Thursday, 16 September 2021

Assisted Reproductive Treatment Amendment Bill 2021

Second reading

Debate resumed on motion of Mr FOLEY:

That this bill be now read a second time.

Ms THEOPHANOUS (Northcote) (15:23): I am honoured to make a contribution on this bill, and I want to start by acknowledging those members who during this debate have shared their deeply personal experiences of assisted reproductive treatments (ARTs), IVF, conception, pregnancy, childbirth and child loss. These members have spoken with bravery and candour to give every one of us a deeper understanding of exactly what it means to struggle with fertility. It is no small thing to relay these most personal of experiences on a topic that, despite all our progress, still carries unwarranted stigma and taboo. Each time our brave colleagues step up and speak about these things they etch away at that stigma and they bring new understandings and humanity to the public discourse on infertility, on pregnancy complications, on miscarriage and on so many other elements that are not included in the mainstream narrative around parenthood. The contribution of the Minister for Women, the member for Dandenong, was a powerful illustration of some of the deeply unfair consequences of Victoria’s current laws in relation to assisted reproductive treatments and IVF. We are privileged in this Parliament to have the chance to amend these laws and make things fairer and easier for Victorians who want to grow their family.

My husband and I have been fortunate in our journey to parenthood. After months of uncertainty, in the end I only needed to take a medication to stimulate ovulation to get things rebooting after years of being on the contraceptive pill, and then we were able to conceive naturally. But for so many Victorians the road to growing a family is much, much harder. I know so many people who have struggled with fertility and so many wonderful sole parents and same-sex couples for whom assisted reproductive treatments have been critical to having children. Growing a family is not a choice that every Victorian or every couple will make, but the realities of having that choice stripped away from you by chance, by nature or by circumstance are heartbreaking. That is why options like IVF are so important and help overcome the barriers that prevent Victorians from making that deep personal choice to become a parent.

We have heard from others with much more experience than I have about just how physically and mentally taxing the IVF journey is for women. We have heard just how expensive it is and just how isolating it can be. In the Minister for Women’s own words:

It is a roller-coaster of hope and despair, and it can leave you feeling utterly broken.

While in a sense no level of legislation or regulation will be able to prevent the inherent uncertainty and the struggle of going through IVF, we can work to make it as fair, as accessible and as compassionate as possible.

In 2018 the Andrews Labor government commissioned an independent review of assisted reproductive treatments in Victoria to be undertaken by Michael Gorton, known as the Gorton review. Eighty recommendations were made to improve the way we support families and provide access to assisted reproductive treatments. We have already begun the process of implementing these recommendations, and as a government we have made some incredible reforms to strengthen our assisted reproductive treatment sector. In a very short space of time we have announced a public IVF service, a public sperm and egg bank and an end to the humiliating police checks and child protection checks for people undergoing IVF. This of course builds on Labor’s legacy in the ART space, which has also seen access to assisted reproductive treatments expanded to single women and LGBTIQ couples. Over the years Labor has led changes that reflect not only changing technologies but also changes in our society. We have seen changes in our understanding and appreciation of surrogacy and the donor relationship, and critically we have seen a greater community understanding of and respect for gender equality, diverse gender identities and sexual orientation and the rights of our rainbow families.

A key reform in this bill goes to the recommendation in the Gorton review around the 10-women limit. In short, currently there is a restriction on donating eggs and sperm to more than 10 women. The restriction was designed to reduce the chance of genetically related people in Victoria unknowingly forming relationships, but in practice it means that if a donor has already reached their limit, it prevents same-sex couples from having biologically related children. For example, if two women in a relationship are seeking to have children, they should be treated as what they are—a family. There is a great deal of joy to be found in the wonders of little ones with shared traits and seeing your own face reflected back in your sibling. This bill will create an exemption for existing families to have genetically related siblings from the same donor irrespective of the limit.

I want to turn now to another important reform in this bill, relating to the withdrawal of consent by a donor. This is an incredibly important change to the current state of play, and it warrants explanation. Right now in Victoria a donor can withdraw his consent for the embryo created with his sperm to be used right up until the point at which it is transferred into a woman. You sort of have to do a double take on this one to really comprehend the significance of it, because what it means is that a woman who has gone through the roller-coaster of infertility, who has taken the step to try to conceive by IVF, who has spent tens of thousands of dollars, who has gone through incredibly invasive medical treatments over months, who in many cases has contributed her own egg, who has crossed that anxious threshold in having finally created a viable embryo and who has all her hopes on the line can then all of a sudden have that snatched away by the donor. It is absolutely heartbreaking, and we are the only jurisdiction in Australia that allows this to happen.

I cannot agree more with the changes in this bill which prevent this from happening. An embryo is not sperm, it is a fertilised egg. A donor has no legal obligation in relation to the child that might eventuate from his donation, yet he currently has the right to extinguish the embryo that would create that child, effectively usurping the reproductive choice from the woman, who has gone through every obstacle to have a choice at all. I can only imagine the immeasurable grief and sense of powerlessness this would create. Indeed some families have even given up on their IVF journey after such a traumatic experience. This law is outdated, it does not reflect community values and it does not recognise the cruelty that it can inflict. We need to do better by Victorians accessing assisted reproductive treatments. The process is hard enough as it is. Under these changes the donor will only be able to modify or withdraw consent up until the moment their donation is used, which applies to either insemination or when an embryo is created. That is a much more sensible arrangement.

