The head of the Northern Territory branch of the Australian Medical Association has criticised “empowered female lawyers” who “don’t give a stuff” about medical guidelines for advocating abortion law reform in the territory.
The government would have to consider “a range of views on termination” – including anti-abortion advocates who picketed hospitals, Robert Parker said.
The comments were in response to concerns raised in a letter published in the Medical Journal of Australia about future access to abortion in the territory, after Darwin’s only public health provider of abortions resigned and was replaced with a specialist on a short-term contract.
Dr Suzanne Belton from the Menzies School of Health Research in Darwin, who co-authored the letter, told Guardian Australia the restrictions on surgical and medical terminations have placed the territory 10 years behind the rest of Australia and 20 years behind other countries.
It called for reform of the NT’s Medical Services Act to allow trained GPs to provide surgical or drug-induced abortions, which under current law must be done in a hospital and is only available at the Royal Darwin public hospital, a private hospital in Darwin and a public hospital in Alice Springs.
However, associate professor Richard Parker, president of the NT branch of the Australian Medical Association (AMA) – who had not seen the published letter – said those calling for law reform were dismissing college of obstetrics guidelines which were based on decades of medical experience.
He also said while there were “probably good arguments for law reform”, the government had to consider “a range of views on termination” in any discussion.
“The problem for the government is you’ve got this bunch of empowered female lawyers on one side demanding [reform] and there’s nothing wrong with that, but then you’ve got the Christian crowd expressing strong ethical issues,” he told Guardian Australia.
“There’s a bunch of people who stand outside Royal Darwin hospital … campaigning against abortion, so the government has to be aware of community reactions.”
Parker said complications from the “potentially fatal side effects” of the RU486 drug, which he said were “very uncommon”, were too risky for patients and doctors, and the Northern Territory, with its “tyranny of distance” was different from other states where most of the population had ready access to hospitals.
“If [women] are in remote and rural areas a couple of hours away from where they can get fluid and blood it’s a fatal episode, which is possibly one of the reasons [for current laws],” Parker said.
Financial assistance through Medicare for women to attend one of the hospital providers as an outpatient was a potential solution, he said, as was expanding the service to hospitals in Gove, Katherine and Tennant Creek, where resuscitation facilities were in place.
Parker also suggested less restricted access to RU486 could open up doctors to the risk of being blamed for complications.
“I had this discussion with a bunch of empowered female lawyers who basically said ‘miscarriages have been happening for hundreds and thousands of years’, and well, that’s true, but the thing is a pregnancy is a private affair. Once a doctor gives a medication they’re responsible for the side effects of that,” he said.
“If a doctor gives RU486 to a woman in a remote area and that woman then dies, that doctor has then made a significant contribution to their death potentially.”
Belton said the NT AMA could be confusing law and clinical protocol in its discussions around the issue.
“A law needs to enable doctors and nurses and midwives to offer termination of pregnancy to women, and then there needs to be something else separately that almost changes every year called evidenc- based medicine which is the nuts and bolts of how you’re actually going to roll that out,” said Belton.
She said the NT AMA was not basing its views on the available evidence, and that studies conducted in the US and Norway found no ill effects in giving the medication to women via telemedicine.
The letter by Belton, Caroline de Costa of James Cook university and Andrea Whittaker of Monash university said there is “overwhelming medical evidence showing that early medical abortions are efficacious, safe and well-accepted”.
Belton told Guardian Australia that hospitalisation isn’t always necessary, as in other states and territories the procedure is often carried out by GPs who have done diplomas in obstetrics and gynaecology, as well as in freestanding abortion clinics.
“We [in the Northern Territory] are at minimum about a decade behind the rest of Australia and two decades behind the rest of the world,” said Belton, adding that in Europe and the US the RU486 abortion drug has been available for up to 25 years.
“Those two medications are life-saving medications and are approved and they’ve had lots of clinical trials,” she said.
“This is very early medication, I’m talking about an abortion you might have in seven to nine weeks’ gestation, which is really when most women prefer to have it done and sorted and when most doctors say they are more comfortable doing it in the early stage rather than the later stage for all sorts of medical reasons.”
National president of the AMA, associate professor Brian Owler told Guardian Australia “doctors, just like the general public, will hold differing views”, but the AMA did not oppose abortion provided it was safe.
Owler said Parker’s concerns about someone dying in a remote area if they’ve been given the drug are “legitimate concerns”.
“We want to make sure that if people who are using this, just like any other treatment, it has to be done in the appropriate clinical setting with access to appropriate resources should a problem occur.”
NT health minister John Elferink said he was prepared to look at improving abortion services, and would be guided by clinicians before any amendment was decided by cabinet.
“Among a variety of issues, the current review into abortion services in the territory will doubtlessly look at whether hospitals are the only place where terminations can be procured or performed,” he told Guardian Australia in a statement.
“I am open to taking advice on this, and will then speak to my cabinet colleagues and my party colleagues about the issue.”