Reply to Abortion Distortions.

Reply to David van Gend

This article is aptly titled. The question is who is making the distortions.

Fact 1. Making abortion legal or illegal has never, historically, made the slightest difference to the safety of women.

The history of abortion in Romania is a case in point. Abortion was legalised in Romania in 1958 but without an adequate provision of access to contraceptive information and services. Under the dictator Ceaucesco, abortion was severely restricted in 1966 followed by a rapid rise in maternal mortality mainly due to abortion deaths as women were forced to seek illegal abortions. Following legalisation of abortion again in 1989, there was a rapid decline in maternal mortality mainly due to the decline in abortion deaths.
The abortion-related maternal mortality rate rose from 16.9 per 100 000 live births in 1965 to 151.3 in 1982, and was still 147.4 in 1989. It dropped dramatically to 57.5 in 1990 and has continued to decline since.

Fact 2. Medicine alone, not the law, has achieved all the gains in maternal safety.

Obviously there are many factors involved in the decline in abortion morbidity and mortality. I would quote three: availability of antibiotics and blood transfusions; better techniques; early access to quality services.

Van Gend quotes Australian figures so let’s concentrate on those. One difficulty is that we do not have any reliable statistics on the number of illegal abortions before 1970 and even death certificates may not have been accurate. Even in the first few years in SA, hospitals could not cope with demand and many SA women were refused abortion and had to travel interstate to Victoria and NSW where the Menhennit and Levine judgements made it easier for women to obtain abortions.

Certainly some illegal abortionists operated openly, often associated with police ‘protection’ and were unofficially accepted because they provided a ‘good’ service. These were expensive. One figure quoted was 50 guineas in Melbourne in 1936 ($110 when the basic wage was around $7.20). In 1974, a gynaecologist quoted $450 when the insurance rebate was around $50. Only wealthy women could afford these fees and those who could not afford them went to less skilled operators, often doctors or midwives.

It is true that maternal mortality rates including deaths due to abortion declined with the introduction of blood transfusions and antibiotics. But up to 1969, and even after that, abortion was the commonest single cause of maternal death . Van Gend should have another look at the ABS mortality statistics. He has chosen to quote 1969 only, which for many reasons was an unusual year, possibly related to a big police campaign against abortionists in Victoria and NSW at that time. In 1968 there were 10 abortion deaths in Australia, dropping to 3 in 1969 and rising to 14 in 1970. Of those 3, one was defined as due to induced abortion, one to spontaneous abortion and one not stated. One difficulty always in the case of illegal abortion is the unreliability of the reporting. After the Mehennit and Levine rulings abortion could be more openly performed, in well equipped clinics which is the third factor in the decline of abortion deaths. Abortion deaths are now rare.

What if Medicare benefits for abortion are withdrawn ?

In the days before the free-standing clinics were established and Medicare (originally Medibank) subsidies were introduced, public hospitals put quotas on the number of cases admitted for termination of pregnancy each week. Cases treated in public hospitals still cost the government money. If Medicare benefits were withdrawn, women would be faced with the full fee for private abortion and associated services, which could put it out of reach for lower income women. Women who could not afford full private fees would have to join the waiting lists in public hospitals which could mean delays which add to the risks associated with abortion. Alternatively they would have to turn to another avenue of cheaper abortion or attempt some form of self-abortion. The Commonwealth Government has refused to allow RU 486 or other potential abortifacient drugs to be imported into Australia. Van Gend refers to doctors performing abortions in the backrooms of their surgeries under the guise of “curettes”, with routine back-up at casualty, which he appears to regard as an inevitable and acceptable alternative. He does not comment on what the full charges might be. Does he think, given high indemnity costs etc, that the rebate for a curette, which is less than that for a termination of pregnancy, would cover the costs?

There are already limits on abortion. Most clinics apply time limits and most abortions at 20 weeks or later are carried out in hospitals or in the few specialised clinics. One clinic quoted in SMH 10. 2. 05 charges an additional $1100 (in cash up-front) for terminations after 19 weeks pregnancy. Medicare statistics do not record the duration of the pregnancy. As Obstetrician Andrew Child has commented, these terminations are not performed lightly but for serious medical reasons. The SA report for 2003 comments that the proportion of abortions performed at 20 weeks or later had declined from 1.3% in 2002 to 0.9% in 2003. With better techniques for early diagnosis, these figures can be expected to decline further.

Long term risks of abortion.

It is a truism that no one likes abortion. To women it is always a difficult choice and one which they feel they must make given their present circumstances, even though they may regret the decision at a later time in their life. It is important that women having made that decision, in consultation with the doctor, should have an accessible, safe and supportive experience. Much has been made of late side effects including mental stress, and such conditions as increased risk of cancer of the breast. To date there is no firm evidence of such late effects. Most women have found that an adoption is a much more traumatic experience than abortion. So-called counselling services that emphasise side effects and moral/ethical issues try to load women with guilt and offer little support or understanding.

Women’s attempts to control their births have persisted through known history and will continue. There might always be a time when contraception has been inadequate, and not all unplanned pregnancies are unwanted. Sadly, in cases where the indication for termination is a serious threat to the foetus, some wanted pregnancies result in termination. The most effective way to reduce abortion is not by making abortion illegal, but by trying to reduce unplanned/unwanted pregnancy by better programs of sex education, access to safe and improved contraceptive methods, and support services for women. The responsibility lies with both men and women. No man should condemn abortion unless he has never exposed a woman to the possibility of an unplanned pregnancy.

Stefania Siedlecky AM.


References on request