient after receiving proper and adequate information about the proposed treatment, including potential risks and benefits and alternative options. These requirements exist for all medical procedures and are imposed by professional medical standards.

As international evidence has demonstrated, restricted termination practices do not decrease the incidence of terminations. Research conducted by the Guttmacher Institute and WHO demonstrates this. Forcing women to travel to Melbourne will not prevent them from having terminations but it runs the very real risk of preventing them from having safe ones. No women who has made the decision to either continue or terminate her pregnancy should face that risk, nor should they be subject to criticism, disapproval or attempts to dissuade her, and never should she be limited by capacity to pay.

Article 12 of the International Covenant on Economic Social and Cultural Rights, which commits parties to protect, promote and fulfil the right of everyone to the enjoyment of the highest attainable standards of physical and mental health, includes the right to appropriate health care, including reproductive health services. It does not mean forcing women to travel or preventing them from accessing services due to cost.

This Government says that women can access the Patient Travel Assistance Scheme. That is not an answer, nor is it timely enough, private enough or indeed actually enough to cover the cost. The Government has talked of a private low-cost provider. I am open to any conversation and any proposal that provides access. Federal Labor has a similar plan for a holistic reproductive health service that is designated as a health service that could access the activity-based funding model. But even if that was agreed today, it would not always meet the needs of every women, particularly rural women, and even if it was announced today, it could not be implemented immediately. We need a solution that helps women today, not in six or 12 months or longer.

That is why federal Labor's plan was multi-layered. It talked about a stand-alone wrap-around reproductive health service, but also recognised that we need the public provision of termination services to meet the needs of women in the short term and the needs of women for whom travelling to Hobart is just as hard as getting to Melbourne.

That is something the minister can do immediately. He can stand in this House today and commit to providing services in public facilities and then he can leave this House as minister and ensure that it is done. We ask in our motion for him to come back to the House and update us on the implementation. We ask this because all year the minister has said that access is provided, that women are not disadvantaged, that they just need to see their GP, and in more recent months that he is working on a solution, and yet women are still forced to fly.

In January, a spokesperson for the Tasmanian Department of Health told BuzzFeed News that the Government was investigating options regarding the provision of surgical terminations. The Health minister, Michael Ferguson, told BuzzFeed later that surgical abortion services had been restored in Tasmania. The situation he said, in a statement, is now exactly the same as it was prior to the recent closure. Federal Health minister, Greg Hunt, said on a Sky News interview that he had spoken to the state minister that day and that services were available. None of this is true. Bits of it are true. It really depends on what you are trying to tell the media and clearly they were not trying to admit what they were doing.

An amount of $2500 to a private service which operates on a limited basis cannot be equated to a restored service. Since then, the Government continues to say that they are working on a plan time and time again, yet these women continue to leave our state.

Tasmanian women have waited for that plan to be realised. We need a resolution. There has been plenty of time to find that resolution. I look forward to a holistic service but we also need to make sure that women are taken care of now.

We no longer have confidence that the minister and his department have acted immediately to provide this service. We know the Government says services are not provided in every state. Of course they are not. The procedure is not legal in every state and where it is legal they are accessible in the public hospital system.

We know the Government says the system has not changed in terms of public hospital provision. Actually everything else has. The decriminalisation of terminations removes the concern of a medical practitioner so that they can perform them in hospitals. The legal ramifications are removed but we have also had the closure of the affordable private clinics. There is a capacity and a need for the Government to take and we need to know that they are going to fix it. It has been six months already.

This House, this parliament, needs to put a deadline on it because at every opportunity this issue has been fobbed off. We need a deadline so that the safety net of public access is provided, and provided urgently. That is what this motion delivers. Not just more words but a provision of accessible service in Tasmania and a report back to this House. The pre-eminent part of this role in this state reports back to us to ensure that it is done: to provide the legal service that this parliament voted for in 2013, to provide the service that was intended when women from across the parliamentary divide from each political party joined together in that first bill in 2001 to deliver. We need action now and we need to enforce a deadline on its provision. We have to have confidence that this circumstance that impacts so badly on Tasmania women will end.

Whilst it is a slight extension to the terms of the motion I will explain where it fits. I congratulate those men and women in New South Wales last week who joined together to introduce access zones. In 2013, in the same legislation, we introduced the first access zones establishing a 150 metre zones around premises at which terminations are provided. We included the creation of an offence for a person to engage in prohibited behaviour in an access zone defined in the bill as 'harassing, intimidating or interfering with a person accessing a service', which I am sure no member in this House would support. There is nothing peaceful about shaming complete strangers about private decisions made about their bodies.

I respect each of us are entitled to our views. What I do not respect is the manner in which some people choose to express them. Standing in the street outside a medical facility with the express purpose of dissuading or delaying a woman from accessing a legitimate reproductive health service, to my mind, is quite unacceptable. It is not protesting, it is bullying. I raise it in today's motion because of the fact that people from both sides of the parliament, of both political divides, joined together to vote in that. In New South Wales they joined together. In Victoria they joined together. In the ACT they joined together. It is only here when the issue of access zones is brought before the parliament that any parliament voted against it. It was just the lower House, the Liberal members in this lower House.
In relation to today's motion, you can be a Liberal Party member and support matters that go to delivering and achieving the rights of women and not be acting in any opposition to conservative policies. In the end our decriminalisation bill passed because despite not a single lower House Liberal member voting for it. In the upper House people like the late Vanessa Goodwin did vote for it. In the upper House people like Paul Harriss who came down and sat in this parliament as a Liberal Party member did vote for it. This is not Labor versus Liberal. This is not progressive versus conservative. It is not even me versus Mr Ferguson. This is saying that the procedure is legal and should be accessible. It is saying that we should not provide access only to those who can afford it. It is about saying we will not force Tasmanian women to fly to Melbourne when they should be with their supporters, with their families and their friends accessing the service in the least traumatic way possible.

