Medicine


 

by Francine Coeytaux, Public Health Institute (PHI)

and Elisa Wells, Independent Consultant

May 28

 

http://rhrealitycheck.org/article/2013/05/28/why-arent-we-taking-advantage-of-the-potentially-game-changing-drug-misoprostol/  

 

Misoprostol: Have you heard about this small, inexpensive, and most importantly available pill that can save women’s lives? Pragmatic Brazilian women first discovered the potential of misoprostol (or Cytoteca, in their parlance) in the 1980s. According to the label on this widely used peptic ulcer drug, it was not to be taken during pregnancy as it could induce bleeding. Living in a country with very restrictive policies and little access to safe abortion services, they recognized the opportunity to circumvent the system and, by word of mouth, spread the word to other women about this easily obtainable pill that could help them safely end an unwanted pregnancy.

 

Thirty years later, women in countries around the world are beginning to do the same-continuing to spread the word, talking to each other about misoprostol, and trying to get their hands on these pills. The women who are accessing the drug in their communities and taking it by themselves have shown us that there are relatively few health risks involved with misoprostol. What began in Brazil as a natural public health experiment has been validated by rigorous clinical studies conducted by international groups such as the World Health Organization and Gynuity. These studies have shown that the use of misoprostol for abortion is very safe, especially when taken early on in the pregnancy; while not as effective as when taken in combination with mifepristone (another abortion pill), misoprostol taken alone will safely terminate 75 to 90 percent of early pregnancies when taken as directed.

 

Misoprostol has also been proven to have numerous other lifesaving properties, including the ability to prevent and treat postpartum hemorrhage and to induce labor. It is registered in more than 85 countries, usually as an anti-ulcer medication, and is used off-label by clinicians around the world for numerous reproductive health indications. In addition to these clinical uses, we are beginning to see positive public health outcomes from community-based use of misoprostol. In countries where abortion is restricted and women are using misoprostol, we have seen a reduction in infections. And in under-served communities, where women delivering at home are taught to take misoprostol immediately after delivery, postpartum hemorrhage is significantly reduced.

 

If we have a cheap and readily available drug that can prevent and treat the two largest causes of maternal mortality worldwide-postpartum hemorrhage and unsafe abortion-why have we not taken more advantage of this exciting technology? Given the global attention being paid to meeting the fifth Millennium Development Goal (MDG 5)-that of reducing maternal mortality-it is difficult to fathom why we continue to squander the opportunity misoprostol offers us.

 

The public introduction of any new technology takes time and is not easy; the introduction of emergency contraception is just one of the latest examples. Reproductive health advocates have been working for decades to increase women’s access to this safe, effective, and non-abortifacient technology. While much progress has been made around the world, the recent action of the Obama administration to prevent full over-the-counter access in the United States is a sad illustration of the hurdles women face in accessing reproductive health technologies. The hurdles we face in introducing misoprostol will be even higher given three inherent characteristics:

It has multiple indications, including abortion.

It is only “second best” to existing drugs, competing with a “gold standard.”

It can be used by women without the assistance of a provider.

The Challenge of Multiple Indications

Misoprostol’s greatest clinical asset-the fact that it can be used for numerous reproductive health indications-also poses enormous challenges for implementation. As mentioned, misoprostol has many uses: to both prevent and treat postpartum hemorrhage, to induce labor, to induce abortion, and for post-abortion care. But these multiple indications pose two major challenges for implementation, one political and the other educational.

 

The political challenge lies in overcoming the stigma of abortion. A survey we conducted in 2010 of organizations that were working with misoprostol for postpartum hemorrhage revealed that the second biggest barrier to the introduction of misoprostol was its association with abortion. To quote one respondent who was asked about the challenges and opportunities for its introduction: “Hypersensitivity of misoprostol as an abortifacient [is a barrier]. We see this in clinical providers, government officials, even donors-a disproportionate concern that if misoprostol were to be made available for PPH prevention and treatment, it would be used for abortion. This is a major obstacle in accepting misoprostol for other OB/GYN indications-the abortion stigma.”

