Cory Bernardi (SA, Liberal Party) Share this | Link to this | Hansard source

In keeping with my usual practice I will wade into matters that cause the most controversy in this place, that being the topic of abortion.

It is a heartfelt topic. It is one on which people hold passionate views on both sides of the debate. I do not propose to cover that, because this bill is not in itself a moral judgement on abortion per se but it does render a judgement, which this Senate has done previously, about the injustice that is done when a baby is killed on the basis of its gender.

Quite rightly, we condemn these practices when we hear about them internationally. It is a matter of fact that there is an international movement through the United Nations from 1994 at the Cairo Population Conference, where it committed those signatories involved:

… to take the necessary measures to prevent infanticide, prenatal sex selection, trafficking in girl children …

Make no mistake: this is a gender equality issue because, overwhelmingly, sex selection, as it is practised in other parts of the world, is about terminating the lives of female babies. I do not know how many take place in this country, but the mere notion—the idea; the concept—that we as a civilised nation think that this is an acceptable use of taxpayers money which can be justified by any measure whatsoever I think is quite abhorrent.

Under this Health Insurance Amendment (Medicare Funding for Certain Types of Abortion) Bill 2013, the proposed new section—which I think is 17A schedule 1—Medicare benefits would not be 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.

The explanatory memorandum of the bill makes it very clear that this would have a very modest—or limited, in government parlance—impact on the financial outcomes of our budget. So it is not about money, and it is not about abortion per se. It is about inequality. It is about gender equality and our affirmation that terminating a baby's life on the basis of gender is sickening and abhorrent. It is worth noting that the explanatory memorandum also states:

This Bill is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.

I state for the record that I agree wholeheartedly with the premise of this bill. If the opportunity comes to vote in favour of it, I will vote in favour of it. I also commend Senator Madigan for his efforts in bringing a legislative instrument into this chamber which reflects the will of the Senate and the motion that the Senate passed decrying these gender-selective abortions. We have to recognise that in the public domain we must be prepared to put ourselves forward to discuss issues that are intensely personal and moral and that people have very strong opinions on—emotive opinions—but we have to be prepared to discuss them in the context of what is overwhelmingly right. The Senate is a unique place. It is a place where we can take considered views on many things and where there can be a conversation between senators to reflect the great diversity of the Australian population. Senator Madigan has brought forward this bill with that in mind, and hence I support it.

It is worth noting that there is very little evidence, or maybe no evidence, available to the government that suggests that termination of pregnancy for sex selection purposes is widespread or exactly on how many occasions it is actually performed in Australia. We recognise that most abortions are conducted in the first trimester of pregnancy. The horrors of late-term abortion and things like that make people feel very desperately uncomfortable—and that is essentially what we are talking about. For those of us who have had children, the gender identity of your child is generally determinable at about 18 or 20 weeks, so it falls outside of that first trimester. So we are already outside of the area where most abortions are taking place. But a baby is viable outside of the womb from about 24 weeks, and even earlier in some instances with medical support. So what we are talking about here is a pregnancy where someone has been told that they are having, generally, a girl and they say, 'I don't want a girl.' That is just abhorrent no matter what you think about abortion.

I have to note that there are experts who say that there are very few of these instances, but also there are experts who say that no doctor would perform an abortion under these sorts of demands or circumstances. Michael Permezel, the President of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said:

I don't think there is any doctor that would perform an abortion on those grounds.

The problem with that is that doctors in jurisdictions like Victoria, where you basically have abortion available on demand, can be taken to a tribunal or disciplined for failing to refer someone for an abortion under whatever circumstances. I reject that in its entirety too. I think conscientious objection and freedom of moral thought and action are absolutely important in this country.

This bill was examined by the Finance and Public Administration Legislation Committee when it was referred in March of last year. The report was presented on 27 June. Not surprisingly, the committee did not make a particular recommendation, but it has been examined by a committee. In the end, we have to make a determination for ourselves. That determination is whether we think it is acceptable for taxpayers' money to be used through the health system to allow even one abortion on the basis of gender. I do not think that is acceptable. It breaches what I would say are our international obligations. It breaches the premise that many people have been fighting for in our country and around the world, and that is gender equality. Quite rightly, we condemn these sorts of practices that happen in other nations. I refer the Senate to the speech that Senator Cash made on this subject some time ago, which approached and dealt with it from the perspective of international obligations and also from the perspective of gender equality. We should have no business condoning, even implicitly or less than implicitly, these sorts of actions, because they go against the fundamental basis that so many of us here believe in.

The 2011 UN interagency statement titled Preventing gender-biased sex selection was released by the United Nations Office of the High Commissioner for Human Rights, the United Nations Population Fund, the United Nations Children's Fund, the United Nations Entity for Gender Equality and the Empowerment of Women and the World Health Organisation. They all reaffirmed the commitment of the United Nations to:

… uphold the rights of girls and women and to address the multiple manifestations of gender discrimination including the problem of imbalanced sex ratios caused by sex selection.

Let me repeat that. The United Nations and these other associated organisations:

… uphold the rights of girls and women to address the multiple manifestations of gender discrimination including the problem of imbalanced sex ratios caused by sex selection.

That is the question before us today: are we prepared to uphold the rights of girls and women? Are we prepared to address the multiple manifestations of gender discrimination which are attributable to these sex-selection abortions? It is a question for all of us today. Ultimately, as with most matters relating to abortion, if this is brought to a vote it will be a conscience vote. There will be people who have very passionate and strong reasons to vote against this bill. But I cannot imagine that out there, in the broader Australian public, anyone really thinks it is okay to terminate the life of an unborn child on the basis of its gender.

It would be interesting to determine how this Senate resolves this issue. I put on the record that, should it come to the vote, I will support this bill—not simply because I have a vehement opposition to abortion but because this goes beyond the pale of even those people who support the right of women to choose, as they so blandly put it. This is not a choice based in anything except selfishness. The choice to terminate a child on the basis of gender is perhaps the most selfish decision that anyone could take. It is saying, 'I do not think a girl is worth the same as a boy.' When has this country thought that was going to be okay?

Unfortunately what happens with legislative instruments is that things sometimes slip through the net. There are unintended consequences; there are oversights. You do not think, when it passes, that people would exploit loopholes but they do. I had some experience with this much earlier in my time in this place when I discovered that there was a loophole in the baby bonus legislation as it was then. I had evidence from people who had actually done it themselves, and from medical practitioners, that people were having terminations after a certain gestation period and, because the child was over a certain weight, they were entitled to the baby bonus. That is abhorrent. We had instances where people suggested, and the evidence supported the fact, that people had done this on multiple occasions. That sort of stuff is sickening. I was told at the time that it was not possible; it could not happen and would not happen. But it did happen, and ultimately the government was forced to address it. There is still some suggestion that it has not been entirely redressed, but we cannot prevent fraud and the misuse of these sorts of opportunities if someone is prepared to lie and deceive. That will be the case in many instances, I suggest, in the arguments we might hear today. People may say someone who wants a termination on the basis of gender will not go to their doctor and say that is the reason; they will make up another reason. That may indeed be true, and I suggest that is the reason we need to have a broader, more wholesale look at whether abortion being available for any reason the right thing for a country. That is broader philosophical outlook.

But whether it has an impact on the level of terminations or the financial requirements of our budget is immaterial to me. What is material is that we have to send a message—a strong message that is consistent with our international obligations—that we as a country are not prepared to endorse or support these types of abortions taking place in this country. We are not prepared to financially support even one abortion on the basis of gender.

I commend Senator Madigan for bringing this bill into the parliament. If the opportunity comes to vote for it I will absolutely endorse it, and I hope my colleagues in this place will do the same—not, as I stress, because they are for or against abortion but because we should all be horrified by the mere concept that even one baby girl or baby boy loses its life simply on the basis of its gender.