Today members are asked quite simply to give effect to the decisions that this House made in 2001 and in 2013, to accept that women are competent and conscientious decision-makers and recognise that a woman is in the best position to make decisions affecting her future and health. When this competent agent forms the decision that she will terminate her pregnancy then she will neither be financially penalised or prevented from accessing a termination due to cost or limited access.

Madam Speaker, I seek leave now to move a minor amendment which will ensure that if it is passed that this motion will not just call upon the minister to provide the services but to adequately resource those services. I do have the right to speak to that but I have taken a lot of the time of the House and I want to ensure that other members get the opportunity to speak.

The amendment to motion 32 moved in my name refers to paragraph 4, after the words 'to provide' and before 'pregnancy terminations' insert the words 'and adequately resourced'.

I will not take much more time allocated speaking to the amendment as I genuinely want there to be time for full contributions from other parties in this House or any member who might be using their right for a conscience vote, who might be using their right to join across the parliament to deliver what this House voted for in 2013.

The intent of the amendment is self-evident. It seeks to ensure there is not a failure to deliver the outcomes this House seeks to achieve through a funding shortfall. Being Tasmanian should not be a barrier to accessing legal reproductive health services. Being poor should not be a barrier to accessing legal reproductive health services. Being a member of this House should mean that when we pass laws to ensure access to terminations are legal, safe and affordable, that it actually happens.

This minister can ensure services are provided and he can do so today. I commend this motion and the amendment to the House. I call on all members to remember this is not about whether terminations should be legal; it is about ensuring Tasmanian women are not disadvantaged and shipped off to other states for services that are legally available in this state. It is about ensuring women can make choices about their own lives and not be forced into financial stress or unsafe practices because we failed them, because our health system has failed them and because our parliament ultimately fails them.

Ms O'CONNOR (Denison - Leader of the Greens) - Madam Speaker, the Greens will be supporting this notice of motion as we strongly supported the Reproductive Health Access to Terminations Act 2013. We do so because we believe nobody - not the state, not any other person - should have the power to tell a woman what to do with herself in the circumstances where she becomes pregnant.

Earlier today out on the lawns there was a prayer gathering which I happened to walk into. Unfortunately, I had exchange with a well-known member of the Australian Christian Lobby and it was a frustrating exchange but it is a conversation women have endured for centuries. It went something like this. 'That's a very unfortunate piece of legislation you will be debating today, isn't it, Cassy?' I said, 'It is a notice of motion because the legislation passed in 2013. Access to terminations is legal in Tasmania'. 'That is very sad still, it is not good, all life is sacred.' I said, 'Are you saying that women should be forced to incubate babies in all circumstances?' The answer was, 'Every life is sacred and important.' I said, 'If only the church you purport to represent spoke as strongly for the children after they are born. If only the church advocated for action on climate change, on inequality and all the other challenges children face as they come into this world. If only the churches - and I say that in a broad sense of the word because I have enormous respect for many of the aspects of the church and have numerous friends who are Christians - but if only the churches did not have such a poor record, such an appalling record on the treatment of children, going back centuries.'
I pointed out to this gentleman the church was no position to tell us anything about how to deal with our bodies in the circumstances where we become pregnant, and the church should keep its nose out of women's business.

I thank Ms O'Byrne for bringing on this notice of motion today. As Ms O'Byrne has said, 'Women must be viewed as competent and conscientious decision-makers.' The notion that people who purport to represent the church and the majority of people who were at that prayer meeting today were males. The notion they should be able to dictate to a women what she should do in this situation is offensive to human autonomy and to the right of every woman to choose what happens to her body.

I do not know how many members in this place have watched or read The Handmaid's Tale. It is that dystopian future that we could dismiss out of hand as something that is fiction or happened in times past, but with women and for feminism and our human rights it often feels like one step forward and two steps back. There is a need for constant vigilance. I believe The Handmaid's Tale is particularly relevant to this debate because at the core of this, and at the core of the conversation I had with the gentleman saying the prayers for the fallen women of this parliament and the world today, is a strong desire and practice to control women's bodies. That has been part of the culture of male-dominated religions, whether they be Christian, Muslim, Hindu or otherwise going back centuries and millennia. It is about control over women's bodies. I will read a review of The Handmaid's Tale in the Sydney Morning Herald -

In the world of The Handmaid's Tale, women's lives are only contingent on their ability to produce babies and a group of rich, religious white men decide the fate of female bodies. The Commander has perfunctory sex with Offred, held down by his wife, Serena Joy, who can't get pregnant, and the women are rounded up to watch a handmaid called Ofwarren, who's bullied for having an abortion, give birth.

Sure, it sounds absurd - until you remember that we live in a culture in which a Texas judge recently referred to pregnant women as "hosts", abortion is still a criminal offence in Queensland and New South Wales, and the Australian Christian Lobby is fighting to reinstate the global gag rule which denies women from Pacific Island nations rights to reproductive health services and abortion access.

The Handmaid's Tale takes the culture's motherhood fetish to its chilling endpoint and reminds us that we need to fight for autonomy over our lives and bodies at every turn.

It is evidenced again today by the protest out the front and a very clear belief, of those who would tell women what to do with their body, in enforced incubation. That is the flipside of not respecting the rights of women to make their own difficult choices. The flipside of that is enforcing incubation on women. That is the story of The Handmaid's Tale, the beliefs are hardly that different. I saw on social media there is a revolting reference from a well-known, purportedly Christian leader in the north of the state, at Legana. He makes it clear that even in circumstances of rape, women and girls should not be able to legally access terminations. Again, enforced incubation.

