Reproductive Health (Access to Terminations) Bill 2013 – Submission

Kath Woolf LLB (ANU), B.A. Hons (Sydney), B.Ed (Queensland)

A.C.T. Co-ordinator Endeavour Forum

Phone: 02 6251 5786

Email: woolf_family@bigpond.com

Postal address: P.O. Box 53  Jamison Centre  ACT 2614

5 April 2013

 

INDEX

Executive Summary

The Bill and human rights breaches

Penalties

Background to attacks on pro-life pregnancy counselling services

Evidence- based information for pregnant women

Counselling and decision-making

Physical, psychological and social sequelae of induced abortion.

         Mental Health

         Clinical Depression

         Post-Traumatic Stress Disorder

         Premature Death

Adolescent Girls –  mental health problems

Sleep Disorders

Repeat Abortions and Mental Health

Studies linking abortion to substance abuse

Damage to social/sexual relationships including domestic violence

Obstetric sequelae in women with previously aborted pregnancies

         Early Premature Delivery and Low Birth Rate

         Short-term risks and complications of surgical abortion

         Long-term complications

Conclusion

Executive Summary

 

The Bill demonstrates a disregard for the human rights guaranteed in international law by Australia and binding on the State of Tasmania: the abortion provisions are breaches of the provisions of the Convention on the Rights of the Child and of Article 6 of the International Covenant on Civil and Political Rights, respectively; the denial of the rights of conscience and  of the right to peaceful assembly are breaches of the provisions of the International Covenant on Civil and Political Rights.

The Bill also lacks concern for the health of women considering abortion. Abortion has serious physical and psychological sequelae of which women should be informed.  The sequelae of induced abortion indicate adverse mental outcomes, including higher rates among aborted women of depression, Post-Trauma Stress Disorder, and premature death.  There are also significant obstetric outcomes both short-term (e.g. infection, haemorrhage, infection cervical weakening) and long-term e.g.(premature delivery of in subsequent pregnancies.  There is growing evidence of the link between induced abortion and breast cancer, especially among very young women aborting their first pregnancy, and those women whose family have a significant history of breast cancer.

Consequently it is irresponsible to attempt to control the manner in which support is offered to pregnant women by those services and individuals who do not favour abortion as a solution to problems women may experience with their pregnancy.  To oblige doctors and counsellors to refer for abortion favours and promotes those services which operate in an ethical vacuum. The proposed penalties for breaches of its provisions are notably excessive and represent a blatant attempt to deny the rights of conscience.

The restrictions on the operation on pro-life counsellors does nothing to ensure that counsellors employed in the abortion industry bring evidence-based information to the attention of women experiencing problems in pregnancy, including the stage of development of their unborn child (preferably through ultra sound imaging) and the risks to their own physical and mental health.

The Bill should be rejected.

 

The  Bill and human rights breaches

The provisions of this Bill seriously undermine human rights in at least two aspects.  Sections 4 and 5 deny any consideration of the rights of the unborn child, allowing abortion throughout the whole period of gestation with merely some regulatory requirements when the unborn child is 24 weeks or older of gestation.  Sections 6 and 7 deny to persons the right to conscience and to lawful assembly.

Sections 4 and 5 of the Bill

These sections deny rights to the unborn child in contravention of the obligations which bind Australian States and Territories as a consequence of Australia’s ratification of:

         the United Nations International Convention on Civil and Political Rights, Article 6 of which states:

Every human being has the inherent right to life.  This right shall be protected by law.  No one shall be arbitrarily deprived of his life.

         The Convention on the Rights of the Child (1989) which marked the 30th anniversary of the Declaration of the Rights of the Child (1959) and the tenth anniversary of the International Year of the Child.

The United Nations declared that the Convention on the Rights of the Child was intended as a standard-setting accomplishment in the field of human rights, making a positive contribution to protecting children’s rights and ensuring their well-being.  The Covenant refers specifically to its precursor, the Declaration of the Rights of the Child (1959), and gives no indication of departing from the principles stated in the Preamble to the Declaration:

“the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth.”

Subsections 7 (2) and 7 (3) of the Bill

Sub-section 7 (2) contravenes the obligations imposed on all States and Territories as a consequence of Australia’s ratification of the ICCPR and is a breach of Articles 18 and 19 of the ICCPR:

Article 18

1. Everyone shall have the right to freedom of thought, conscience and religion. This right shall include freedom to have or to adopt a religion or belief of his choice, and freedom, either individually or in community with others and in public or private, to manifest his religion or belief in worship, observance, practice and teaching.

2. No one shall be subject to coercion which would impair his freedom to have or to adopt a religion or belief of his choice.

3. Freedom to manifest one’s religion or beliefs may be subject only to such limitations as are prescribed by law and are necessary to protect public safety, order, health, or morals or the fundamental rights and freedoms of others.

