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Thursday, 25 September 2014
Page: 7086

Senator McLUCAS (Queensland) (11:27): I rise to make my personal contribution to the debate on the Health Insurance Amendment (Medicare Funding for Certain Types of Abortion) Bill 2013. I concur with Senator Back. It is Senator Madigan's right to move an amendment on something he feels very strongly about. I also concur with Senator Back that it is the right of every senator to have their contribution recorded on an issue of this nature. It is an issue on which people have a right to vote on the basis of their conscience. Issues to do with life and the termination of pregnancy require a measured, balanced and sensible debate that allows everyone to have a part. Termination of pregnancy always brings strong views to any debate. I think it is incumbent on this chamber—and I think we do it rather well—to respect each other's point of view and allow the debate to occur but ensure that the will of the Senate is the result.

The bill amends the Health Insurance Act 1973 by inserting a proposed new section 17A. Proposed section 17A(1) provides that a Medicare benefit is not payable if:

(a) the professional service involves a medical practitioner performing:

   (i) a medically induced termination on a pregnant woman; or

   (ii) a service that relates to or is connected with performing a medically induced termination on a pregnant woman; and

(b) the termination is carried out solely because of the gender of the foetus.

Section 17 of the Health Insurance Act covers the funding of medical services performed outside hospitals.

I want to make it clear. I, like every single senator in this place, am strongly opposed to any termination which is based solely on gender selection. I do not think there would be a person who would concur that that is a good and proper thing and that we should allow it. Clearly, gender selection in Australia is not something that Australians agree with. However, let us move to why we are having this debate today.

I ask the question: what is the problem that this bill is trying to fix in Australia? We know that, internationally, there are circumstances where gender selection is a problem. But, quite rightly, the Senate Finance and Public Administration Legislation Committee undertook an inquiry and tried to answer that question. What is the problem that we are trying to solve in Australia? There is no evidence that says that terminations are systematically being performed in our country, based on gender selection. That is not the case here. It was made clear through submissions to the committee, which held its inquiry last year and reported in June, that that was the case. This is not an issue that needs an answer. We do not have systematic gender selection terminations being performed in our country. Liberty Victoria submitted to the inquiry, and said:

We believe that changing access to Medicare for abortions in Australia because of cultural biases and practices occurring in other countries is inexcusably bad public policy.

They said, very clearly, that this might be a problem in other nations. It is not in Australia and, therefore, does not need a fix. Reproductive Choice argued that gender selective terminations 'cannot be disguised' and cited evidence of skewed gender ratios in China and India.

Women's Health Victoria pointed out—and this is a really important point—that Australia's sex ratio at birth is 105.7 male births per 100 female births and, therefore, within the normal range of 102 to 106. Let us not forget that women give birth to more boys than girls. We always have; we always will. The ratio of boys to girls in Australia is 105.7. The normal range in the world is 102 to 106. So we are well within the normal range. The facts do not support taking the action that this bill represents. The evidence is there and this Senate has made it a practice of ensuring that legislation passed by this place is based on evidence.

The bill, on implementation, also has unintended consequences and practical limitations. Practically, the bill may be easily circumvented because Medicare items cover more than one service. I quote from the submission from Children by Choice:

The Medicare Benefit Schedule Item Number that this Bill seeks to amend also subsidises the provision reproductive health procedures other than pregnancy termination, such as treatment of miscarriage. There is no recording of the reason for the provision of the procedure under that Item Number, and thus no solid evidence that Medicare funding is being used for termination of pregnancy for the purpose of sex selection.

There is a practical delivery problem that this bill does not address. It is practically impossible to deliver the outcome that Senator Madigan is actually trying to achieve.

The bill also has the potential to be discriminatory and unfairly targets certain groups of women. Evidence presented to the finance and public administration committee also stated that measures like this enacted in other countries have been found to be ineffective.

The Young Women's Christian Association noted that UN agencies and the WHO interagency statement indicated that restrictions had been ineffective. I quote from their submission:

Governments in affected countries have undertaken a number of measures in an attempt to halt increasing sex-ratio imbalances. Some have passed laws to restrict the use of technology for sex-selection purposes and in some cases for sex-selective abortion. These laws have largely had little effect in isolation from broader measures to address underlying social and gender inequalities.

So even where there is a problem—and Australia does not have a problem—laws such as this have been found to be ineffective. The Young Women's Christian Association also stated that the bill may encourage discrimination against women from some South Asian, East Asian and Central Asian communities when seeking access to reproductive health services. That is questioning the motivation for a woman seeking to terminate a pregnancy. I think the Young Women's Christian Association's submission has some very real validity in making that point.

Colleagues, any decision to terminate a pregnancy is ultimately a decision for a woman, on the advice of her clinician and on the advice from whomever she wishes to seek advice from. It is a fundamental right of a woman to be able to terminate a pregnancy. It is her decision. She can seek advice from her clinician—and she should—and from others whom she wants to receive advice from. This is not a decision for government; it is not a decision for the parliament. This is a decision for a woman alone. Any of us who have known women who have had to go through this process know that this is a very difficult decision that women make and they need to be supported in that decision-making.

