This is our submission to the Senate Standing Committee on Community Affairs inquiry into ‘Universal access to reproductive healthcare’. Members of the public and organisations have until Thursday 15 December 2022 to make submissions.
This is a submission from the Rationalist Society of Australia (RSA) to the Senate Committee’s inquiry into ‘Universal access to reproductive healthcare’. The RSA is Australia’s oldest freethought organisation, working to promote reason, evidence-based policy and secularism.
We support the right of a woman, in consultation with her medical and mental health advisors, to determine whether to terminate a pregnancy.
Too many barriers remain for Australian women in accessing reproductive healthcare, including contraception and abortion services, particularly for women in remote and regional areas. These barriers are unacceptable in modern-day Australia, adding to mental duress and putting the health and lives of women at risk. In this submission, our primary focus is on the religious-based barriers – especially publicly funded institutions that refuse lawful health services.
Institutional conscientious objection in publicly funded religious hospitals
Around Australia, publicly funded religious hospitals utilise ‘institutional conscientious objection’ to prevent services being offered in their hospitals even if the community, the government, individual doctors and patients all agree the services should be provided.
Because of this, unnecessary barriers are put up for women – often, vulnerable women – to get the timely and required treatment that they need and that they deserve as Australian citizens and taxpayers.
In allowing such religious hospitals to continue operating in this way, governments are continuing to privilege narrow religious interests above the wellbeing of women and the wider community. This should not be happening in 21st-century Australia.
As a recent ABC media article revealed, health practitioners who work in religious hospitals say the application of strict religious code of ethics in their workplaces puts patients’ lives at risk. They told of having to urge vulnerable women to leave the religious hospital and seek urgent help from a public hospital, as the religious hospital would wait too long before terminating a pregnancy.
Earlier this year, it was reported in The Guardian that at least one patient each week was being turned away from seeking a termination at a publicly funded religious hospital in Victoria. We believe that all hospitals that receive public funding should be legally required to provide advice and services for abortion. Due to the limited accessibility to public facilities, women can incur high out-of-pocket expenses for access to time-critical care – another significant barrier to healthcare.
Equally concerning, the ABC revealed the extent to which medical practitioners in religious hospitals are falsifying medical records to circumvent the institutions’ code of ethics in order to provide patients with contraceptive treatment. Alarmingly, one staff member at a major public Catholic hospital said there was “so much fudging of documentation” that it would be “really difficult to accurately” know what was happening in the health system.
As social researcher Neil Francis noted in Religiosity in Australia (Part 2): Religious minds, religious collectives, ‘institutional conscience’ is a confected notion. A ‘conscience’ is the interaction of the private thoughts and emotions of a natural person exercising moral judgement. Institutions are not natural persons; they are legal confections of ‘personhood’.
Institutions are confections of law, not natural persons, and their codes of conduct that prohibit certain choices are not conscience: they are rules that suppress real conscience and extinguish agency. Such prohibitions are particularly egregious when services are being provided to the public, on the public purse.
When an institution seeks to mandate or prohibit particular actions through a Code of Ethics or Code of Conduct (or mission statement or any other enterprise document), this is not “conscience”. It’s ideological regulation (Beca & Astete 2015). Insofar as it aims to apply penalties to violators of its prearranged conditions, it acts like law, not conscience. In practice it suppresses conscience.
We know that the Australian population is becoming increasingly less religious. The 2021 Census showed that people identifying as Christian fell to less than half of the population – 43.9 per cent. Australians identifying as not religious surged to 38.9 per cent – and would be likely to overtake Christians at the 2026 Census.
It is untenable for the public funding of healthcare services to remain hostage to religious dogma that is becoming increasingly irrelevant to most Australians – including most religious people who have increasingly progressive views on issues such as access to abortion.
There may be good policy reasons for permitting individual healthcare workers to conscientiously object to providing abortion services, but there are not good policy reasons for permitting a publicly funded hospital to have a blanket prohibition on its healthcare workers providing lawful healthcare.
Unequal access to services
Another major barrier to universal reproductive healthcare that must be addressed is the wide variance of accessibility of abortion and contraception services depending on a person’s geographic location. Indeed, the situation in Australia has been labelled a “postcode lottery”, with women in different areas facing vastly different rules, costs (including for travel times) and levels of accessibility.