 

Article 19

1. Everyone shall have the right to hold opinions without interference.

2. Everyone shall have the right to freedom of expression; this right shall include freedom to seek, receive and impart information and ideas of all kinds, regardless of frontiers, either orally, in writing or in print, in the form of art, or through any other media of his choice.

To provide that “ a medical practitioner [who] has a conscientious objection to terminations, …….. must refer the woman [seeking an abortion] to another medical practitioner who the first-mentioned practitioner knows does not have a conscientious objection to terminations” is a breach of the obligation on the Tasmanian Government to respect such a medical practitioner to hold to a “belief of his choice”.

Likewise, the provisions of subsection 7 (3) which obliges a counsellor [who] has a conscientious objection to terminations [to] refer the woman to another counsellor who the first-mentioned counsellor knows does not have a conscientious objection to terminations” are in breach of the obligations of the Tasmanian Government has to observe its obligation to guarantee those right obliging all Australian Governments under the ICCPR.

Section 7 – ‘refer’

The financial penalties for those counselling services that ‘confess’ that they do not ‘refer for abortion’ reveals a radical misunderstanding of the word ‘refer’ in this context.  Counselling services do not refer in any manner analogous to medical referral such as is usually needed for consultation with a medical specialist. The false implication to be drawn from the language of the Bill and accompanying rhetoric is that a lack of a ‘referral’ by a pregnancy counselling service somehow prevents the woman who is being counselled from accessing abortion services if she wishes to do that after being offered all alternative assistance.  This is absurd.  Abortion services are advertised in newspapers, telephone directories (hard copy and on-line).  To impose an obligation under severe financial penalty on a service or individual to facilitate the access is morally repugnant.

Section 9 of the Bill –access zones

The imposition of broad-based restrictions on persons who wish to object to the business carried on at an abortion clinic is illegitimate to the extent that they impede the right of peaceful assembly:

Article 21

The right of peaceful assembly shall be recognized. No restrictions may be placed on the exercise of this right other than those imposed in conformity with the law and which are necessary in a democratic society in the interests of national security or public safety, public order, the protection of public health or morals or the protection of the rights and freedoms of others.

The behaviours prohibited by paragraph 9(a) appear reasonable enough and, in fact, are most likely already by law, that is, “in relation to a person, besetting, harassing, intimidating, interfering with, threatening, hindering, obstructing or impeding that person”..

However, the drafting of paragraph 9(b) is ambiguous:  it prohibits “a protest, or sidewalk interference, in relation to terminations”. Is the intention to take as synonymous “a protest” and “side walk interference’.   Prohibiting a protest  in relation to terminations can be a breach  of Article 21 of the ICCPR:

Further, the vagueness of paragraph 9(d) which prohibits, in addition to the behaviours specified in paragraphs (a) to (c), “any other prescribed behaviour”.  This is capable of arbitrary application and a breach of the common law right to know what is forbidden.

Access zones applicable to the prohibited behaviours are provided for in section 9(2), and cover an area within a radius of 150 metres from premises at which terminations are provided.  The extent of the access zones is excessive, even absurd.  Such a circle of diameter 300 metres around an abortion clinic would cover several blocks of the city of Hobart in every direction from the facility, potentially covering churches, community centres and other places where person might gather to express opposition to abortion.  The exclusion zone would prohibit any gathering whatever in smaller towns.

It should be noted that Tasmanian law on sodomy was overturned in 1994 by the United Nations Human Rights Committee (UNHRC).  Toonen v Australia [1][1] was a landmark human rights complaint brought before UNHRC by Tasmanian resident Nicholas Toonen in 1994.

On 31 March 1994, the Committee agreed that, because of Tasmania’s law banning sodomy, Australia was in breach of the obligations under the treaty:

         criminalising consensual sex between adult males in private was a violation of his right to privacy under Article 17 of the ICCPR; and
distinguishing between people on the basis of sexual activity, sexual orientation and identity was in violation of article 26.

In response, the Commonwealth Government passed a law overriding Tasmania’s prohibition on sodomy.  The Toonen decision has subsequently been referenced by the Committee and by other treaty bodies in making rulings.

It would be ironic if the human rights guaranteed by Australia’s international obligations worked to uphold in Tasmanian law the rights provided in Articles 17 and 26 of the ICCPR interpreted to guarantee the equal rights of homosexuals, while failing to protect the rights guaranteed in those Articles in the ICCPR which guarantee the right to life, the right to hold and express one’ beliefs, and the right of peaceful assembly.

Penalties

The penalties proposed in the Bill are ludicrous if they were not indicative of a threatening approach to the exercise of free association and freedom of expression by counselling services which will not, as a matter of conscience, refer women to services which will refer women to abortion services.

The penalties imposed on a breach(es) of the above provisions are manifestly excessive. Each can attract a fine of 500 penalty units; on the current value of $130 per unit that amounts to $65,000.  The fine can be additional to imprisonment for a term not exceeding 12 months, or both.