As Ms O'Byrne said, this is not about whether abortion is legal in Tasmania. The services are simply not available to women. The service system has not responded to the fact that women in Tasmania, and young women, have the right to legally access surgical terminations. That is the law out there. It is a law resoundingly passed by this parliament in a very moving and significant debate. I acknowledge the enormous amount of work Ms O'Byrne has put into this issue. I know you put your heart and soul into it and worked with people such as the wonderful recently retired Glynis Flower, and Susan Fey - extraordinary, wonderful, good women who understand that this is an issue of human rights.

We are not here to debate the law. We are here to acknowledge that right now there are women who are making the decision to travel interstate because they do not have other choices here. That is for women who can afford to travel interstate and who can afford to access the procedure. Whichever way it goes they will still be isolated, as we heard from the written testimony of the young woman whose story Ms O'Byrne read out and which I have read out in the previous Matter of Public Importance debate. The isolation of women in that situation when they are sent interstate feels like a systemic punishment to those women.
In Tasmania, where the law protects the right to choose, the system banishes the women to a service interstate. There will be women and girls who, because they do not know what their choices are, because there is no service response here and there is no access to surgical terminations in the public system, find their choices are limited. It is historically, in those situations, where women have taken matters into their own hands. You have backyard abortion operators and women have died as a result of this.

Here in Tasmania it is putting women and girls, particular women in regional Tasmania, out of urban areas and areas of socio-economic disadvantage as the notice of motion says. They are impossible situations and that is untenable. The parliament has an opportunity today to set this right and make sure we are not abandoning Tasmanian women and girls in this situation. We are not saying to them we have fixed the law now, it is lawful in Tasmania to access a termination but as a parliament we fail to hold the government and minister of the day to account on the accessibility of these services.

In another review on The Handmaid's Tale, they specifically mention Tasmania -

In The Handmaid’s Tale, the wives of wealthy and influential men struggle to get pregnant, while their socio-economically less fortunate but reproductively blessed sisters become their property with the sole purpose of conceiving a child for them.

With abortion still illegal in Queensland and New South Wales, severely limited in most other states and Tasmania's only abortion clinic recently shut down, forcing those seeking a termination to travel the mainland, the reproductive rights of Australian women are in short supply.

We may not be incubators like Offred and her fellow Handmaids, but limiting our choices about when to be pregnant doesn’t make us much different.

Madam Speaker, I appeal directly to you because I understand yours will be a casting vote in this situation. This is the parliament's opportunity to make sure the changes to the law are reflected in the services provided. This is the parliament's opportunity to help the Health minister establish a good service in the public system. I completely respect there are members of this House who struggle with this question. I accept that but this is not about your belief system. This is about the law. This is about human rights and those of women in Tasmania, our right to bodily economy and that there are so few choices available in Tasmania at the moment that we are making a difficult situation for women in Tasmania much worse. The wording of the motion is not intended to be political. I respect that it has been carefully worded in order to provide an outcome. That outcome is something that in 2018, in 21st century Tasmania, should be unarguable. It should be supported. We strongly support this motion. We strongly support the rights of women and girls in Tasmania and we wholeheartedly support the provision of affordable, accessible, safe, surgical terminations in the public health system in Tasmania.

Mr FERGUSON (Bass - Minister for Health) - Madam Speaker, I am speaking to the amendment that has been moved by Ms O'Byrne on this motion. During my contribution I will be looking at the clock, aware that there will be a vote on this matter at 5 p.m. I will be looking for some guidance from the Labor Party on the extent to which this particular amendment needs to be debated. The Government wishes to bring forward an amendment to this motion and because of the practices of this House and the way that private members' time works potentially I could see a circumstance where I am denied the opportunity to move an amendment on behalf of the Government.

Ms O'Connor - Why haven't you flagged it previously?

Mr FERGUSON - I will be looking for some guidance on that point because if it was agreeable to members of this House that we could consider the amendment immediately and allow my broader contribution to be made I would be grateful for that to occur.

Ms O'Connor - Why did you not circulate it? You chastise us when we do not circulate amendments.

Madam SPEAKER - Could I seek clarification? You are asking for this amendment to be moved and you want to put another amendment later.

Mr FERGUSON - I can indicate to this House that at this moment my office is preparing an amendment on behalf of the Government which we would wish to put forward during this debate to be considered.

Ms O'Connor - Why don't you explain it?

Mr FERGUSON - If I may just continue. If I am reading the room correctly the amendment is with us and I will very happily circulate it to members as soon as it is available. It would be very unfortunate if the Government had a motion to amend the substantive motion that deals with some of the matters that are raised by the Deputy Leader of the Opposition then I would look to that opportunity. Until the amendment is here - and I respect that members will want to see it - I also will be looking for some guidance from the mover so that I could be satisfied that the opportunity will be presented for that.

Ms O'Connor - You have to explain what is in the amendment so that we have some idea.

Mr FERGUSON - As soon as it is here you will see it.

Ms O'Byrne - In responding to the request from the minister, we have not seen the amendment. The Speaker has given me the call, the minister has asked for some clarification around the process on whether we would be comfortable to vote on the amendment that is before the House and when that amendment is either agreed to or disagreed to then deal with the amendment that he is raising. We have not seen the amendment which does make it a little awkward but I can say it is not my intent to in any way restrict the capacity of members to make a contribution on each side of this House around the substantive motion that is before the House.

Mr FERGUSON - To assist the House I table the foreshadowed amendment and members are now able to read it. I am not speaking to our foreshadowed amendment at this moment. I thank members for the courtesy of allowing me to speak to that point.

In rising to speak to this motion on the basis that I will have another opportunity to speak, I offer to keep this brief because I have much more to say on behalf of the Government given the nature of the amendment that the member for Bass has put forward. We do not agree with the amendment but we are quite happy for the House to consider it forthwith if that is the wish of the House. I am looking for some guidance otherwise I will continue my contribution.

