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Women’s Health Strategy Unit
GPO Box 40596
Casuarina NT 0811
Submitted via email directly to: DOH.email@example.com
Primary contact: Natasha Fyles
Secondary contact: Dr Sarah Watson
Phone (08) 8985 8018
Attention: Minister Natasha Fyles
Attorney General; Minister for Health
Leader of Government Business
Dear Minister Fyles
Please accept this submission to the Women’s Health Strategy Unit in response to the governments discussion paper - Termination of Pregnancy Law Reform; Improving access by Northern Territory (Persons) women to safe termination of pregnancy services
Who Are We?
The Sex Worker Outreach Program, Northern Territory (SWOP NT). SWOP NT is a peer-based health promotion service that engages sex workers, and works with other sex industry stakeholders within the Northern Territory, to encourage workplace safety in accordance with the industry’s legal, health & safety requirements. The SWOP project is a member of Scarlet Alliance and is located within (NTAHC) Northern Territory AIDS & Hepatitis Council, Darwin, as a NTAHC program that delivers peer services across the Territory. SWOP’s peer-led health promotion, through outreach, advocacy and broader programming, aims to improve sex workers’ lives by holistically addressing issues – including human rights.
Sex Workers Are Experts in our own Sexual and Reproductive Health
"The meaningful involvement of affected communities in sexual health responses improves the relevance, acceptability and effectiveness of sexual health programs, and recognises their right to self-determination and participation in decision-making processes that affect their lives."
SWOP NT emphasises that sex workers are well equipped with knowledge of prevention of pregnancy during the provision of sexual services at work. Methods of contraception are chosen to prevent BBV’s and STI’s and pregnancy and therefore includes frequent condom use. Sex workers are generally well aware of options for termination in each state and territory in Australia but like other persons who seek terminations of pregnancy are not always able to fully access support and or appropriate options that enables the best choice for each individual’s circumstances that reside in the Northern Territory.
As a peer program, SWOP NT is opposed to any regulation that will inhibit sex workers’ ability to work safely, and this includes any reduced access to pregnancy termination services required for sex workers workplace health and safety (WHS) or for our private lives.
Sex workers within the SWOP NT program do not support the existing legislation specific to pregnancy termination in the Northern Territory and we welcome long awaited reforms for people seeking holistic and safe termination of pregnancy options. We are adding our direct experience as sex workers as safer sex experts, who may also be affected by condom breakage in our work and our private lives and therefore like other people who fall pregnant, are at times living with an unexpected pregnancy.
Our submission expresses the direct experiences of sex workers working under a two-tiered licencing system within the Northern Territory, including FIFO workers from other states and territories: The current criminalisation of some sex workers in the territory is relevant to SWOP NTs’ response to the governments discussion paper for the termination of pregnancy reforms as the Northern Territory licencing of the sex industry has detrimental impacts on sex workers’ privacy and compounds stigma and discrimination against sex workers as some sex workers are able to work legally and others are by default criminalised.
What happens when some aspects of sex workers WHS and Public health are criminalised?
SWOP NT states that a system that deviates from decriminalisation, for example by over-regulating with specialised licencing constraints, creates a two-tiered system where some persons are able to choose freely and others are not.
Criminalization increases vulnerability to blood borne viruses (BBVs) & sexually transmitted infections (STIs) by fuelling stigma and discrimination. This sets up barriers preventing sex workers’ free access to sexual & reproductive health services, safer sex prophylactics and educational support networks, as provided by SWOP NT.
SWOP NT, as a primary harm reduction service, argues that removing penalties for example sex work ensure there are less barriers to workplace health and safety. Sex workers WHS must include appropriate options for “safer abortion” as decriminalisation of both sex work and abortion leads to the reduction of stigma and discrimination, and opens doors for access to wider services, achieving better outcomes for not just sex workers but generally for positive public health.
We know from sex workers’ direct experience in the Northern Territory and as FIFO workers, that:
Sex workers are diverse in gender - women and transmen work in the sex industry. Stigma and discrimination against sex workers seeking abortion services is not uncommon as the questions in relation to partners support in pre counselling triggers workers who will not disclose that a condom had broken with a client due to judgement in the assessment process. Multiple stigma is increased for Transmen, Brotherboys, Queer and or Intersex workers who have expressed great difficulty when attending abortion assessments and or clinics to undergo surgical abortion.