The overall of these provisions is a transparent attempt to severely disadvantage pregnancy counselling services which offer real alternatives to abortion by way of material and emotional support to women having problems with pregnancy by obliging their workers to direct women  to abortion providers in contradiction of their ethical convictions under threat of  heavy fines.

Background to attacks on pro-life pregnancy counselling services

One of the linguistic ‘king-hits’ used by pro-abortion counselling services, abortion providers and pro-abortion lobby groups is to dub those pregnancy support services which do not ‘refer’ for abortion as ‘false providers’.  It is nothing short of a scandal that this insult is still alive, resurrected by the same type of persons who invented it over a decade ago.  It is critical to understand the birth of these misrepresentations.

In 1995 a panel of women were appointed by the National Health and Medical Research Council (NHMRC) to prepare a paper on abortion provision in Australia.  It was titled Services for the Termination of Pregnancy in Australia: A review. Draft consultation document 1995 (the Draft). The Draft came down resoundingly in favour of policies and actions which would promote the acceptance of abortion as a “normal” medical procedure of no particular significance. To this end the Draft urged greater provision of abortion facilities, extension of counselling services for abortion, universal training in abortion techniques in medical and nursing schools, and the repeal of all abortion laws.

The authors consisted of seven women all involved in advocacy of abortion on demand and/or in provision of abortion services.  Three of those women, Barbara Buttfield, Lyndall Ryan, and Margie Ripper had earlier that year launched a piece of pro-abortion propaganda called “We Women Decide”.  The same three women were on the Management Committee of the Adelaide Pregnancy Advisory Centre, an abortion provider. Abortionist Dr Peter Bayliss rubbished the report as “Scientifically valueless” having merely canvassed “a relatively few obliging women, like those who speak to Oprah”.

A fourth member of the NHMRC Panel, A Watkins, was also involved in the management of the Centre. Another, Jo Wainer, was the co-director of a Melbourne abortion  clinic; together with  Ryan and Ripper they addressed the 1993 Abortion Rights Network of Australia demanding that all abortion laws be repealed and that a “foetus must always be viewed as part of a woman’s body” (contrary to all biological and physiological knowledge).

Another, Dr Weisberg, was Medical Director of the Family Planning Association of NSW.  The Chair of this ‘expert’ Panel was Judith Dwyer, a former CEO of  the Family Planning Association of South Australia.

The Panel’s Draft report demonstrated:

  • impatience with any moral or legal parameters regulating abortion counselling with recommendations that abortion be treated as a ‘normal’ procedure which should be compulsorily taught in medical and nursing schools;

  • promotion of abortion services through every community organisation, including dissatisfaction that Aboriginal communities had a lower abortion rate than Australian overall rates; and, significantly;

  • an unprovoked attack on counselling services which did not refer for abortion.

The Draft was published for community discussion and attracted  widespread community objection to its bias.  However, at its 126th Session in 1998 the NHMRC noted that the Paper had been withdrawn from sale in early 1998 after the factual accuracy of the document was challenged. At its meeting on 30 August 2000, NHMRC looked at the possibility of reviving the project as:

the Executive was not satisfied that the information paper addressed the terms of reference originally set nor that the paper presented a dispassionate and national discourse on the subject. The information paper continues to contain some inaccuracies, for example in reporting state legislative provisions.

Language – labelling and deception

Nonetheless, the thrust of the Draft and its Paper successor continues to be cited in the canon of readings of pro-abortion advocates eg the Association for the Legal Right to Abortion (ALRA) (WA) Inc. and in the main media, for example:

Back in 1995, the National Health and Medical Research Council coined the term “false provider” to describe services that publicly claim to provide all-options, non-sectarian counselling, yet refuse to discuss abortion as a choice or refer callers to abortion clinics.

Adele Horin, Sydney Morning Herald, February 25, 2006

As explained above, the NHMRC did not coin the term ‘false provider’ and pro-abortion advocates, writers and legislators should finally confess the falsity of such statements.

While the Draft stressed that “adequate information is essential for informed consent”, the Panel accepted as “best practice” hiding ultrasound images of the foetus from the mother.[2][2]  Allowing the image to be visible to the patient when the gestational age of the foetus is being ascertained through ultrasound imaging was deemed “unsympathetic or punitive”. In other words, the sight of her unborn child, surely a critical piece of information the woman needs to make an informed decision about the baby’s fate, is to be suppressed.  This equates to deception.

In pursuit of deliberately promoted ignorance, some pro-abortion counselling services still continue to describe the fetus/unborn baby as “products of conception”, “contents of the uterus”, “blob of tissue”.  ‘Information’ according to many abortion advocates means essentially the provision of details of abortion procedures.  The nature of the child to be aborted is not deemed a consideration.[3][3]

The current Bill exhibits the same thinking as that displayed in these discredited publications.  It does  not impose a matching obligation on abortion counsellors  to provide accurate biological and medical information to women, including

         the risk of physical consequences  of abortion,

  the adverse psychological sequelae which characterise post-abortion syndrome

  the developmental stage of the child whose fate is being decided.