 

This political fear is strong, despite the evidence that all indications of misoprostol use are potentially life-saving. And because of this fear, there is a great deal of sidestepping going on as organizations begin to introduce misoprostol at the community level for postpartum hemorrhage while trying to stay clear of its potential use for abortion. “We feel there is tremendous promise for use of misoprostol for [postpartum hemorrhage], so we do not want to jeopardize that application by highlighting the other indications,” said another respondent.

 

The political controversy only exacerbates the programmatic challenge of informing women, their partners, and their health-care providers of the different doses and the proper timing of administration needed for different indications. This is usually facilitated by the registration and labeling of products in appropriate doses for each of misoprostol’s various indications.  

 

But because the vast majority of misoprostol use is currently done “off-label”(it’s being used for an indication other than the one the product is registered for) there is an urgent need to find ways to get women accurate information about how to use it for the different reproductive health purposes. Mobile technologies are beginning to open the information door to some women, but challenges remain. We need to find ways of achieving a broader level of knowledge about correct use, and to help women differentiate between the proper uses for each indication, including abortion.

 

The Challenge of Competing Against a “Gold Standard”

For both indications-abortion and postpartum hemorrhage-misoprostol is the second best option, up against another drug long considered the “gold standard.” For abortion, the most effective medical abortion regimen is mifepristone combined with misoprostol; when used together, the success rate is 93 percent, and when misoprostol is used alone it is 78 percent successful. Thus, where mifepristone is available, such as in the United States, it is the drug of choice.

 

In the case of postpartum hemorrhage, injecting oxytocin is the first line of treatment because, when oxytocin is at full potency, it is more effective than misoprostol. But oxytocin, unlike misoprostol, needs to be refrigerated. As a result, the quality of the drug is easily compromised by exposure to heat-a problem in many Global South countries. Finally, the administration of oxytocin requires that the women deliver in a health-care facility, another “gold standard” established by the medical community.

 

In reality, in many places in the world, we are not meeting these “gold standards,” in spite of decades of trying to do so. Mifepristone is far from universally available, oxytocin stock-outs are common in many places and/or the quality has been compromised, and many women continue to deliver at home, without skilled attendants. In these situations, misoprostol is a very good alternative and even has the advantage of being in pill form, making home use possible and safe.

 

Which brings us to the third challenging characteristic…

 

Women Can Use it Without the Assistance of a Provider

Another survey respondent summed it up nicely: “This is a gender issue. Misoprostol faces this unbelievable barrier because it is a drug for women.”

Therein lies both the greatest opportunity and the greatest challenge.  

 

Misoprostol has the potential to be a game-changer when it comes to maternal health precisely because it can be used safely and effectively by women themselves. The foremost obstacle to achieving MDG 5 is the weak health-care infrastructures of many countries. Misoprostol offers the opportunity to circumvent this obstacle for two of the three principal causes of maternal mortality-postpartum hemorrhage and unsafe abortion. Yet despite growing evidence that women can safely and effectively take misoprostol by themselves, in their homes, for both uses, health-care practitioners are insisting on controlling access to the drug, viewing it as an important addition to their clinical tool kit and a service only they can “provide” instead of as a pill that can be used by women, to help themselves, with little or no assistance from a health-care provider. The failure to relinquish control over the use of misoprostol not only gets in the way of women who are intent on helping themselves, it risks negating the most attractive aspect of this new technology: it’s self-use properties. To quote another respondent to our survey: “Many people are more concerned about what might happen with an intervention (i.e., side effects) than what might happen without an intervention (i.e., maternal death). In this case, women are more likely to be harmed by omission of the intervention than from any danger posed by the intervention itself.”

 

Obviously, as we work to make misoprostol available at the community level we need to acknowledge that it is a powerful drug and that incorrect use can lead to serious consequences-such as uterine rupture during labor induction. While some would use this as an argument for placing restrictions on access, we see this as a call to put accurate and comprehensive information about its safe use into the hands of women.