There are other reforms contained in this bill which are aimed at removing discrimination and making assisted reproductive treatments more accessible to more Victorians. This includes expanding the range of professionals who can perform artificial insemination to include, for example, nurses under the direction and supervision of a doctor in a registered assisted reproductive clinic. It also means that doctors can carry out artificial insemination outside of registered clinics and patients of these doctors are able to seek pretreatment counselling outside a registered clinic. Fundamentally this will mean more access to treatments closer to home, more choice of clinicians and lower costs for patients. Quality and safety will remain key. Doctors and other health professionals acting under the supervision of a doctor will still be required to provide the same information and meet the same standards as doctors operating out of a clinic.

There are many improvements contained in this bill, but I want to turn to an aspect which goes to language. We all know that words matter and words can hurt, so we are amending the guiding principles of the Assisted Reproductive Treatment Act 2008 to make the language non-discriminatory and more sensitive to Victorians seeking to grow their families. This includes changing ‘commissioning parents’ to ‘intended parents’ throughout the act in reference to surrogacy arrangements. This more sensitive language is preferred by those with lived experience and acknowledges the basic humanity of wanting to start or grow a family. This is not a product or a project someone is buying, it is a child and a lifetime of love, care and commitment. We are also clarifying the meaning of ‘donor’ to make clear that anyone who provides an egg or sperm to their partner is just that—a partner or a parent. So much of the process of going through assisted reproductive treatment can reduce people going through it to clinical units. That can be incredibly hard and make an already incredibly difficult process even more distressing, because the reality is that words do matter; they shape the world we live in and the way our society views issues. These words are dehumanising, clinical and divisive, and if we are honest and true in our commitment to diverse families we need to make sure that the language we are using to describe them in all settings reflects the respect and understanding with which we want to see them treated in our society.

I am proud that this bill will result in the implementation of a further 10 priority recommendations from the Gorton review, with a strong focus on reducing discrimination, improving access and providing more certainty for Victorians accessing assisted reproductive treatment. These are complex policy issues with deeply personal consequences—literally matters of life and death. I thank the former Minister for Health, the member for Altona, for her bold leadership, and I thank the current Minister for Health for continuing with it. I commend this bill to the house.

Ms SHEED (Shepparton) (15:33): I rise to make a contribution in support of the Assisted Reproductive Treatment Amendment Bill 2021. I was in my parliamentary office on Tuesday evening when debate commenced on this bill, and I was so impressed to hear the contributions that were made by the member for Lowan and in particular by the Minister for Women. The minister shared her very personal experiences of attempting to achieve a pregnancy through assisted reproductive treatment (ART) processes. The anxiety, the stress and the devastating emotional pain associated with multiple treatments were shared in a frank and forthright manner and reflect the experiences that I have heard from so many women over the years. So many women have stories to tell about their reproductive journeys. And it is not just women’s business always; it is very often a very shared journey that partners go through to achieve a pregnancy that may be so wanted.

I have lived a lot longer than a lot of people in this house, and so in my lifetime I have seen the remarkable advances in women’s health and in reproductive capacity through assisted reproduction. I was married in 1974 and had my first child in the mid-1980s after years of wanting to be pregnant but not and struggling with endometriosis, just by sheer luck falling pregnant. The notion of how that would occur, were I not able to, was a very significant feature of those early years in my marriage. I wanted children, we wanted a family, and it was starting to look like that might be a problem.

In those very early days there was very little prospect of a treatment such as we are talking about today. I watched in wonder as the first IVF child was born in 1980. There were headlines; it was truly an amazing thing. It was almost the stuff of science fiction that such a thing could happen. I watched in 1988 when the first surrogate child was born, when Maggie Kirkman asked her sister, Linda, to carry her baby and the child, Alice, was born. These things were truly so amazing.

Over the years the technology in relation to reproductive treatment really roared ahead of the law, and it took the law quite a while to catch up and to start regulating it. After the birth of Maggie Kirkman’s first child, Alice, the law was immediately changed to make it illegal, so it took some time for a whole range of procedures and rules to be developed around it to put in place the safety net, I suppose, for the notion of surrogacy to proceed. So all these developments have been quite remarkable, and they have come with a lot of difficulties along the way. I think for all of us who know women who have been on that journey, we have seen how arduous it can be. It has never been better described, in my mind, than by the Minister for Women on Tuesday night.

The advances in women’s health more generally have also been remarkable. I think it is really worth thinking about the fact that back in the 1970s and 80s finding a woman doctor to go to was a rarity—and in regional areas so much more so. Finding the sort of treatments that you might have wanted in a regional area was just so difficult and so often intrusive and unpleasant in every way. So many people travelled to the city to get the treatments they wanted, whatever that might be. Just accessing the contraceptive pill, in the early days, was something that was very difficult for young women to achieve—hormonal treatments for conditions like endometriosis, the loss of miscarriage. All these sorts of issues surrounding women’s health used to seem such difficult things. And while they are, emotionally, the access to the sorts of services that we have now is really outstanding, and I think we have women’s health clinics throughout Melbourne. We even have a small one in Shepparton. I think the opportunities that that has provided in terms of giving access to the sorts of services that women and girls want have been just fantastic.