Evidence- based information for pregnant women

It is instructive that the first regime designed to give women essential information and time to reflect on it was established by the ACT’s Health Regulation (Maternal Health Information) Act 1998.  That Act provided that a person should not perform an abortion unless a woman had been provided with information in accordance with s 8:

Section 8 Health Regulation (Maternal Health Information) Act 1998 (ACT) (the Act)

 

What information must be provided

(1)   Where it is proposed to perform an abortion a medical practitioner shall—

        (a)     properly, appropriately and adequately provide the woman with advice about—

              (i)     the medical risks of termination of pregnancy and of carrying a pregnancy to term; and

           (ii)     any particular medical risks specific to the woman concerned of termination of pregnancy and of carrying a pregnancy to term; and

               (iii)     any particular medical risks associated with the type of abortion procedure proposed to be used; and

               (iv)     the probable gestational age of the foetus at the time the abortion will be performed; and

        (b)  offer the woman the opportunity of referral to appropriate and adequate counselling—

     (i)     about her decision to terminate the pregnancy or to carry the pregnancy to term; and

                (ii)     after termination of pregnancy or during and after carrying the pregnancy to term; and

(c)        provide the woman with any information approved under section 14 (2); and

(d)        provide the woman with any information approved under section 14 (4); and

 (e)     provide the woman with any information approved under section 14 (5).

     (2)     No charge shall be made for the materials provided under subsection (1) (c), (1) (d) or (1) (e).

 (3)     Complying with this section does not in itself discharge any other contractual, statutory or other legal obligation of a medical practitioner or other person to provide information to a patient.

 

The Act also provided for Ministerial approval of the information pamphlets and required a ‘cooling-off’ period of three days between approach to an abortion provider and performance of the procedure, as decisions taken under pressure are notorious for being regretted later when the pressure is removed.   It should be noted that in August 2002 when all provisions relating to the offence of abortion in the ACT were removed from the Crimes Act 1901 (ACT), the Health Regulation (Maternal Health Information) Act 1998 (ACT) also was repealed.  Lobbying for its repeal were the pro-abortion groups in the ACT.

The Bill should provide that women are enabled to make informed and free choices, imposing an obligation on all medical staff and counsellors to provide counselling which was objective and truthful to pregnant women.

Counselling and decision –making

It is a favoured position of abortion advocates that counselling is to ‘non-directive and that the woman’s decision is to be supported in order to preserve her ‘autonomy’.  No opinion adverse to abortion is to be expressed in any way for fear of subverting or influencing the decision.  This is a flawed theory.  In taking many important decisions affecting one’s self, family and life situation, a person would normally seek information which would assist in making a decision, even requesting advice and insight into other ways of perceiving a problem and evaluating possible solutions. Only in relation to the very critical decision as to whether to abort a developing child is information represented by pro-abortion counsellors as merely a threat to the woman’s ‘autonomy’.

It is patronising to suggest that women cannot cope with information and advice and need some kind of “absolute autonomy not granted to other members of society” which takes no account of the rights of others (only 5% of women of women having an abortion said they had a medical reason). To discount the relevance of the substance and significance of a decision is unrealistic and does the woman no favour.

Naomi Wolf, noted feminist author and advocate of the “pro-choice” position on abortion, has taken issue with this very approach; she once said that she found the language of “choice” and “decision” limiting in promoting understanding of what is at stake:

Pro-choice advocates tend to cast an abortion as ‘an intensely personal decision’. To which we say, no: one’s choice of carpet is an intensely personal decision. One’s struggle with a life-and-death issue must be understood as a matter of personal conscience. There is a world of difference between the two, and it’s the difference a moral frame makes.[4][4]

Objective counselling which opens up options for the management of the pregnancy other than by abortion is surely an empowerment of the woman as it widens her range of choices.  Providing this information does not direct the woman to choose any particular option.  Pregnancy counselling services with objection to abortion are perfectly willing to provide information about abortion: the methods used; documented studies of its physical and psychological sequelae and to make the offer of counselling for post-abortion syndrome.

However section 9 of the Bill goes beyond this by dictating that a counsellor who holds an objection to abortion “must refer the woman to another counsellor who the first-mentioned counsellor knows does not have a conscientious objection to terminations”

One might ask why pregnancy support services are being targeted in this way when other services unashamedly proclaim their moral and ethical foundations.  For example, no one would expect Lifeline to provide to a person, still insistent after counselling on proceeding with suicide, with the website address of Exit or one promoting Dr Nitschke’s solutions for self-help suicide.

Physical, psychological and social sequelae of induced abortion.

It is vital when adopting any measures which facilitate access to abortion to give careful consideration to the documented sequelae of abortion.  Studies of women who have had an abortion show a consistent trend of negative effects on their health and well-being, including relationship failures, dysfunctional behaviours and mental health problems.