“People who may need access to safe abortion services are not only cis-women. [i]Trans-men, gender queer and gender-non-conforming persons, as well as others of diverse gender identity who do not identify as women, can and do get pregnant. It is therefore not only cis-women and girls who over the course of their lives may need and/or seek an abortion. Individuals of diverse gender identity, however, face extensive challenges in accessing safe abortion information and services, a result not only of the stigma surrounding abortion itself, but additional barriers they face in realizing their sexual and reproductive health and rights (SRHR)” 
Sex workers who are diligent at work with use of condoms who choose to undergo surgical termination due to breakages and or who have chosen not to use contraception with a sexual partner outside of work are then judged for their occupation. Clinical staff in other states have asked sex workers questions in counselling and assessment process’s that have assumed that pregnant sex workers had not used condoms at work.
One worker from SWRG, Poppy, states: “I was made to feel ashamed of my work as a sex worker because I disclosed my choice of work and because I chose to have a surgical termination. The reality was that I have a partner and at that time in our lives my pregnancy was not possible due to many factors, but none were related to my work. I paid out a significant amount of money to travel interstate and I did leave the decision to terminate my pregnancy quiet late as I wanted to be sure I made the best decision for myself”
Sex work is at times undertaken by young people. Young people who sell sex are particularly at risk with multiple issues that includes barriers to service provision due to fear of mandatory reporting. A recent Policy Brief by Sex Workers from The Asia Pacific region raises and addresses Reproductive Health barriers for young people and youth who seek pregnancy termination services.
The Global Network of Sex Worker Projects (NSWP) states in the 2016 policy brief as part of the; “Recommendations for policy makers:
Implement comprehensive, accessible, and affordable SRH services and information for young people under 18. This must include HIV prevention and treatment, harm reduction supplies and information, abortion and maternal care”
“Age of consent legislation and parental consent requirements for access to sexual health examinations, harm reduction commodities, HIV testing, and abortion services, also create
barriers to accessing services, as most young people do not want to disclose their activities to their parents” 
Sex workers who are survivors of sexual assault ‘who work illegally are fearful of reporting the assault. SWOP NT has at times not found out that a worker needed assistance until they were ready to disclose that they had survived a sexual assault. Often the period of time is post the recommended time period for safe use allocated for the morning after pill” from Clinic 34 and often the outcome is that the worker needs to travel away for safer options than is currently offered in the Northern Territory for termination if determined by the worker as an unwanted pregnancy.
Northern Territory sex workers have travelled interstate to receive treatment options for unwanted pregnancy for lack of options and in relation to not disclosing sex work or working in criminalised environments. The level of stigma and discrimination that sex workers report to SWOP in relation to health service providers is unacceptable. Inappropriate questions based on stigma and discrimination, judgements of where and how a sex worker works is unfortunately very common.
Stigma and discrimination affects sex workers lives daily as many sex workers have not disclosed to any other person but another sex worker, agency owner, or sex worker only organisation that they are working in the industry. This level of fear creates a reluctance to access public health professionals especially if the worker is working under a criminalised system, which we have in place in the Northern Territory.
These reforms outlined in the discussion paper from the government and the recommendations from public submissions will mean people who require access to abortions outside hospital settings are able to choose to do so in privacy. For sex workers who already are challenged by criminality, geographic locations, cultural and socioeconomic constraints, internalised stigma and external stigma and discrimination the changes that allow for better physical and mental health outcomes such as being able to access RU486 mifepristone for medical abortion is vital. In 2015 RU486 has been approved to access over the phone in other Australian jurisdictions. 
Sex workers are a cross section of our society they are daughters, sisters, mothers, fathers, brothers, and sons who all may at some point require a termination of pregnancy the LGBTI and sex worker communities must be a part of the voices of people who seek support of Pregnancy termination services.
“According to Medicare, 44 men had abortions or D & Cs in Australia last year. Official statistics on how many had abortions are unclear because Medicare uses the same item code for abortion and D & Cs in the event of a woman having a miscarriage” ……….Statistics for the Northern Territory were documented as “No men gave birth to babies in the Northern Territory.” 
SWOP NT has documented that sex workers travel interstate for termination of pregnancy and therefore questions based on gender diverse sex workers experiences if the statistics from Medicare for the Northern Territory are unable to determine if transmen or Brotherboys or persons who are Intersex travelled interstate seeking termination of pregnancy due to our current legislation.
