ROYAL COMMISSION (ON 14UMAN RELATIONSHIPS Final Report Volume,3 ri 11MWO,81P (si PtC181i m0 .~~M LiS 18,1201 flailL.a ri Li 10 * 2DEC iJ ROYAL COMMISSION ON HUMAN RELATIONSHIPS Final Report Volume 3 UBRARY lDFPOSfT imMATERIAL Contents of the report Introduction, summary and recommendations Part I in Volume 1 Education for human relationships Part II in Volume 2 Health and medical education Part III in Volume 2 Sexuality and fertility Part IV in Volume 3 The family Part V in Volume 4 Equality and discrimination Part VI in Volume 5 Rape and other sexual offences Part VII in Volume 5 ROYAL COMMISSION ON HUMAN RELATIONSHIPS Final Report Volume ,3 Part IV Sexuality and fertility AUSTRALIAN GOVERNMENT PUBLISHING SERVICE CANBERRA 1977 © Commonwealth of Australia 1977 ISBN 0 642 03027 8 ISBN 0 642 02889 3 (series) Printed by C. J. THOMPSON, Acting Commonwealth Government Printer, Canberra ROYAL COMMISSION ON HUMAN RELATIONSHIPS 100 William Street Sydney 21 November 1977 Your Excellency, In accordance with Letters Patent, dated 21 August 1974, we have the honour to present to you the Final Report of the Royal Commission on Human Relationships, prepared as at April 1977. Elizabeth Evatt Felix Arnott Anne Deveson His Excellency The Right Honourable Sir John Kerr A.K., G.C.M.G., G.C.V.O., K.St.J., Q.C. Governor-General of Australia Government House Yarralumla Canberra, A.C.T. 2600 Commissioners Justice Elizabeth Evatt (Chairman) Dr Felix Arnott Anne Deveson Secretary Robert Hyslop Contents 1. Sexuality 1 Time span of action 24 Introduction 1 Source of method 24 Sexuality and sexual problems 1 Level of use of contraceptives 24 Conclusions 5 Evaluation of methods 25 Sex and the handicapped 6 Effectiveness 25 Rehabilitation and information 6 Naturalness 29 Removal of constraints 7 Safety 30 Education 7 Mortality 30 Social activities 8 Morbidity and side effects 32 Conclusion 8 Conclusions 36 Sex and the ageing 8 Morbidity and other risks of Sexuality and life cycles 9 pregnancy 36 Menstruation 9 Benefits from contraception 37 Menopause ii Contraceptive use 37 Male and female cycles 12 Introduction 37 Conclusion 13 Women at risk 38 Sexually transmitted diseases 13 Knowledge and use of Syphilis and gonorrhoea 13 contraception 40 Other sexually transmitted diseases 15 Attitudes and other factors Programs to combat sexually affecting contraceptive use 41 transmitted disease is Conclusion 44 Treatment, notification and Attitudes towards contraceptive tracing contacts 15 methods 44 Education 16 Problems in the use of contraceptives 45 2. Fertility and fertility control 18 Inability to find a method to suit 45 Introduction 18 Difficulties in use and method Some important definitions 19 failure 45 Fertility and fecundity 19 Non-use of contraceptives 48 Fecundabiity 19 Survey of reasons 49 Fertility control 19 Young people 50 Contraception 20 Conclusion 52 Family planning 20 The male role in contraception 53 Abortion 20 External constraints 54 Methods of contraception and their Access to services 54 evaluation 20 Medical attitudes 55 Methods of contraception 20 Other constraints 55 Oral contraceptives 21 Motivational factors 56 Intra-uterine devices 21 The intra-psychic theories 56 The diaphragm 21 Role conflict 57 Condoms 22 Other factors affecting Withdrawal (coitus interruptus) 22 motivation 57 Spermicides 22 Conclusions 58 Periodic abstinence methods 22 Contraceptive services - 58 Injectibles 23 Introduction 58 The 'morning after' pill 23 General practitioners and Female sterilisation: tubal gynaecologists 59 ligation 23 Family Planning Associations 63 Male sterilisation: vasectomy 23 Nature and scope of services 63 Future possibilities 23 Distribution of services 64 Classification of methods 23 Need for expansion 65 Mode of action 23 vii Funding 66 Western Australia 92 Doctors and nurse practitioners 66 Other States 92 Other problems 68 Evaluation 92 Womens community health Overseas experience in centres 68 advertising 92 Community health centres 69 More effective campaigns? 93 Natural Family Planning centres 70 Views about advertising 94 Hospital services 71 Conclusions 95 Outpatient clinics 71 Contraception and the law 96 Maternity and abortion patients 72 Introduction 96 Contraceptive services run by State Advertising of contraceptive Health Departments 73 supplies and services 96 Other sources of contraceptive Distribution, display and sale 99 services 74 Prescription items 99 The pharmacist 74 Non-prescription items 100 Community health nurses and Prescription requirements and community health workers 75 paramedical personnel 101 Aboriginal health and medical Oral contraceptives 101 services 76 The intra-uterine device and Remote areas and the Royal diaphragm 103 Flying Doctor Service 77 Consumer protection 103 Domiciliary