An overall view of the negative outcomes following induced abortion can be gained from two studies which recorded a range of outcomes. A 1991 study of 232 women from 39 States in the USA done with a mean time of 11 years after the abortion showed a 94% failure rate in unmarried relationships; a 45% rate of negative feelings about subsequent pregnancy and problems of bonding with later child(ren).   In sum, the procedure years afterwards “worsened interpersonal relationships correlated with higher post-abortion levels of anger and guilt”.[5][5]  A 1993 study of 828 aborted women found that the women reported: suicidal tendencies (27%); lowered self-esteem (81%); drug/alcohol abuse (32%); nightmares (32%); feelings of despair/hopelessness (46%); attempted suicide (11%).[6][6]

Australian research indicates that there is a clear link between self-destructive behaviour and abortion.  A Queensland study on 1,122 young women found that those who had an abortion were 3.6 times more likely to abuse hard drugs, twice as likely to be binge drinkers and nearly twice as likely to suffer depression.[7][7]

It is perhaps testimony to the general ignorance of the sequelae of induced abortion the majority of the women studied reported being surprised at such intense reactions to their abortion.[8][8]

 

Mental Health

A nationally representative US co-morbidity survey of 5,887 women found abortion to be associated with an increased risk of a variety of mental health problems (panic attacks, panic disorder, agoraphobia, PTSD, bipolar disorder, major depression with and without hierarchy), and substance abuse disorder after statistical controls were instituted for a wide range of personal, situational and demographic variables.[9][9]

A review of the medical records of 56,741 Californian medical patients found that women who had abortions were 160% more likely than delivering women to be hospitalized for psychiatric treatment within three months, and remained significantly higher for at least four years.[10][10]

A 25-year longitudinal study of 1,265 women born in Christchurch NZ, studied from birth to 25 years, found abortion associated with “…elevated rates of subsequent mental health problems including depression, anxiety, suicidal behaviours and substance use disorders.”[11][11]  A study of over 500 women born in Christchurch over thirty years found that women exposed to induced abortions were 30% more likely to have mental health problems.  Although rates of all forms of disorder were higher, mental health problems most frequently associated with abortion were anxiety disorders and substance use disorders.[12][12]

Analysis of California Medicaid records show that women who have abortions subsequently require more treatments for psychiatric illness through outpatient care.[13][13]

Clinical Depression

A study of over 700 Norwegian women aged between 15 and 27 found that women who aborted in their twenties were 3.5 times more likely to be depressed. Controlling for variables reduced the association but it still remained significant, at 2.9 times.[14][14]

Compared to women who carry their first unintended pregnancy to term, women who abort their first pregnancy are at significantly higher risk of clinical depression as measured an average of eight years after their first pregnancy.[15][15]

 

Women who reported induced abortion were 65% more likely to score in the high-risk range for clinical depression, compared to women whose pregnancies resulted in birth.[16][16]

Post-Traumatic Stress Disorder

Three months after undergoing a surgical abortion procedure almost one-fifth exhibited high rates of post-traumatic stress disorder.[17][17]

65% of American women who had undergone abortions reported symptoms of post-traumatic stress disorder (PTSD); they attributed their condition to their abortions and slightly over 14% reported all the symptoms necessary for a clinical diagnosis of PTSD.[18][18]

Premature Death

A record linkage study of more than 1.1 million pregnancies, including all Finnish women of childbearing age between 1987 and 2000, found that, within one year of the abortion, an average six times increased suicide rate associated with abortion compared to women who gave birth. The increased risk of death by accident and homicide was four and ten times respectively.

For the under 25 year olds the suicide rate for women who aborted was more than twelve times that of women who gave birth.[19][19]

A study of 173,279 low income Californian women over an eight year period compared the death certificates of women who had delivered child(ren) with those of women who had aborted.  Women who had aborted were more likely to die: from suicide (154%); from accidents (82%); from circulatory disease (187%); from cerebrovascular disease (446%); from AIDS (118%); and from natural causes (44%).[20][20]

A Finnish register linkage study found that within a period of12 months women who aborted were six times more likely to die from suicide than women who have delivered.[21][21]

Adolescent Girls –  mental health problems

In a US longitudinal study of adolescents who participated in two series of interviews in 1995 and 1996 it was found that, compared to their peers who carried unplanned pregnancies to term, adolescent girls who abort were:

         5 times more likely to seek help for psychological/emotional problems;

         over 3 times more likely to report trouble sleeping; and

         9 times more likely to report marijuana use.[22][22]

A study of inner-city adolescent mothers found that those with a history of induced abortion were twice as likely to be involved in alcohol, marijuana or cocaine compared with non-using controls.[23][23] In a study of drug abuse among Boston inner-city women during pregnancy, those using cocaine were twice as likely to have a history of two elective abortions (19% vs.9%) and three times more likely to have had three or more elective abortions (9% vs. 3%) than non-cocaine using controls.[24][24]

A retrospective review of hospital charts over a one year period compared women who tested positive for cocaine during pregnancy compared with matched controls who did not use cocaine found that cocaine use was the best predictor of increased incidence of abortions.[25][25]