 

The Way Forward

This week policy makers from around the world are gathering in Malaysia at the third Women Deliver Conference to continue to share ways of reducing maternal mortality. Misoprostol is the single-best opportunity to do just that. But the true potential of this simple and cost-effective technology lies in our willingness to abandon our “provider” frame and put the pills directly in women’s hands. Our challenge is to let women be the shapers and the users of this new technology, not the beneficiaries of what we can provide or what we think they need. Can we stop worrying about women’s “misuse” or “abuse” of misoprostol and show that we truly trust women with their own reproductive health care? Let us remember that it was women who discovered this drug in the first place, specifically to circumvent the weakness of the health-care system. Let us give them back this powerful tool and get out of their way.  Our responsibility is to ensure that women have easy access to the pills and all the knowledge necessary to use them effectively and safely.

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The website www.doctorsforchoiceireland.com has just gone live.

Doctors for Choice is an alliance of independent medical professionals and students advocating for comprehensive reproductive health services in Ireland, including the provision of safe and legal abortion for women who chose it.

We believe that women should be supported to make their own decision regarding their sexual and reproductive health and to manage their own fertility, with doctors and nurses providing expert advice and care without judgment, recourse to the law or fear of criminal sanction.

We welcome your support. If you are a doctor or a medical student we will gladly welcome you into membership. You can contact us at doctorsforchoice@gmail.com

Follow them on Twitter and Facebook.

 

e: doctorsforchoice@gmail.com

t:  @doctors4choice

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http://www.nwci.ie/news/2013/03/22/suicide-in-pregnancy-is-much-rarer-now-thanks-to/

Suicide in Pregnancy is much rarer now ‘thanks to legal abortion’

22 Mar 2013

PeadarOGradyfBDr Peadar O’Grady, Doctors for Choice speaking at seminar “Abortion – The Lives and Health of Women”

Article by Dr Peadar O’Grady, Consultant Child and Adolescent Psychiatrist and member of Doctors for Choice

It is important in discussing the relevance of suicide in the current abortion debate that good medical practice does not come second place to legal arrangements for certification. Maternal mental health matters because of the effects on the mother of mental distress, self-harm and the catastrophe of a completed suicide, but also because of the devastating effects any and all of these can have on any children involved. It is often observed that during pregnancy the incidence of mental health problems and suicidal ideas is high but the risk of completed suicide is lower than usual for comparable women. Even so, because the total of maternal deaths in pregnancy is low, suicide is still one of the top 4 causes of maternal deaths in developed countries.

Groups at higher risk of suicide are those with an unwanted pregnancy, particularly teenage mothers and those on low incomes. In its 2009 report on Maternal Mental Health, the UN’s World Health Organisation (WHO) has highlighted the increased risk of mental health problems in, “unintended pregnancy especially among adolescent women”. The WHO emphasises the further risk from factors such as poverty and lack of support, “in contexts in which there are strong, gendered role restrictions on women including lack of reproductive rights”. ‘Reproductive rights’ for women means the right to decide whether or not they want to have children and, if so, how many and when.  To be vindicated this right requires access to abortion services but also access to good quality obstetric, contraceptive and STD services as well as sex education and information. In his 2011 journal article ‘Suicidal Mothers’, Salvatore Gentile agreed that maternal suicide attempts during pregnancy were increased where there was: “teen age, unplanned pregnancy, unmarried status or recent divorce, unemployment, and difficult access to safe abortion service(s).”

It has also been observed that suicide in pregnancy (and the year after delivery, known as the ‘puerperium’) has become much less common with access to legal abortion services. Professor Robert Kendell summarised this conclusion in the title of his 1991 review in the British Medical Journal: ‘Suicide in pregnancy and the puerperium, much rarer now: thanks to contraception, legal abortion and less punitive attitudes’. It is therefore clear from the WHO and peer-reviewed research that restricting access to abortion, that is, denying women ‘the right to choose’, raises the risk of suicide in pregnancy.