So this bill seeks to strengthen the current laws and to make assisted reproductive treatment more accessible and inclusive, and it provides that necessary framework in a world that now is just remarkable in terms of what can be achieved. I was really pleased to hear from the second-reading speech given by the minister that this will make reproductive treatment opportunities available in regional areas. Now, the cost of access to treatments such as ART is always added to enormously if you have to travel to Melbourne, if you have to stay for a few days, if you are going through all the processes that are required. So the opportunity for people living in regional communities to be able to access it close to their home, to be able to go home after they have had a treatment, is an opportunity that will be very welcome, and it will expand the opportunities for many people who perhaps give up much earlier than they would have otherwise because of the cost and because of the inaccessibility.

The range of people who will be able to undertake the procedures is also being widened, and it will include nurses and other properly trained health professionals. They will be able to carry out artificial insemination under the supervision or direction of a doctor in an assisted reproductive clinic. While this no doubt will present challenges, it is hoped that some of our major regional centres will be able to take it up, that it will become more widely available and that, I suppose, effectively more clinics of this nature will appear in smaller regional areas.

But I do fear and I want to comment on the fact that we have a massive shortage of doctors looming in regional areas—doctors, nurses and allied health professionals. Everyone out there in regional areas is well aware of this, and it has been exacerbated by an ageing workforce, particularly among general practitioners but also just from the closed borders over the last 18 months. Regional areas have had the huge benefit of overseas doctors being brought into the country and serving time in regional areas, called areas of need, until such time as they may well then choose to go back to the city. I was recently approached by the Murray City Country Coast GP Training body for a briefing on just this issue, and that was in the context of the training programs that are undertaken for regional GPs in regional areas likely being transferred out of the regional training organisations that currently exist—and that was one of them in Victoria—back to the colleges and possibly to more city-based areas. Their concern is that of the 900 supervising GPs that are out there, many of them in regional areas, and the 600 trainees who go through that program, there will be a falling off of numbers at a time when we can absolutely least contemplate that happening.

So many practices—and I talk about Shepparton here—have a lot of old GPs. They are much loved, they have been around for a long time and some of them wanted to retire two or three years ago but are still going because they cannot sell their practice; they cannot even find someone to come in and take over their practice. It is a really serious situation that nobody has addressed properly. There have been programs introduced through universities to get country kids into medicine, to do medicine. These universities are not meeting their quotas, and they are not achieving the outcomes that they talk about. The ideal is there, but the reality is not occurring. I fear that with this assisted reproductive treatment program that could become available, that could be so much more widely available, the paucity of GPs, doctors, specialists and all these allied health professionals in our regional areas may lead to it not occurring in a really fair and equitable way. I hope that the minister will really look to doing something about this and provide some opportunities for this to be dealt with in a way that will ensure that accessibility. Victoria has been at the forefront, and this bill really just puts into place the protections that are needed.

Mr CARBINES (Ivanhoe) (15:43): I am pleased to join our debate on the Assisted Reproductive Treatment Amendment Bill 2021 following the member for Shepparton and the member for Northcote. It has been touched on by previous speakers the really heartfelt and empathetic way that people who have lived experience share that with the house—and share that with Victorians for all time in Hansard, in a way—giving some greater sense of the impact and the importance of the reforms and the work and the amendments and what they mean for many people who obviously do not have an opportunity to articulate those views in this place but are relying on and counting on individuals here representing their communities to perhaps share their experiences, doing so on behalf of many other people in the community who do not have that opportunity directly but really value it to share an understanding of the journey that many have been on when it comes to assisted reproductive treatment.

I want to touch on a few different elements. Firstly I will just quickly reiterate the proposals in the bill of course and the amendments that will seek to improve access to artificial insemination by expanding the range of individuals permitted to perform artificial insemination. The key element I think in the debate and the discussion relates to addressing discrimination, including by ensuring the limit on using donated gametes—eggs and sperm—enables existing families, rather than only 10 women, to have genetic siblings and allowing a surrogate’s partner to be reimbursed the costs incurred as a direct result of the surrogacy arrangement in accordance with regulations. I say from the outset: in people in my electorate that I have spoken to, particularly those who undergo assisted reproductive treatment procedures and support, there is a level of anxiety in dealing with supply and with what some of the reforms that we are outlining in our amendment bill here mean around access for women. I understand that. That is a very legitimately held anxiety for people who seek access to ART as a treatment. One of the perennial issues is demand and supply and being able to address that.

You could make I think a reasonable argument that in expanding, in an equality sense, those who have the legal capacity and availability to access ART, there is also in the good of that—in the well-intentioned desire for equality in legislation and access and reflecting the community that we legislate on behalf of—still anxiety from some people, in a very contested and limited market, about what the opportunities are and what work we can do as clinicians, as a government and as a Parliament to continue to hopefully encourage the capacity for more supply so that there are greater opportunities for more people. I am sure we are going to see this through not only the medical treatment capacity and the amendments in our bill but also our desire and our election commitment around access through the public health system to ART so that more people can afford and have access to it. What we also need to be doing is making sure what avenues might be able to provide greater opportunities around supply so that more people can have access and hopefully success in having a family. They are I think legitimate anxieties, but they are couched in an understanding that the amendments around equality are so very important. Perhaps there is more that we can do to provide greater support in relation to those matters.