In a San Diego study of drug use, women who used heroin or methadone were more likely to have had abortions (2.4 vs. 1.2) than non-drug using controls.[26][26] A study of young women in the state New York found that the current use of illicit drugs (other than marijuana) was 6.1 times  higher if there was a history of a prior abortion. In contrast, women with post marital births were much less likely (0.14) to report current use of illicit drugs.[27][27]

A study at the Medical College of Ohio compared differences in 35 women who had their abortion as teenagers with 36 women who had their abortions after the age of 20.  Antisocial and paranoid disorders as well as drug abuse and psychotic delusions were found to be significantly higher in the group who aborted as teenagers.  Adolescents were more likely to retreat into sexual activity or drug and alcohol abuse.[28][28]

Sleep Disorders

 

Women who abort were nearly twice as likely as delivering women to be treated for sleep disorders within six months of the pregnancy ending, according to a record based study of nearly 57,000 women.  Sleep disorders can indicate unresolved trauma.[29][29]

 

Repeat Abortions and Mental Health

 

In a Danish study it was found that, whereas psychiatric admissions increased with self-reported number of past abortions (one abortion 3.4%; two abortions 4.0%; three abortions 6.0%), no increase was observed as number of live births increased.[30][30] Unfortunately the South Australian repeat abortion rate is high (South Australia has the best mandated abortion records):

 

     Under 15  7.7%

     15 – 19                   16.7%

     20 – 24                   34.5%

     25 – 29                   44.5%

     30 – 34                   49%

     35 – 39                   45%

     Over 40                  39.7%

 

The overall repeat abortion rate was 37.0%.[31][31]

 

Studies linking abortion to substance abuse

 

Women who were binge drinkers during their pregnancy had a significantly higher rate of previous therapeutic abortions.[32][32] In a California study of more than 12,000 women during 1975 – 1977, of those having a history of two or more abortions, virtually all (98.5%) consumed alcohol throughout the entire nine months of a subsequent pregnancy and at higher levels than any of the other categories studied (up to 3 oz. Per day).[33][33]

Increased use of alcohol, tobacco, drugs and tranquillizers was found in women who aborted compared to women who were refused abortion and had a variety of pregnancy outcomes where each group had presented for abortion for psychiatric reasons at a Capetown, South Africa hospital.[34][34]

A 1991 Alabama study of women attending maternity, family planning and obstetrical clinics throughout the state, found that the prevalence of positive findings for any drug, marijuana or cocaine significantly increased with an increasing number of abortions.[35][35]  A significant association was found between a recorded and treated drug overdose either before or after an induced abortion with a majority of such events occurring within two years of each other.[36][36]

A nationally representative US co-morbidity survey of 5,887 women found abortion to be associated with an increased risk of a variety of mental health problems (panic attacks, panic disorder, agoraphobia, PTSD, bipolar disorder, major depression with and without hierarchy), and substance abuse disorder after statistical controls were instituted for a wide range of personal, situational and demographic variables.[37][37]

Compared to women who carried to term, women who abort are twice as likely to use alcohol, five times more likely use illicit drugs, and ten times more likely to use marijuana during the first pregnancy they carry to term.[38][38]  Compared to women who deliver unintended pregnancies  those women who abort were more likely to report, four years later, more frequent and recent use of alcohol, marijuana and cocaine.[39][39] Women who aborted a first pregnancy were five times more likely to report subsequent substance abuse compared to women who carried to term.[40][40]

In a Toronto study of pregnant women, cocaine users had a higher mean average of elective abortions compared to non-users of drugs.[41][41] Women hospitalised for major psychiatric disorders with a history of abortion were significantly more likely to have received the diagnosis of psychoactive substance abuse (DSM-IIIR criteria) and significantly more likely to report substance abuse, alcohol abuse and cocaine abuse compared to women with no live birth.[42][42]

Damage to social/sexual relationships including domestic violence

These sequelae of abortion were commonly characterised by self-hatred, hatred of the male, and hatred of men in general were all significantly correlated to each other.

The 260 women interviewed in an Elliott Institute study reported that losing their temper more easily (53%) and becoming “more violent when angered after the abortion (48%).[43][43]

A study of pregnancy outcomes (abortion or carrying to term) based on a national survey of low-income women who delivered within the previous 18 months, found that irrespective of other difficulties in raising a first child, a lack of male support was associated with an abortion outcome with the next pregnancy. Those who had an abortion were:

   over three times more likely to report heavy alcohol usage;

   twice as likely to report cigarette smoking; and

   more likely to report subsequently being slapped or kicked by the child’s father.[44][44]

A study of 906 and 658 Chicago women and men respectively, found abortion was associated with conflicted relationship compared to those with no abortion exposure.

Abortion in a previous relationship:

 

   was associated with domestic violence in the current relationship.

   men were more likely to report jealousy (95%) and conflict about drugs (385%) if their current partner had abortion exposure.