Claire Moore (Queensland, Australian Labor Party, Shadow Minister for Women) Share this | Link to this | Hansard source

Senator Madigan has brought this bill back to our chamber so we can consider the issues he put forward at the last parliament. As I said at that time in the debate we had, you will not find a single member of this chamber who would in any way support the use of terminations for gender selection. It is important we raise that as a standard and acknowledge this is a principle we do not accept.

However, when we had the finance and public administration process look at Senator Madigan's bill in the last parliament, the many very impressive submissions we received looked particularly at the issue of whether the bill that Senator Madigan has brought to us, the suggestion that making a change to the Medicare legislation, the Health Insurance Act, is the best way, or even an appropriate way, to look at the concerns he has raised about the issue—the international issue—of gender selection. Indeed, as I said at the time, I commend the fact that Senator Madigan talked about the Cairo program of action in this bill and in the discussion paper he brought forward—about what we as a world were going to do about human rights and, in particular, women's rights. That program was published in 1994. I commend the use of this document. I wish more people would refer to this document in this place. I talk about it regularly.

In this document it does say that we should do, among a number of other things, everything we can do as a nation and as an international community to look at the very abhorrent issues of gender selection. They are all listed there; I commend it. It also talks about the important issues of women's reproductive health rights and the particular responses that women needed to make to ensure that their own health is being looked after effectively and professionally so that they can make appropriate choices about their health.

There are a number of points I want to make about using the Health Insurance Act to look at the issue of gender selection in our nation. In the first place, there is no clear evidence that this abhorrent practice of gender selection is a practice that is used in this nation. There have been very isolated examples of people who have claimed that this has happened, and we did hear about those during the introduction of Senator Madigan's bill. We have had people talk anecdotally about how this could be used by some people.

However, the core aspect of this is that it is a medical issue. By using the Health Insurance Act as the model for which any action would be taken in this legislation, we are looking at an area that is particularly covered by issues of personal rights and privacy. If you look at our Medicare statistics—the only basis on which you can have any understanding of or make any statement about how terminations are used in this nation—you will not be able to clearly identify where terminations have taken place or, in particular, any reason for these terminations. On that basis, there is no evidence to say that the use of termination for gender selection is an active issue in our nation. The Medicare item about which Senator Madigan is moving his motion does not indicate the motivation for the decision to terminate. We have very clear statistics that show it covers a wide range of medical processes.

This was clearly pointed out in the evidence provided to the finance and public administration committee by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, as well as the then Department of Health and Ageing. The department gave an indication of how Medicare operates in this nation, so this bill will not be able to address the core issue that Senator Madigan has chosen, I think quite rightly, to bring to our attention. He is concerned about the prevalence, if any, the understanding, if any, of the issue of gender selection in medical practice in this country, but I am going to make an argument about what I think should be done on this important issue.

I just want to put on record some of the evidence that came forward from RANZCOG, which is the College of Obstetricians and Gynaecologists. It points out the very rare occasions where there could well be medical advice that looks at this issue, where this medical advice could be used in gender selection. I want to put this on record, because it is quite sensitive. I quote from the submission that was put by the then RANZCOG president Professor Michael Permezel:

There are rare but important reasons of 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 both gender [and]

(b) Other probable hereditary clinical disorders … that do not have a recognised genotype.

So when we are looking at changing the blunt instrument of legislation, we are actually intruding, I believe, upon a very sensitive, personal medical decision. I have always said this is a very important decision to be taken by a woman, her medical practitioner and any other person she chooses to engage in that discussion. So the professional advice of the college, of the people who are best trained to work in this area, is that it is important to understand that there are times when a gender selection process may be used. It is important to have that on the record so that there are not just blunt generalisations about this process.

However, in terms of what we need to know about what should operate in our nation, I absolutely take seriously the concerns that were raised originally by Senator Madigan. I know that it has been raised by many other senators in this discussion. The concern, the worry, is about whether there is indeed the use of gender selection in medical decisions and how to then take that on. As a community we should be engaging with medical practitioners, engaging with the people who work in the wider medical community, to ensure there is an understanding that this process is not legal in Australia. We should be very clear that we do not accept it and, as I said at the beginning of my contribution and which I imagine will be repeated by most speakers in this debate, that there is no support for this process in Australia—no support at all.

What we should be doing is raising our concerns about this and talking with the range of people who made contributions to our finance and public administration inquiry. We should be talking with them because they showed their interest by responding to the Senate's call to consider the issue. We should be clearly identifying if there should be some kind of process that looks at whether there is any indication that there is the use of termination for gender selection or the attempted use of termination for gender selection. We should be very clear that we as a nation do not support it. We should be very clear that there should be an education or awareness program that looks at wider community engagement, rather than just using what I have described before as this blunt instrument of legislation. We should also look at this bill, which I do not believe will be effective in responding to the needs that Senator Madigan has brought forward.

The idea of using medical legislation to address a wider social issue is not peculiar to the Madigan bill we have in front of us; similar legislation has been brought forward in a number of parliaments across the world, and there is a full record of that on the medical websites. There has been an assessment of whether bringing forward legislation alone is effective, and indeed there was some evidence provided to us that it is not effective. The WHO paper that came to us says:

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.

It goes on to say:

… 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.

So taking a legal based process into medical legislation does not work in isolation. We need to ensure that the rights, independence and, most importantly, the education of women and girls are introduced in our country and the nations of world, which was the intent of the Cairo declaration. The intent of the declaration was to empower women and girls across the world so that they have equity and the strength to assess their own rights, make their own decisions and be able to operate in communities that give them that respect and independence. On that basis, I believe that the Madigan legislation serves a valuable purpose in raising before us the concerns and making us genuinely think about whether there is evidence in Australia that these issues occur. More importantly, it ensures that people across our country working in the professional areas that are concerned about the empowerment and rights of women, as well as the importance of the absolute privacy and rights of a medical interaction between any patient and any doctor, have the opportunity to engage in considering the issues.

One of the most interesting pieces of evidence we received in our inquiry was on gender bias in our country. The statement was made that, if there were any active interventions to change the birth rates in our nation, either by gender or in religious groups, that would be evident in a statistical review of what is occurring with birthing in Australia. The evidence we received was that there have not been anomalies—a greater number of male children born to the detriment of female children. I know Senator Madigan's main concern in this debate is discrimination against girl children. If there were an active process in the nation of using termination to stop female births, that would appear in the statistical evidence we have before us, and there is no indication of that.

We could continue to use that methodology if Senator Madigan and other people who share his concerns are worried that there is an overfocus on selecting gender with decisions about birthing. If the birth rate changes over a period of time and more male children are being born, you would be able to see that there is an issue. There is no indication of such an issue now, but there is no problem in continuing to consider these issues into the future.

I think we have a responsibility in our own country to look at our own practices. In the body of evidence our committee had and in the wider discussion by the medical profession, the people who look at the social make-up of our nation and the women's groups who came forward in large numbers to raise concerns about how they felt this legislation was intruding on a woman's rights it was put forward that they do not believe that this is a real and active issue in Australia at the moment. We do know that in some nations it has been. There is an international commitment to look at practices to ensure that across the world women and girls are effectively empowered and able to make their own informed decisions without being pressured or forced to be covered by various forms of legislation that is taking away their own choice and independence.

I urge people interested in this debate to look at what their major concerns are. If they are concerned about discrimination against women, they should be looking at the wider community and seeing whether there is any evidence in Australia that this is a real issue. If people are concerned about the issue of abortion in Australia—and many submissions received by the Senate Finance and Public Administration Legislation Committee were focused on the wider issue of abortion in Australia rather than on gender selection and the use of abortions for that purpose—if people are concerned about the rate of abortion in Australia and if people are concerned about abortion laws in Australia, which we all know are the state governments' responsibility, they should take up the debate on those issues. They should openly say that they are concerned about abortion in Australia. They should not hide behind putting a guilt trip on women about the choices they make and hide behind an argument that is based on the very document, the Cairo declaration, that has been developed to ensure that women are empowered and have their rights.