Decriminalisation is the best practice model of regulation
Sex workers are acutely aware of the damage that any criminalisation has on the health of Australia’s population. SWOP NT agrees with the proposed reforms as detailed in the paper, including:
1.Decriminalisation of abortion
2.Providing a definition for ‘termination of pregnancy’ which clearly permits the use of medicine such as RU486 and clearly permits terminations outside of hospital settings
3.Ensuring people who seek support for termination options are provided with supportive care from health professionals about future contraceptive options
4.The provision of a ‘suitably qualified medical practitioner’, not just a specialist, be able to provide terminations of pregnancy
5.Provision for health professionals such as pharmacists and nurses to dispense and administer medications under the supervision of a doctor
6.Removing the requirement for two doctors to examine a person who is seeking an abortion under 14 weeks’ gestation
7.Removing the need for a person to justify the reason they seek an abortion
8.Enabling young people and minors to have access to consensual to treatment
9.Requiring doctors with a conscientious objection to refer a patient to another doctor who can assist
10.Establishing safe access zones around places where terminations are performed.
SWOP NT seeks that the following be additionally implemented:
1. A person who is pregnant be permitted to terminate a pregnancy after 14 weeks if they are assessed by two suitably qualified medical practitioners that it is appropriate in all the circumstances, noting that some foetal abnormalities are detected late in a pregnancy.
2. SWOP NT considers that the Act should make allowances for a person who seeks health services to not have to undergo mandatory counselling about future contraception before or after they have had an abortion. Doctors already owe a duty of care under the relevant clinical guidelines to provide support, advice and guidance about contraceptive options and sex workers are able to contact SWOP NT for appropriate referral to long term referral pathways for sex workers to reputable organisations such as Family Planning and Clinic 34 for reproductive health support under clinical care.
3. SWOP additionally recommends that the drafting of legislation be “inclusive not exclusive in use of language and terminology in relation to preferred gender pronouns” and that the terminology for persons that can become pregnant and should be able to access safer pregnancy termination options be broader than current terminology limited to “Cis-gendered women and girls” within the discussion paper.
On behalf of Northern Territory sex workers SWOP NT wishes to thank the Northern Territory government for the opportunity to submit our voices as sex workers to add to public consultation comments on the government’s discussion paper to pursue the government’s commitment to putting in place urgent reform of the Northern Territory Medical Services Act.
SWOP NT endorses the Family Planning Welfare Association of NT and the WHAT RU4 NT? Submissions in full.
We in sincerity ask the government to pass legislation that does not discriminate against people who seek abortion including sex workers who work legally or illegally and follow the guidance of people who live in the Northern Territory who are “key affected populations” in being able to access with equity holistic abortion services and medical treatment”.
SWOP NT refers sex workers to both Clinic 34 and Family Planning NT, these organisations need to be able to offer broader options for people who need support and referrals for pregnancy termination. SWOP NT and the SWRG have faith in the Northern Territories politicians to endorse the World Health Organisations (WHO) internationally ratified policy guidelines that recommend full decriminalisation of access to termination of pregnancy options that represents an important step for holistic reproductive health rights. 
Leanne Melling - Thurs-Fri
Skye Ozanne - Tues-Wed
SWOP NT Outreach Officers
Sex Workers Outreach Program (SWOP NT)
Work Mobile: 0447022332
Work Landline: 08 8944 7707
Northern Territory AIDS & Hepatitis Council
46 Woods Street, Darwin, 0801
 https://www.ntahc.org.au/what-we-do/training-and-education/advocacy-heal... A PowerPoint and oral presentations from NTAHC - SWOP NT & Care & Support Coordinators/officers & CDC Senior Policy Officer.
 Kelleway Mitch (2014), STUDY: Yes, Trans Men Can Get Pregnant Despite Testosterone, Dysphoria.
 Rankin, Laura (2013), Not Everyone Who Has an Abortion is a Woman – How to Frame the Abortion Rights Issue.
 WHO | Safe abortion: technical and policy guidance for health systems
Safe abortion: technical and policy guidance for health systems. ... Authors: World Health Organization, Department of Reproductive Health and Research. Publication details. Number of pages: 132. Publication date: 2012
[i] A “cis-woman,” shorthand for “cis-sexual woman” or “cis-gender woman,” is a woman whose assigned gender is female, and whose assigned female gender is more or less consistent with her personal sense of self. Definition borrowed from About.com Civil Liberties
The overarching term ‘young people who sell sex’ refers to adolescents under 18 and young adult sex workers up to 29 years of age. This broader definition points to similarities between the experiences of
those under and over 18, as indicated by the large number of studies on young people who sell sex that include persons both under and over 18 years of age.
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