Abortion in current relationship:

 

   for women, was associated with various forms of sexual dysfunction (122-182%), verbal conflict about money, relatives and children.

   for men, more likely to report arguing about children (196%).[45][45]

 

UK researchers found 30% of women having second abortions were in abusive relationships with a statistical increase with three or more abortions.[46][46]

 

Child Abuse and/or Neglect

Women with a history of one induced abortion were 2.4 times more likely to physically abuse their children.[47][47] For first born children, maternal history of abortion was associated with lower emotional support in the home among children aged one to four, and more behavioural problems among five to nine year olds.[48][48]

 

Obstetric sequelae in women with previously aborted pregnancies

         Early Premature Delivery and Low Birth Rate

Reviewing 75 studies published 1980-2008 an international group of researcher found a clear link between abortion and very premature birth and very low birth weight:

One abortion increased risk of:

 

   premature birth, before 37 weeks by 20%;

   very premature birth, before 34 weeks by 50%;

   very low birth rate by more than two and half times, 170%.

Two or more increased risk of:

 

   premature birth, before 37 weeks almost doubled, 90%;

   very premature birth, before 34 weeks by more than two and half times, 160%;

   very low birth rate by more than three and half times, 260%.[49][49]

 

Evaluating over 2 million singleton pregnancies occurring between 1995-2000, 46% of which involved no previous live births, researchers, using the German Peri-natal Database,  found abortion increased the risk of very premature birth before 34 weeks of gestation by:

   30% for one abortion;

   90% for two or more abortions.[50][50]

French researchers, examining the records of 1,943 pre-term births (about one third of all premature deliveries in France), found that abortion was associated with: very premature deliveries VPD before 33 weeks gestation(VPD and extremely premature deliveries at 22 to 28 weeks gestation(EPD).  Increased risks for VPD and EPD respectively were:

   placenta abruption, 40% and 50%;

   placenta previa, 140 % and 310%;

   foetal growth restriction, premature ruptured membranes, early onset of labour, 70% and 120%.[51][51]

 

Short-term risks and complications of surgical abortion

Mortality

The risk of maternal death from abortion is related to the stage of pregnancy and procedure used. In developed countries such as the USA where woman can access safe termination of pregnancy the overall case-fatality rate for abortion is less than 1 death per 100,000 procedures.[52][52] Mortality rates are higher with the more invasive procedures and with increasing gestational age: 0.4 per 100,000 cases at less than 8 weeks of gestation; 3 per 100,000 cases at 13-15 weeks; and 12 per 100,000 cases after 21 weeks.[53][53] Causes of death include pulmonary embolism, anaesthetic complications, infection, haemorrhage and amniotic fluid embolism.[54][54]

In Australia three maternal deaths were reported in association with termination of pregnancy in the 1994-96 triennium and none in the preceding or subsequent triennia, suggesting a mortality rate of less than 1 death in 100,000 procedures.[55][55] In the most recent report, Maternal Deaths in Australia 2000-2002, there were no deaths attributable to abortion over the 3-year data collection period.[56][56]

Morbidity

Risks related to induced abortion may relate to the anaesthetic or be specific to the procedure.  A Canadian retrospective cohort study of 83,469 terminations reported 571 immediate complications (0.7%).[57][57] Rates of complications vary in different studies because of methodological differences such as the criteria used to define complications and circumstances in the provision of care.

A 2002 Danish study combined results from the mandatory reporting to the National Induced Abortion Registry of complications detected in hospital or within two weeks of discharge, for induced abortions conducted in Danish hospitals or clinics from 1980-1994. The authors reported an overall complication rate of 34 per 1,000 procedures within 2 weeks of a vacuum aspiration procedure. Five per cent of women had complications in the form of bleeding or re-evacuation of the uterus. There were more complications in teenage women than in other age groups.[58][58]

Other studies have also reported that infection, haemorrhage, uterine and cervical injury, retained tissue and failure of abortion are among the more common early complications and may result in the need for blood transfusions, and further medical and surgical treatment.[59][59] The risk of complications increases with operator inexperience and gestational age and depends on the method chosen.[60][60]

Complications related to anaesthesia

In pregnancies less than 12 weeks gestation the procedure is simple and usually takes under 15 minutes. The risk of anaesthetic complications is therefore low but as with all anaesthetics, may be increased in the presence of obesity, smoking, diabetes and other chronic illnesses.