This issue, as we have heard and will continue to hear from many speakers, does cause people to take very strong positions, and they have personal experience on which to base their arguments. But I urge people in this debate to look at the evidence around current medical practice in Australia, to look at the processes we have in place and perhaps then look at what their real concerns are, and to re-engage and recommit to oppose the use of abortion or medical practice that represents gender selection, except for those exclusions, which I have mentioned, put forward by the royal college. I urge people to look at how we can ensure that any community that may still have lingering cultural concerns in this area understands what the Australian processes are and what the Australian law is. We need to ensure that people have a sense of their own power, their own independence and their own ability to seek as much support as they possibly can within the Australian system to make their own choices. I have consistently been of the view that we need to enshrine effective choice in all our policies. We need to ensure that people get all the appropriate information and that they are able to make their own choices without fear of judgement, without fear of criticism and without fear of demonisation.

I would like to add briefly that a concern I have had with the contributions that have been made since Senator Madigan introduced this legislation is the inference that this practice is particularly prevalent in some ethnic community groups in Australia. I believe that we need to ensure that we do not gratuitously label a whole community group on the basis of a particular practice that someone may have heard had occurred in some cases. We have a responsibility to ensure that we build unity in Australia. As we all know, when people come to our country they swear allegiance to our laws. We believe that that is an important thing to do. But, if there is any concern that there is any lack of knowledge or understanding of this, it is our responsibility as legislators to look at what is in effect both here and internationally to ensure that in Australia our law is well known, that we work with the professionals—particularly those who work in the field of medicine or of examining legislation which pertains to medical practice—and that we listen to them and do not let any concerns about something that we find offensive, which is gender selection, colour the other use of our tools as legislators.

I thank Senator Madigan again for bringing forward an important issue for us to consider. I am strongly opposed to this bill. I do not think it works. If you look at how the whole process works in Australia, I am not convinced that it is necessary in Australia. I do not believe that gender selection and the use of termination to that end is active in this nation. I think that we should take the messages from Cairo about the independence and empowerment of women and work collectively towards that aim, rather than try to divide the Senate on something that does not meet the needs that it purports to.

Richard Di Natale (Victoria, Australian Greens) Share this | Link to this | Hansard source

Too often in this place we have debates about issues and we circle the topic without actually naming it. Let us be clear about what we talking about today. We are not talking about gender selection and abortion. We are talking about abortion. Gender selection is a non-existent issue in the Australian community. This is not an issue that those of us who have worked as medical practitioners face. It is just not a reality. In all my time in medical practice, there has never been one occasion when I was confronted with a situation where I was being asked to refer someone for a termination on the basis of the gender of that foetus.

I have spoken to my colleagues about this, many of whom have worked for many years in general practice. It is simply not an issue. None of them have ever been confronted with a situation where this exists. You only need to look through the medical literature to understand that it is not an issue in medical practice. It is just not. Senator Moore indicated that there are some limited circumstances where there may be some inherited genetic defect that is associated with a particular sex, but that is not about gender selection. That is about a decision to terminate based on the viability of the foetus. It has nothing at all to do with gender selection. So let us name what we are talking about here today. Let's name it. This is a bill that goes to the heart of the woman's right to choose. That is what this bill is about.

I have to say I am a little annoyed that, with so much division within the Australian community on so many issues, here we are debating an issue on which the Australian community has largely spoken. Of course, there is some disagreement at the margins, but, largely, this is an issue where the Australian community has made its opinion very clear. The Australian community supports a woman's right to choose. That is what the Australian community supports. People will raise all sorts of arguments through this debate. People will say that this is a decision in which the Australian parliament has no role—that this is a decision between a woman and her health professional. Some people will say that somebody's religious views have no place in determining the laws that shape issues like a woman's right to choose. Some people will bring in the issue of rape and incest, and what options are available to women in those circumstances. They are all legitimate arguments, so I absolutely support each and every one of those. But my position on this topic comes from a more pragmatic perspective.

The simple fact is that, when you prevent women from having a termination, you do not reduce the number of terminations; you just put women at risk. That is the consequence of any law that attempts to prevent a woman from accessing a safe and medically supervised termination. The numbers do not change when abortion goes from being legal to being illegal. The only thing that changes is that women die. Let us not forget that, every year around the planet, tens of thousands of women die from unsafe abortions. That is what happens right now every year.

It is a confronting issue. When I was in my medical training, one of the rotations that we had through that training was to assist in a clinic that practised terminations. I suspect the rationale was that if you, as a medical practitioner, are going to be involved in referring women to have terminations then you should know what that involves. And it is confronting. I do not deny that for a moment. I have some very clear memories of that experience. I remember talking to some of the women beforehand. I remember the trauma and emotional turmoil that some of them were experiencing at that time; others approached it with a more matter-of-fact perspective. I remember talking to those women and acknowledging what a difficult time it was for many of them. I remember being in the theatre when the procedure was done, and I will not go into the detail, but it is a confronting procedure. It is a memory that stays with me.

I had to go away from that experience and reflect on my own views on the topic and how I would handle this as a medical practitioner. I came to the view quite easily when I understood that around the world every day denying women that option, as difficult as it is, was to actually accept that we would increase the number of unsafe abortions conducted every year. We have 20 million unsafe abortions going on every year around the planet. Not only do tens of thousands of women die; many are left with horrific complications from the 20 million unsafe abortions that are done because women cannot access medically supervised terminations.

If we are going to confront the reality of what an abortion means in a medically supervised environment, and those people who argue against a woman's right to choose are all too prepared to present us with the graphic illustration of that intervention, let us look at what denying that intervention means. It means that 20 million women around the world are going to be in an environment where a sharp object is inserted through the cervix in an effort to disrupt the amniotic sac. It means that some of those women will have their uterus perforated. It means that some of those women will end up with sepsis, infection and death. It means that some of those women will end up with uncontrolled bleeding. It means that we are inflicting serious damage on people where a safe and medically supervised alternative exists. Some women will take all sorts of cocktails and ingest all sorts of drugs that cause very serious damage in an effort to make a decision that is their right to make.

So let us be clear about what is going on here. Let us not cloak this argument in terms of a problem that does not exist. Gender selection is not a problem for the Australian community. As medical practitioners, we simply do not confront it. There is far too much division on too many topics of debate in this country, and we are experiencing some of those right now. It is with some pride that I see that the Australian community are united in their view. When you compare where the abortion debate in this country sits next to what is going on in the United States, it is with some pride that we have a much more developed and defendable position.

The Greens will not be supporting this bill. We will not be supporting any bill that restricts a woman's right to choose. We acknowledge that this is a decision that must be limited to a doctor or health professional and a woman who decides that she is going to make that decision. I do not believe that the deeply held religious views that are often at the heart of this debate have any place in the formation of public policy in this area and we should reject that. Ultimately, we must know that if we are to support this piece of legislation, the consequences are that more women will be exposed to unsafe abortions and all of the horrendous complications that flow from that and that more women will die. It is for that reason that the Australian Greens will not support this bill.

Anne Ruston (SA, Liberal Party) Share this | Link to this | Hansard source

It is tremendously sad that we have to stand here today and debate a bill such as this, the Health Insurance Amendment (Medicare Funding for Certain Types of Abortion) Bill 2013. To think that anybody would make a decision about whether they were going to continue with their pregnancy on the basis of the gender of the child seems entirely abhorrent to me, as I am sure it would most Australians. Having only had a chance to have a quick read of this bill—and as the opposition noted this morning, we have not had a great deal of time to look at the details of it—it strikes me that the bill is not necessarily about abortion per se; it is more about access to a Medicare payment.

