Intended and unintended consequences of abortion law reform: perspectives of abortion experts in Victoria, Australia

Abstract

Law reform, while positive, has failed to address a number of significant issues in abortion service provision, and may have even resulted in a 'lull' in action.

Abortion law reform in Victoria: lessons for the UK

“…However, this study2 also demonstrates that the removal of specific criminal prohibitions against abortion should not be seen as a panacea. Indeed, albeit for reasons apparently unconnected with the legal reform, it found that public service provision and access to later abortion services appear actually to have decreased in Victoria since 2008.…”

“…Keogh et al 's2 study in this issue provides the first robust confirmation that the incidence of legal abortions has not risen since decriminalisation. Neither has the removal of criminal sanction led to more late terminations.…”

“…Whatever the shortcomings of legal reform, Keogh et al 's2 study nonetheless suggests that the sweeping away of criminal law prohibitions against abortion in Victoria has been a crucial first step towards improving services. Respondents accepted that reform had been important in repositioning abortion as a health issue, rather than a matter for criminal law, and in transferring formal legal decision-making powers from doctors to women.…”

Association between timing of diagnosis of trisomy 21, 18, and 13 and maternal socio‐economic status in Victoria, Australia: A population‐based cohort study from 2015 to 2016

“…Timely presentation for antenatal care and financial capacity are the most likely socio‐economic influences on a women's choice of first or second trimester screening. The fact that disadvantaged women are more likely to have a prenatal diagnosis of a major trisomy after 17 weeks has important management as well as ethical implications, as surgical termination of pregnancy is less available and less affordable in Victoria after 17 weeks and entails higher surgical risks to the woman …”

“…Ideally, women should be offered prenatal screening in the first trimester, as this maximises choice and facilitates subsequent genetic counselling and prenatal diagnosis of an affected pregnancy before 17 weeks gestation. Earlier prenatal diagnosis not only is psychologically preferable for women but also improves access to surgical termination of pregnancy in Victoria if requested, as services are limited after 17 weeks gestation . Further opportunities for trisomy detection occur at the time of second trimester fetal morphology scan (typically performed at 18 to 22 weeks), but its sensitivity for T21 is lower.…”