Misinformation abounds in Cairns abortion case
Cairns gynaecologists Caroline de Costa and Michael Carrette report on misoprostol and the Cairns woman charged with procuring her own abortion.
Last Wednesday, 8 July, in the Cairns Magistrates' Court, the case against a young woman charged with procuring her own abortion was adjourned until September 3, when she will face two days of committal hearings. She is charged under section 225 of the Queensland Criminal Code.
Her partner is charged under 226 of the same Code with assisting her to procure an abortion, and will likewise face committal proceedings. The matter has previously been mentioned in the Magistrates' Court on three occasions and the couple are on bail; the woman if convicted faces a prison sentence of up to seven years, her partner one of three years.
It is alleged by police that the woman used the drug misoprostol to bring about abortion at about eight weeks of pregnancy, on or soon after Christmas Day 2008. The drug was alleged to have been brought into the country from the Ukraine. Police searched the couple's home on March 30 this year, for reasons not made public, and are said to have found packets of the drug and instructions for its use in Ukrainian.
Whether or not the court accepts the allegations remains to be seen, but one thing is certain: in the week in which the woman is said to have used this drug, many hundreds of women across Australia used misoprostol, safely and effectively, to induce abortion. Some did so legally, some illegally, and some in environments where the legal situation is mired in uncertainty.
Reporting the outcome of the July 8 hearing, the Cairns Post said that police had stated that misoprostol is "the morning-after pill" and is "illegal in Australia" Both statements are untrue.
The "morning after pill" — better termed emergency contraception — contains hormones very similar to those in the normal contraceptive pill. It prevents pregnancy rather than causing early abortion, and is available without prescription in pharmacies throughout Australia, including in Cairns.
Misoprostol is a drug licensed in Australia only for the treatment of stomach ulcers, and available on a doctor's prescription for this purpose. However it is very effective in treating a variety of gynaecological complaints and is widely used in medical practice across the country for these — doctors using drugs like this are said to do so "off-label."
Misoprostol used alone is also quite effective for inducing early abortion, and very effective for late abortion ( the womb becomes more sensitive to its effects as pregnancy progresses.) For early abortion misoprostol is usually used in conjunction with either mifepristone (RU486) or methotrexate, which increase the effectiveness and safety of the abortion procedure. Some 61 doctors across Australia now have approval from the TGA to use RU486; an unknown but significant number of doctors use methotrexate plus misoprostol for medical abortion.
All Australian hospitals performing late abortions (usually around 18-20 weeks of pregnancy), for severe abnormalities in the fetus or serious medical conditions in the woman, do so using misoprostol. About 1500 such late abortions are performed in Australia each year. In Queensland there are 21 public hospitals and several private hospitals performing these procedures. The situation is similar in all states — misoprostol is extensively used.
The drug is also widely used prior to the performance of surgical abortion; it softens the cervix (the neck of the womb) making the use of instruments safer for the woman. At least 90,000 surgical abortions are performed annually in Australia. If just 50% of these involve misoprostol use — and that is probably an under-estimate — then up to 1,000 Australian women underwent an abortion involving the use of misoprostol in the week in which the young Cairns woman is alleged to have self-administered the same drug.
Misoprostol can also be obtained illegally with relative ease in Australia. Information about its actions and its use, including precautions that should be taken, is freely available on the Internet. Conversations with medical colleagues have revealed an awareness of many anecdotal reports of misoprostol use by women in Australia without medical prescription or supervision, in particular by women from China and South East Asian countries.
Use of misoprostol in this way would no be recommended by any medical practitioner. However most women would be aware that should they develop heavy bleeding or other complications they could seek medical assistance and have this provided confidentially and safely by emergency services. In fact misoprostol has dramatically lowered the death rates from abortion complications in countries in South America and Africa where abortion remains illegal, but where unsafe abortion by untrained practitioners using instruments was until recently the only option available.
At the adjournment of the Cairns case on Wednesday it was stated that police were still preparing an apparently large volume of evidence, and the defence promised to bring 12 witnesses including "politicians and doctors" although the identities of these people remain unknown.
Sections 225-226 of the Queensland Criminal Code appear to have been used just once in the 110 year history of the Code. In 1955 a Dr Ross was charged with performing a surgical abortion on a Mrs Ada McCarthy; doctor and patient were initially convicted in a lower court but had the conviction overturned on appeal.
Sections similar to 225-226 used to exist in the criminal legislation of all Australian states but have gradually been removed as abortion law has been brought into line with current abortion practice and majority community views. In 2008 the Victorian Law Reform Commission, in its report to the Victorian Parliament that ultimately led to the decriminalisation of abortion in that state, declared that the woman should never be held culpable for an abortion, no matter what the circumstances, and this view would seem to be consistent with the opinions of the majority of Australians.
Only NSW still retains a similar clause to Queensland's in the NSW Crimes Act, but several recent cases in that state have meant much more liberal interpretation of the law.
The young woman could have attended abortion services in Cairns and quite possibly have undergone abortion under medical supervision. Medical abortion has been openly practised in Cairns since 2006, though with considerable concern on the part of practitioners as to its lawfulness. But information about abortion and abortion services is still not easily accessed by all sections of our community — young women finding themselves with an unplanned pregnancy may be fearful, anxious about the consequences of seeking information from a doctor, and susceptible to misinformation.
Queensland Health has largely ignored its responsibility, in caring for women's reproductive health, to provide easily accessible early abortion and support services and abortion information. The result may be the only conviction in Australia in 150 years of a woman for self-procuring an abortion.
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Legal issues lead Cairns doctors to cease medical abortion
Queensland doctors continue medical abortions bans, use of RU-486 widens
Hugh (Charlie) McColl
Thank you doctors for your timely, calm update.