Women in remote and regional areas face greater barriers to accessing timely services, especially if religious-based hospitals and service providers are the only available options. Researchers at Monash University have identified “abortion deserts” across Australia, with some places not even having a GP available to prescribe, or a pharmacist to dispense, abortion medication. Women should not be so disadvantaged for where they live.
Women in urban areas also face difficulties in accessing abortion and contraception services due to the combined effect of ‘institutional conscientious objection’ at religious hospitals and ‘conscientious objection’ of individual medical practitioners in public facilities.
Nicole Huig from a counselling service told the ABC the situation was complicated for women in South Brisbane. She said the area had become known as “the wrong side of the river” because The Mater Hospital refused to provide such services and individual health workers at the public Logan Hospital objected to providing terminations or contraceptives.
The ABC reported:
Those hospitals are meant to refer on, and many have partnerships with private clinics. But for some women, by the time they jump through the hoops to get an appointment, it’s too late, and they’re forced to carry through with the pregnancy. Nicole is aware of six women in this situation this year — ‘but that’s only the women who’ve actually accessed our service’.
Views of clerics at odds with own flock
It’s important to note that religious clerics who claim to speak for their communities are out of touch with their own flocks on many social issues. In the 2021 publication Religiosity in Australia (Part 1): Personal faith according to the numbers, Neil Francis showed how the views of Catholic bishops on issues such as abortion and voluntary assisted dying, for example, were at odds with Catholic Australians – and have long been so.
The 2019 Australian Election Study (AES), by the Australian National University, showed that, overall, 93 per cert of Australians, including 90 per cent of Catholics, support abortion being available. Similarly high support was found among other religionists, including 92 per cent of Anglicans, 95 per cent of Uniting/Methodists, and 85 per cent of smaller Christian denominations. Of those Catholics in support of abortion, 61 per cent supported availability on demand. Just 2 per cent of Australians and 1 per cent of Catholics believe it should never be available.
Given the data, Francis argues:
Those clerics continuing to actively oppose abortion choice are still speaking in terms of religious “tradition”. However, even amongst those remaining in their flocks — for many have left — most don’t agree that prohibition of abortion services is a valid part of their religious tradition. … Thus, prohibitive abortion policy clearly serves the particular interests of the church’s senior hierarchy at the expense of the interests of the Australian — including Catholic — public.
Publicly funded hospitals operating under a religious code of ethics therefore are serving the interests of religious leaders rather than the interests of the general public or the people of the hospital’s faith background.
Conclusion and recommendation
It is untenable and unreasonable for women to continue to face barriers in accessing lawful health services on the public’s purse due to the privileging of religious dogmas that are becoming increasingly irrelevant to most Australians and, indeed, most religious people.
While we support the right of individual medical practitioners to exercise a ‘conscientious objection’ and, therefore, not directly take part in providing abortion or contraception services, we believe that taxpayers’ money should not go towards funding religious hospitals that apply an ‘institutional conscientious objection’ to these policy areas.
The Health Legislation Amendment (Conscientious Objection) Bill 2022 (Vic) (which, unfortunately, did not pass the Victorian Parliament) provided a workable model for addressing the problem. The Bill would have done two key things:
- impose an obligation on publicly-funded denominational hospitals that provide gynaecological, obstetrics or neonatal services to provide advice and services for contraception, the supply of contraceptives, and medical and surgical abortion; and
- prohibit publicly-funded denominational hospitals from directing or otherwise causing a registered health practitioner employed or engaged by the denominational hospital to refuse to provide such services on the basis of the hospital’s conscientious objection.
Importantly, nothing in the Bill would have affected an individual registered health practitioner’s right to conscientiously object to providing such services or advice on the basis of that individual’s own sincerely held beliefs or moral concerns.
We recommend that the federal government work with state and territory governments to:
- Make it a condition of federal hospital funding that any hospital providing gynaecological, obstetrics or neonatal services provide advice and services for contraception, the supply of contraceptives, and medical and surgical abortion,
- Enact State and Territory versions of the Health Legislation Amendment (Conscientious Objection) Bill 2022 (Vic).
Dr Meredith Doig,
President, Rationalist Society of Australia