Despite this the opposing notion that choosing an abortion increases the risk of mental health problems, and even suicide, persists. This false conclusion is a misreading (often deliberate and repeated) of the fact that there is often a higher incidence of mental health problems found in people who have had abortions than among those giving birth. However ‘correlation is not causation’. When previous mental health and unwanted pregnancy are taken into account there is no higher rate after an abortion. This makes abortion a ‘risk indicator’ rather than a ‘risk mediator’. As we have seen the likely mediators are unwanted pregnancy and previous mental health problems. It is also well known that, following abortion, mental health problems are more common where the woman has had a negative attitude to abortion before and a negative reaction after, especially when she has been under pressure to have an abortion. The ‘right to choose’ must be without pressure to choose a certain way. Good counselling and practical support before and after this decision is the key to supporting women with unwanted pregnancies.

A similar example of prejudice clouding judgement is the observation that LGBT individuals are at higher risk of mental health problems. One conclusion (by many of the same fundamentalist Christians who populate the anti-choice lobby) is that homosexual or transgendered people should be ‘cured’ from this presumed ‘disease’. The modern psychiatric approach, based on evidence, has been to reject the notion of homosexuality or transgender as diseases by identifying the high incidence of bullying and discrimination as causative factors, or ‘risk mediators’, for mental health problems in this group.

When the allegation, that abortion leads to mental health problems or suicide, is systematically investigated, it is found to be false. In the US the American Psychological Association in 2008 found there was no credible evidence that choosing to have an abortion raised the risk of mental health problems. In the UK the National Collaborating Centre for Mental Health’s review in 2011 reached the same conclusion. Where there the choice of legal abortion services is available there is no increase in suicide (or mental health problems) caused by choosing an abortion with informed consent.

Anti-choice proponents have emphasised that ‘Abortion is not a treatment for suicide’ and ignored the fact that there is no such narrowly-defined thing as a ‘treatment’ for suicide. However, abortion, for those who choose it with proper supports, can be as much a ‘treatment’ for the risk of suicide as blood pressure tablets are a ‘treatment’ for the risk of a heart attack. Both can be preventive, lowering the impact of a relevant risk factor; that is, the distress of an unwanted pregnancy and high blood pressure respectively. The ‘treatment’ for unwanted pregnancy is ‘non-directive counselling’ and the ‘treatment’ for suicidal risk in unwanted pregnancy is ‘risk-reduction’, which includes facilitating the choice of accessing abortion services.

In Ireland, abortion, and even access to information on abortion, is heavily restricted with a criminal sanction, confirming the ‘punitive attitude’ Prof Kendell referred to over 20 years ago. Women are forced to travel, usually alone or with a very restricted support network because of the costs of travel. As a result, in this Irish context, the restriction of access to abortion services is mediated by restrictions on travel. The following groups, whose ability to travel is compromised, are therefore at an increased risk of restricted access to abortion and hence at an increased risk of suicide:

  • Women too sick to travel
  • Adolescents and young women
  • Women with young children
  • Migrant women
  • Women with Disabilities
  • Women with no or low incomes
  • Women whose pregnancy, involves a fatal foetal malformation
  • Women pregnant as the result of rape or child sexual abuse.

The obvious solution to these risk factors is to end the unnecessary, dangerous, and, for the most part, ineffective legal restrictions on abortion services. This is the very successful approach taken in Canada for the last 25 years. Abortion there is subject to healthcare guidelines and not criminal law; just like every other medical service. It is an ongoing absurdity that pregnant women are in some way considered to be exceptions to the usual rules of capacity to make a decision.

It seems likely however that, instead of the Canadian model, emergency legislation in Ireland will deal only with the risk to just some of those whose ability to travel is restricted. The ‘need’ to distinguish between, and medically certify, a risk to the life, as opposed to the health, of pregnant women has put an emphasis on suicide that shows little concern for either crisis pregnancy or suicide.

