OPINION: by Paul RussellNews Weekly
Cutting the abortion rate - the political options
, March 26, 2005
While common ground exists on the sanctity of life, there exists a wide variety of thought amongst pro-life groups about the best ways to tackle the issue of abortion.
The current debate - begun in earnest by the federal Health Minister, Tony Abbott MP, in Adelaide last year - will, we hope, have an outcome in federal legislation in the not too distant future.
Most will be aware that the existence of abortion in Australia is regulated via state and territory parliaments. So, in regard to the current debate, the question is: What are the possible outcomes in the federal parliament and how effective might they be?Limitations
Recognising that politics is the art of the possible, we should acknowledge that practical limitations do exist. There is an identifiable mood for change in our society; but just how much change can be made is essentially a judgement call that pro-life politicians will need to make. If they push for too much, the risk of failure increases.
Contemporary wisdom suggests that it is better to have a win that reduces the incidence of abortion by some degree than it is to fight valiantly for the whole, and gain nothing.
We would do well to consider the fact that few, if any, gains have been made at all in the last 30 years and that to have a win at this time will have a positive effect on public opinion that could become a springboard for the future.
And so we return to the question of the possible legislative outcomes. The federal parliament can legislate, using the territories powers, even to the extent of banning post-20-week abortions (one suggested option), in Australia's territories.
We would all remember Kevin Andrews' Euthanasia Laws Bill 1996
that put an end to the Northern Territory's brief flirtation with legalised euthanasia.
However, there are some major differences between the euthanasia bill and any action using the territories powers in respect to abortion.
First, the euthanasia bill stopped a practice that was peculiar to the NT only, whereas abortion is available nationwide. Second, to legislate for the territories only
might be seen by some MPs as a cynical use of power in restricting the availability of post-20-week abortions to some citizens and not to others. An unintended consequence might also be to create "abortion tourism".
The territories question aside, there are a number of other options, namely: informed consent provisions, mandatory counselling, and a ban on Medicare funding for abortions carried out after 20 weeks gestation.
Each option has some appeal and, while there are some ethical and strategic questions, it would help to know precisely what effect each might have on the rate of abortions. In other words, which would be the most effective in reducing the incidence of abortion?
A 2004 report to the United States Heritage Center for Data Analysis* looked at the effects of different pro-life legislation in the US during the 1990s. The four types of legislation were: informed consent policies (including counselling), partial-birth abortion bans, parental involvement laws (in the case of minors) and Medicaid funding restrictions.
Of the four types, the restriction of Medicaid funding was clearly more effective in reducing the incidence of abortion and was 2.5 times more effective than the next best result (for informed consent). This is a noteworthy difference, especially as the US Medicaid system supports low-income earners only (whereas Australian Medicare is universal). Partial-birth abortion bans and parental involvement legislation were less than one tenth as effective as the Medicaid option, possibly because they individually represent only a small proportion of the total abortions anyway.Reduction
The Medicaid option reduced the ratio of abortion by 29.66 abortions per 1,000 live births (according to the Centers for Disease Control and Prevention (CDC) data), and by 32.4 abortions per thousand live births (according to the Alan Guttmacher Institute (AGI) data). Medicaid funding restrictions reduced a state's abortion rate by 2.08 abortions per 1,000 according to CDC data and 1.57 according to AGI data.
These figures give us an indication only about the possible effects of legislation on the abortion figures. It should be said that it is more than likely that the public debate surrounding the passage of the bills in question contributed to the decline in abortions.
As we have seen in Australia, a public debate brings the issue to the forefront of people's minds and gives pro-lifers the opportunity to highlight the gruesome procedures themselves. The "yuk factor" does have an effect.
We should also consider the fact that, in the US, only low-income earners have access to Medicaid. It is fair to assume that this demographic would have no alternatives; whereas, in Australia, an abortion would still be available in public hospitals at little or no charge.
What is clear from the analysis is that reducing funding availability and informed consent were the most effective legislative options. Indeed. they are probably the only real options available through our federal parliament. Of the two, reduction in Medicare funding would appear to be the most effective and least problematic. Why is this so?
Informed consent is an idea based on the understanding that the more information a pregnant woman is given about the abortion procedure, the attendant health risks and real alternatives, the less likely she will be to proceed."Cooling off" period
Some proposed options include a mandatory "cooling off" period. While every attempt should be made to counsel against abortion, legislation to this effect could create unintended consequences and, even where a good outcome is achieved through a bill, the results may be negated.
The unintended subtext of a bill that substantively is about informed consent can clearly be read as to mean: "If, after being fully informed (about the procedure, etc) and fulfilling any other mandated requirements, a woman still wishes to abort her child, then this is acceptable (tolerable)."
This position effectively abandons the sanctity of human life argument in favour of the "woman's choice" argument, albeit a choice made after jumping through a series of hoops.
The other problem revolves around the question of who provides the counselling. It is hard to imagine the government mandating counselling by pro-life organisations although, in a tender process, some groups might gain funding.
In some states in the US, informed consent legislation has been effective because the legislatures and public officers were clearly pro-life and maintained close control over procedures and providers.
This is not likely to be the case in Australia, the clear risk being that pro-choice agencies and bureaucrats could water down or undermine the process.
Even if pro-life agencies were to provide mandated counselling, a further ethical dilemma comes into play. As evidence that the informed consent regulations had been fulfilled, the counselling agencies would probably need to provide written proof that a pregnant woman had met the requirements.
This would effectively be a licence to abort. Catholic counselling services in Germany only a few years ago were directed to cease their services by the Holy See for this very reason.
This leaves us then with the Medicare funding option. While we can mount sound arguments why the Federal Government should not use any taxpayer funds for abortions, the public debate has focussed in a particular way on late-term procedures.
Newspaper polls have consistently shown that public opinion against abortion is strongest in regard to second and third trimester procedures.
The strongest argument for removing Medicare funding of post-20-weeks is the fact that the foetus is able to survive outside the womb at about 20 weeks' gestation.
Currently, Medicare payments for abortions are available for up to 26 weeks. The argument, therefore, for moving the cut-off back to 20 weeks reflects the simple fact of the increase in medical knowledge and expertise since 1974 when the schedule item was first introduced.
- * For a copy of the report: Analyzing the Effects of State Legislation on the Incidence of Abortion During the 1990s [Michael J. New, Ph.D.], see www.heritage.org/Research/Family/CDA04-01.cfm
- Paul Russell is South Australian state president of the National Civic Council.