I have had a look at what currently occurs in Australia, though not with any great expertise, and I could find no evidence to suggest that the termination of pregnancies in Australia for sex selection purposes is actually occurring. If people were seeking to terminate a pregnancy on the basis that the child they were carrying was not the sex that they wished for, I am sure they would not put that down on the form as the reason for the termination.

In a global context, I am not sure that this bill is entirely contained to the matters that Senator Madigan has put forward in his explanatory memorandum. I think this is more about gender equality, if you look at it in the international space. In 2001, the United Nations Office of the High Commissioner for Human Rights, the United Nations Population Fund, the United Nations Children's Fund, the United Nations Entity for Gender Equality and the Empowerment of Women and the World Health Organization all issued an interagency statement calling on the world to prevent gender-based sex selection.

We need to remember when we are talking about this that in most instances in foreign countries this is not about the termination of pregnancies where the mother is carrying a boy child; it is normally directed at the mother carrying a girl child. From a gender equality perspective, I think this is a really important issue. Whilst I am sorry that we have to even be discussing this issue, like many of the issues that get brought before us in this place, it is probably best to get it out in the open and have a discussion about it. Actually airing issues and getting a public debate about them sometimes can provide the solution that otherwise would never be forthcoming if we kept these things hidden behind closed doors because people do not want to talk about them. Unfortunately, around the world in countries where the value of a female is considered to be less than the value of a male, the practice of gender-based terminations does occur.

The only information I could find at short notice related to the 1994 International Conference on Population and Development in Cairo. It identified a number of countries around the world where sex-based terminations were occurring. It listed countries such as China, India, Afghanistan, Pakistan, Taiwan, South Korea, Bangladesh, Azerbaijan and Armenia. We can only hope that in the 10 years since that conference we have seen a decline. Hopefully, some of those countries have seen the good sense of not continuing with this practice. But the cold, hard reality is the fact that in overwhelming numbers around the world pregnancies are being terminated because the family have not wanted to have a girl child.

We need to be very careful that we do not stand on our moral high ground in Australia where we have a wonderful standard of living. In a country where people are faced with a lack of access to contraception, where people are tremendously poor and where the girl child is possibly a greater burden on the family because of her incapacity to be able to go out and work, we end up with a situation where, through the cold, hard necessities forced upon people by poverty, the mother may choose not to continue with the pregnancy. Notwithstanding that, it is still a terrible thing for us to even be talking about here.

Everyone in Australia would probably have a lot of trouble accepting that someone would choose to terminate a pregnancy because they did not want a child of the sex that they were carrying. I think there would not be anybody in Australia who would not support the sentiments that Senator Madigan obviously intended in putting forward this particular bill. I would like to think that in bringing forward this discussion about this not occurring in Australia—and as I said, there is no evidence to suggest that it is happening in Australia—everybody in this place should condemn the practice of gender-biased sex selection and abortion, whether it is in Australia or overseas. It is almost impossible not to support the sentiment that Senator Madigan has behind the bill he is putting forward.

But I would be extremely disappointed if, in the process of the debate of this particular bill in the public space, the broader community and the media, there were some suggestion that in any way this government or previous governments would countenance allowing people to terminate a pregnancy on the basis of gender. I think that would be a very dangerous message to be putting out into the wider marketplace. It is also worth noting that already gender selection is prohibited in most states of Australia. My understanding is that three states have specifically enacted legislation in relation to this issue. In addition, the National Health and Medical Research Council guidelines state that:

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.

Like many of these debates that we have in this place that look on the surface to be very simple, there is often a reason for some sort of exception. As rightly pointed out here by the National Health and Medical Research Council, there are particular genetic conditions that only affect one sex.

It comes back to the debate more broadly, but we need to have a think about this. If we go along this gender-based argument that Senator Madigan has put forward, are there going to be the protections put in place if somebody knew that they were going to have a child and because of the sex of that child and the genetic condition that they carried that the child was going to have a terrible life? There is always a circumstance in which additional consideration needs to be given. In the absence of having all the facts of one of those situations in front of me, it is certainly not something that I am going to pass judgement on, because that would be particularly inappropriate.

Also, in listening to the earlier contribution by Senator Bernardi, I was quite horrified by his comments in relation to the suggestion that people were using the baby bonus and having terminations sufficiently late in the pregnancy when the unborn child was considered by law to be a person. As we know there is a time during gestation when the unborn child becomes legally a person. I think everybody in this place would be equally horrified were somebody terminating at a time to enable them to collect the baby bonus.

In wrapping up my contribution, can I say that I support 100 per cent the sentiments expressed by Senator Xenophon on this bill. Senator Madigan is seeking for the government not to fund such an abhorrent activity, but I would think that the Australian public would be pretty distressed to think that such an activity, if it were not funded by the public purse, was still unacceptable.

In acknowledging the 2011 inter-agency statement about preventing gender-biased sex selection, I put on the record again that this is about upholding the rights of girls and women not just to address multiple manifestations of gender discrimination, including the imbalance in sex ratios caused by sex selection. I am very happy to say that I could not possibly support a situation where Australia would, as a matter of course, countenance the legislative approval for gender based abortions. However, looking at the information in front of me, it is my understanding—and I will stand to be correct if other people in this chamber are able to provide me with additional information—that currently this is not the case, where people are seeking to do this.

As I have said, there are states around Australia that have sought for this practice to be unlawful. I would ask that Senator Madigan, in his concluding remarks on this bill before it is put to the floor of the chamber, advise as whether he has any particular instances to suggest that this activity is occurring. I would not like the public to think that the reason this debate has been brought on is that it is occurring and therefore leave some suggestion out there in the wider community that there are Australians seeking to undertake this practice.

It has been very interesting to have a look at this matter and to investigate the activities around the world. It just makes us realise time and time again what a fantastic country we live in in Australia, how fantastic the laws are in Australia in protecting or advising our community on the things that the majority of the population are prepared to accept or not accept. I do not think that the Australian population would accept in any way that people would seek to terminate a pregnancy on the basis of the sex of the child they were carrying.

Joe Bullock (WA, Australian Labor Party) Share this | Link to this | Hansard source

At 9.20 this morning, my office was contacted and I was directed to speak on the Health Insurance Amendment (Medicare Funding for Certain Types of Abortion) Bill 2013 as part of the Labor Party's plan to talk this matter out. It was a direction that I was prepared to resist but I spoke to Senator Madigan and he said he would welcome my contribution. For what it is worth, this is it. I have been put in a position where I am speaking unprepared. My colleagues in the Labor Party will need to consider whether they are prepared to run that risk again in future at the end of this contribution.

In my maiden speech I said at the end a few words about my wife which were probably inadequate for that brilliant, beautiful and courageous woman who took the remarkable decision to marry me. I do not know why she did it. At the time we met, I was old and ugly and approaching 40 and she was just delightful. But I put my mind to it and she ended up agreeing—I can be very determined when I put my mind to things. One of the things I put my mind to thereafter was having a family because it was something that Helen and I really wanted. By the time we worked out that that was not to be, the bureaucrats advised me that I was too old to adopt and that we would therefore have no children.

Like Noah, I responded to that by building. We built an extension on the house for the family we were not going to have and in 2003 my sister-in-law gave birth to my nephew Ethan and, when he was just shy of two, he came to live with us and formed a warm attachment to me that I am thrilled with, delighting in his company. He is a wonderful little boy. And after him came my parents-in-law to live with us, and my brother-in-law and my sister-in-law. Then the family that did not exist comprised seven and we all lived together happily.

One day, my sister-in-law, who is Chinese, did not come to dinner when we sat down for dinner. I thought, 'Oh well, she must be feeling ill.' The next day she was not there again. I said, 'What's up?'

'Oh,' said my wife, 'She's had to go back to China. There's a family matter that she's got to attend to.'