In summary, in terms of mental health concerns, it is important to stress that unwanted pregnancy and previous trauma or mental health problems are the most relevant risk factors for mental health in pregnancy and that women on low incomes and child and adolescent mothers are at particular risk; the focus should be on care and support. Restriction of access to abortion increases suicide risk and supported choice reduces suicide risk. While there is no medical need for aspecial legal framework for abortion, doctors are perfectly capable of certifying the need to support a woman’s choice of abortion services to reduce her risk of mental health problems and suicide.

Doctors for Choice is an organisation of doctors who wish to promote choice in reproductive healthcare. This means advocating for informed consent as the basis for decision making within the doctor-patient relationship. The NWCI and Doctors for Choice recently organised a Seminar on “Abortion – The Lives and Health of Women”, see presentations from the seminar.

 

 

3 March 2013

 

Ipas News

 

Inter-American Human Rights Commission to hold

landmark hearing on abortion rights

 

On Friday, March 15th, the Inter-American Commission on Human Rights will hold a landmark hearing on the negative impactof criminal abortion laws. It is the first time the IACHR will hear testimony on theharmful effects these laws have on the lives of young girls and women and their families in Argentina, Bolivia, Brazil and Peru.

 

Ipas and Ipas Bolivia, in collaboration with Women’s Link Worldwide, ISER/Brazil, Promsex/Peru, Argentina, the Special Rapporteurship on the Right to Sexual and Reproductive Rights/Dhesca Brazilian Platform and Asociación por los Derechos Civiles/Argentina, will present findings from legal research on the impact of abortion criminalization on women’s lives, health and criminal justice systems. These findings indicate that states are systematically violating women’s rights to health, equality and non-discrimination, privacy and due process of law. The organizations will present recommendations to the IACHR on measures to be taken by states to respect and protect women’s human rights.

 

Legal indications for abortion are extremely limited throughout Latin America, and several countries-Nicaragua, El Salvador, the Dominican Republic and Chile-have outlawed abortion entirely, even when necessary to save a woman’s life. Previous regional human rights decisions have called on states to ensure access to abortion in narrow circumstances-such as when a pregnancy threatens a woman’s health or if she’s been raped. This hearing will address the broader social and legal impact of criminal laws.

 

The hearing will be take place 11:30 a.m. at the IACHR’s Rubén Darío Room (8th floor), 1889 F Street, NW, Washington, DC. It will also be webcast live on IACHR’s web site. It will be conducted in Spanish, with translation available.

Great article in the Argentine newspaper Pagina 12, about a network of women, called Pink Rescue, who accompany other women in the use of misoprostol for safe abortion. They give information, advise about risks and help make sure the women get a checkup afterward.

Articulo excelente sobre Socorro Rosa servicio de acompañamiento de mujeres que están usando el misoprostol para abortar con seguridad. Dan información, consejan sobre los riesgos y ayudan a segurar que la mujer haga un examen de control despues.

http://www.pagina12.com.ar/diario/suplementos/las12/13-7899-2013-03-16.html

Parliamentary Assembly

Assemblée parlementaire

   

Doc.13110

24 January 2013

 

Failure to provide assistance to rape victim in Cologne, Germany, 15 December 2012

 

Written question No. 624 to the Committee of Ministers

by Ms Carina HÄGG, Sweden, Socialist Group

 

On 15 December 2012 in Cologne, Germany, two Catholic clinics rejected assisting a suspected rape victim in providing a gynaecological check-up for reasons claimed to be related to the ethics rules and procedures governing the hospitals which fall under the authority of the Catholic hierarchy in Germany. The 25 year old young woman woke up on a bench in a public park after having been drugged at a party she attended in Cologne with no memory of what happened in the intervening hours. With her mother, she went to a general practitioner who suspected that the young woman could have been the victim of rape/sexual assault. The general practitioner prescribed emergency contraception which is standard practice under German law in cases of rape/sexual assault, thus providing the young woman the ability to exercise her right to decide according to her own convictions whether to carry through or interrupt a possible pregnancy resulting from the sexual assault. After informing the police and in order to investigate possible criminal acts the general practitioner contacted two nearby hospitals for further medical testing, ie. conducting a ‘rape-kit’ – these were St.Vinzenz-Krankenhaus in Cologne-Nord and Heilig-Geist-Krankenhaus in Longerich (both happen to belong to the Foundation of Cellitinnen of Holy Maria).