Ms O'BYRNE (Bass) - Madam Speaker, with your indulgence. As long as the minister is happy to give me time to comment on his amendment then I am in no way concerned about putting our amendment at this point as long as the minister who will then have the bulk of the time which allows the time for me to be able to respond to the amendment that he has moved, which substantially changes the intent. While still directing the Minister for Health to report back it removes all responsibility from him as minister and places it with his department to continue consultation around adequate resourcing, which is a substantial change to the intent of the original motion.

Our amendment, which is simply about adding the words 'that the termination in the public system be adequately resourced' to be voted upon. We can then move to the minister's amendment. If he is happy for us to make a contribution on that, we should be able to vote on that amendment and then the amended or unamended motion at that point.

Ms O'Connor - Point of order Madam Speaker. Is this your amendment, Ms O'Byrne?

Madam SPEAKER - Yes. Ms O'Byrne's amendment.

Amendment agreed to.

Mr FERGUSON (Bass - Minister for Health) - Madam Speaker, I thank members opposite for the courtesy of facilitating that. I extend the same courtesy by not wasting the House's time with a division.

I speak on the now amended motion. I have now shared with members opposite the proposed Government amendment, which I am not moving at the moment.

As I stand here, there are members of the Tasmanian community who have a range of views on the substance of this issue, that is abortion and terminations of pregnancy. I hope we can have a debate which genuinely respects that there is that difference of opinion in the community and indeed in this House. There has been far too much attention drawn in the debate already to biases that people will make.

I make an important point. If we do respect that, we should recognise and the Government recognises, that for those people who describe themselves as 'pro-choice', that is because they have chosen to take a view that it is the woman's body and she and only she and her doctor should decide whether or not pregnancies are continued. If we respect the range of people and their good motivations in this area, we would also respect them for taking a different view, that the pregnancy they are carrying is a pregnancy with the potency for a human life. I respect human life. I respect those two different world views. I do, we all must. I say that as an attempt to bring good faith and goodwill into this debate.

We do, and I do, recognise that this is a deeply personal issue for all Tasmanians and particularly any woman who finds herself in a circumstance of not wanting to be pregnant and wanting to terminate her pregnancy. I have not been in that situation and so I can only dare to imagine how difficult that would be. It is a time of great vulnerability. I have spoken to many people about this from a range of points of view. They share with me their deepest thoughts. I am thankful for the secrecy and the confidence that they show to share their stories.

There is no doubt, that there is a time where she requires support, love and assistance from a trusted counsel. I say they are universally sad circumstances when this service is provided in our public hospitals, which is the substance of this motion.

Public hospitals are there to save lives and at times need to take action to save the life of the mother. These difficult circumstances can arise where there is a pregnancy with complications, ectopic pregnancies or other traumatic events. These are some very difficult and sensitive challenges that women and families face at times. I remind this House that there are times where a child is desperately wanted but it is dangerous for the mother. These are very trying, very sensitive and very difficult circumstances. The politicking that we have seen on this has not helped any Tasmanian person.

Our public hospitals are there to support women in these circumstances and are there for life-saving provision of health care. That is what I support. That is what this government supports. That is what is happening in our public hospitals. I have taken advice on this.

Members opposite might be keen to hear from me on this point. I have taken advice on this. This has been consistent policy under successive governments, the Labor government, the Labor-Greens government and the Liberal Government. I have advice that tells me the policy has not changed in at least 10 years. That has not changed.

One thing that has changed is the motion the Deputy Leader of the Opposition has brought to this House. Yesterday on Twitter was the first draft of the Deputy Leader's motion which built on and added to an earlier motion that brought to this House in our previous sittings which called on the Government to do this and that. Going away for a couple of weeks and thinking about, the member has found a way to strengthen, toughen, be more controlling and has spent the last fortnight thinking of ways of making it directive.

The motion tabled yesterday, which was shared for the Tasmanian community and has been in the news, was ruled out of order and not allowed. You cannot try to bring a motion into the House that directs a minister on policy. It is not allowed and has been ruled out of order. I do not believe the member drew attention to this fact. The motion had to be fixed. The motion, apart from whatever else it wanted to do -

Ms White - What about the actual issue?

Mr FERGUSON - This is the actual issue.

Ms White - No it's not. This is the politics you engage in. It is disgusting.

Mr FERGUSON - The Labor Party is strategising on this and trying to dictate government policy from the opposition benches and trying to dictate to a minister what he or she is obliged to do on behalf of their Cabinet. It is a pathway, hoping to attract the casting vote of the Speaker and a further pathway to Labor strategy around bringing another motion into this House on another day. You even put the date in, but Ms O'Byrne got it wrong. It was not correct, was not allowed and is not compliant. The House does not and cannot have the power to direct a minister to act in a particular way. Importantly, that point was not mentioned in the contributions made. The motion had to be fixed because Ms O'Byrne misled the Tasmanian people in suggesting she was going to bring that motion forward and she did not because she was not allowed to.

The fact is that terminations of pregnancy, whether they are surgical or medical, are regulated through the standalone Reproductive Health Access to Terminations Act 2013. Since that act was proclaimed, terminations can occur without the need for approval from a doctor for pregnancies up to 16 weeks gestation with no requirement for pre- or post-counselling or referral to another doctor before termination. For pregnancies of more than 16 weeks gestation and up to full term, a doctor can provide a termination with the woman's consent if the doctor reasonably believes that continuing the pregnancy would involve greater risk of injury, or injury to the physical or mental health of the woman than if the pregnancy were terminated. Factors to be included in this 16 weeks through to full-term period include, 'the woman's physical, psychological, economic and social circumstances'. It was the case previously that it had only been lawful to terminate a pregnancy when the mother's life was in danger. A second doctor under this act must agree and at least one must specialise in gynaecology or obstetrics.