It did not sound right to me, and the next day I asked again. The fact was that my sister-in-law had again fallen pregnant, but because of the one-child policy in China and because of the uncertainty of her visa and whether she might need to go back to China, she had returned home in order to have an abortion. I thought a bit about this and I prayed a bit about it and I decided that I did not like it much.

For 37 years I have been engaged in negotiations. We have had some tough negotiations over the years with some of the largest employers in the country, and they tend not to take prisoners. Negotiations in the retail industry are tough. I had to engage in some negotiations in order to get here, and they were tough. The majority of the people who preselected me fully understand where I stand on issues, and do not support it. Yet I managed to negotiate my way through to get a seat here. But the hardest negotiations in my life took place over the next three days and nights—negotiating across half a world with people who did not speak English to convince my sister-in-law to come home and give birth to a baby.

That was six years ago, and my niece is Ella. Ella is not like Ethan, my nephew. Ella is very shy. She does not talk to me much. She runs and hides her head in her mother's skirts and is generally very remote. But sometimes she looks at me, and she opens her eyes up like saucers and gives me a big smile. And that just means the world to me. It means more to me than anything I could achieve here. And if anyone says to me that that lovely little girl does not deserve to live because she is a girl, or that that lovely little girl does not deserve to live because some petty bureaucrat in Beijing is committed to a plan of social engineering, then they are going to have to stop me. And when I make up my mind I am a bit hard to stop.

I said in my maiden speech that on issues like this, that were matters of life and death, I would always vote to support life. I support life. I support Senator Madigan's bill as a small step in the right direction, and I will consistently support the preservation of human life against all challengers.

Ian Macdonald (Queensland, Liberal Party) Share this | Link to this | Hansard source

I will not take much of the time of the chamber on this debate. I cannot believe that there would be any senator—there would be few people out there in the wider public—who would not support the thrust of this bill or the sentiment underlying it. To suggest that a pregnancy should be terminated simply because of the sex of the child—because the parents wanted a child of the other sex—is just repugnant and repulsive. As Senator Ruston said, it is almost a shame that we should have to debate this bill.

So, I indicate to Senator Madigan that I will be supporting his bill. If it were brought on for an earlier vote I would be supporting that, as well. I might say to Senator Madigan and to Senator Bullock that when it comes to other questions relating to the abortion debate we would, perhaps, part company—although, I do not say that definitively. But I cannot believe that there would be any senator who would oppose the sentiment of the bill and therefore what is written in this bill.

As others have said, whether this legislation is needed is questionable. Again, as Senator Ruston said, I understand that in three states there is specific legislation on this. I heard what Senator Moore said earlier—that there is no real evidence that this happens. If this bill were passed by the parliament and became law, you would hardly think that someone who did want to terminate a pregnancy—I cannot believe that there would be too many people who would do this—because they work out that that is not the gender they want for their child, then they would hardly walk into their doctor waving a red flag and say, 'Hey, Doc, I don't want a boy; I want a girl, so give me a termination.' So it is going to be difficult to police in any case, but in so far as this bill sends a message and indicates the will, I am sure, of all parliamentarians—and, I would venture to say, 99.9 per cent of the Australian public—then there would be no reason for anyone to vote against this bill.

There are a number of arguments that have been raised by other people in this debate. It does not serve a great deal of purpose to repeat them. I was interested in Senator Bullock's honesty and frankness when he said that the Labor Party has a strategy to talk this out. I am disappointed that that sort of thing happens. It rarely does happen—particularly on Thursday mornings—but it is interesting that the Labor Party have adopted that strategy. I would hope that the majority of the Senate will, at some time, have the opportunity to express their views on this. I am very confident that it would receive overwhelming support.

I conclude by saying that on a range of issues I have different views from some of my colleagues on this side of the chamber, but on this particular question before the chamber at the moment I think all senators, regardless of their party affiliation, would be united in support for the principles espoused in this bill. I will be supporting the bill.

Sue Lines (WA, Australian Labor Party) Share this | Link to this | Hansard source

I rise to oppose this bill, and I do so on the basis that I certainly do not support gender-selection abortion but do oppose this bill because I think it represents the thin edge of the wedge. I want to also put on the record that I am not speaking out on this matter. When this matter was raised in our caucus the other day, I went straight to Senator Moore, as manager of our business, and said, 'I want to speak on this bill.' The reason I want to speak on this bill is that I am a passionate advocate of women's rights. I have always been for as long as I can remember. I believe it is a woman's right to choose and have been a passionate advocate of that position for a very, very long time. I think what we heard from Senator Bullock today, despite us having quite contrary positions on a woman's right to choose abortion, was an illustration of what a difficult decision it is for a woman when she chooses to have an abortion. You heard him talk about an extremely distressing family matter. It is not about the lovely six-year-old niece he now has; it is about the choice women make at the time they discover they are pregnant. That is what the choice is, and I think Senator Bullock illustrated what a difficult choice that is for women.

So why am I opposed to this bill? One, there is no proof at all in Australia that abortions are taking place because of gender selection. I would have to say that I was very active in Western Australia many years ago when we had the very difficult fight when Labor was in government to decriminalise abortion in Western Australia. The catalyst for that was when two doctors in a clinic in Rivervale were charged for breaking the Western Australian law by the police under Western Australian laws for performing abortions in a clinic which was widely known and well used by women. That really did force all of us in Western Australia to confront the issue of what we did about a woman's right to choose. Those clinics—and there are a number of them in the Perth metropolitan area—had been running quite unhindered but contrary to the law for many years.

So a member of the WA Labor Party, Cheryl Davenport, put up a private member's bill. And we all know how divisive this type of legislation is in our community. It was extremely divisive. It brought out ugly protests, extreme positions and quite ridiculous statements—and I have to say a lot of them were led by men. I do not wish to offend anyone in this chamber, but I have to say it is always men who seem to lead the charge for somehow curtailing women's rights to abortion. That is why it was heartening to hear Senator Di Natale speak so passionately this morning as a former medical practitioner on why he supports abortion.

After a very long and emotional fight—and it certainly had an emotional impact on Cheryl Davenport—the law was changed in Western Australia. I do not want to revisit that law. I am up for the fight, make no mistake, but I think it is settled It is a woman's right to choose. No-one is forcing women to go off and have an abortion. And it is not a decision taken lightly in any sense of anybody's imagination.

I read the report. Senator Madigan himself has no evidence to suggest that sex-selective abortions are systematically happening in Australia. We heard from Senator Ruston this morning that indeed three Australian states have outlawed such abortions, although they would be, as Senator Macdonald said, quite hard to police. So what is really the purpose of this legislation? When the bill was investigated, there were many organisations, including Reproductive Choice Australia, who agreed with Senator Madigan that indeed we do not have any evidence of this practice occurring in Australia.

Many submitters—people we should be mindful of when we make decisions about whether we support a bill, experts in this area—vehemently disagreed with the bill. They were groups such as Women's Health Victoria, the Public Health Association of Australia, the AMA and the Women's Centre for Health Matters. Then we get onto the civil liberties groups: the New South Wales Council for Civil Liberties, Children by Choice, Liberty Victoria, the Women's Abortion Action Campaign, Women's Legal Services, Women's Legal Services New South Wales and Reproductive Choice Australia. These are all groups that focus on this issue and have a very valid point of view. In fact, as I said, we do not have any evidence this is happening in Australia.

Certainly, as I said at the outset, whilst I absolutely, fundamentally support a woman's right to choose, I do not support abortion on the basis of gender selection unless there are the circumstances Senator Moore pointed out in her speech earlier this morning. Sometimes there are specific gender related conditions that foetuses have, and parents may then make a choice to take an abortion on that basis.

