Jacquelyn Baker reviews Barbara Baird’s Abortion Care is Health Care (Carlton: Melbourne University Press, 2024)
In June 2022, the United States Supreme Court overturned the ruling set in 1973 by Roe vs Wade. This was a landmark case that ‘recognised that the decision to continue or end a pregnancy belongs to the individual, not the government’ and that the right to seek an abortion was protected by the Constitution as an ‘essential liberty’. As a result of the decision to overturn Roe vs Wade, there is now ‘no federal constitutional right to abortion’. In its aftermath, 14 states enacted abortion bans and 16 states have, at the time of writing, banned abortion after conception. The devastating consequences and implications of revoking the gains won by Roe vs Wade were felt around the world. In Australia, reportedly thousands took to the streets to draw attention to the fragility of a person’s right to a safe and legal abortion. This is the context in which Barbara Baird’s Abortion Care is Health Care was written.
Baird’s book traces the provision of abortion services in Australia in order to understand how abortions have been provided and how this service can be improved. Abortion Care begins in the 1990s—an oft-overlooked period in our national history when abortion, as Baird points out, had become normalised under the law—and traces this history to the present-day with references to the Covid-19 pandemic. It picks up on the historical literature that has traced feminist and women’s liberationist demands for safe and legal abortion and fills a significant gap in our understanding of the way abortion has been, and continues to be, provided in Australia. Furthermore, by beginning her history in the 1990s, Baird is able to mount a compelling investigation of what the author describes as “neoliberal abortion”. Baird successfully utilises this term as her central framework to reveal the absence of the welfare state, the centrality of the market and the emphasis placed on the notion of “individual choice” in her analysis of the provision of abortion. For those new to the concept of “neoliberalism”, Baird traces the term to the 1970s when it referred to a set of ideas about economic and social policy and follows it into the 1980s and 1990s when the ALP federal government—led by Bob Hawke and then Paul Keating—had introduced economic and policy reform frameworks in Australia. She then explains that the LNP federal government (led by John Howard and elected in 1996) pursued major policy and economic neoliberal reform. She points to the way neoliberal policies have made way for small government systems which ‘give[s] the market priority over the state as the rightful driver for the management of the economy and the distribution of wealth and social goods’ (p. 10). In addition, she notes that neoliberal policy approaches have contributed to the ‘withdrawal of the welfare state’, which has been caused by cuts in funding to public healthcare and by the privatisation of some health and social services. Ultimately, I found Baird’s framework of “neoliberal abortion” to be convincing and well argued.
Baird is extremely well placed to write this history. She has researched and written extensively about women, gender and sexuality. Her PhD thesis examined women’s experiences of abortion before 1970 in South Australia and she has since examined contemporary discourse on abortion, particularly in law reform, political debate and in the media. Since 2017, she has been the co-convenor of the South Australian Abortion Action Coalition. Baird is currently an Associate Professor in Women’s and Gender Studies at Flinders University.
Abortion Care is divided into seven thematic chapters, which are guided by her framework outlined above and trace each chapter’s titular theme from the 1990s to the present. It begins by providing an overview of the (predominately) private provision of abortion services and further expands on the impact and influence of neoliberalism. Chapter two shifts its focus to the public sector, followed by a chapter that highlights the perspectives of doctors. Chapter four examines the decline of some private clinics as well as the impact and growth of MSI Australia (formerly Marie Stopes Australia). Chapter five investigates the provision of early abortions—that is, abortions conducted during the first trimester of pregnancy. Chapter six looks at what decriminalisation is in the context of abortion provision and how it has been legislated in different states and territories. Finally, chapter seven looks at the provision of late-stage abortions. I appreciated the thematic approach as it enabled Baird to delve deeply into her chosen topics and explain how they relate to her notion of “neoliberal abortion”.
This book is extremely well researched. Baird has provided a thorough bibliography and ample detail in the ‘Notes’ section of her book. Oral history interviews are the basis of Abortion Care, which are supplemented with additional sources which include, but are not limited to, documentaries, media and published accounts, government reports and activist material. Between 2013 and 2017, Baird travelled to different cities in each state and territory of Australia to conduct oral history interviews. Her attempts to draw out location-based differences and similarities are reflected in the breadth of the book’s scope. Abortion Care is not the kind of history that predominately focuses on Victoria or New South Wales; rather, it provides a balanced investigation of abortion provision throughout Australia, including in the Northern Territory, Queensland, Western Australia, Tasmania and South Australia. For example, through her meticulous research Baird found that there has been a fairly widespread absence of public health provisions of abortion since the 1990s across the country—that is, with the exception of South Australia, the Northern Territory and some small hospitals in Melbourne. Moreover, this reviewer found Baird’s oral history interviews with doctors to be a particular highlight of the book, as they were often at the “coalface” of abortion provision.
Baird concludes the book by stating that while ‘access to high quality abortion services in Australia is by many metrics good’, there are still many who fall through the cracks in the neoliberal system of abortion care (p. 232). She found that one-third of all people who have an abortion still experience some form of systemic reproductive injustice and that those who are marginalised by poverty, racism, ableism, homophobia and transphobia, and are in abusive relationships, lack internet literacy or connection or are ineligible for Medicare entitlements, are more likely to experience barriers to their access of this service. While Baird adds a caveat to her conclusion by saying that her ‘book is not a vehicle for policy direction, or for activist or advocate strategy’ (p.241), I found this to be at odds with Baird’s research statement posed at the beginning of the ‘Introduction’ in which she seeks to trace the provision of abortion services in Australia in order to to understand what the history of abortion provision means in terms of ‘how [this service] can be improved’ (p. 2, emphasis my own). Indeed, Baird offers useful suggestions and insights. Her research shows that the provision of abortion would be so much more equitable if healthcare professionals received better and further training, if laws that only allowed abortions in exceptional circumstances (such as when late-stage abortions are only allowed when a foetal abnormality has been detected) were eliminated and if people living in regional and rural areas had the same level and ease of access to abortion services as their metropolitan counterparts. This could be achieved, Baird argues, if federal and state governments took on more responsibility for the provision of abortion, rather than leaving it predominately in the hands of private practitioners and entities. Furthermore, I found her discussion about the harmful narratives around late-stage abortions and foetal anomalies which reproduce pro-natal eugenic discourse, and the work of disability advocates in challenging these narratives, particularly galvanising as a feminist who is pro-abortion and anti-eugenics.
As I write, new laws have come into effect that will reportedly make it easier to access abortion in Western Australia. This means that abortion has now been decriminalised in every state and territory in Australia. While I celebrated this victory, I couldn’t help but be reminded of Baird’s cautioning words, that ‘the success of decriminalisation bolsters uncritical faith in law reform as an avenue for progressive change’, which encouraged me (as it did many others in Australia when the ruling of Roe vs Wade was overturned) to not become complacent and to continue to speak up for the equitable provision of abortion. After all, this service is still subject to the whims of the market, as the majority of abortions performed in Australia continue to be done so by private providers. I think there are plenty of practical lessons to learn from the history of abortion provision in this country—many of which could be gleaned from Abortion Care.
