In the late European summer of 2018, I visited beautiful Portugal to meet with a lot of people from around the world who felt strongly about abortion and who wanted to develop an advocacy agenda. The exact location was secret, and I was only informed a few days before the gathering. There was an irony in that years earlier my PhD thesis described the social, economic and human rights conditions that manufactured clandestine unsafe abortions.
That the organisers felt it necessary to conceal our meeting point seemed normal to me. Women talking about their bodies, in the language and way that suits them is controlled to the extent that women face real violence when we assert an opinion. Safe abortions are elusive globally and around 68,000 women die annually from unwanted pregnancies that end due to poor clinical care or lack of access to any information or botched home abortions. But it does not have to be that way.
The participants in Portugal spoke of legal gains around the world that were heartening. Young African lawyers were blazing trails that demanded women be provided with safe, humanitarian sexual and reproductive health care which included abortion. Other women from Latin America spoke of setting up underground abortion networks to assist where no legal abortion was possible. Web-based services that post abortion tablets to women were blossoming and sharing learnings.
Participants Developing an Advocacy Agenda for Abortion in the 21st Century September 2018 Lisbon
The recent death of Justice Ruth Bader Ginsburg, the ‘notorious’ lawyer who was the architect of sex based rights in the US, has sent a sober reminder to women around the world that the control of their fertility, whether it be by contraception or abortion, is merely legal whim that could be retracted when political tides turn.
“We will never see a day when women of means are not able to get a safe abortion in this country,” RBG told me. An abortion ban, she said, only “hurts women who lack the means to go someplace else.”
Source: Notorious RBG, by Irin Carmon & Shana Knizhnik, p.175-6 , Oct 27, 2015
In Australia we are vigilant. Abortion remains criminalised in South Australia. The right to enter an abortion clinic is still challenged by strangers in the street. In 2019 the High Court of Australia upheld the safe access zone laws for patients where they exist, but they don’t in Western Australia. That’s not safe.
Finding a doctor who will provide a referral to an abortion service is complicated. Women resort to Google. Women pay large sums of money upfront for most abortions in Australia despite having Medicare cards or having private insurance and paying their taxes to the public health system. There are excessive regulatory controls over early medical abortion medicine in Australia. That’s not safe either.
Medical, nursing and pharmacy students obtain little chance to observe an abortion clinic in primary health care and often get through their basic training without any of their sexual and reproductive values being expanded. Australian women are shamed by doctors, nurses and pharmacists for requesting contraceptives, sterilisation or abortions.
Mythologies abound about the harm of abortion, either the procedure or the effect of ending a pregnancy despite yards of evidence showing very little harm done and good outcomes for women and their existing or subsequent children.
The Centre of Research Excellence in Sexual and Reproductive Health for Women, an initiative of Monash University focusses its attention on the recalcitrant GPs of Australia who are unable or unwilling to provide long acting reversible contraception or abortion services to their patients.
Recently SPHERE through the Women’s SRH COVID-19 Coalition released a series of bulletins about how to manage sexual and reproductive health during this pandemic. They are sensible, practical consensus statements underpinned by sound data. That’s safe.
The most recent one calls for nurses and midwives to be given training and the powers to prescribe tablets for abortions under 9 weeks to enable greater access for women in all areas of Australia. This will mean leaping legal, regulatory and professional hurdles. Other communiques encourage the use of telehealth and removing mandatory ultrasounds.
But these opportunities existed BC (before COVID 19) and will continue AD (after the panDemic). We don’t need a pandemic to talk about women having a national coordination and information referral centre for unplanned and unwanted pregnancy, or to get a national Medicare funded abortion telehealth service if doctors find it too difficult to deliver.
I will be glad when we are not celebrating 28th September anymore because then all abortions will be safe, legal, accessible and affordable. All women will have access to the information and services they need to manage their fertility (and Ruth would be proud of us).
More information about the campaign for International Safe Abortion Day can be found here: http://www.september28.org/
Assoc. Prof Suzanne Belton is President of the PHAA NT Branch and a member of the PHAA Women’s Health Special Interest Group Committee. She is a medical anthropologist and midwife with clinical experience in community health, women’s health, family planning and refugee health. She is also the Former Chairperson for Family Planning Welfare Association NT and a past representative for Australia in International Planned Parenthood Federation.