Like other speakers on this bill have said this morning, I think that if this bill is passed it may well impact on the rights of women to have an abortion. I think it is the beginning of something much bigger and I really do agree with Senator Di Natale that this is not a bill about gender selection but about abortion. As Senator Moore reminded us, abortion is a state issue and that is really where it should remain. As I said, I was involved in the very long and emotional fight in Western Australia and, whilst I am up for that debate again, I really do think this is an issue we should not be revisiting.

Recently Anne Summers wrote in relation to this bill, and she also agreed that there was no evidence to suggest that such abortions were being performed in Australia. But Anne Summers warns us that this is a red-hot issue among the American right-to-lifers, and she believes this is clearly being imported to Australia to try to inflame the abortion politics in this country. That would certainly be a backwards step. So the question I ask is: is this bill really about gender selection? If it is, what is the evidence? By Senator Madigan's own admission, there isn't any. Or is it really about abortion? If we as a community have concerns about this issue, shouldn't we be putting our efforts into community education—about the value of children, the rights of women to choose and a whole range of things—rather than voting up a bill which would be almost impossible to police and which, by everyone's admission, has no bearing on what is happening here in Australia? If there are concerns, let's get some community education happening. Let's not put a bill in place which really does not have any bearing at all.

Given that there is no evidence of gender selection, I am inclined to think that this is about the broader issue of abortion. We know that where restrictions on abortion start to creep in they are often presented in a very rational way. Nobody has advocated this morning for a broad sweep of abortion on the basis of gender selection. We all think that is an abhorrent thing to do. But I think that this bill is really the thin edge of the wedge and that to present something as rational when it really is not begs a bigger question. Although the bill may sound reasonable enough, I think the issue is what the bill introduces and what follows on from that. These bills are often crafted so that over time abortions become more difficult to access. So let us have a look at a practical application of the bill. If the bill were passed, would there then be an additional set of questions a woman would have to answer before being granted the right to terminate her pregnancy? Would she have to undergo some kind of psychological testing? Would there be some criminal penalty if, at a later stage, it was found that indeed an abortion was performed on the basis of gender? What is the practical application here and how does that get extended to impact on a woman's right to choose? Nobody has thought that through and we do not know how it would work in practical terms. I think that it is simply something that sounds reasonable but over time it would start to impact and start to restrict how abortions are performed in this country.

I say that because I have looked at what is happening in the US. In the US the abortion debate seems to come up every few years and it is hotly contested. Twenty-two states have adopted much more restrictive practices. There are up to 70 different restrictions around abortion limits—on doctors, clinics, medication and coverage. That came from this kind of reasonable discussion and then it starts to really impact on the rights of women. I do not think that is something that people in this place support, and I would hope that in 2014 we are not going to be going down that track. As Senator Moore reminded us, the federal parliament does not have the power to regulate in this area. This is a matter for the states and that is really where this matter should be best dealt with.

We already have some restrictions in Australia. In the US, in Texas, there is now an example of where abortion clinics, in order to operate, have to have access to hospitals, and many hospitals refuse that access. In my own state of Western Australia, a public hospital in a low-socioeconomic area of Perth was contracted out to be privatised and run by the Catholic Church. The Catholic Church made it very, very clear to the state government that it would not perform any type of reproductive technology—and it is the right of the Catholic Church to make that claim; I am not suggesting for one minute that they cannot make that claim. But the question then arises: should they be running our public hospital systems? What has now happened in Midland is that we had a public hospital run by the state which performed the whole range of reproductive and family planning matters—abortions, vasectomies and all sorts of reproductive and family matters were performed at that hospital—and now those matters will not be performed by the new Catholic hospital. That has created a dilemma for the state. If an abortion clinic needed to refer a patient to that Catholic hospital, that person would not be admitted. So we already have these types of unintended consequences happening in our country. They are not anybody's intention, but that is what happens when we are not clear about what our public health agenda is. So let's get some certainty here about what we are doing.

We cannot support this bill, because it does start to impinge on women's rights. We also have to look at cost issues. If this bill were passed and additional procedures had to be put in place—questionnaires, testing and psychological testing—would the costs start to increase? We need to ask what the practical implications of this bill are. We have not had a discussion about those sorts of things. That is where my concern starts to creep in—that is, that we start to discriminate against women.

I do not think anyone in this place would want to make it harder for low-income women, in particular, to make those choices about their family and to take the really tough decision to have a termination—of course, not on the basis of gender but to simply exercise her rights. We do not want to see a bill impinge on a women's right to choose—because she has to somehow convince a psychologist, a doctor or a nurse, that it is not a gender based abortion. There are certainly no protections around that in this bill.

I would hope that we can have a rational and respectful debate on this bill. As I said, as a feminist and a supporter of women's rights, I cannot support this bill, for the reasons I mentioned. I say again that I do not support the use of abortion on the basis of gender selection. But I think the bill before us today is really looking at a much bigger question. Let's leave the issue of abortion with the states, where it properly belongs. The government say—to use their rhetoric—'We don't run abortion clinics'. Therefore, the government should not be supporting a bill that puts some control over what is happening.

The decision whether to have an abortion is a very personal decision. It is decision between the woman and her family and the medical practitioner. We as politicians and parliaments should not be interfering in that fundamental right. So I would urge people today to not support this bill. It needs to be seen for what it is, and my view is that it is really about the whole issue of abortion; it is not just abortion on the basis of gender selection. Who is to say that, if this bill were passed, we would not be here in a few months' time with another private members bill that looks to curtail some other aspect?

If abortions were happening in this country on the basis of gender selection, of course we would need to be doing something about it, but there is absolutely no proof, by Senator Madigan's own admission and by the admission of those who work in the area—the women's health groups and so on—that that is the case. In fact there was a study done—which is in the additional comments by the Australian Greens—of some 600 patients who had terminations. The study found that none of those patients had had an abortion because of gender selection. As Senator Macdonald said, it is very hard to get to the bottom of this. But we do have a clinical study before us that said that there is no proof, and I think we have to take it at face value.

So I would urge all of my colleagues in this place—no matter which political party you belong to—to not support this bill. But let's be vigilant about gender selection abortions, if we think they are going on—but there is no evidence of that. I would say that, if we have any concerns at all, the best way to combat that is through our women's health clinics, through our hospitals and through our medical practitioners—not through the blunt instrument of a bill in the federal parliament which would punish every single woman who desires to have an abortion. It is a women's right to choose, and I do not want to support any bill that I believe interferes with that right for women in this country to make what is a very difficult choice.

Nick Xenophon (SA, Independent) Share this | Link to this | Hansard source

I would like to comment on Senator Lines' contribution on the Health Insurance Amendment (Medicare Funding for Certain Types of Abortion) Bill 2013. I too share a concern and revulsion at the thought of abortion for the purpose of gender selection—and that is something that Senator Lines made very clear. I will also not be supporting this bill, but I will make my position in relation to that fairly clear shortly. I also want to say that Senator John Madigan is someone I place enormous trust in. He is a man of great integrity. I do not think his motives are in any way sinister. These are long-held and sincere beliefs that he has, and he is entitled to have this matter brought before this place.

There are potentially two issues in respect of the bill before us today that must be addressed. The first is a procedural one, as I understand my colleague Senator Madigan may wish to bring this bill to a vote today. If that is the case, he will need to move a motion to that effect to bring about a vote on the second reading stage of this bill. This chamber knows my position on the use of procedural devices to truncate debate, to in effect use the guillotine. As a general rule, this is not a course I would favour, and it is something that should never be considered lightly. In my view, every senator who wishes to has the right to speak on every bill and, if that bill passes the second reading stage, the right to participate in the committee stage of that bill. However, in the case of private senators' business, I can see good reason for there to be an exception to the rule.

