Duncan Kerr (Denison, Australian Labor Party) Share this | Hansard source

The budget reply debate permits members to range over a wide field and, on this occasion, I want to put forward a proposal for the consideration of the public as to whether Australia needs to develop a national sexual and reproductive health strategy. There is currently no national sexual and reproductive strategy, although in 2000 the then Commonwealth Department of Health and Aged Care commissioned a report which recommended the development of such a strategy. In December 2005, the Commonwealth Department of Health and Ageing released $12.5 million for targeted chlamydia screening programs. My proposal is that the department and the community in partnership develop a sexual and reproductive health strategy which takes a comprehensive approach to the population’s sexual and reproductive health rather than just focusing on disease and the rate of abortion.

Despite the increasing incidence of sexually transmitted infections, STIs, rape, HIV-AIDS and abortion and the continuing high rates relative to other developed countries of teenage pregnancy, sexual and reproductive health has not been a priority area for Australian governments.

A division having been called in the House of Representatives—

The issue I was addressing before the division in the House was a proposal for a national sexual and reproductive health strategy for Australia. I make it plain that I am speaking to an initiative which I understand will be the subject of discussion by the parliamentary committee of which I am a member, the PGPD, the Parliamentary Group for Population and Development. But the idea makes important sense. Currently, the community must negotiate a range of service providers for sexual and reproductive health issues, and that makes access for many difficult, if not impossible. If we had a national strategy on sexual and reproductive health it would address fragmentation of services and ensure a broad and comprehensive approach to sexuality, people and their relationships and access to services.

A national sexual and reproductive health strategy could be underpinned by principles of relevant international declarations and statements which demonstrate the legitimacy of sexual and reproductive rights as a basic human right and which promote education, prevention and early intervention. Of course, those declarations and statements include the Jakarta declaration of 1997, the Ottawa charter of 1986, the Cairo declaration of 1994, the Beijing declarations of 1995 and the IPPF Charter on Sexual and Reproductive Rights of 1998.

The purpose of such a strategy would be to provide a framework for cooperation and support for and between government and non-government agencies, private practitioners, research organisations, service providers, community groups and the wider community to work together on a number of issues, including: improvement of sexual and reproductive health; improvement of the wellbeing and the safety of the Australian community; promotion of respectful, equitable, non-violent relationships; reduction in the transmission of HIV and sexually transmitted infections; reduction in the prevalence of undiagnosed HIV and STIs; improvement in the health care of people living with HIV and STI related chronic diseases; reduction in unintended pregnancy rates; reduction in maternal and neonatal complications associated with early pregnancy; reduction in the discrimination associated with early parenthood; reduction in preventable infertility; reduction in discrimination on the grounds of sexuality and gender identity; reduction in rape and sexual assault through education and prevention; and an increase in the community’s access to a range of sexual health services in locations where people actually live.

This is an issue which has an economic as well as a social context. Because of the fragmentation of our approach, we are not providing an effective national response to some of the large issues in the lives of many in our community. I appreciate that this is a difficult area that governments enter with trepidation, but I believe that this is not an issue that can be ignored if we are going to have an effective response in the interests of our community. We have been capable of courage in the past in relation to controversial issues. Australia’s record in terms of its national response to the HIV-AIDS issue has put it to the forefront of all countries. We have an enviable record internationally because of the courage, in particular, of Dr Neal Blewett. When he was health minister in the Hawke government of the early 1980s—at a time when many governments dived for cover; and regrettably some still do—Neal Blewett spoke directly and bluntly about the need for an effective program to deal with these issues. He communicated with the people who were most likely at risk of transmission and infection, and opened the window of enlightenment rather than closing the window and allowing the darker prejudices of people to dominate that particular debate.

We should not shy away from the fact that there are literally thousands and thousands, if not tens of thousands or hundreds of thousands, of young men and women and women and men of middle age and even older who do not have access to effective programs that deal with sexual and reproductive health. This is not an issue that is confined to aberrant behaviour; it is an issue that affects the community as a whole and it is one on which a national government can give effective leadership should it choose.

For too long, we have failed to develop a comprehensive strategy for addressing these crucial issues, which many of us wish did not require our attention but we know they do so. It is therefore an issue that I put on the table in response to this budget. I am certain it involves costs in the many millions of dollars in consequences for the wellbeing of the Australian community, with loss of work time, but it also involves the unnecessary destruction of lives. That is not something that we should endure on a continuing basis, and I believe there are inspirational opportunities for Australian governments. We should focus in our responses to the budget, as many speakers have, on the day-to-day consequences of those large macroeconomic decisions. But underlying those large macroeconomic decisions are real human lives and, where there are gaps, we need to identify them. One area where I think it is plain that there is a gap is in the failure, as yet, to develop a national sexual and reproductive health strategy for Australia.