General anaesthesia is sometimes used, for example in later pregnancy terminations carried out in a hospital. In a study comparing complication rates between local and general anaesthesia, general anaesthetic was more likely to be associated with complications such as persistent fever, haemorrhage, uterine perforation, cervical injury and abdominal surgery.[61][61] Rare anaesthetic complications include laryngeal spasm, aspiration pneumonia, malignant hypothermia and cardiac arrhythmias.[62][62]

Injury

         Uterine perforation

The risk of uterine perforation is low and increases with advancing gestation.  A number of studies estimate uterine perforation rates ranging from 0.86 to 1.4 per 1,000 cases, with lower rates in early pregnancy and when the procedure is performed by experienced clinicians.[63][63]

         Cervical trauma

Cervical trauma occurs in no more than 1 in 100 cases27 and is less frequent when surgical termination is performed by experienced clinicians and when the cervix is primed prior to the procedure with prostaglandin analogues such as misoprostol.[64][64]. Young age is a risk factor for cervical damage26 and cervical priming is recommended if the woman is under 18 years of age or at a gestation of more than 10 weeks.[65][65]

         Haemorrhage

The risk of haemorrhage following abortion is low.28 Blood loss requiring transfusion is estimated to occur in approximately 0.5 to 2 cases per 1,000 procedures (including later terminations and methods other than suction curettage).[66][66] The risk is lower in earlier in pregnancy with a rate of 0.88 per 1000 procedures before 13 weeks compared with 4.0 per 1000 at more than 20 weeks of pregnancy. Haemorrhage can be caused by uterine atony, retained products of conception, cervical damage or uterine perforation.[67][67] General anaesthesia is associated with a greater risk of uterine atony.[68][68]

         Infection

Post-termination infection occurs in up to 10% of women, but is usually not serious.[69][69] Infection may be related to unrecognised chlamydial infection or bacterial vaginosis pre-termination. Risks of infection are reduced by prophylactic antibiotics and routine screening for lower genital tract infection.30-32

         Retained products of conception

Retained products of conception occur in fewer than 1% of terminations according to large cohort studies, although higher rates are associated with inexperienced operators and higher gestations.[70][70]

         Complications of induced abortion at 12 to 20 weeks

 

Complications increase with increasing gestation and the earlier a termination occurs the lower the risk. A recent retrospective study from Canada suggests, however, that dilatation and evacuation between 15 and 20 weeks can be as safe as suction curettage before 15 weeks.[71][71] The main complication of second trimester medical abortion is retained products of conception causing bleeding.[72][72]

 

Long-term complications

 

Effect on future reproduction

There is conflicting evidence of the effect of termination on subsequent fertility, miscarriage, or ectopic pregnancy in ensuing pregnancies.  The possible long-term adverse effects of pregnancy termination on future reproduction are of particular concern to women. Many women are young, and may plan to have children in the future. The following rare complications following a pregnancy termination can impact adversely upon future fertility: cervical weakening, scarring and stenosis, Asherman’s syndrome, post-infection fallopian tube damage, and hysterectomy following post-abortion complications.

One recent multi-centre study has found that previous induced abortion is associated with an increased risk of very preterm delivery. It appears that both infectious and mechanical mechanisms may be involved.46 In 2004 the RCOG concluded that while there are no proven associations between termination of pregnancy and subsequent infertility or placenta praevia, there is some evidence that a termination may be associated with a slight increase in the risk of subsequent preterm delivery and miscarriage.[73][73]

Breast Cancer

In recent years the debate about the possible association between induced abortion and breast cancer has received increased attention. Previous studies have found inconsistent results.

A case control study of breast cancer in young women born recently enough so that some or most of their reproductive years occurred after the legalisation of abortion was conducted with residents of Washington State diagnosed with breast cancer from January 1983 through April 1990 were interviewed in detail. They were compared with a control group of women.

The risk of breast cancer was found to be 50% higher in the first group of women; the risk varied according to the age at which the abortion occurred and the duration of pregnancy.  The highest risks were observed when the abortion was done at ages younger than 18years or at 30 years of age or older.  No increased risk of breast cancer was associated with a spontaneous abortion (miscarriage). The authors’ conclusion was that an induced abortion can adversely influence a woman’s subsequent risk of breast cancer.  In women with a positive family history (defined as breast cancer occurring in a sister, mother, aunt, or grandmother) the risk was greater and was particularly strong where a woman had her first abortion when she was under 18 years of age.[74][74]

While it is not the place to examine the extensive literature on the link between abortion and breast cancer.  Nonetheless, it would not be responsible behaviour for abortion/pregnancy counsellors to ignore adverting to the risks, especially where there is a family history of breast cancer.

Conclusion

The Bill should be rejected outright for its disregard for the human rights guaranteed in international law by Australia and binding on the State of Tasmania: the abortion provisions are breaches of the provisions of the Convention on the Rights of the Child and of Article 6 of the International Covenant on Civil and Political Rights, respectively; the denial of the rights of conscience and the right to peaceful assembly are breaches of the provisions of the International Covenant on Civil and Political Rights.

The Bill also lacks concern for the health of women considering abortion. Abortion has serious physical and psychological sequelae of which women should be informed.  Consequently it is irresponsible to attempt to control the manner in which support is offered to pregnant women by those services and individuals who do not favour abortion as a solution to problems women may experience with their pregnancy.  To oblige doctors and counsellors to refer for abortion favours and promotes those services which operate in an ethical vacuum. The proposed penalties for breaches of its provisions are notably excessive and represent a blatant attempt to deny the rights of conscience.