As the minister said in the second-reading speech, we have:

… always been at the forefront of assisted reproductive treatment innovation both in Australia and internationally. We led in-vitro fertilization and donor treatment procedures in the 1970s and 80s, and Australia’s first IVF baby was born in Victoria in 1980.

I will just touch on that too, because in earlier parliaments I was a member of the Law Reform Committee, which did a range of work in a parliamentary inquiry, the inquiry into access by donor-conceived people to information about donors. That led—going right back to that work in the early 1980s—to retrospectively providing the opportunity for access to genetic history for those donor-conceived people who, legitimately of course, as adults and voters themselves these days, did not always have access to that history to find out who their families were under the law. That has changed now, but what our Law Reform Committee work did in 2012 was recommend that there should be retrospective legislation to address those anomalies. Through some good work from the then Attorney-General, the former member for Box Hill, and a former Premier and member for Hawthorn, Ted Baillieu, there was some shift in access for those donor-conceived offspring. Then further to that, not only through a private members bill from the former Leader of the Government in the upper house, Mr Jennings, but also through some work that was done on the Labor Party platform heading to the 2014 election, some commitments were made then by of course the member for Altona, a former Minister for Health, in implementing legislation in this place that provided that retrospectivity, provided that equal access to information about genetic heritage for people who were donor-conceived back in that early pioneering time when perhaps equality of access to information was not provided. So it has been a long journey but also a very significant part of what this Parliament has done in an equality sense under the law, even though it required a level of retrospectivity.

Going back to the last election, of course, that commitment we made as a re-elected Andrews Labor government was to make sure more Victorians can start a family and discover the joy of parenting through IVF without the high costs:

An IVF cycle can cost up to $15 000. But while people with fertility issues are eligible for Medicare rebates, they can still be left thousands of dollars out of pocket just for following their dreams of starting a family.

This is in the Premier’s media release of 13 November 2018. It continues:

About 13 000 Victorians were treated at IVF clinics in the last financial year, but less than 10 per cent accessed services at the state’s only bulk-billing clinic.

Of course we have made significant financial commitments, including announcing $70 million to establish Victoria’s first public fertility care service, including a public sperm and egg bank, addressing a further two recommendations in the report by Michael Gorton, AM. Obviously as Parliamentary Secretary for Health I have been to community engagements with Michael, and I commend him for his work and the points that he has made in relation to thanking the clinicians, counsellors, scientists, researchers, legal experts and leaders in the field who are passionate about improving the patient experience and who contributed to the review.

There are lots of, to be frank, vested interests, many for good reasons, but also it is very important to protect consumers—and it is sometimes rough language to bring it down to that—and to ensure that for consumers, particularly with medical procedures, for whom emotionally this is really important and a last opportunity for them to seek a medical intervention to have a family, there are accountabilities for the providers of those services, particularly because of the expenses that are involved and the sacrifices that families make and the emotional journey that they are on, and that there is a lot of transparency and accountability on those medical providers. I think with the further opening up of these services in the public realm for more people across the community to have access, that does break open some not particularly competitive—that is perhaps not the right word—or some closed practices that will benefit around equality of access, accountability around the services and the supports for families and patients who need to know that they are not being taken advantage of in their most vulnerable time, when they are making very careful judgements both financially and clinically about their desire to have a family. There need to be strong supports and accountabilities there.

The last point I did want to mention, if I had a moment, was just around a couple of other quick matters. One of those was not directly addressed here, but I think it is a further matter to deal with. That is around altruistic donors in Victoria. Many overseas clinics, to ease the administrative burden, will pay a small amount for costs reasonably incurred. It also lessens the burden on the donor, provided their giving is an altruistic act. When you look at the amount reimbursed it is quite clear the intent is an altruistic act, but Victoria requires extensive evidence. The law is the same as in other states such as the ACT, but they do not require the same documentation. It is this process in the Victorian Assisted Reproductive Treatment Authority on the Victorian side that perhaps leads to many months of delays and lots of toing and froing with overseas banks and the donor, so I think that is another element that we could look at further to provide support to people who are seeking ART. I commend these continued reforms to the house as we have supported other reforms to ART.

Mr TAK (Clarinda) (15:53): I am proud to speak and make a contribution to the debate on the Assisted Reproductive Treatment Amendment Bill 2021, and I am honoured to follow the hardworking member for Ivanhoe in his capacity as the Parliamentary Secretary for Health and to follow other speakers from all sides in this house. In March last year I was lucky enough to have the chance to make a contribution on similar amendments in the Assisted Reproductive Treatment Amendment Bill 2020. There were some very moving and passionate speeches that day, and we have seen it again this week. I am very honoured once again and grateful to many of our previous speakers for sharing their personal life experiences, especially the powerful contribution from the Minister for Women. I can see that the Minister for Multicultural Affairs is here, who also shared her journey, which was very heartfelt.