Another area that I want to touch on, which, again, is often shied away from in public debate, is the issue of AusAID and family-planning guidelines. It is an issue which I know the minister is currently considering, but we are one of the few countries in the world which have guidelines that substantially restrict the capacity of AusAID to provide effective family planning in countries to which our aid is directed. Australia has followed the United States. The United States in turn responded to the pressure from the religious right to constrain the way in which their program delivery of overseas aid is offered. It means that Australia and the United States, alone of donor countries, place restrictions on the use of aid funds. It means that, even if a woman is dying or injured from an unsafe abortion, there is no effective way of our aid program intervening and providing effective information and treatment, even if we are engaged in work in other areas of sexual and reproductive health. It is not a sensible framework for us to continue, and I wish that those who are currently engaged in discussions—I understand that there will be a roundtable and a launch on 30 May of a document called ‘The Way Forward’—would encourage further debate in relation to those issues.

I do not pretend to be the author of these ideas; they are shared by many parliamentarians. The secretariat of the Parliamentary Group for Population and Development has provided much of the text that I have referred to in my remarks. It is a bipartisan group which involves many members from the government side—I suspect, actually, there are more from the government side than from the opposition in its active membership—and I am not seeking to make my remarks partisan. It is an issue that requires attention, and I hope that we get constructive outcomes both in beginning a dialogue about the need for a national strategy for sexual and reproductive health and in unwinding some of the constraints that have prevented effective aid delivery as part of our AusAID programs for overseas countries.

The next issue I want to address, which is also an important economic issue, relates only tangentially to that which I have addressed. It relates tangentially in the sense that Australia’s HIV-AIDS program has been enlightened in the area of harm minimisation when it comes to providing, for example, needle exchange programs and education about appropriate and safe means of injecting that minimise the transmission of HIV-AIDS. That is not intended to condone drug-taking behaviour in any way—it is a straightforward and sensible harm minimisation strategy—but it leads into what I think is a failure of our parliament to have a serious economic debate about the manner in which we deal with drug related issues.

In that regard, I commend to the attention of members of the Main Committee and the House at large a recently released report by the Australian Drug Law Reform Foundation, authored by David Collins of the Macquarie University, Helen Lapsley of the University of New South Wales and Queensland University, and Robert Marks of the University of New South Wales, which is the first Australian study to quantify the cost of illicit drug use. The report points out that the illicit drug market draws resources away from legitimate businesses supplying legal goods and services and paying their fair share of taxes. In launching the report, the foundation’s president, Dr Wodak, called for a new national approach to drugs, because law enforcement was failing as a strategy to protect both people and the economy. He said:

The potential for increased business efficiency could lead to greater export competitiveness, better worker and management rewards, higher profits and higher return to shareholders. We know that return on investment is very good with drug treatment, harm reduction and social services. Other governments around the world have already stopped pretending we can arrest and imprison our way out of this problem.

I am not suggesting that within the matrix of social responses to drug law there is not a legitimate argument that can be put for law enforcement and policing to be part of the strategy. It is a legitimate argument that can be put, but we have failed to look at the other two elements of any sound and effective strategy for education, social education or social messaging and effective targeting of messages to those who are actually users, and we have failed to look at treatment and rehabilitation programs in a way that balances out the equation. We have certainly failed to look at alternative models of dealing with drug law as a whole.

It is important to use the same rigour when we talk about drug law and the way we approach drugs as we do with other social phenomena. It is quite odd that we have not had any Productivity Commission report or any serious analysis by economic institutions of the effectiveness of the institutional way we are seeking to deal with those issues. The report that I have referred to is available from the Australian Drug Law Reform Foundation website at http://www.adlrf.org.au, and I would commend it as a starting point for a larger discussion about how we can have a more objective, more rational, economically sound debate about our approach to drug use in our community.

In doing so, I will make a couple of quick remarks about its extent in Australia. There is no doubt that we pretend too often that drug use is an abhorrent social phenomenon. The truth is that we cannot recruit people now into our intelligence services, for example—those we trust with the highest level of responsibility—on the basis that they must be drug free before recruitment. It is simply impossible. There was a scandal when a footballer was reported to have used drugs, and that particular young man’s reputation has been the subject of public debate and discussion. I personally wish him well. But we should not pretend that it would not be widespread right across the community—and in the Australian defence forces.

We have just heard reports in the legal profession of a senior lawyer who is alleged to have died as a result of administration of a drug. Again there are outraged reports about drug use within the legal profession. But there is no reason to expect that amongst parliamentarians, amongst lawyers, amongst dentists, amongst doctors, amongst footballers, amongst members of the Australian defence forces, and amongst people in the community as a whole this issue is not one of significance. If we look at the statistics, that must be the case. Statistics show that over a third of the population have used illicit drugs at some stage of their life. We simply cannot imprison and treat as criminals all those persons; it is an absurd approach. So I do commend a starting point for rational debate and economic analysis that allows us to test some of the effectiveness of some of the propositions and deal with what I believe to have become an overemphasis on law enforcement and imprisonment as a solution for a much larger problem.

Finally, to balance this up at the end and put it in some context in the discussion of drugs, there has been a report recently that alcohol, for example, kills an Indigenous person every 38 hours. So we have our scandals and our hysteria about illicit drugs, but, if we know that a legally available drug is killing an Indigenous person every 38 hours, we know that across the population as a whole the greatest harms occasioned to our community are being caused by drugs which are lawfully available. I certainly do not except myself from those issues but I do commend a serious analysis rather than a trivial analysis of this issue.

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