Firstly, the time allocated to private senators' business is severely limited, and a crossbench senator like Senator Madigan will have only two opportunities a year to put forward a private member's bill to be considered and brought to a vote. This is one of those times, and Senator Madigan is entitled to have an issue that he feels strongly about not only debated but voted on. Although I agree it is not good practice to truncate debate on an issue of conscience, if—as I think one of the other contributors in the debate this morning has said—as is often the case with private senators' bills, you can talk them out so that a vote is not brought—I am not talking about this bill; I am not suggesting it is happening here—then that is a matter that we need to consider. The paradox is that, if you bring it to a vote now, it may mean that some who would have been inclined to support this bill may say, 'Because we have not had a chance to participate in the debate, we are inclined not to support it, because of the debate being truncated.'

So, while the word 'parliament' has in its roots the meaning of 'to debate and to discuss', it must axiomatically also provide an opportunity to vote on issues. Should Senator Madigan wish to bring this bill to a vote today, I will support his right to do so with some reservations, but the principle of having a matter dealt with one way or the other in the context of a private senators' bill seems to carry more weight.

The second issue goes to the merits of this bill. I acknowledge Senator Madigan's sincere and long-held beliefs on this issue, but I cannot support this bill for the following reasons. Firstly, on the issue of gender selection, the United Nations and other human rights and health organisations have identified this as a serious problem to the extent that it has skewed the sex ratios in some countries. So, as such, the issue of gender selection is important in a global context. Indeed, the Senate overwhelmingly passed Senator Madigan's motion in relation to this very issue last year. I was not in the chamber at the time, but I can indicate my support for that motion, but it does not follow that I support this bill. Secondly, the bill seeks to tackle this issue on what I consider to be a fundamentally flawed basis. Existing abortion laws would not permit an abortion on the basis of gender selection. No reasonable interpretation of current laws around Australia, which must involve consideration of the physical and mental health of the woman seeking a termination, would allow it. Seeking to remove Medicare payments for something that could not be allowed by law is, in my view, redundant. Thirdly, I am concerned that the bill could be misinterpreted by some as legitimising gender-selective abortion outside the Medicare system. As pointed out by the Australian Medical Association in their submission to the committee inquiry into this bill, the Office of the United Nations High Commissioner for Human Rights, the United Nations Population Fund, UNICEF, UN Women and the World Health Organization issued an interagency statement in 2011 regarding the prevention of gender biased sex selection. This excellent statement considers gender biased sex selection in a human rights context and evaluates past attempts at addressing this issue. As the statement points out:

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. Prohibitive legal responses should be seen as a demonstrable attempt on the part of government to redress sex-ratio imbalances, based on the hypothesis that combating the use of technology for non-medical reasons will lead to a rapid halt in sex selection. Yet there is wide agreement that 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.

I strongly support this statement.

I agree that Senator Madigan states in the explanatory memorandum to this bill that gender selection is discriminatory and greatly prejudicial to women and female children in society, but I cannot agree with the measures proposed in the bill. I believe this bill would be unworkable and unenforceable. There are better ways to deal with the issue that Senator Madigan seeks to address, and it is an important issue. If we want to address these issues, and we must, particularly on a worldwide scale, then we need to improve the status of girls and women in our society. When girls and women are valued as much as men, when they are no longer treated as property or less than human by some, we will see an end to this practice. I do not believe this legislation, no matter how genuine and how sincere Senator Madigan is in respect of this bill, will bring about the solution that he is seeking. As such, I will not be supporting this bill. Again, I emphasise: if Senator Madigan wants to bring this bill to a vote, we should respect his wishes to do so.

Christopher Back (WA, Liberal Party) Share this | Link to this | Hansard source

I thought Senator Day was ahead of me. I want to make a contribution to the debate on Senator Madigan's proposed bill. Let me put two issues on the table very clearly and quickly. The first is my complete and utter opposition to the concept of a termination being carried out solely because of the gender of the foetus. In that sense, I am strongly in support of the motivation of Senator Madigan in bringing this matter forward. I know how passionate he is. I probably echo the comments of almost every other speaker. I do not think there would be anybody in this parliament—and overwhelmingly in the Australian population—who would accept, concur with or agree with the notion of termination of pregnancy based solely on the selection of gender of the offspring.

The second point that I want to make is that the matter is of such importance and of such interest that I believe it deserves the opportunity for every senator in this place who wishes to speak on the matter to have the opportunity to speak on the matter. I take up Senator Xenophon's point a moment ago in relation to Senator Madigan's lack of opportunity under normal circumstances to be able to have this issue go to a vote. I am not in the leadership of the government and I am not in a position to give any indication or assurance to Senator Madigan as to what the outcome might be. It is unacceptable to me if this matter is talked out today. It is unacceptable to me if, the next time Senator Madigan has the chance to aerate this, it would be in 11 or 12 months time. I think that would be grossly discourteous to a colleague, to a fellow senator.

I want to put on record that I would not be supporting a gag motion today because I believe every senator has their right to speak on this matter. I want to give Senator Madigan my assurance that, whatever influence I might have—however great or however small that might be—in the event that, due to the inability of all of us who wish to speak to this today do not have that chance, I will be using whatever persuasion I can to make sure that the time is allocated for that matter to come to a vote. I hope that there would be respect from the mover of the motion to that effect. I have spoken to Senator Xenophon to explain to him my position, and I would urge that we end up with the best of all circumstances, and that is that we do have the opportunity to speak fully.

I now want to address a couple of points that have been raised by others, because it causes me the caution that I am expressing in terms of when we bring this to a vote. Senator Lines made the observation that she is not aware of evidence in the medical world of the number, if any, of terminations carried out solely because of the gender of the foetus. That is information that the Senate does need. If it is not an issue, then we need to know it is not an issue. If it is an issue, we need to know that it is an issue before we reasonably vote on it. The information available to me is that the records kept by health authorities actually do not provide a breakdown on why a lady miscarries, for whatever reason, be it a pathological condition or some problem with the foetus itself.

A foetus, in all mammalian species, has the capacity to somehow understand that, in some circumstances, it might not survive postnatal life. We know that naturally-occurring miscarrying, as it is called in humans, or abortion in animals, does occur because of some innate capacity or ability of the foetus to understand that it is not going to survive postnatal life. Our medical records, I understand, do not give us the capacity to separate miscarriages of the type I have described and terminations as requested or arranged by the lady herself. If we do not have that data, then we cannot possibly at this moment have the information on the intention of the person seeking a termination of pregnancy. That is the first thing I would be keen to know—what the data is—before we exercise a final decision.

The second goes to a comment made a few moments ago by Senator Xenophon. As I understand from Senator Xenophon's contribution, the way the legislation is structured at the moment would not actually allow a person to avail themselves of Medicare provision of payment in the event of termination as a result of their decision based on gender selection. I think Senator Xenophon may have used the word 'redundant' in his contribution. I understood him to say that it is redundant because such a provision does not exist now. Again, I do not know the law and I certainly defer to Senator Xenophon and the fact that he is a lawyer. If he makes that statement, all I can do is accept that he has researched it and knows it. Again, I think the Senate should be appraised of the actual fact in relation to this matter.

Others have made a contribution in terms of whether this is a state issue or not. We are talking about a Medicare benefit, which I would have thought put it rightfully into the federal sphere. Once again, if this is purely a state matter, then I would like to have that point clarified. If, because of the provision of Medicare funding for such a termination, it is within our remit in the federal sphere, I would like to know that. I am an arch federalist, as would be obvious to anybody who hears my contributions, and I do not want to see the rights of the states being overridden by Canberra. If it is a Medicare issue, it is funding centrally from the Australian taxpayer, then clearly it is in our remit.