 

However, both hospitals rejected the check-up of the suspected rape victim. Their Ethics Commissions had held consultations with Catholic Church authorities, after which the decision was taken to rule out such gynaecological check-ups in such cases since they are connected with a possible unwanted pregnancy as well as providing the victim with emergency contraception. The refusal to provide medical treatment based on Catholic ethics was maintained by the two hospitals even after the general practitioner clarified that he had already provided the suspected rape victim with the emergency contraception (which the Catholic hospitals would therefore not have had to provide).

 

In Germany, failure to provide assistance to a person in danger (unterlassene Hilfeleistung) is an offense according to paragraph 323c of the Penal Code (Strafgesetzbuch).

 

Ms Hägg,

 

To ask the Committee of Ministers:

 

– whether such actions by the Catholic hospitals in Cologne are in line with both the letter and the spirit of the laws in relation to the protection of victims of sexual assault/rape, specifically paragraph 323c of the German Code penal?

 

– whether it is known how many hospitals / health centres may be able to legally circumvent national laws in relation to the protection and assistance to victims of sexual assault based on  so-called ‘ethical’ grounds in Council of Europe member States?

 

– whether the public at large as well as victims’ associations and women’s groups should be informed in advance of all such hospitals / health centres in Council of Europe member States which may legally be allowed to circumvent national laws in relation to the protection and assistance to victims of sexual assault based on so-called ‘ethical’ grounds so that they may be able to better guide victims of sexual assault/rape?

http://www.essentialbaby.com.au/pregnancy/pregnancy-nutrition-and-wellbeing/locking-up-pregnant-women-20130212-2e9ln.html

Locking up pregnant women

Date January 16, 2013

Amy Gray

Queensland’s Child Protection Inquiry has received a submission from the Queensland Police Union (QUPE) advocating that pregnant women who use drugs and alcohol should be locked up or placed under conditions to protect their unborn babies.

Inside the nine page document are a series of recommendations of changes to be made to the Child Protection Act, chiefly concerned with the QUPE complaining at having to do DoCs work and their plans to regulate all those wayward pregnant women.

As they state in their submission, the part of the Act which pertains to the rights and liberties of a pregnant woman “needs to be abolished.” A woman is now considered secondary to the pregnancy she carries.

 The QUPE calls on the inquiry for the rights to:

  • request intervention orders against pregnant women
  • take the mother into care pending birth
  • impose forced medical check ups
  • impos[e] conditions on the mother during the pregnancy, which may extend to where she resides and who she has contact with during her pregnancy

In case it’s not clear, the Queensland Police Union would like to start rounding up, monitoring and curtailing the personal choices and liberties of pregnant women.

Though this organisation has delivered a shoddily presented and ill-conceived set of recommendations to a panel, it does not mean it will be accepted or, even if it is, inquiry recommendations are often left to mould on shelves without adoption. So far, so ineffectual. What is newsworthy here is how the Queensland Police Union, whose members protect and defend their state, view women. And they don’t view them well at all.

Socially, this is not news for women. With every chastisement, unsolicited recommendation and unbidden hand that launches at our bellies, we’ve long known we were pregnancy-policed by the public. Now it appears real police would like to get in on the fun and tell us that we are hosts for the child – not a mother growing dependent life, not even two parties: we are the lesser life form because it’s all about the baby.

