Alan Eggleston (WA, Liberal Party) Share this | Hansard source

The debate on the Therapeutic Goods Amendment (Repeal of Ministerial responsibility for approval of RU486) Bill 2005 has been very interesting both here in the Senate and in the public arena since the matter was first raised towards the end of last year. It seems to me that there have been two streams in this debate, the first arguing that there is a pressing need to have RU486 available to the women of Australia and the second about whether the categorisation of abortifacient drugs in a special reserve category, with their availability subject to ministerial approval, should remain in place.

Presumably everybody here in the Senate knows that I practised as a GP obstetrician in a large regional centre in WA for quite a long time. With that background, my questions about RU486 are: firstly, does RU486 add anything useful to what is already available in Australia for termination of a pregnancy, particularly in rural and regional areas, which is where I worked for some 22 years? Secondly, is RU486 as convenient and safe as methods of termination already available in Australia?

I suppose we have to look a bit at the history of maternal morbidity and mortality, and also look at the history of abortion, perhaps over the last century. Of course, things have come a long way since 100 years ago, when everywhere in the world there were very high death rates associated with having babies, and there had been for centuries past. The fact that women were forever pregnant and had a much shorter life span—largely because of the complications of obstetrics—had much to do with the secondary social position of women in society. Men lived longer; women tended to die in childbirth and were often anaemic and tired from endless pregnancies.

Abortion 100 years ago was a very secret thing. Nobody knew about it, but presumably it occurred and was done by backyard abortionists. And, of course, there was a high incidence of complications from abortions. But, in both obstetrics and the termination of pregnancy, things have changed greatly. In the latest triennium of Australian maternal mortality figures, I think there were only 34 deaths in over 760,000 births. That was for the three years from 1997 to 2000. It is interesting that 20 years before that, in the triennium from 1964 to 1967, there were over 200 deaths in roughly 600,000 deliveries. So, over the century, maternal mortality has fallen steadily. We in Australia now have, in effect, abortion on demand. It is performed in hospitals, under hospital conditions and with a very low complication rate. So it is an interesting observation that we now have a very safe set of figures for both deliveries and terminations of pregnancies.

I have found, in discussions of RU486, that there is a widespread misconception that it is a kind of superior morning-after pill. In fact, as Senator McGauran has said, RU486 is far from being a morning-after pill and is much more complicated to use than the morning-after pill. The morning-after pill is taken as two pills 12 hours apart within 72 hours of unprotected intercourse. It might produce light bleeding, like a period, but that is the end of it. By contrast, RU486 is recommended for six- to seven-week pregnancies and, in some countries, is used to terminate pregnancies of up to 14 weeks.

Furthermore, the use of RU486 is much more complicated than taking the morning-after pill and much more complicated than going to hospital for a surgical termination of pregnancy. It involves at least three separate visits to the doctor over 14 days. On the first visit the woman is given an anti-progesterone pill to kill the baby. At the second visit, two days later, she receives Prostin to induce contractions to expel the foetus, and at 14 days she is reviewed to see if the abortion is complete. If it is not, the woman is admitted to hospital for a surgical procedure to evacuate the contents of the uterus after any infection has been treated. By any measure we would have to agree that the use of RU486 is a much more complicated procedure than a woman just going to a hospital in the morning to have an ultrasound and then having a short surgical procedure carried out to perform a termination of pregnancy. It is a much more complicated procedure, and it is not done in a hospital.

According to the website RU486facts.org, the incidence of adverse after-effects with RU486 is very high and it is said that 23 per cent of the adverse effects have been judged to be severe. For example, there is a seven per cent haemorrhage rate. It is well known that deaths have occurred from haemorrhage from the use of RU486. It is significant that because of the risk of haemorrhage in RU486-induced home abortions it is reported that the People’s Republic of China has banned the use of RU486 in China. I think that is very interesting, given that the Chinese government has long had a policy of limiting its population. One would have thought that if this drug were convenient and simple to use, without any untoward after-effects, then probably the Chinese government would have promoted it among its own population.