Before I go on, I want to correct or perhaps provide further information in an observation that Senator Lines made about a new hospital in the eastern suburbs of Perth at Midland. It is a public hospital to be run by the Catholic Church. Senator Lines was quite right, the Catholic health system has made it clear that they are not prepared to participate in procedures of a nature that will terminate pregnancy. However, there is no dilemma, as was outlined. There is no need for any greater expenditure of taxpayers' money because within a few hundred metres of that new hospital there is a facility in Midland which will undertake these procedures and it is there now. I am not suggesting for a moment that Senator Lines has been elevating this matter—and I know she has not been—but I am saying to the wider community, who might have been concerned by an apparent absence of a range of medical services available as a result of a decision of the Catholic health system in running the hospital, that they can be reassured that there is such a facility down the road.

We have made enormous advances in reproductive technology over the last 20 to 30 years. We have a very deep understanding now, for example, of endocrinology, of the hormonal balances and imbalances that regulate many of the bodily functions in animals and in humans, particularly in primates. Of course, we know that, when it comes to reproductive management, it is a hormonal endocrine based system rather than a nervous system. Some people in the chamber—and, Mr Acting Deputy President, I suspect you are one of them—might be a little disturbed and distressed by the comment that I am about to make. From an endocrine point of view, in the early stages of embryonic and then foetal life it is the female hormones in the embryo and, in particular, the foetus that develop first and maleness is in fact suppressed femaleness. That is a point about which some of us may be interested at some time in the future. So as foetuses we have a predominance of female hormones and it is as the male develops that the development of the male hormones takes over and we end up with the characteristics of maleness. Oestrogen and testosterone are very similar biochemically, as indeed are other hormones replicated between males and females. Maleness is just suppressed femaleness.

I make that observation because the other great advance that has taken place in the last few years is the use of ultrasonography to determine that an animal is pregnant, the rate of growth and the normality or otherwise of the foetus or foetuses. It is incredible to see, as early as 15 or 16 days into the pregnancy, an image of the first cells of a heart beating when you are examining the patient using an ultrasound machine. I make these observations because ultrasonography has been of immeasurable benefit to us as humans, and in my own background as a veterinarian, to determine the stages of pregnancy and the normality or otherwise of the foetus or foetuses. But it is also largely ultrasonography that is used when making decisions about the gender of the foetus—which brings me back to the point at question.

These advancements will go on; and we hope they do and that they are for the betterment of the community. With regard to the concerns and reservations I have expressed, Senator Madigan is quite right to voice his concern about this issue. People have spoken today about gender imbalance. Senator Bullock spoke about China's one child policy. And only now, having actively selected boys in the past, is China coming to realise that boys are spectacularly bad at having babies. And therefore, as Bernard Salt has often commented, China is going to find itself in a degree of difficulty in the future in terms of population replacement.

Those advances will go on. But can you imagine a circumstance in which not only does someone make a decision whether they want a boy or a girl but also foetal skull size is used to medically determine what the intelligence of the child is likely to be. Skull size relates to brain size and brain size relates to intelligence. Decisions made along those lines would be abhorrent. The length of the femur at a certain stage of foetal development could be used to determine the eventual athletic ability of a child. People would regard these sorts of decisions as being absolutely abhorrent. I therefore concur with Senator Madigan in the spirit of the amendment he has put forward to the Health Insurance Act.

I will conclude where I started. I, like most others, philosophically support Senator Madigan in bringing this matter before the chamber. Secondly, it raises so many unanswered questions that we deserve to have answers on before we make a final decision. Thirdly, in my view it is the right of every senator who wishes to speak on this matter to have that opportunity. Having said that, if we do not go to a vote on this matter today, as a courtesy to Senator Madigan I want to see that opportunity for debate. I would support this legislation if it comes to a vote. I will not support a gag to bring it on this morning.

Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Mental Health) Share this | Link to this | Hansard source

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.

and

  "…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.

Carol Brown (Tasmania, Australian Labor Party, Shadow Parliamentary Secretary for Families and Payments) Share this | Link to this | Hansard source

I rise to speak as an individual senator on the Health Insurance Amendment (Medicare Funding for Certain Types of Abortion) Bill 2013 and also to touch on the discussion that has been happening in the course of this debate about talking this bill out. I certainly do not come in here to talk this bill out; I come in here to put my view forward, as each and every senator has a right to do. At 9.30 this morning, I thought we were going to be talking about the Fair Trade (Australian Standards) Bill 2013. Then the Order of Business was changed to accommodate Senator Madigan's private senator's bill, which was supported by the Labor Party. I very strongly support senators having the opportunity to put their views forward, particularly on private senators' bills, because there is a lot of interest in those bills.

But, as we know in this place, our time is organised around Senate business. We have meetings, committee meetings and meetings with constituents who come here to talk to us. So we organise our time around Senate business. I believe that every senator should have the opportunity to speak to the bill if they want to take that up. Many senators would not have been aware that the Order of Businesswas going to change. I just wanted to put that on the record.

This bill seeks to amend the Health Insurance Act 1973 by inserting a new section to remove Medicare funding for abortions procured on the basis of gender. Like every senator whom I have heard speak in this debate this morning, I too want to make it clear that I strongly oppose terminations based solely on gender. However, I do not support this bill. This bill, I believe, is an attempt to erode the right of women to make choices about their own bodies and to reignite a debate about abortion. If those who support this bill are truly concerned about the occurrence of gender-based abortion in Australia—and I do not believe there is an issue about gender-based abortion in Australia—rather than seeking a solution through the law, they should challenge that stereotype or discrimination based on gender. This bill will not achieve it nor does it seek to achieve it. Instead, we need to continue to work to eradicate sex discrimination. We should support policies and programs that promote gender equality. This must include action to address violence against women. This must also include fair representation of women in all areas—in the boardroom, in the media and in the government. I believe that women have the right to make decisions about their own bodies and I believe that access to safe and legal abortion is a fundamental aspect of this right.

We have already heard about the 2011 interagency report titled Preventing gender-biased sex selection, which was issued by the United Nations Office of the High Commissioner for Human Rights, the United Nations Population Fund, the United Nations Children's Fund, the United Nations Entity for Gender Equality and the Empowerment of Women and the World Health Organization. That report rightly states that the practice of gender selection is discriminatory and generally prejudices towards the girl child and women. I absolutely believe that it is critical that we take action to address prejudice and discrimination based on gender. However, I also believe that this is not what this bill is about nor is it an appropriate means of addressing such inequality.

The Finance and Public Administration Committee conducted an inquiry into the bill in June last year. The inquiry was chaired by Senator Helen Polley. Unfortunately, I was not able to attend or participate in that inquiry. In evidence to that inquiry, the Australian Medical Association stated:

…the interagency statement offers a range of recommendations for addressing the issues and does not recommend denying financial assistance for legal medical procedures.

The AMA pointed to this interagency statement in its submission, in particular:

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

The AMA went on to say: 'There is a wide agreement that 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.'

We must take effective and necessary actions to promote equality and empower women and girls to bring an end to discrimination. But this bill will not achieve this; in fact, I believe that the bill will disempower women. This bill puts women's rights at risk and for all of the reasons based on ideology rather than the evidence of any real problem, which as I have said I do not believe exists in Australia and has also been mentioned many times in some of the contributions that have been given here this morning.

In bringing this bill to the Senate, Senator Madigan asserted that gender-based abortions are happening in Australia. However, I do not believe that there was evidence presented to prove this assertion in his second reading speech or throughout the Finance and Public Administration Legislation Committee inquiry into the bill. Put simply, as others have said in this debate, there is no evidence that terminations are being performed in Australia based on gender. In their evidence to the Finance and Public Administration Committee inquiry on the bill, Liberty Victoria stated:

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.

I believe this bill acts as a blunt instrument. In evidence to the same inquiry, Reproductive Choice Australia argued that gender selective terminations cannot be disguised, and cited evidence of skewed gender ratios in China and India. On this point, Women's Health Victoria also pointed out that Australia's sex ratio at birth is 105.7 male births over 100 female births— (Time expired)