I am very proud to be a member of this government, a government that is committed to fairness and equality in all areas of life, and assisted reproductive treatment is one such example. Victoria has been the leader in this space, even in a global context. We led IVF and donor treatment procedures in the 1970s and 1980s, and Australia’s first IVF baby was born in Victoria in 1980, as the member for Shepparton has already talked about.

Forty years on from that it is estimated that there are some 25 000 women and their partners who access assisted reproductive treatment in Victoria each year. We are establishing public IVF and Australia’s first public sperm and egg bank to give more Victorians the chance to start building their families. That commitment to establish public fertility care services, which the member for Ivanhoe has already talked about, is an investment of $70 million over three years in the 2021–22 budget—$50 million of this investment will fund statewide public fertility care services and $20 million will go towards public infrastructure for the service. Fair and equal access to treatment regardless of bank balance just makes sense, because everyone should have the opportunity to start their family, to experience that amazing gift. I was very glad to support similar legislation last year, the legislation that removed unfair and harmful police checks for those going through the assisted reproductive treatment process, and I am glad to support this bill.

This is another important bill, the objective of which is to implement priority recommendations from the Gorton independent review of assisted reproductive treatment. The implementation of the priority recommendations will make the lower cost treatment of artificial insemination more accessible, reduce the barriers for all people seeking to have a family, including LGBTIQ people, and improve access for individuals seeking treatment. Again, we are talking about reducing discrimination and making assisted reproductive treatment fairer and easier to access for all Victorians regardless of their sexuality, gender identity or relationship status. We are here again resolving to remove the unnecessary barriers to treatments and to make lower cost treatment easier to access.

I had the opportunity last year to read and reflect on the Gorton review and the stakeholder submissions that were made. The review was commissioned by the Andrews Labor government in 2018. An interim report of the review was released, as we know, in November 2018, with the final report released in July 2019. It was a comprehensive report that resulted in some 80 recommendations, and I am happy to see that this bill implements 10 priority recommendations. One of those is recommendation 3 which states:

It is recommended that s. 8 of the Act be amended such that artificial insemination may be carried out by (i) a doctor; or (ii) by a person acting under the direct or indirect supervision and direction of a doctor who is carrying out artificial insemination on behalf of a registered provider.

This is an important change, one which will enable artificial insemination to be carried out by a person acting under the supervision and direction of a doctor in a registered clinic. It is expected that the procedure will generally be carried out by an appropriately trained nurse, but it could also be carried out, for example, by a medical intern. We heard the member for Shepparton state in her contribution the difficulties experienced sometimes in regional areas with a shortage of medically trained doctors to carry out this procedure. It is important that people from all walks of life, wherever they live, can access this treatment. The review notes that more complex cases for assisted reproductive treatment may already be carried out by a person under the supervision and directions of a doctor in a registered clinic. There was little justification for the inconsistency that restricted less complex artificial insemination cases to doctors only.

Importantly this change will assist those seeking access to lower cost treatment and a less-invasive option for artificial insemination. It should particularly benefit single women, LGBTIQ people and people in rural and regional areas—again a commonsense change that will help make assisted reproductive treatment fairer, more affordable and easier to access for all Victorians. It will also give patients greater choice. Importantly for patients who prefer a female practitioner to perform the procedure for religious, cultural and other reasons, the chances will be greater for accessing a female practitioner where the procedure can be performed by health professionals in addition to doctors. And this is very relevant especially to the multicultural community, such as in my constituency in the electorate of Clarinda—religious and cultural considerations are extremely relevant to my constituents—and also in our culturally and linguistically diverse electorates, such as in Clarinda once again.

I would just like to say that there are other changes, but the changes are all positive changes, again, regarding equality and fairness for all Victorians. In the time remaining I would just like to again say thank you to all of our speakers and to the minister for bringing this bill forward. There have been some really moving contributions, and this really just shows how important this bill is. They have also given us all cause to reflect. I am proud to support this bill and the implementation of the priority recommendations from the Gorton review, which will lower the cost of treatment and make treatment more accessible; reduce barriers for all people seeking to have a family, including LGBTIQ people; and improve access for individuals seeking treatment regardless of their background, where they live and where they come from. This government continues its history of supporting and working to make assisted reproductive treatment fairer, more affordable and easier to access for all Victorians, and I commend the bill to the house.

Ms RICHARDS (Cranbourne) (16:03): I rise today to speak on the Assisted Reproductive Treatment Amendment Bill 2021, and I reflect that in my very short tenure as a member of Parliament we are at our best when we are grappling with complex and deeply personal issues. I want to pay credit to the contributions from both sides of the house—in fact all sides of the house—and of course begin perhaps by acknowledging the contribution from the Minister for Women. I was very pleased to be in the chamber when the minister gave her heartfelt contribution, and I think the generosity of that contribution is something that many of us have reflected on as part of this debate. But I do not think it can be overstated, the importance to other people who are deep in the darkest night of the soul and really right in the middle of these challenges that the minister spoke about with extraordinary passion and insight. Those really deep feelings but also her experience were a revelation to me, and perhaps a revelation to others as well, and I really do hope that others will take the opportunity to watch, listen to and read that contribution, because I think when they do, other people and particularly people who are right in the middle of the extraordinary challenges associated with assisted reproductive treatment or other fertility challenges will take great heart from being in company with people who are able to express those feelings in a place like this.

