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STANDING COMMITTEE ON FINANCE AND PUBLIC ADMINISTRATION - 29/10/2008 - Item 16525 in part 3 of schedule 1 to the Health Insurance (General Medical Services Table) Regulations 2007

Estimates & Committees
Sarah Hanson-Young 29 Oct 2008

CHAIR -Thank you all for your opening comments. We will go to questions.

Senator Hanson-Young -On the introductory page of your submission, you say that disallowing this item would actually be contrary to the Millennium Development Goals, to which Australia is a signatory. Could you explain that?

Ms Brassil -The government signed up to the Millennium Development Goals, one of which is to reduce maternal mortality and morbidity. We believe that introduction of this item would just add to the stress, particularly for women in our society and potentially create problems for maternal mortality and morbidity.

Senator Hanson-Young -In relation to women in rural and remote communities, even if there is a local hospital chances are they would not perform these types of procedures anyway. A woman and her family would have to work out how she would get to a city. In terms of providing support and advice to clients and practitioners, would that put extra stress on people to perhaps put off undergoing any of these procedures, perhaps before that late term item would kick in? You would not know whether somebody needed to be managed through this process because the genetic testing would not happen until 20 weeks. What if it happened earlier-say the woman was sick and the pregnancy was looking dangerous? If it is going to take six to eight weeks to work things out-get on the list at a metropolitan hospital and, say, make sure the farm is looked after-how does a woman manage that situation?

Ms Nixon -I know that you are from South Australia. You are probably aware that rural maternity services have been closed down consistently over the last 15 years. That means services are pretty unavailable in regional and certainly remote South Australia. What we are talking about is a very upsetting procedure for anybody. Whether it is a planned pregnancy, an unplanned pregnancy, a wanted screened pregnancy or ending a pregnancy after 14 weeks and in the second trimester, it is an enormous emotional burden for anyone-for a person on their own, for a woman in a family context or with children. Transport issues are enormous in South Australia, as are childcare issues. These are the very basic things that anybody would have to cope with on top of the grief and loss involved with ending or losing a pregnancy.

So I think it does really speak for itself in terms of what we are talking about here. This is not a technical issue; it is a very deeply interwoven social issue. And we are operating in a social context that has changed around social acceptance of genetic screening. I think that is a really important piece of the background information. It is different than it was 20 years ago.

Senator Hanson-Young -Just so that we can be clear and concise: in terms of the women and the families that any of you would be in contact with, what would be the reasons that somebody would need to access this item?

Dr Weisberg -Basically, it would be because there is something wrong with the pregnancy. Either they have had a death in utero or they have had genetic screening or they have had an ultrasound at 18 weeks which has shown a major abnormality of the foetus, or there is a probability of the mother having a life-threatening condition which the pregnancy would aggravate. Those would be the major reasons. They would be medical contraindications or medical indications to have the pregnancy terminated.

For a woman who is carrying a child to 16 or 20 weeks to then have to have a further delay while she accesses public hospitals, knowing that there is something wrong with the pregnancy, just adds to the stress. It is a difficult enough decision and an emotion decision and a very sad decision for women to have to make. It is not one that women make easily. I think that any delay that would be occasioned by removing this item number would add to the stress-not just of the woman herself but also of the whole family who are involved in the decision making and considering how this abnormal child would affect the whole family.

Senator Hanson-Young -If you do not feel like answering this question, please, by all means, deflect it. Do you feel that the debate that we are having here in relation to whether we fund a particular item number is something that we should be discussing or is this simply the federal jurisdiction trying to impact on what is currently managed by the states in terms of whether or not abortion should be legalised?

Dr Weisberg -If you are asking me my opinion about abortion-

CHAIR -Can I just remind everyone-so that we keep on track in relation to all witnesses and the questioning-that we are not here to debate abortion.

Senator Hanson-Young -That was not my question.

Dr Weisberg -Your question is whether it should be the state legislation or the federal. I honestly believe it is better to have a federal legislation, because that applies to the whole of Australia, and not have different legislation in each state, which just confuses the issues.

Senator Hanson-Young -You have spoken about why women and their families perhaps need to access this item number. If it was disallowed, what is the process from here? If you were not able to access this, what types of avenues would a woman have and what types of costs would be incurred?

Ms Brassil -If this is disallowed, for a start, there is a pejorative in that in that it really says to women, 'We're not going to support you through this very difficult time.' It feels like a value judgement in relation to second trimester abortions. I can only say that I think people should think about themselves being in the situation where you might be carrying a foetus that has died or carrying a very severely abnormal foetus and have to make those terrible decisions.

It adds another level of grief associated with what is already a very difficult decision and it therefore also adds a deal of complexity around that that may not have occurred, through a very, very difficult time for the woman and her family-her immediate family, her husband, often her children as well and then her extended family and, in a rural area, members of the community. It is difficult to understand, to some degree, why we are having this discussion when it is very clear in terms of the item that it is for very specific areas. The woman and her family are forced into these very, very difficult decisions which then create a whole series of psychological complexity, financial complexity and organisational complexity for their lives. Given the small number of charges against this item, it seems difficult to understand why we are having this discussion.

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