Despite abortions being performed in Queensland for years, a 19-year-old woman and her partner were recently charged in Cairns

Abortion is an emotive topic and one on which most people have a strong opinion.

So it’s no wonder recent developments have stirred the community.

A 19-year-old woman, whose court case is pending, is alleged to have used smuggled misoprostol from overseas for an abortion.

Court case sparks debate 

She is the first woman to be charged with procuring an abortion in Queensland for more than 50 years, prompting a campaign for law reform to take abortion out of the criminal code.

On Wednesday, Stephen Wettenhall, State MP for Barron River, was given a petition of 800 signatures by the Cairns Women’s Network calling for the Legislative Assembly of Queensland to repeal sections 224, 225 and 226 of the criminal code so that terminating a pregnancy would no longer be subject to criminal law.

The case has also prompted doctors to seek legal advice on whether or not to continue providing medical abortions in the interim.

Doctors stop abortions

Already, the only two Cairns doctors who have a license to supply the controversial abortion drug RU486, Dr Caroline de Costa and Dr Michael Carrette, have ceased to dispense it, while the sexual health clinic at Cairns Base Hospital, which provides medical abortions using methothexate rather than RU486, has yet to make a decision and is seeking legal advice.

Doctors shelve abortion drug

"I think it’s a concern for any woman in Queensland who has a medical abortion in a clinic," the director of Cairns Sexual Health Clinic, Dr Darren Russell, says. "And for any doctor who offers medical abortions in Queensland, it also raises concerns."

Pro-abortion lobby group Reproductive Choice Australia has advised all Queensland-based doctors not to get involved in medical abortions while the situation remains tenuous.

Meanwhile, the well-argued issue of abortion is being raised in the general community, with people revisiting the moral dilemma of whether or not it should be legal at all.

Abortion is ruled by state rather than by federal law.

In Queensland, abortion law is based on Section 58 of the UK Offences against the Persons Act 1861, which states that if someone uses an instrument or drug to procure a miscarriage on a woman, they can incur a penalty of 10 to 14 years’ imprisonment.

The Queensland criminal code of 1899, sections 224-226, says a doctor performing an abortion, a woman procuring an abortion, and anyone assisting by providing something to be used in an abortion, is committing a crime.

There is a defence for doctors who carry out "in good faith and with reasonable care and skill, a surgical operation upon any person for his benefit, or upon an unborn child for the preservation of the mother’s life".

The most recent ruling in Queensland was by Justice McGuire in 1986, in a case against a doctor.

Justice McGuire took a wider view of the welfare of the mother to include not only the preservation of her life, but of her health.

In its broadest sense, the law doesn’t just cover women who suffer physically and mentally from continuing with their pregnancies, but social and economic factors can be considered too.

The defences in law for abortion, however, are technically just for surgical abortion. Doctors and patients to date have just assumed medical abortions are legal and that charges would never be laid against them.

As Dr Heather McNamee, a general practitioner who specialises in adolescent health, and works with Youthlink and in private practise, says: "We did much soul-searching but there was the assumption we wouldn’t be prosecuted under a law that existed before women got the vote."

Two different combinations of drugs were used for early medical abortion in Cairns until last week.

One combination used was RU486 (also known as mifopristone) and misoprostol.

Gynaecologist and obstetrician Dr Caroline de Costa was the first person in Australia allowed to prescribe RU486 in July 2006 after she succeeded in her campaign to have the "Harradine amendment" removed.

(This amendment had given the Minister for Health rather than the Therapeutic Goods Administration (TGA) responsibility for the regulation of abortion drugs).

RU486 is still strictly limited in Australia.

There are just 53 doctors authorised to administer it, and it can only be given to women in the first nine weeks of pregnancy, if they are in danger of losing their life should their pregnancy continue.

Dr de Costa says in three years she administered the drug to less than 30 women.

The current situation in Queensland, however, makes matters more difficult.

"Here it won’t be ruled by the TGA, but by Queensland law," Dr de Costa says.

So far, no Australian drug company has received approval to make it (none has applied until this year) and it has to be imported from New Zealand.

Despite the difficulties involved, Dr de Costa recommends RU486 as a safe and widely used drug.

"It was developed in the 1980s in France, and has been used for nearly 30 years," she says.

It is used in Europe, the US, and in 35 countries worldwide.

Effective for 95 per cent of women who will have a complete abortion within four hours of using it, it works by blocking progesterone, which is needed to sustain pregnancy, so the lining of the womb breaks down.

It is usually followed with the drug misoprostol, which makes the womb contract.

The drugs can be taken at home after consultation and the offer of counselling.

The second combination of drugs still being used in medical abortions in Cairns is the more old-fashioned methothexate and misoprostol, which is prescribed in the sexual health clinic at Cairns Base Hospital.

Dr Heather McNamee, who works in private practise, says the use of methadrexate is not as reliable as RU486.

"It’s completely safe but you might need another dose," Dr McNamee says.

"It’s also not as quick so there might be prolonged bleeding over a week, and there’s a slightly higher failure rate."

(Failure of a medical abortion would mean a woman would have to have a surgical abortion).

Dr McNamee would rather see RU486 more readily available and says she believes the reason it’s so restricted is because of anti-abortion sentiment in the country.

Medical abortion is also much cheaper than surgical abortion.

Dr Caroline de Costa says medical abortion is either free or costs just the price of the drug, $60, plus the normal consultancy fee, as opposed to surgical abortion, of which there is just one option available in Cairns, a private clinic, which costs $750 for a termination.

Late medical abortions are performed by Queensland Health in public hospitals, and by private hospitals, when there is a serious fetal abnormality, using misoprostol.

The question, then, arises what will happen if medical abortion ceases in Queensland because doctors fear litigation?

Will it mean women will have to opt for surgical abortion or travel to other states?

Surgical abortion is more expensive, less private, and because of the need for anaesthetic, it carries a bigger health risk.

Medical abortion, however, is not without its detractors.

Dr Tim Coyle says RU486 is a dangerous drug, which can lead to haemorrhaging and death.

And safety was a reason senator Brian Harradine gave for making the Minister for Health responsible for abortion drugs in 1996.

Dr Coyle, who is a member of Cherish Life, says his interest would be in seeing women provided with independent counselling and given options other than abortion, rather than to have current laws changed.

Next week, Stephen Wettenhall is bringing the Women’s Network petition to Parliament, however, in a bid to make such changes.

"I think the petition indicates a heightened level of concern about the circumstances in which the criminal law in Queensland is capable of being applied in connection with termination of pregnancies," Mr Wettenhall says.

"An amended criminal code in Queensland is not on the current legislative agenda, but I do support a change.

"I do acknowledge that there are strong and diverse points of views.

"My personal view is that abortion is between a woman and her doctor and her partner, and a private matter."

While people feel strongly about abortion and come from many perspectives, there seems to be agreement that abortion levels in Australia, estimated to be between 80,000-100,000 annually, are too high.

"We need to be able to talk freely about why there is a high abortion rate," Dr de Costa says.

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