I do want to commend the members for Lowan and South-West Coast as well for their generous and considered contributions. I also caught the members for Tarneit and Footscray talking about the real-life burden that is often experienced. There are lots of words like ‘gametes’ and ‘embryos’, but these contributions and the experiences of people are the experiences of families, of children, of women, of men and of people from all parts of the state, people who are toiling away in complex jobs and people who are waiting for that phone call. I think that that has been expressed so beautifully in fact—real humans, real hopes and dreams and real pain.

I did catch the member for Northcote as well, and I thought that the member’s insights into the stigma associated with language were pertinent and something that I really think is important for us all and a good and important reminder. I was very fortunate as well to hear the member for Shepparton. She always makes considered contributions, but I loved the way the member for Shepparton provided an eyewitness account of the history of the reforms. I remember especially some of the reforms that governments of all persuasions and all levels did struggle to catch up with, especially as they related to surrogacy. It had a particularly personal interest for me, but I thought that that insight into how science was moving quickly and the law and reform was struggling to keep pace with science was an important reflection.

I also remember that there was a lot of concern that this was going to be the end of morality—that when we were starting to have the opportunity for people to be able to experience support with their fertility that was going to be the start of something evil. Instead it has been the start of something so much more wonderful. The best and the most moral expectations of women are what the community should expect in all things.

I do commend the Minister for Health for the work that has gone into bringing about this reform, and his team—the public servants, the servants of the public. How important it is that they have been able to bring this to us. I of course also am grateful to the member for Altona and the role that she had when she was the Minister for Health, because I know that she does bring a lens of humanity to her reform agenda. Another person who has been really important in bringing this reform to us today is Michael Gorton, AM, in his role as an eminent person who has undertaken a really landmark review of assisted reproduction. That was initiated in April 2018. I am grateful to the scientists, researchers, nurses, clinicians, doctors and counsellors who have been involved in this important work. I did, I think, hear the member for Dandenong refer to them as ‘angels’.

This bill provides more certainty for people intending to use assisted reproductive treatment, and it does provide balance with the consent of donors over their reproductive donations. The bill brings into law something that the 21st century has already acknowledged and finally reflects the values of the community and the nature of donor relationships. It does, importantly, align Victoria with other jurisdictions.

As with many people, I have experienced the pain of yearning for a child and have seen very close up what can happen when that is so much more difficult for so many. The amendment bill we have before us today addresses discrimination against single women, against same-sex couples and against LGBTIQ+ people. Now, this is not some sort of political posturing. It is not a choice based on the grounds of what is popular politically. These are amendments on the grounds that these groups of people have had difficulty accessing services and support that they would ordinarily be able to access if not for their marital or partner status, their sexuality or their gender identity.

The bill expands the circumstances in which a deceased person’s gametes can be used with their consent and makes consequential changes to the Status of Children Act 1974. This bill also ensures treatments such as artificial insemination are made more accessible and allows nurses—highly trained nurses who are clinicians—under supervision to perform this treatment. It clarifies consent requirements for access to donated eggs, sperm and embryos and includes the assumption that consent is withdrawn if a couple become separated.

Partners of surrogates are also allowed by this amendment bill to be reimbursed for costs incurred because of their partner’s surrogacy. This is again something that does reflect our government’s focus on fairness. There are so many ways that we can be blind to inequality, and it is really important that we do listen and reflect on that scientific approach that comes when we do undertake a review like the Gorton review and the department’s consultation with key stakeholders on the implementation of the priority recommendations.

Last Friday—and I have spoken about this before this week—we brought together a group of over 65 women from the south-east of Melbourne, mostly from Cranbourne. I was joined by the clever member for Bass and a woman from the member for Narre Warren South’s office, and we held a women’s virtual afternoon tea. We held this with a very eminent obstetrician and gynaecologist to talk about the effect of vaccination on fertility and particularly what effect the COVID-19 vaccines can have on fertility. I do want to say that what that highlighted to me—not that I think it needed to be highlighted but perhaps sometimes it does shine a light on things—was how cautious so many women are about making sure that they can stay healthy and that their children, whether unborn or future children, will also be healthy. To have 65 women join us as part of that discussion and have a really powerful scientific response to the concerns about the effect that the vaccine can have on fertility does demonstrate that we have in mind the best interests of women and the best interests of those who are struggling with fertility. This is a safe and great bill. I commend it to the house.

Mr FOWLES (Burwood) (16:13): It is my pleasure to make a contribution today on the Assisted Reproductive Treatment Amendment Bill 2021. I do so following my friend, a fine Labor woman, the member for Cranbourne. I will be followed by another fine Labor woman, the member for Thomastown. I have to say there have been so many fine Labor women who have been involved in the carriage of this bill to date and with the formulation of many parts of it.

I want to acknowledge up-front the contributions of the members for South-West Coast and Lowan. They gave considered and thoughtful contributions. It is really pleasing when those sorts of contributions can be made in this place and we can find ourselves in broad agreement on the thrust of legislation as important as this.

