The claim

The debate around the decriminalisation of abortion in NSW continues to rage with news that two Liberal MPs may move to the backbench and strip the Berejiklian Government of its majority if amendments are not added to the bill.

The Reproductive Health Care Reform Bill, which passed the lower house in August, is due to be debated in the Upper House this month.



In an op-ed in the Sydney Morning Herald on August 4 Associate Professor Joanna Howe and Professor Suzanne Le Mire, criticised a provision in the bill that would mean doctors with a conscientious objection to abortion must refer a woman to another doctor without an objection.



In making their argument, the academics from the University of Adelaide Law School said that the Victorian abortion laws were a relevant case study for the NSW legislation.



"Since abortion was decriminalised in Victoria in 2008, post 20 week abortions have increased by 39 per cent," the academics wrote.



Is that correct? RMIT ABC Fact Check investigates.



The verdict

Dr Howe and Professor Le Mire are wrong.



On the raw numbers, there were 328 post 20 week abortions in Victoria in 2008 — decriminalisation came into effect in October that year.

Those numbers rose sharply immediately after the law change in 2009, and stayed above 2008 levels for five years.



Since 2014 however, the number of post 20 week abortions has remained below pre-decriminalisation levels.

In 2017, the latest data available, there were 324, which when compared to 2008 represents a 1 per cent decrease.



Did abortions performed after 20 weeks increase 39 per cent in Victoria after decriminalisation? ( Supplied: Marie Stopes )

Statistician Susanna Cramb, from the Statistical Society of Australia provided Fact Check with a more robust analysis of the numbers using joinpoint statistical software.

That analysis showed a 14 per cent decrease between 2008 and 2017.



And looking at the rate of post 20 week abortions as a proportion of all births — which better takes into account population growth — also showed a decrease in post 20 week abortions since decriminalisation.



Dr Howe and Professor Le Mire told Fact Check they calculated the 39 per cent increase by comparing the average number of post 20 week abortions from 2000 to 2008, to the average number from 2009 to 2016.



This method was not explained by the authors in their op-ed and Fact Check does not consider it to represent the expression "since 2008".



Dr Cramb told Fact Check this was a "crude approach" to calculating the change in the number of abortions over time, and that there were no advantages to the method.



The NSW Reproductive Health Care Reform Bill

Introduced to Parliament by Independent MP for Sydney Alex Greenwich, the Reproductive Health Care Reform Bill aims to decriminalise abortion in NSW by repealing offences relating to abortion in the Crimes Act and abolishing any common law rules relating to abortion.



According to Mr Greenwich, the bill is based on Queensland and Victorian laws, which have been in place since December 2018 and October 2008 respectively.



The bill would make abortion for any reason legal up to 22 weeks' gestation. After 22 weeks, two doctors must "consider that, in all the circumstances, the termination should be performed".



Those circumstances include all relevant medical circumstances, current and future physical, psychological and social circumstances of the person having the abortion, and the professional standards and guidelines governing the medical practitioner performing the abortion.



In Queensland, the law (which Fact Check explored in detail in 2018) is almost identical, while in Victoria, the same stipulation for two doctors to consider all the circumstances applies after 24 weeks rather than 22.

Pro-abortion supporters outside NSW State Parliament on August 6, 2019. ( ABC News: Jonathan Hair )



A talking point

Dr Howe and Professor Le Mire's claim was repeated in another Sydney Morning Herald op-ed a week later, this time by Debbie Garratt, who is the executive director of Real Choices Australia, a group offering "professional education and training around reproductive health issues" and support to pregnant women.



"Since abortion was decriminalised in Victoria, late-term abortions have increased by 39 per cent," Ms Garratt wrote.



The claim was also repeated in a social media video by Martyn Iles, who is the managing director of the Australian Christian Lobby.

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The organisation states on its website it is "a grassroots movement made up of over 150,000 individuals who are seeking to bring a Christian influence to politics".



In the video, Mr Iles referred to the academics' op-ed and said:



"Since abortion was decriminalised in Victoria in 2008, post 20 week abortions have increased by, wait for it, 39 per cent."

The source of the claim

Dr Howe and Professor Le Mire's op-ed provides a source link for the claim — a document on the Real Choices Australia website.

That document lists the number of post 20 week abortions in Victoria from 2000 to 2017.



Real Choices Australia states on its website it is not a lobby group and has no religious or political affiliations.



The document provided by Dr Howe and Professor Le Mire refers to "Victorian Perinatal and Morbidity Statistics".

Another page on the Real Choices website provides a number of Victorian Government reports containing post 20 week abortion figures.



Fact Check accessed the government reports independently and verified the figures contained in the Real Choices document for the years 2001 to 2016.

These numbers were also confirmed in a document sent to Fact Check by a spokesman for the Victorian Department of Health and Human Services.



The Real Choices Australia figure for 2017 differed from the official statistics by one, while it was unclear where the 2000 figure had come from.

In an email, Ms Garratt told Fact Check she was unsure of how it had been calculated.

The raw numbers

Dr Howe and Professor Le Mire said "since abortion was decriminalised in Victoria in 2008, post 20 week abortions have increased by 39 per cent".