There has been much discussion about the appropriate place for the provision of this service. I have already made the point, and it is interesting the mover of this motion was my predecessor as Health minister and yet the policy that exists today in relation to provision in our public hospitals is the same as it was under Ms O'Byrne.

Ms O'Byrne - Governments change.

Mr FERGUSON - I hear the interjection. Government does change but it is interesting that with changes of government over successive years the policy has never changed. I am not proposing to give a chapter and verse outline as to why that policy has not changed over the years, but I can say there are real and practical problems for that suggestion. There is a range of practical problems with this, quite apart from the issue of whether that is the role for government in our public hospitals.

I will speak for a moment about what occurs and where the differences occur with private clinics. Separate from the issue of terminations, the private sector remains an important deliverer of health services in our state. In relation to this area, the same is true. Our public hospitals only provide surgical terminations in cases of high need, such as to save the life of the mother or where there is severe foetal illness or damage. These are individual ethical decisions that are taken by families. All other surgical terminations are provided in the private sector and, as I have said, I am advised that there has been no change to that policy in at least 10 years.

There are some facts to confront here and I am happy to do so. We recognise, as obvious as the nose on your face, that the lower cost standalone private provider that was in business here in Hobart in Tasmania closed operations in December last year. I recognise that. I have given many media conferences where I have acknowledged that. I have also acknowledged that there has been a disruption in the provision of those private services. We have recognised that. While the Labor Party has played their politics around what they know to be my private views on abortion, which are on the record and I do not resile or run away from, they are not the determining issue on this matter. I am delivering government policy on behalf of the Government under the law of Tasmania.

Frankly, the rhetoric from members opposite is quite personal. It is quite attacking and it has been consistent. When the Labor Party saw this as an opportunity during the state election campaign, they came up with I think version four of their health policy where they tried to pretend that they were going to fix it. At the time of that closure in December, it was stated that the closure was a business decision due to the low and declining surgical terminations demand in Tasmania. I was advised at the time that one of the main drivers for that change in demand was less demand for surgical abortions, but a shift in demand for medical abortions, for example, through the abortifacient drug RU486, as one example. Following the closure of that clinic, private abortion services are now only available with established obstetrics gynaecological practitioners who offer the procedure. As I understand it, at this stage there are two private clinicians who have chosen to be identified as providing surgical terminations.
Much has been said about the Government's decision to expand the Patient Transport Assistance Scheme for women who choose to fly interstate to secure a termination service. I reject the statement made by Ms O'Connor as quite wrong that this was an attempt to punish women. I also reject as wrong the statement that somehow the Government was forcing women to go to Melbourne. That is the rhetoric of politics. It is wrong, it is not true and it can only be understood through the prism of party politics.

Yes, I hear all the murmurings, but I want to say that on 15 January 2018, the Government extended the Patient Transport Assistance Scheme to women who choose to fly interstate to access surgical termination services on the basis that that service was not readily available in Tasmania. There was no value judgment, as has been suggested. There should not be rhetoric that it was an attempt to punish people. You should not say things like that.

Ms O'Connor - That is what it feels like for those women.

Mr FERGUSON - That is not what this was about. It was wrong to assert otherwise and equally to say things such as that the government is forcing anyone to go anywhere. That denies the reality that this is a sensitive subject with individual anguish and difficult decisions people are making.

Dr Woodruff - That is the response of the individual, anguished citizens who have made those comments. That is exactly how they feel. You are not listening, minister.

Mr FERGUSON - I am listening to everybody. I will say that.

It is understood that those women travelling to Victoria attended a private clinic in Melbourne and this clinic has been providing low-cost surgical terminations. This is a highly political motion being moved by Labor. Despite their claims to the contrary this is not a genuine discussion on health services. Labor even had to have their motion fixed before it could be brought forward for debate. After going in with heavy rhetoric on directing this and demanding that, all for the purposes of the newspaper and television news, they faced an embarrassing slap down and they needed to  back-pedal from their overreach.
Ms O'Byrne does not have the right, from Opposition, to direct any minister in a Cabinet government. That is not the role of this place, I am advised. By all means, hold the government to account on actions, policies and decisions. It is not the role of members opposite to make certain directions and determinations as if you were the government. That is not how it works and you have been found out. That is not even the policy Labor took to the state election. Labor's policy at the time was not a mandate for all surgical terminations to be provided in public hospitals. It was for a promise on the never-never from Bill Shorten and only if federal Labor were to win the next federal election. Labor and the Greens, when in office, despite anything our audiences today have heard from members opposite, did not bring surgical terminations into public hospitals, even during the debate the Parliament went through in 2013.

Labor knows and I will repeat, because we have said it on many occasions, if anybody really cares about the issue, regardless of your world view or your personal opinion, there is a private provider interstate who is looking to establish a private lower-cost surgical termination service in Tasmania. As the public record shows, it is currently in commercial negotiations around suitable premises. With that being the case, the department, without value judgement, without rushing to conclusions about people and their views, is working with that provider through the licensing and regulatory process. This is not under the Reproductive Health Act but under the Health Establishments Act, a long-standing act that deals with any private service that wishes to establish in our state, whether a private hospital, dentist's rooms or a termination of pregnancy provider.

It is my advice that the confirmation of this service is currently subject to commercial negotiations and these discussions are progressing. The provider is likely to make an announcement on this proposed service in the near future. This is a continuation of the longstanding policy of successive state governments.

Madam Speaker, I move –

That the amendment removes all words of paragraphs 4 and 5 and replace them with new paragraphs 4 and 5.

