Home - Claire Moore - Labor Senator for Queensland

BILLS: Health Insurance Amendment (Medicare Funding for Certain Types of Abortion) Bill 2013

Senator MOORE (Queensland) (09:50): 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.