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Wednesday, 17 November 2004
Page: 66


Senator ALLISON (1:15 PM) —There has been a lot of debate in recent weeks about the Minister for Health and Ageing's statements that 100,000 abortions a year in Australia is a tragedy. The Democrats agree that the number of terminations in this country is far too high, and I think now is a good time for us to examine how we might reduce that figure. Today I want to look at some of the statistics that are available, particularly with a focus on the young. UNICEF put out a report on teenage birthrates in 2001 which found that in 1996 at least 1.25 million teenagers worldwide became pregnant each year in the 28 OECD nations that were reviewed. It said that half a million teenagers will seek an abortion and about three-quarters of a million will become teenage mothers. In Australia approximately 25 per cent of 15-year-olds and 50 per cent of 17-year-olds have had sex. There is evidence that the age of first sexual intercourse is getting younger and that this sexual activity is resulting in pregnancies.

It is true to say that the teenage birthrate in Australia has dropped enormously over the last 30 years, down to 20 per thousand teenagers from 50.9 in 1970, but that is still a very high rate. Twenty teenage girls in every thousand have babies, and a further 24 girls in every thousand have terminations. At 44 pregnancies in every thousand teenage girls in Australia, our rate is high, but it is not the worst. The United States figure is 85.8—almost one in 10 teenagers getting pregnant. But at the other end of the scale, which is what I want to focus on today, in the Netherlands, Japan, Spain and Italy the figure is just over 10. In other words, our rate is four times as high as theirs.

If we just look at births, our rate is six times higher than that of Korea and three times that of Japan, Switzerland, the Netherlands and Sweden. Of course, teenage pregnancy and birth are not equally distributed within society. Australia's highest teenage birthrates are among Indigenous women. In 1999, 21.3 per cent of Indigenous births were to teenagers, compared with 4.2 per cent of non-Indigenous births. Australian women in socioeconomically disadvantaged groups and in certain geographical areas are also more likely to be teenage mothers.

Giving birth while a teenager is strongly associated with disadvantage later in life. Teenage mothers are more likely to drop out of school, have low levels of qualifications, be unemployed and low paid, live in poor housing conditions, suffer from depression and live on welfare. Children of teenagers are more likely to live in poverty, to grow up without a father, to become victims of neglect or abuse, to become involved in crime and abuse, drugs and alcohol, and eventually to become teenage parents themselves, beginning the cycle all over again. Having said that, I want to acknowledge that there are many teenage mothers out there who do a great job of parenting and who do not suffer from those disadvantages, but they are in the minority and, for the most part, their lives are a hard slog.

The 2002 results of the 3rd National Survey of Australian Secondary Students, HIV/AIDS and Sexual Health found that, in their most recent sexual encounter, almost one in 10, or 9.4 per cent, of Australian secondary school students did not use any form of contraception, while a further 11.8 per cent used withdrawal. On average, young people delay seeking prescription contraception for one whole year after initiating sexual activity. Teenagers are the most frequent users of emergency contraception at Australian family planning clinics. Forty-five per cent of sexually active Australian high school students do not use condoms consistently, and 31 per cent use condoms without any other form of contraception.

As well as pregnancy, the problem with unprotected sex is sexually transmitted disease, and 3.5 per cent of sexually active students have been diagnosed with a sexually transmitted infection. Chlamydia is one of the most common notifiable diseases in Australia, and most infections occur in the under 25-years-of-age group. Adolescent rates of chlamydia have been estimated to be as high as 28 per cent. Of course, chlamydia is associated with pelvic inflammatory disease, which may lead to tubal infertility, chronic pelvic pain and ectopic pregnancy.

The point I want to make today is that the picture for Australia's young people and their reproductive health is not rosy, and it is not likely to be improved while the debate centres on terminations, which simply instils fear and shame in women. As in all health matters, prevention is better and so much cheaper than cure. At the centre of our thinking on the issue should be the idea of giving parents the choices necessary to plan the timing and the number of their children. We have just not made the same progress in reducing teenage pregnancies and births, most of which are not planned, as many other OECD countries. For example, Austria and Germany, both of which had higher rates than Australia three decades ago, have reduced their teenage birthrates to well below ours, and there are many other countries that have made substantial improvements in their teenage birthrates. Norway has reduced its teenage births by 72 per cent. This is despite a number of factors in the past three decades which could be expected to increase teenage birthrates, such as what some might describe as a weakening of traditional models of sexual behaviour and increased sexual pressures on young people. The UNICEF report suggests that those countries that have taken steps to equip their young people to deal with these social changes are the countries that have been the most successful in containing teenage birthrates, while those that have undergone the sociosexual transformation but have done little to prepare their young people still have very high, and sometimes climbing, teenage birthrates.

I think we should be looking at the Netherlands in particular. It has reduced its teenage birthrate to the lowest in Europe and has just 3.9 teenagers in every 1,000 seeking abortion. Norway has lifted the average age of first intercourse, and it did this by being open about sex and contraception, having good sex education and providing sexual health services to teenagers through youth health centres.

I think that what we need to do in Australia is to look very carefully at this area. Australian governments have not implemented comprehensive sexual health education programs to teach young people how to have rewarding sexual relationships or to protect themselves from potentially adverse consequences. Arming students with information about health, sexual health and contraception has been demonstrated to be the most reliable way to ensure that young people make responsible and safe choices. I think some people fear that if we open this debate in schools and we start talking about it that that will encourage sexual activity. The evidence around the world is that the opposite is the case.

Current state and territory government approaches are demonstrably patchy and inadequate for the task of reducing unwanted teenage pregnancies and preventing sexually transmitted infections. Some Australian schools, I admit, run very sophisticated and very good sexual health programs for all their students; others provide only optional subjects and not all states cover the same issues. What we need is national leadership on sex education in schools.

Next week, no doubt, we will be debating some legislation where the federal government sets conditions on schools to do with civics education—running flags up flagpoles and the like. I would like to see those conditions extended to sexual health. But of course any sex education would need to involve a comprehensive evidence based approach that focused on prevention. It would be a mistake to go down the path of the `just say no' approach. It does not work anywhere, it never did work in this country and it is not going to work in the future.

I urge the government to learn from the work that has been done in other countries on reproductive health. I have focused on teenagers but there are many ways in which we can also improve reproductive health services to women who are older than teenagers. Emergency contraception would be one that I would draw attention to. Since January this year it has been available to women, but how many women, teenagers and others know that emergency contraception is available? We do not know because there is no program to make sure that people understand it is available. Some pharmacies provide emergency contraception and others do not. We do not even know what percentage of pharmacies are participating or how often this service is used. These sorts of statistics are critical for us to collect in order to know what makes a difference. In the United States, emergency contraception, as far as I know, is still not available. The President of the Planned Parenthood Federation of America argued:

This is a safe drug that could prevent more than a million and a half unintended pregnancies a year and reduce the number of abortions by about 800,000 if it were widely used.

It is quite clear that there are many ways in which we can reduce the current level of abortions in this country and we ought to do that, but using the best evidence available, looking carefully at the needs of women and, as I said, taking a national approach to this problem.