The Government, in moving this, is happy for it to be incorporated in the original motion. It is sensible. It is not the Opposition directing traffic in a government that it was not elected to be -

(4) Calls on the Government to provide advice from the Department of Health and Human Services following consultation with relevant stakeholders including  RANZCOG, general practitioners and other stakeholders on the provision of adequate resourcing to deliver statewide surgical terminations in the public and/or private system by 3 July 2018;

(5) Directs the Minister for Health to report back on this motion to the House by 3 July 2018.

How good is that? I have even adopted -

Ms O'Byrne - You are now going to speak to this for 20 minutes?

Mr FERGUSON - I have even adopted the dates Ms O'Byrne tried to direct the Government to act within. This is a far more reasonable approach for this House to take. The motion put forward is trying to hardwire a situation forcing all terminations to happen in our public hospital system.

Ms O'Byrne - No, it doesn't.

Mr FERGUSON - Yes, it was. I can read. That is exactly what it was, that it be done by no later than 1 July.

Ms White - Why not, minister?

Mr FERGUSON - Seventeen days. It is unreasonable and ridiculous and forgets that even under the previous Labor-Greens government - that was not their policy. It was not even in your alternative health policy as recently as the March election that you lost. Your alternative health policy had barely anything in it, no definition around what it would do. Only when you saw a political opportunity did you start to pretend that this would be in your health policy and it was funded. It was simply another version of your failed health policy.

I feel it is responsible for me to offer in moving this amendment that I would be content in responding and reporting back on this motion to this House. That is sensible. That is reasonable and that is also appropriate because of the way that the Labor Party has conducted itself. Members of the public are free to look at the parliament website, the notice paper, the evolution of this motion and how it has graduated through its various stages of trying to direct government policy, which is not the role for the Opposition. You remember, 26 per cent of voters in Bass voted for you. The Government was elected and only the Government can make government policy.

This motion is an appropriate response. I am content to be scrutinised on this as I have since December of last year. I am content to give an account of myself and to undertake to you, Madam Speaker, and to this House. I would in good faith, if the House were to agree with this, report back to this House. What could be more reasonable than that, given the history of the conduct of the Labor Party on this issue throughout this period from December until now - regardless of the fact that we know there is a private provider looking to establish in Tasmania at arm's length from the minister - and who forgot that the Minister for Health has no role in the licensing of private health establishments?

This was something I had to explain to you, Ms White, at Estimates a couple of years ago. It is a licensing decision for the secretary under the law.

Ms O'Byrne - On indulgence, Madam Speaker, the minister may not be aware but he gave a commitment that he would allow us time to respond to the amendment. He has been speaking for some time. It is entirely up to him about how honestly he wants to approach this matter.

Mr FERGUSON - I have given a commitment to allow the member opposite to respond to all of my remarks, including this amendment. That will happen.

I now move to the problem with Labor's approach, even though in government they did not do it, and I know why they did not do it. It is because they had the same advice from the department that I have. Apart from the ethical considerations that have been considered previously by governments and members, there are difficulties in bringing all surgical terminations into public hospitals. I suspect the previous minister knows this because she was probably advised likewise.

It is also important for me to point out that there are competing priorities for theatre time in the public system, including both elective and emergency surgery. Decisions are always made based on clinical need. The delivery of pregnancy terminations in the public system would displace other obstetric and gynaecological procedures from the allocated theatre time, necessitating the prioritisation of cases of high need. We recognise our hospitals are very busy. It is ironic that the member opposite, who has been frightening people around her health crisis, who says the hospitals are at bursting point -

Ms White - So you deny Tasmanian women access, then. Shut them out - 'Too busy for you, you're a woman'. You're revolting.

Mr FERGUSON - What did you say?

Ms White - You heard me.

Mr FERGUSON - I did not, actually. You are not willing to repeat it? How interesting. There is the respect in this debate from the Leader of the Opposition. The Leader of the Opposition who wants to scare Tasmanians with her health crisis now wishes to add this caseload to the Royal Hobart Hospital.

Clearly there are these practical problems and then there are the obvious ones which you have not addressed in your motion, which is important. Clinicians in all of our hospitals have the right, as at law, to not participate in an abortion if it is against their conscience. That is a right Tasmanian clinicians have. Plainly there are pragmatic problems with imposing this caseload on a public hospital and clearly, from a timing point of view, they are going to need to be seen as soon as possible. For any member of this House who might have some experience in how theatre managers allocate their times and select their staff, how would you guarantee that staff's rights were protected? That is not a guarantee you can provide.

I want to make an important observation. It is my view that these are the reasons why the policy has always been this way. You can shake your head and disagree. You were the health minister. I am certain you would have had advice on this. I cannot otherwise find an explanation for why the policy has not changed in at least 10 years and you were health minister in that period.

I reiterate that I respect people opposite and in the community who believe what they do about abortion across the spectrum. I invite members opposite to show the same respect to our community because this is not an easy issue for many Tasmanians. It is not even an issue for many health practitioners. I want to handle this and I hope I can demonstrate that I have handled this respectfully, professionally and operating within the law of the land. If anybody has a claim otherwise they should give evidence, but they will not find any.
The closure of the provider last December was a decision that we recognise has impacts on people. I have made it very clear that the department is handling an inquiry and discussing right now with a potential provider. What is to happen with that if your policy was implemented?

Ms O'Byrne - Nothing. We'd just have multi layers of response as we do with this.

Mr FERGUSON - Of course they would not come. Why would they for such a small case load? Why would they? It would not be possible. It would not be feasible because based on what I know about this process and the interested party; it would be a visiting service. It would not be available at all times because of the awareness of the likely demand.

If the members opposite wish to politick around that that is obviously a matter for them, but the Government recognises and respects the views of everyone in the community on this issue. We humbly and respectfully put forward this amendment as a sensible approach to broker an improvement to the motion itself. That does not mean the Government loves all of your motion at all, but we want to improve it and we think it is a sensible approach.
In so moving, I make a commitment to follow through on providing the advice that the motion calls for. I can see that members opposite do not look very happy with the amendment because they would rather direct the Government. They would rather control the Government that you were not elected by the people to serve.

