Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694818799360.pdf (Australia)
Human Rights (Children Born Alive Protection) Bill 2022Submission 11 Human Rights (Children Born Alive Protection) Bill 2022Submission 11 • The National Women’s Health Strategy 2020-2030 priority and action 1: Maternal, sexual and reproductive health and in particular the rights of ‘women to empower choice and control in decision-making about their bodies’ prioritises equitable access to pregnancy termination services.
Midwives as primary health practitioners are pivotal to improving equity, accessibility, and availability of vital sexual and reproductive health services for women, their babies and their families.

‘The Bill’ would be inhibitory to this strategy achieving its key priorities.
• Further barriers to reproductive rights of pregnant women in Australia and their access to care are detrimental to their health and wellbeing and may further contribute to increasing socioeconomic disadvantage, gender-based violence, mental health related presentations, and suicide (Barton., 2017 & CARE., 2020).
This is likely to further limit access to termination of pregnancy services in rural and remote areas of Australia and further reduce the number of trained health professionals willing to provide this essential service.

Midwifery continuity of care with a known midwife throughout the childbearing continuum demonstrates that preterm birth is reduced by 24% (Sandall et al., 2016) and by 50% in Aboriginal and Torres Strait Islander babies (Kildea et al., 2019).
For women with pre- existing perinatal mental health conditions midwifery continuity of care reduces preterm birth and increases rates of breastfeeding through having a known and trusted carer, who is also able to provide on-going counselling and support in a community setting (Cummins et al., 2022).

Continuity models are sustainable and support workforce retention by enabling midwives to work to full scope in a flexible model of care (Fenwick et al., 2017).
In 2022, 15% of care was in Midwifery Group Practice caseload care, with a known midwife as the lead carer (AIHW, 2022).

Expanding access to preconception care will enable this trusted relational model of care to engage in supporting universal access to reproductive life planning.

‘The Bill’ is likely to contribute to a worsening of maternal and neonatal outcomes for women and children.
• ‘The Bill’ demonstrates inaccurate understanding and definition of fetal viability (the ability to survive with or without medical intervention outside the uterus), what medically constitutes as being born alive and termination of pregnancy and abortion procedures as they relate to early and later gestations in Australia.

There is no consensus about when abortion becomes ‘late’ and what that means (Flowers, 2020).
The decision to provide a termination of pregnancy is made in partnership with the woman and her healthcare professional.

All health professionals involved in termination of pregnancy should be familiar with legislation as it pertains to the jurisdiction of the termination, including birth registration eligibility requirements (refer to Queensland Clinical Guidelines, 2019 as a benchmark).

Most jurisdictions across Australia have gestational age limits around terminations of pregnancy.
Outside of this, there is usually a collaborative requirement for a second medical practitioner/multidisciplinary involvement and may also include counselling for the woman (Children by Choice, 2023).

The contributory factors to the request for late gestation termination are usually complex.
The process of induced fetal demise/feticide 3 Human Rights (Children Born Alive Protection) Bill 2022Submission 11 Human Rights (Children Born Alive Protection) Bill 2022Submission 11 Human Rights (Children Born Alive Protection) Bill 2022Submission 11 Fenwick, J., Sidebotham, M., Gamble, J., & Creedy, D. K. (2018).

The emotional and professional wellbeing of Australian midwives: A comparison between those providing continuity of midwifery care and those not providing continuity.
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31(1), 38–43.

https://doi.org/10.1016/j.wombi.2017.06.013 Flowers P. Late termination of pregnancy: an internationally comparative study of public health policy, the law, and the experiences of providers (report for the Catherine Helen Spence Scholarship).
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Abortion-related care and the role of the midwife: a global perspective.

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https://internationalmidwives.org/assets/files/definitions-files/2018/06/eng-definition of the midwife- 2017.pdf International Confederation of Midwives.(2014).

Position Statement Midwives’ Provision of Abortion- Related Services.
https://www.internationalmidwives.org/assets/files/statement-files/2018/04/midwives- provision-of-abortion-related-services-eng.pdf Kildea, S., Gao, Y., Hickey, S., Kruske, S., Nelson, C., Blackman, R., Tracy, S., Hurst, C., Williamson, D., & Roe, Y.

(2019).

Reducing preterm birth amongst Aboriginal and Torres Strait Islander babies: A prospective cohort study, Brisbane, Australia.
EClinicalMedicine, 12, 43-51. https://doi.org/https://doi.org/10.1016/j.eclinm.2019.06.001 National Women’s Health Strategy 2020-2030. https://www.health.gov.au/sites/default/files/documents/2021/05/national-women-s-health-strategy- 2020-2030.pdf Nursing and Midwifery Board (2018).

Midwife standards for practice.

https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional- standards/Midwife-standards-for-practice.aspx Queensland Clinical Guidelines.

(2019) Termination of Pregnancy.


https://www.health.qld.gov.au/ data/assets/pdf file/0029/735293/g-top.pdf Queensland Clinical Guidelines.

Perinatal care of the extremely preterm baby.

Guideline No.

MN20.32-V2- R25.

Queensland Health.

2020.

Available from: http://www.health.qld.gov.au/qcg Rosser, S et al (2022).
Late Termination of Pregnancy at a Major Queensland Tertiary Hospital, 2010 – 2020. https://www.mja.com.au/system/files/issues/217 08/mja251697.pdf 6 Human Rights (Children Born Alive Protection) Bill 2022Submission 11 Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2016).

Midwife‐led continuity models versus other models of care for childbearing women.

Cochrane Database of Systematic Reviews(4).

https://doi.org/10.1002/14651858.CD004667.pub5 Swanell, C. (2022).
Navigating Australian’s “abortion deserts”: why is it still so hard?

https://insightplus.mja.com.au/2022/25/navigating-australias-abortion-deserts-why-is-it-so-hard/ Taft, A., Shankar, M., Black, K., Mazza, D., Hussainy, S. & Lucke, J.C. (2018).

Unintended and unwanted pregnancy in Australia: a cross-sectional, national random telephone survey of prevalence and outcomes.

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209(9), 407-408. https://www.mja.com.au/system/files/issues/209_09/10.5694mja17.01094.pdf Western Australian Government (2022).

https://www.mediastatements.wa.gov.au/Pages/McGowan/2022/11/McGowan-Government-to-reform- WAs-abortion-laws.aspx World Health Organization.

Abortion Care Guideline.

2022. https://www.who.int/publications/i/item/9789240039483 7 Human Rights (Children Born Alive Protection) Bill 2022Submission 11