Helpfully, the Queensland Police Unionclarifies that it is not calling for anti-abortion laws, which must be a blessing for those living in a state with ambiguous abortion laws at best. Because it’s never a legal slipperly slope for female body autonomy when you request the legal rights of a woman be removed, right?

Let us leave aside for the moment the fact that this recommendation comes from the same union that complains about the workload of administrative duties relating to investigating children at risk and sex offenders in the community.

Instead, let us focus on the impact of this decision for women within society within the framework of statistics.

The Australian Institute of Health and Welfare in their Drugs in Australia 2010 report state that “Alcohol, tobacco and illicit drug use was significantly lower among pregnant women than women who were not pregnant. The proportion of pregnant women smoking has declined from 2001 to 2010.“

The report lists the findings of a National Drugs Strategy Household Survey which found that alcohol consumption amongst pregnant women dramatically drops, with 48.9 % abstaining completely, 48.7 reducing their alcohol intake and 2.0% maintaining their existing drinking (the level of which is not verified). Only 0.2% of respondents increased their intake of

When it comes to illicit drug use, 8.3% of women who were pregnant and/or breastfeeding in the past 12 months admit to the use of cannabis, pharmaceutical for non-medicinal purposes and other illicit drugs. Bear in mind that this figure includes women who had used drugs prior before they knew they were pregnant and, according to the report, “are significantly lower than for other women in the community”.

Bearing in mind the above statistics, if a system exists that penalises and curtails a pregnant woman for drug or alcohol issues, how likely would a woman be to actually seek assistance for the matter? The fear of being taken into ‘care’, restricted from seeing people she knows and other restrictions would prevent her from seeking the help she may need.

Karen Healy, President of the Australian Association of Social Workers agrees. In an interview with the Australian, she branded the proposal “concerning” and that “It could lead to women not disclosing they are using drugs to medical practitioners…It may actually reduce the capacity of medical professionals to monitor these children.”

So, not only would this recommendation actually not prevent the risky behavior, it could potentially not only drive it underground but also scare women away from support.

So, who will think of the babies, you ask? Who will protect them from their mothers? There is no doubt there are at risk pregnancies – but they are not widespread  and policing and punishment won’t help. Only rational programs and support will. There is no doubt this is a complex area but if we don’t learn from the horrors of past generations, we will never solve problems for the future.

Consider also the implications of who would be under review should this recommendation become enacted. Will it be across all classes? Or will only women from lower-socio economic backgrounds be targeted?

As stereotypes and our national sport of bogan-bashing goes, poorer people are often depicted as drinking more than any other class in Australia. This is a particularly curious stereotype given statistical analysis shows that personal income rises, so too does alcohol consumption across both genders. (Drinking Patterns in Australia 2001-2007, Australian Institute Health and Welfare). One can’t shake the feeling these desired powers would be used almost exclusively against lower socio-economic brackets.

The more troubling aspect of this recommendation is disturbing matter of race that underpins it all. As part of the Inquiry’s aims, the Commissioner has called for recommendations to “reduce the over-representation of Aboriginal and Torres Strait Islander children in the child protection system”.

So, is it a logical conclusion that the Queensland Police Union would apply these requested powers over the same over-represented community? That the focus of this would be of pregnant women of Aboriginal and Torres Strait Islander heritage?

It is our indigenous communities who face the most intervention and there is no doubt there are challenges and problems for them, just as with many other Australians. But legislating against them (again) will not work, nor does the evidence show that it ever has worked.

The report from Queensland’s Child Protection Inquiry is due in April, a month before National Sorry Day. People around the country will gather to remember the apology from five years ago. It is a time when we recall the horrors suffered by Australia’s indigenous population. A population who still suffer from reduced education, health, social and economic opportunities than other Australians. A population whose children were stolen from them in an effort to make them assimilate and disappear into Australia’s population. A population targeted by the Queensland Police Union and other groups who still want to curtail their liberty and take their children.

What is the point of saying sorry if we keep trying to make the same mistake?

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