That is my contribution. I look forward to the responses from members opposite. Madam Speaker, I commend the amendment to you and to the House.

Ms O'BYRNE (Bass) - Madam Speaker, I respectfully say I find the minister's contribution neither humble nor respectful to this House. I find his contribution not respectful because he alleged a number of things and yet failed to even remain in the Chamber for my contribution, which I took particular pains over. It is true I am rather emotively led on this issue sometimes. I took particular pains to ensure that it was a reasoned and practical speech and an opportunity for this House to join together and find a resolution.

The minister's contribution was highly political and judgmental. He said that women are 'choosing' to go to Melbourne. They are choosing to go to Melbourne, Madam Speaker? That is what this minister truly believes. When you have no other choice then it is not a choice. You can either not have a termination or you can go to Melbourne. That is not a choice. For the minister to believe that shows how he fundamentally misunderstands what women go through. They have a significant decision to make about the future of whether or not they will carry a child, and they do that with full capacity to make that decision. It is hard for many women to do that so when they have made that decision they should be able to access what is legally available here.

That is what the parliament of 2001 sought to provide, by making amendments to the Criminal Code that allowed the scope that would allow women to access terminations. That is what the parliament of 2013 had to deal with because doctors were concerned that when they wanted to provide terminations in the public hospital system they would not be able to because they would be subject to legal redress. That is why we had to bring it to this House. Women were being sent away because doctors were frightened - and you know what? It turns out they are still frightened.

In an ABC interview, an article published by Felicity Ogilvie today, it says the ABC encountered a culture of secrecy and fear surrounding the provision of surgical abortions. Some doctors performing publicly funded terminations would not complain openly about the restrictions placed on providing abortions for fear of Health minister Michael Ferguson shutting off funding or ordering services to be stopped. They found a feeling amongst some doctors performing terminations in Tasmania that they have to do so in a secretive manner so Mr Ferguson does not find out. That is what is happening in our hospital system. You ask how our hospital system is going to deal with this tsunami of women wanting to come and have individual freedoms. The reality is, the numbers are not that high. You know they are not that high, you referenced that in your conversations about a private provider. In reality, they will deal with them in the same way they deal with them now and do not tell you about it. They will deal with them in the same way the Royal Women's Hospital deal with it. They will deal with in the same way they do in South Australia. They deal with it because they are health professionals who day-by-day have to make those choices.

How dare you come into this House and say women have no right to access this because there are more important things and how dreadful that staff might have to make a choice. There is no choice there. This is a legal health procedure that a woman and her doctor can consent to occur, should occur. How dare you.

Mr Ferguson - Very respectful.

Ms O'BYRNE - Talking of respect again. The minister interjects with respect. You did not come in here and listen to my contribution, which I made a point of making as non-political and non-offensive so any one of those people sitting on the other side of the House could have the decency to support it in a way their upper House colleagues have done in the past, in the way their colleagues in others states would do. Any one of you could have the decency to do that. That is how it was presented but we get the political diatribe this minister comes in with. I am appalled.

If I can deal with issues of what has changed in the 10 years, and you are right, there was no change done in that time. We only decriminalised abortion as a result of the access block in 2013, just before the election. We commenced conversations at that point about how to provide public services. Do not tell me what the department would have advised because I know what they would have advised. They would have advised there are circumstances where women cannot afford private services and should be supported. There are times when women could not travel to Launceston or to Hobart because they live in the far north-west and should be supported. That is the advice I received and you know it is the advice you received, minister. You choose not to see it.

Mr Ferguson - Rubbish.

Ms O'BYRNE - It is not rubbish, oh my goodness.

Mr Ferguson - You cannot say what I have seen and have not seen, seriously, and you think you are not being political.

Madam SPEAKER - Order.

Ms O'BYRNE - The reason the circumstance has changed is that the law has changed to give doctors the confidence they will not be subject to any criminal action if they perform a termination in the public hospital system. That is the first part of the law that changed.

The second part that was medical terminations has rightly supported women in the early stages of their pregnancy, less than nine weeks gestation they can have a termination. It has changed because the private providers left and the minister has known all those things. He knew when Moonah closed, he knew when Launceston closed and he knew when the one in Hobart closed and he could have acted.

To come in this House with this motion and say, all of a sudden, we are going to have this wonderful consultation with relevant stakeholders, including the Royal College of Obstetrics and Gynaecology, who support public access, general practitioners who support public access and a referral pathway and other stakeholders - I wonder who they might be, minister - about resourcing and delivering statewide surgical terminations. What the hell has he been doing since the last service closed? He expects us now to amend this motion in a way that gives it absolutely no real power, no real engagement and no real strength.

The minister is right, we have had a couple of motions. We had a motion genuinely calling on him to take some action around access to terminations. Then we looked at everything he had been saying for the last few months when he told the federal health minister services had been restored, when they had not. When he told the media that most states do not provide it, and he knows that is because in other states it is illegal. When he said services were available, the women simply had to go and see their GP. You condescending, awful human being. Go and see your GP. Do you know what happens then? The GP says, I have no idea because there is no referral pathway. We had one woman whose GP rang the Royal Hobart Hospital and they said to her, 'We don't provide them.' She thought about maybe adopting the baby out. That is the response.

Mr Ferguson - That is the health department advice, to visit your GP if you have concerns.

Madam SPEAKER - Order.

Ms O'BYRNE - This minister knows it. Why on earth he thinks we would not then go, maybe the will of this parliament should be affected, the will of this parliament that voted to decriminalise, the will of this parliament that said women should be able to access services. That is what this bill does.