Fact Check considers the 2008 figures to be "pre-decriminalisation" on the basis that the law change was not enacted until October 23 of that year.



In 2008 there were 328 post 20 week abortions in Victoria and in the last full year before decriminalisation — 2007 — there were 345.

The number increased sharply immediately after decriminalisation, peaking at 410 in 2009, and then remained above 2008 levels until 2013.



Since 2014 however, the number of post 20 week abortions has remained below pre-decriminalisation levels.



In 2017, which is the most recent year for which there are figures, there were 324 post 20 week abortions, nearly exactly the same amount as 2008.



In fact, comparing 2008 to 2017 shows a 1 per cent decrease in the number of post 20 week abortions in Victoria since the procedure was decriminalised.



A different approach

Fact Check asked the Statistical Society of Australia for help in interpreting the figures.



The society's Dr Susanna Cramb suggested using joinpoint statistical software to track the trends in the number of abortions.



According to the US-based National Cancer Institute, who provide the joinpoint software used by Dr Cramb, the software allows users to test whether an apparent change in trend is statistically significant.



Dr Cramb supplied Fact Check with an analysis, using the software, of the figures included in the Real Choices Australia document cited by Dr Howe and Professor Le Mire in their op-ed.



As illustrated by the graph below, Dr Cramb's analysis showed a likely increase until 2009 with a significant decrease since then.

An analysis of terminations performed after 20 weeks in Victoria by year.



She noted, however, that 2009 had a very high number of abortions, and was a potential driver of that significant decrease.



"If we remove 2009 … there is still some evidence of a decreasing trend since 2010 but it is not quite significant," Dr Cramb said.



"Certainly in 2009 - 2011 the number of abortions were higher than for 2008 and earlier, but numbers have been decreasing since."



According to Dr Cramb, not only was there not a 39 per cent increase in post 20 week abortions since decriminalisation in 2008, using the modelled trends shows a 14.2 per cent decrease between 2008 and 2017.



What about the rate?

Statistician Sabine Braat, also from the Statistical Society of Australia, told Fact Check that "the number of abortions may not give the full picture" given the number of women aged 15 to 44 in Victoria had increased since 2008, and it was likely the number of live births had as well.



"The abortion rate [the number of abortions per 1,000 live births] adjusts for differences in population size and reflect how likely post 20 week abortion is among women aged 15 to 44 years in Victoria," Ms Braat said.



A spokesman for the Victorian Department of Health and Human Services provided Fact Check with statistics for post 20 week abortions as a proportion of all births.



That data showed that in 2008, post 20 week abortion made up 0.45 per cent of all births in Victoria.

Like the raw numbers the rate spiked in 2009, but since 2014 has been below the 2008 pre-decriminalisation level.



In 2017, post 20 week abortions made up 0.41 per cent of all births, representing a decrease of 9 per cent since 2008.

There was a decline in the number of terminations as a proportion of live births in Victoria between 2008 and 2017.



So where has the 39 per cent increase come from?

Fact Check contacted Dr Howe and Professor Le Mire in regards to their claim.

In response, Professor Le Mire explained how the 39 per cent figure was reached from the source provided.



"Based on the stats, the average number of late term abortions for the years 2000 to 2008 compared to the average number of late-terms from 2009-2016, shows an annual average increase of 39 per cent in the number of late-term abortions post decriminalisation," Professor Le Mire told Fact Check in an email.



Comparing eight year averages pre and post-decriminalisation does indeed show a 39 per cent increase, but in their op-ed, the academics did not say this is how they reached that figure. Rather, they use the expression "since 2008", which Fact Check considers to mean the increase or decrease after that time.

Further, in calculating the averages, Dr Howe and Professor Le Mire include a low number of abortions in the year 2000, which Fact Check was unable to verify, and exclude the 2017 figure.



According to Dr Cramb, there were no advantages of calculating the increase in this way.



"This is a very crude approach," Dr Cramb said in an email.



What do the providers say?

A 2017 qualitative study assessed the impact of the 2008 decriminalisation of abortion in Victoria by interviewing expert healthcare workers involved in the process.



"We purposively sampled for the individuals with the most experience of abortion service provisions pre and post law reform — individuals with experience at each stage of abortion service delivery and working in Victoria," the researchers said.



The researchers found there was one overarching sentiment present in all interviews with the 19 experts: abortion law reform had been a positive event, but little had changed about the practical provision of abortion.



In particular, the healthcare providers interviewed agreed that access to abortions had not increased as a result of the law reform.

In fact, while not a consequence of decriminalisation, the experts expressed concern that access to post 20 week surgical abortions had decreased since 2008.



"Of particular concern to these experts was the lack of availability of abortion for women over 20 weeks' pregnant," the researchers said in their discussion.



"While Victorian law now offers a clear and simple legal framework for providing abortions up to 24 weeks, this research suggests that other barriers continue to limit provision even in situations where the legal criteria could be met."

Principal researcher: Ellen McCutchan

factcheck@rmit.edu.au



Sources