workers and mobile Advertising claims 103 clinics 77 Quality of products: standards 104 Student health services 79 Packaging and instructions 104 Occupational health services 79 Pregnancy testing 105 VD clinics and abortion clinics 80 Sterilisation—vasectomy and tubal Policy goals for contraceptive ligation 106 services 80 Mentally handicapped and People with special needs 81 sterilisation 108 The poor 82 Infertility and artificial Migrants 83 insemination 109 The handicapped 83 Conclusion 84 3. Unplanned and unwanted Cost of contraceptive services 84 pregnancies 111 Cost of contraceptive supplies 85 Introduction ill Planning for expansion 86 Incidence and causes of unplanned General practitioners 86 pregnancies 112 Clinic services 86 Unwanted pregnancies 113 Policies for expansion of services 87 Incidence of unwanted Getting the message across 88 pregnancies 113 Introduction 88 Women at risk 115 Education and information 89 Unwantedness—an Service provision 89 unacknowledged problem 115 Motivation 90 Reasons why pregnancies are Media 91 unwanted 118 Advertising compaigns by FPAs 91 The reasons women give for Victoria 91 their pregnancies being Australian Capital Territory 91 unwanted 118 vifi Summary 122 Definitions 147 Underlying reasons for unwanted Foetal development 147 pregnancies 122 Timetable 148 Voluntary childlessness 123 Summary 149 The motherhood role 123 The right to be born 149 Pregnancies unwanted by the The moral issues 150 father 124 The role of the law 153 Costs and consequences of Abortion and contraception 153 unwanted pregnancies 125 Defining the circumstances: who Consequences to the mother and decides? 154 her relationships 125 Abortion on demand: the Consequences to the child and medical role 156 the family 126 Counselling 157 Costs to the community 127 Family consultation 157 Unwanted pregnancies and the Panels: assessors 158 options 128 Conclusions 159 The options 128 Time limits on abortion: viability 159 Marriage 128 The stages of pregnancy 159 De facto relationships 129 Viability 160 Abortion 129 Definition 160 Adoption 129 England 161 Keeping the child 130 United States 162 Pregnancy counselling and World Health Organisation 162 pregnancy support services 130 Sweden 162 Conclusion 162 Late abortion and infant 4. Abortion 134 preservation 162 Introduction 134 Abnormalities 163 Legal and moral issues 134 The mother's life or health 163 The law and abortion 134 Infant preservation and child Abortion law in England 135 destruction 163 Abortion law in Australia 137 Australian Capital Territory 164 New South Wales 137 Abortion services 165 Victoria 138 Introduction 165 Australian Capital Territory 139 Abuses in abortion practice 167 Queensland 139 Unsafe procedures; lack of Western Australia 140 facilities and expertise 168 Tasmania 141 Delay 169 South Australia 142 Overcharging 170 Northern Territory 142 Lack of follow-up services 171 Summary 143 Disapproving attitudes and lack Other countries 143 of counselling 171 Criticisms of the law 143 Criteria for abortion services 172 Policy of abortion law 144 Proper medical procedures, Protection of the pregnant facilities and expertise 172 woman 145 The avoidance of Protection of the foetus 146 unreasonable delay which The foetus and human may prejudice the safety of development 147 the abortion 172 x Reasonable fees for the full Characteristics of women having range of services 172 abortions 198 Follow-up services 172 Age 199 Proper counselling before and Marital status 199 after; a friendly atmosphere is Number of children—previous important 172 pregnancies 200 General comments 173 Country of birth 200 Abortion clinics 173 Religion 200 Range of services 173 Employment 200 Method 174 Northern Territory 200 Fees 174 Conclusions 201 Staff 175 Changing patterns of abortion 201 Counselling 175 Consequences of abortion 202 Procedures, equipment and Introduction 202 training 176 The consequences: definition 204 General comments 176 Mortality of abortion 204 Private practitioners 177 Conclusions 205 Occasional abortions 177 Morbidity of induced abortion 205 Abortion specialists 177 Length of pregnancy 205 Comments and conclusions 178 First trimester methods 205 Public hospital services 178 Second trimester methods 205 The survey of admission Experience of operator 206 procedures 178 Sterilisation 206 Medical procedures 179 Pre-existing medical conditions 206 Morbidity rates 180 Legality of abortion 206 Medical experience 181 Abortion facilities 206 Intake procedures at public Australian morbidity and the hospitals 181 Commission survey 206 Fees 182 Long-term physical consequences Follow-up services 183 of induced abortion 207 Referral 183 Conclusion 208 Hospital staff 183 Psychological consequences of Referral services 184 induced abortion 208 Methods