Sepsis is the other significant, severe complication of RU486 abortions. According to a World Health Organisation study, 30 per cent of women who had an incomplete RU486 abortion developed pelvic infections. There is growing evidence, in addition, that mifepristone, which is the antiprogesterone drug used to kill the foetus in RU486, actually depresses the immune system, making the woman concerned more susceptible to the infections which cause septic shock. So my conclusion has to be that, far from adding to the range of safe methods for the termination of pregnancy available in Australia, making RU486 available in this country would be a significantly retrograde step, adding avoidable risk to any woman using this drug to terminate a pregnancy.

It seems to me that there is something in common between supporters of home deliveries and those who are calling for RU486 to be made available in Australia to induce abortions in non-hospital settings. In the case of home deliveries, the argument is that, since the incidence of complication in childbirth is low, most home deliveries will be incident free. The catch is that it is not possible to predict in which deliveries unexpected complications like haemorrhage or obstructed labour will occur. The same applies to home abortions induced with RU486. It is impossible to predict beforehand which ladies using this medication will suffer severe and significant complications in the home environment and have adverse effects thereby. It seems to me that there is a certain naivety about those driving this move to have RU486 made available in Australia in failing to recognise that the possibility of serious consequences from the use of the drug, including death, really does exist and that they really do occur.

I came into this debate when I was asked to express a view about Dr Sharman Stone’s rationale for permitting RU486 to be made available in Australia, which was that it would be convenient and useful for women in regional Australia to have access to this drug to induce abortions rather than go to a hospital for a surgical termination of pregnancy. At the time I felt that I had to express my disagreement with Dr Stone. In contrast to Dr Stone, I believe that RU486 would be hazardous for use in regional Australia because quick access to a surgically equipped medical facility is frequently not available to women in country areas and, if it is, they often have to drive a long way to get there.

The view that I expressed was also expressed by the Chief Medical Officer of the Commonwealth when he was specifically asked by the minister about the use of RU486 in country areas. In addition, the same view has been expressed in a letter circulated to members of the federal parliament by Mr David Gawler, a consultant surgeon at the Royal Darwin Hospital. He specifically mentioned that he believed that there would be particular problems in the use of RU486 with Indigenous women in remote communities in the Northern Territory. I am aware that other doctors working in areas with high Indigenous populations, such as Broome, have, as Senator Adams said, expressed a contrary view to the surgeon, Mr Gawler. But I have to say that my own experience in dealing with pregnant Indigenous women in the Pilbara was that it was a common experience that it was difficult to get them to return for follow-up. In view of the requirement for return visits with RU486, I can foresee difficulties with the use of this drug with Indigenous women in remote areas.

So, from my point of view, I cannot see any net gain to the Australian community from permitting RU486 to be made available in Australia as a means of terminating pregnancy instead of using the currently available and safe surgical methods, which are, from my experience, much simpler and certainly, as I said, much safer to implement for the women concerned.

Turning to the second dimension of this debate, concerning ministerial approval for abortifacient drugs, I would like to make some brief remarks. Abortifacients are not the same as other drugs used to treat medical conditions. It seems to me impossible to deny that such drugs as these involve broader social considerations about our society and, in fact, about who we are and what we stand for.

For me, one of the major causes of concern about the use of RU486 is that it would be difficult to collect data on the number of abortions performed in Australia since most of these abortions would go unreported. From a public health, general sociological and general public interest point of view I think it is important to know how many terminations of pregnancy are being performed in our country. It is a commonly held view that there are between 90,000 and 100,000 abortions performed annually in Australia. I think it is a matter of concern that the number of abortions has reached that level, particularly as the figure includes an increasing number of mid- to late-term abortions on what would otherwise be viable foetuses. This is certainly a trend which I think we as a society should be giving deeper consideration to.

The purpose of the private member’s bill before the Senate today is to remove ministerial authority and to include RU486 in the list of restricted goods which are abortifacients and to leave the evaluation of the use of abortifacient drugs to the Therapeutic Goods Administration. Abortifacient drugs are not the same as other medications. They are not there to treat leukaemia, some rare disease or some common disease like bronchitis. Abortifacients are drugs which induce abortion and mean that an abortion occurs. So, quite apart from the safety issues I have mentioned, it seems to me that there are broader public interest issues surrounding the issue of abortion which mean that decisions about the use of such drugs in Australia require ministerial overview, and, accordingly, I will be voting for the status quo.