It is also a matter for clinicians to be able to determine whether it is safe to perform a termination, and this bill inhibits the clinician's capacity to do this. We should not interfere with that relationship between a woman and her clinician.

This bill does impact on a woman's right to a termination.

The National Health and Medical Research Council's Ethical guidelines on the use of Assisted Reproductive Technology in clinical practice and research constrains gender-selective terminations for non-medical purposes. The guidelines state:

Sex selection is an ethically controversial issue. The Australian Health Ethics Committee believes that admission to life should not be conditional upon a child being a particular sex. Therefore, pending further community discussion, sex selection (by whatever means) must not be undertaken except to reduce the risk of transmission of a serious genetic condition.

This is an issue that is complex and does need discussion.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists in their submission made the following statement. Of course:

The College does not support termination of pregnancy for the reason of "family balancing" or "gender preference".

But they go on to say—and this is important:

There are rare but important reasons for gender selection on medical grounds. These include (but not exclusively):

a)   Rare serious genetic (X-linked) conditions where there is no other way of determining a possibly seriously affected child other than by gender

b)   Other probably hereditary clinical disorders (phenotypes) that do not have a recognised genotype

   e.g. parents—

and here they use language that I would probably not use myself, but I am quoting their submission and they say—

   e.g. parents that have two severely intellectually handicapped sons may elect for a female child in order to reduce risk of a severely intellectually handicapped offspring in their next pregnancy.

These are really difficult questions—really hard questions—for families who want to have children. What is it for us to interfere in those difficult decisions?

I have met, over many years, with people from the fragile X syndrome foundation—people who have had to make very hard decisions. Now we know what fragile X is; now we know how it presents. And is it our business to interfere in the right of those families to have a child? Is it? Shall we let those people make good, sensible, thoughtful decisions, because they want to have children too? Let us let them have their decisions as well.

The National Association of Specialist Obstetricians and Gynaecologists made this comment:

The National Association of Specialist Obstetricians & Gynaecologists … has had a recent email survey of its councillors, with the result that no one was in favour of social gender selection.

A question was raised as to how this could be enforced, with the suggestion to require laboratories which perform MBS funded antenatal chromosome testing to not release the sex of the embryo except for specific medical indications eg Haemophilia, Duchene's muscular dystrophy etc until after 20 weeks, which is when they can find out by ultrasound anyway. It will be very unlikely anyone will terminate a pregnancy after that for a non medical indication.

Clinicians have very serious concerns about the bill. The Australian Medical Association has stated specifically that it does not support the passage of the bill and that:

… Medicare benefits … should not be used to address social issues.

They go on to say:

If the Australian Parliament is inclined to prevent gender-biased sex selection as per the interagency statement by the OHCHR, UNFPA, UNICEF, UN Women and WHO referred to in the explanatory memorandum for the Bill, it should do so in a more direct and specific way.

So, essentially, the AMA is saying, 'If you want to do this, do not use the Medicare Benefits Schedule to achieve the outcome.' They do not go to the question of whether or not there is a need for any action, but they are saying, 'If you are going to try and remove a problem'—which, I contend, is not a problem and that is: sex selection using termination as the methodology—'do not use the Medicare Benefits Schedule to achieve that outcome.' They say:

The interagency statement states at page 7:

   It is clear that, while intending to effect a common good, restrictive laws and policies implemented in isolation from efforts to change social norms and structures can have unintended harsh consequences, and may violate the human rights of women.


   "…the causes of biased sex selection lie in gender-based discrimination, and that combating such discrimination requires changing social norms and empowering girls and women."

And I totally agree with the submission that the AMA is making. They conclude by saying:

The interagency statement provides a suite of recommendations about the many levels on which this social issue should be addressed. It does not recommend denying financial assistance for legal medical procedures.

There are alternatives to achieve the bill's aims—for instance, the previous example I talked about.

This bill is designed to solve a problem that Australia does not have; that is the first principle. But even if there were a problem, to use the Medicare Benefits Schedule to achieve the stated outcome would be the wrong method by which to do it. Do not start trying to curtail the use of the MBS, which is for a universal health service, provided to everyone on the basis of clinical need, to solve a medico-legal problem. And that is essentially what the submission from the AMA says.

This is not a problem in Australia. All the evidence points to the fact that there is not systemic gender selection through termination of pregnancy happening in our country. If there were, there would be a need for an answer. But there is not.

Senator Madigan, I respect your right to move a motion to deal with problems as you see them. But I say to you: this is not needed, because we do not have that problem, and the way that you are trying to solve the problem that you see is not going to work. I will not be supporting your legislation.

I thank the Senate for the opportunity to speak to this bill, and I concur again with Senator Back: every senator should have the right to speak on such an important piece of legislation.