We put in a new motion that had a timeframe around it and we did have to make one change. We had to move from 'directs' to 'calls'. I cannot remember the phrase you used, but an absolutely appalling phrase saying that the whole thing should have been thrown out. It was an absolute waste. Honestly, you just do not understand. You do not understand what brings this matter to this House.

I do not support the amendment. The reasons are there because if we stop at paragraph 3 and we ask the minister to immediately ensure women are not forced to leave the state to access surgical terminations, this minister has just said that women are not forced to go. He already disbelieves that reality. He disbelieves that reality so no effect is given to paragraph 3.
If we then move into his paragraph 4 and our paragraph 4 said that we should be able to provide terminations in the public hospital system under all circumstances in which terminations are permitted by law in accordance with sections 4 and 5 of the Reproductive Health Access to Terminations Act. If we do not have that, then we do not have a commitment for those women for whom any standalone facility will not meet the needs and then they still have to go to Melbourne. They still cannot access services. If cost is the prohibitor or if access is the prohibitor, it does not change. It does not change if we do not require that.

The minister says that he is going to consult. Well I do not know what he has been doing. If the department was going to consult, what have they been doing since before the services closed, since they were first warned? They have chosen to do nothing. The fact is he was not in the Chamber for my contributions because he was busily scrabbling, trying to write some kind of amendment that he could get everyone to agree with. We have seen that kind of game played over there before. He was not in here for my contribution. He came in here and he did not even have an amendment to move. The third one, it is not the minister telling us how he has implemented anything, it is the minister's reporting back on the motion: 'Yes, I received the motion and yes, so the department has done some work and no, I am still not going to provide public access.'

The minister made it very clear in his contribution that he does not believe in providing access in public health facilities. I support a standalone facility - someone coming in and providing that service - I have no problem with that. We know there is a need for women for whom access is still difficult, for whom getting to Hobart is as hard as getting to Melbourne. For whom that sort of service is not going to meet their need. For whom a private facility might still be just too expensive. The situation has not changed. The minister says that he does not have to do anything because nothing else is different over the last 10 years.

The three services are closed. There is access to medical terminations now and the minister knows that the private centre has closed and he knows because at each time he would have been advised. At each time he would have been advised that something needed to be put in place to ensure that women were not at risk of not being able to access services. I know that because across the health spectrum in any of the services that are provided in the private health system, if there is a risk of them not being provided, the health department immediately says 'we need to be aware that if they are not provided we are going to have to look at what kind of service support we are going to have to give to ensure that there is not a gap in service delivery'. That is what happens across every aspect of health service.

Of course we are not going to support the amendment, because it takes away anything that delivers an outcome and the outcome is the outcome that this parliament has voted for. It is the outcome that people across political divides historically have voted for, that members of your upper House voted for. Paul Harriss, who sat in here as a Liberal Party member - he voted for it. The late Vanessa Goodwin - she voted for it. It is only the members in this House that did not. One of them stood in here and said 'I really would like to, and I tell you what, if we win government I will put in exactly the same legislation, I just cannot vote for yours'. Can we not put politics aside now? Can we not just say, yes we each have different views, and I do respect that Mr Ferguson is clearly a man of great faith for whom this is a difficult issue, but this parliament made a decision.

It made a decision that said we are not going to judge women, we are not going to penalise women, and we are going to treat this as a health issue. If this minister cannot do that himself, then this minister needs to say, 'I need someone else to do it'. As an absolute minimum, let us put politics aside, let us give effect to the decisions of this parliament and let us for once act for the women of Tasmania who have been fighting since the 1800s, when this law was first put in place. Women have been fighting for personal agency, for the ability to make decisions about themselves and not to have barriers put in place. Barriers about women even legally being able to make decisions about their body, barriers about women being legally allowed to access services here, and now barriers that are being placed because financial access means that they cannot get there. It is not choice if you have to go - if you have no other option.

It is not choice and we need to ensure that when we decriminalised terminations in this state that we did not then somehow agree that we would just make it harder and harder for women to access the best reproductive health available. That is what women deserve, that is what agency is and that is what empowerment is. It is an empowerment that is merely a privilege extended to some women who can afford it and we should all be ashamed if that is what we vote for today.

Ms O'CONNOR (Denison - Leader of the Greens) - Madam Speaker, this has been a compelling, at times extremely frustrating and saddening debate to listen to. We will not be supporting the Minister for Health's proposed amendment to the motion. I listened carefully to his contribution and he made a number of good points. If we accepted the amendment put forward by the minister there would be no meaningful action on this issue until well after July and there is nothing in the amendment that compels the Government or the department to take any action to deliver access to surgical terminations in the public system.


Ms Archer
Dr Broad

Mr Barnett Ms Butler

Mr Brooks Ms Dow

Ms Courtney Ms Haddad (Teller)

Mr Ferguson Ms Houston

Mr Gutwein Ms O'Byrne

Mr Hodgman Mr O'Byrne

Mr Jaensch Ms O'Connor

Ms Petrusma Ms Standen

Mr Rockliff Ms White

Mr Shelton (Teller) Dr Woodruff


Mr Hidding Mr Bacon

Madam SPEAKER - The result of the division is 11 Ayes and 11 Noes. Therefore, I have to use a casting vote. In accordance with Standing Order 167 I cast my vote with the Ayes. With the indulgence of the House on this historic occasion I wish to clarify my reasoning. I will be casting my vote with the Ayes for the reason that this motion allows the delivery, or potential delivery, of statewide surgical terminations in the public and/or private system by 3 July or rather, the investigation of that. The previous motion did not include 'statewide', it only mentioned the public hospital system. This is a broader approach and I hope we can see it implemented.

Amendment agreed to.

Motion, as amended, agreed to.