I want to especially acknowledge my friend the member for Dandenong, the Minister for Women. She gave an extraordinarily brave speech, a very personal speech—a speech that must have been painful in part to write and deliver. It was searingly personal, and it was exceptionally brave. I want to pay particular tribute to the clarity of her argument and her willingness to draw upon personal experience to embellish the understanding of every Victorian in relation to the challenges that women face in accessing assisted reproductive treatment.

I want to acknowledge, too, the contribution of the member for Tarneit—again, a contribution that was illuminating and enlightening but drawn from personal experience. I also want to acknowledge the work of the member for Altona in her previous roles in assisting with a range of legislative reforms in this broader topic area and acknowledge, too, the very thoughtful contributions of the members for Northcote and Footscray on this issue. It is terrific that Labor has so many amazing women to draw upon when debating legislation such as this. I am acutely conscious of the fact that I of course am not, but I think it is terrific that we have got such depth and strength in the women’s caucus within the Victorian parliamentary Labor Party.

The world’s first IVF baby was born about 30 hours before me, so if you are looking for a date and point, I am it. The oldest product of an IVF conception is my age to within 30 hours and, well, haven’t we all been on a journey in that time since 1978. It has been an extraordinary journey for so many couples that has resulted in the great gift of family. It has been an agonising journey, sadly, for many couples who despite the incredible interventions of this stunning technology have been unable to conceive. It has also been a journey that has not been without political difficulty. There are a number of ethical issues raised by the application of this technology that I think have been very, very well resolved, at least in this jurisdiction. But nonetheless it has been the cause of considerable debate amongst parts of the Victorian community and parts of the global community, and I appreciate that there are strongly held views on both sides of this debate. But what I would say is that the opportunity to allow people to start a family is something that we should all embrace in this place, and I think it is absolutely terrific that it has been in many respects Australian scientific advancement that has allowed that to happen.

I want to reflect briefly on the experience a family member of mine had with IVF. I am fortunate that in a very, very large family I can normally find one person who is the subject of or is affected by just about any bill that goes before this chamber. I had a conversation with her this week that was illuminating for me. I always had a sense that the process of accessing assisted reproductive treatment was really difficult, was really harrowing and took a really long time. What I did not understand was just how harrowing, just how expensive, just how difficult and just how time consuming it was. It is extraordinary the sacrifices that principally women make in furtherance of this goal of starting a family. My family member’s experience was relatively straightforward at first. First there are what are known as stim cycles—the stimulated cycles, when the egg collection happens. Of course it happens under general anaesthetic. You have got a bunch of injections in advance of it, you are bloated and uncomfortable and you feel awful afterwards, and it costs $12 000 or $13 000. In a typical cycle you might only harvest 10 or 12 eggs and you might end up with none of those eggs fertilised, but at typical rates you might end up with three of those eggs, say, that are successfully fertilised, but those three might become only two or one or zero once you roll forward five days and assess whether they have become an embryo.

This is the agony, I think: that you make all of this emotional investment, all of this financial investment and all of this investment of time and energy and you might yet find yourself in a situation where there are no viable embryos to implant. Or of course at the next stage you might actually have viable embryos to implant and then the pregnancy itself might fail, and that is an agony I cannot profess to imagine in any way. That is an acute piece of agony for those going through it.

In my family member’s experience, she ended up having six stim cycles—so, again, each of them at sort of 12 or 13 grand—plus the transfers, so that is an additional procedure. You have the stim cycle to harvest the eggs; you have the transfer part to insert embryos into the uterine wall—that is a separate process at sort of 3 grand a go. And she had six stim cycles that resulted in no pregnancies, no pregnancies at all. At that point you are well in financially, you have made an enormous commitment to the process, you have had to endure any amount of personal pain but you have got all this financial overlay as well, which is very, very challenging. She was fortunate. She changed provider, she got some genetic testing done—that is another 600 bucks an embryo by the way—she had one stim cycle with them, three embryos were tested and were good and she had two transfers for two pregnancies at that point. So she has her daughter, and she is pregnant now with her second child. So it is an ultimate success, but it made it clear to me just how long and difficult and expensive this process can be. Now, there are Medicare rebates of course, but in their circumstances that is some $70 000 in out-of-pocket expenses, which is obviously well beyond the means of many families, and for those who can afford it, it becomes a very, very large impost.

I am very pleased that, in order to address this, the Victorian government has committed to establishing public fertility care services with an investment of $70 million over three years. I thank the Minister for Health for his commitment to this issue and for committing to establish a public sperm and egg bank in Victoria, the first of its kind in the nation. By establishing public fertility care services, we are going to allow more Victorians to achieve their dream of becoming parents through assisted reproductive treatment.

Of course it is not just IVF. This bill makes some amendments to make access to artificial insemination more easily available. It makes amendments that make it easier for lesbian couples to have genetic siblings but where each of the two partners might each have a pregnancy and carry one child or multiple children. It does much to improve the current framework, including in relation to donor sperm and the rights of donors. Sadly I have run out of time. I could readily go on, but I do commend this very, very important bill to the house. I thank every one of the people who worked so hard to bring it to the chamber, and I wish it a speedy passage.

