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Activism

Throughout her professional career Caroline has been active in advocating for improvements in women’s reproductive healthcare, and improvements in the quality of information provided to women about their reproductive health choices.

For the past twenty years she has been very involved (with many others) in movements to bring about abortion law reform in Australia. This included the successful efforts to overturn the Harradine Amendment in 2006, which was followed by Caroline and Dr Mike Carrette using the Authorised Prescriber legislation of the Therapeutic Goods Administration to become the first doctors to import and use mifepristone (RU486) for medical abortion in Australia. Subsequently due to the input of many others the drug is now widely available.

Caroline has written widely in academic journals and the lay press about the need for abortion law reform in many parts of Australia particularly Queensland, NSW and the NT and continues to speak and campaign for abortion law reform to enable equality of access to abortion services for all Australian women.

Caroline was also active in improving antenatal care for immigrant women in Western Sydney in the 1980s, and in the movement at the same time to involve midwives much more fully in the care of women experiencing normal pregnancy and birth. As a member of the NSW Health Dept Maternal and Perinatal Committee and numerous subcommittees and of the committee producing the 1988 Shearman Report of maternity services in NSW, she helped transform the nature and standards of care in NSW.

She has also been an advocate for improved healthcare for asylum seeker women. In 2003 under arrangements with AusAid she visited Nauru to perform gynaecological surgery in Nauru hospital; at the same time she visited Top Side asylum seeker camp and so has firsthand knowledge of conditions on the island. More recently in 2013, 2014 and 2015 she has visited the Darwin detention centres, partly in conjunction with organization Chilout, to investigate care provided to mothers and babies. She gave evidence to the committee led by Professor Gillian Triggs that resulted in the Forgotten Children report and published her view in the Medical Journal of Australia.

 

Caroline and Jerome de Costa

Caroline’s interest in women’s health and women’s rights began in her first year of medical school in Dublin, Ireland, in 1968, when she became the single mother of a baby boy, Jerome. ‘Unmarried mothers’ in Ireland at the time were highly stigmatised and in most cases had their babies taken away by the Catholic Church. She managed to avoid this and while bringing up Jerome and studying helped form a group of similar single mothers and agitated for better conditions and assistance for them, partly through the Irish Women’s Liberation Movement.

 

Caroline and Jerome travelled aboard the ‘Contraceptive Train’ in May 1971

She was also part of the ‘contraceptive train’, the historic group of women who in May 1971 travelled by train from Dublin to Belfast to buy condoms and bring them back into the Irish Republic, where contraception was completely illegal.

Later as a senior medical student and a junior doctor training to be a specialist obstetrician and gynaecologist she participated in the clinics of the Irish Family Planning Association which were violently opposed by the Church and often raided.

Under Women's Reproductive Health Rights

Queensland’s Termination of Pregnancy Bill 2018

On 17th October 2018 the Queensland Parliament passed the Termination of Pregnancy Bill 2018 by 50 votes to 41, removing abortion from the 1899 Queensland Criminal Code, allowing doctors to have a conscientious objection to personally performing abortion while requiring them to make an effective referral for a woman requesting a termination, and introducing 150 metre exclusion zones around clinics and premises providing abortions. You can read about this Bill here

The passing of the Bill was an emotional moment for the many women and men who had campaigned so long for this reform. Caroline has been a member of Pro-Choice Queensland and Pro-Choice Cairns, and a campaigner for abortion law in Queensland, ever since she began practice in women’s health in  rural Queensland in 1994. Much of the history of this movement can be found on the website of Children by Choice (link) the organisation providing help and information  to women faced with making a decision about an unintended pregnancy. Caroline is a Life Member and strong supported of the work of Children by Choice.

17th October 2018

Winding down after witnessing the debate and vote in Parliament House, Brisbane.jpeg

Under Women's Reproductive Health Rights

RU-486 (Mifepristone)

What is RU-486?

RU-486 is the drug now known as mifepristone that is combined with another drug, misoprostol, and used for medical abortion. RU486 is available and widely used in the United Kingdom and most of Europe, the United States, China, Israel and much of the Middle East, in New Zealand and in many other countries.

In Australia, Dr Mike Carrette and Caroline de Costa were the first two doctors permitted to prescribe the drug for the purposes of abortion (in 2006). Mifepristone is now widely available in Australia. In August 2012 the Marie Stopes International Australia group obtained approval from the Therapeutic Goods Administration (TGA) to market the drug nationally and in 2013 it was listed in the Pharmaceutical Benefits Schedule. .

History

The campaign to overturn the ‘Harradine Amendment’ and permit use of RU-486 in Australia began in late 2005. Senator Lyn Allison and others were preparing a legislative attempt to remove from the Therapeutic Goods Act the restriction on RU-486. In October 2005 Caroline de Costa published in the Medical Journal of Australia an article entitled ‘Medical abortion for Australian women – it’s time’. (www.mja.com.au) The article was widely read and distributed and co-incided with a growing campaign that included women’s health groups and legislators from both state and Federal parliaments and across the whole political spectrum. In February 2006 a Private Members Bill brought to the Senate by four women senators passed with a large majority on a conscience vote and the following week also passed the House of Representatives.

More details of this campaign and the history of mifepristone in Australia and overseas can be found in Caroline’s book RU486- the abortion pill (Boolarong Press 2008).

Current availability of the drug

The overturning of the Harradine Amendment did not automatically permit the import and use of mifepristone in Australia. Initially pharmaceutical companies were reluctant to take up import and distribution of a drug with such a controversial history despite the strong evidence from overseas of its effectiveness and safety. At first the Authorised Prescriber regulations of the TGA were used for individual doctors to import and use the drug. The French company Linepharm under the direction of Dr Andre Ulmann was instrumental in bringing an application to the TGA to import mifepristone into Australia and later joined forces with the Marie Stopes organisation who now hold distribution rights in Australia.

Mifepristone, used in conjunction with misoprostol, is now available for early medical abortion in all capital cities except Darwin and in many other urban and rural areas throughout Australia. Women wishing to know more about mifepristone and medical abortion can contact the websites of Children by Choice, Brisbane www.childrenbychoice.org.au or Marie Stopes International Australia www.mariestopes.org.au

Asylum seekers & refugees

Caroline has been for many years an advocate of better health care for asylum seekers and refugees in Australia, and has been active in providing care to women in detention. In 2003 she provided gynaecological services on Nauru that included consultations within asylum seeker women in the detention centre Top Side. Put photo of me on Nauru here

In December 2013 she visited the three Darwin detention centres then in operation as part of an official visit of inspection organised by Chilout (link); She also made informal visits to all these centres in order to meet a large number of asylum seeker women and hear their stories, and she returned to Darwin to make similar visits in 2014 and 2015. In 2014 she published in the Medical Journal of Australia an account of what she was told by these women. de Costa C. Antenatal care for asylum seeker women: is “good enough” good enough? Med J Aust 2014 Sep 1: 201(5): 299-300.

On 1st July 2015 she was a signatory along with 42 others to the Open Letter to the Prime Minister in regards to the punitive measures now in force as part of the Border Force legislation, for doctors and other professionals publicising instances of abuse or harm observed by them in detention centres.

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