Ms HALFPENNY (Thomastown) (16:23): I also rise to speak in support of the Assisted Reproductive Treatment Amendment Bill 2021. As the member for Burwood fleetingly talked about, the first Australian IVF baby was born around 40 years ago in Victoria. Victoria is seen as one of the leading states in assisted reproductive treatment, with over 30 per cent of treatments currently being performed in Victoria at the moment. In some ways, when I get up to talk about this bill, having heard the contributions by so many colleagues and friends that have had experience with assisted reproductive treatment, it is sort of difficult to follow them, because of how eloquently and how personally they explained their situations—the stress, the anxiety, the roller-coaster of emotions, the treatment itself and going through these things in order to have children. I, for example, was very fortunate to be able to conceive my two boys without having to undertake such treatment, but of course we all know, in most cases, people very close to us that have undergone some sort of assisted reproductive treatment. And while we do not have the direct experience, you can see some of the awful toll that it takes upon families and individuals.

So looking at this legislation—and I think this has also been raised by previous speakers—it really is a piece of legislation that I think embodies social reform and also shows how far our society has come. We know that Labor is the party of reform, and the current Victorian Andrews government has really even accelerated the pace in the type of social reform that we have seen since being elected to office in 2014. But when we look at it—as I think was also mentioned by the member for Shepparton and others—assisted reproductive treatment legislation 40 years ago was very controversial. It was really around how we fought on the rights for women and women’s right to have children through assisted means, but when we look back now, we missed out on so many other people just as deserving within our society—and what I am talking about of course is the LGBTIQ community. And whilst this legislation 40 years ago was very progressive in allowing, basically, heterosexual couples to have access to this treatment, it was denied all others. Whether it was single women or same-sex couples, they were denied access even though they are just as good as parents—and we certainly all know that.

So this legislation is part of the response to the Michael Gorton landmark independent review into assisted reproductive treatment. That review came up with 80 recommendations for reform, and our government is considering all of them. But at the moment this legislation that we are debating today is looking at the implementation of 10 priority recommendations from that review. What we are talking about in terms of this legislation is the values of our Labor government—that is, laws to reduce discrimination and to ensure a more inclusive and fairer Victoria. That commitment to fairness and equity and equal access is the main tenet of the legislation and the changes that we are making today. The idea is to make sure that we provide an accessible framework for Victorians that want to start a family and that they are supported every step of the way on their fertility journey. Of course accessibility and affordability are at the heart of this bill, with amendments in place to ensure Victorians can access treatments and it can be free from discrimination.

Just as a couple of examples of the amendments—and I know other speakers have gone into detail with these; I will also just go through some of them just to outline them for the purpose of this speech—we are talking about improving access to artificial insemination by expanding the range of individuals permitted to perform artificial insemination. This is of course extremely costly when you have to go to a particular private clinic where there are only particular specialised medical practitioners that are able to perform these procedures. So we are widening the number of health professionals that can actually perform—with training—these procedures, on the basis of reducing the cost and increasing accessibility. It is also about ensuring that for people in regional areas—and Deputy Speaker, you would know all about the problems in many aspects of health for Victorians in regional areas or in any regions where sometimes health is not as accessible as it is in the big metropolitan areas. So this idea of an increase in the number of health professionals that can support and assist with artificial insemination will increase accessibility and also reduce the cost. Also the bill talks about making sure that when there is counselling required prior to treatments, again, we are expanding the number of organisations qualified to provide that advice and counselling prior to any treatment being taken.

We also look at some areas where, while they may have had good intentions a long, long time ago, looking back now you just wonder how it sort of ever happened. For example, there is legislation now that talks about what is called the 10-women rule, and it is about how many egg or sperm donations from the same donor can be used. This has prevented, for example, same-sex couples from perhaps having their children through assisted reproductive treatment have siblings from the same embryos or sperm, and this has also occurred when it is two women. It means that those women are treated individually. Of course it is about language and about purpose, and I guess in the wording within the legislation it is sort of assuming that two women are not one family but two individual women. This sort of language hurts, and it just builds on the long history of discrimination and persecution of families that have not been what, in the past, society thought they should be. So these are some of the areas where this legislation will make big differences in order to support those families and individuals that are using assisted reproductive treatments in order to have families and have children.

We all know that this treatment is very difficult. We know that it is very emotional. We know that it can often be very painful and often not successful. So I think any legislation that we introduce that makes that a little bit easier for those wanting children through assisted reproductive treatments, supporting them and making sure that each and every individual is treated equally and is able to access such treatment, is really supporting one of the most fundamental rights that all Victorians, all people, all humans, should have. And this bill goes that little bit further in providing that access and removing some of the discriminatory wording and actions that have been in the legislation for far, far too long.

Ms HORNE (Williamstown—Minister for Ports and Freight, Minister for Consumer Affairs, Gaming and Liquor Regulation, Minister for Fishing and Boating) (16:33): It gives me great pleasure to rise to speak on this bill because it is one of those bills where behind every piece of legislation there is a story, and for every bit of this Assisted Reproductive Treatment Amendment Bill 2021 there is a plethora of intensely personal and life-changing stories.

The Andrews Labor government is committed to improving our state’s assisted reproductive treatment laws, and this bill is the next step on our path to making it fairer and easier for more Victorians. Community values and reproductive technologies have come so far over the past few decades, and this bill builds on the work of this government and past Labor governments to expand access to reproductive technologies. Whether it be giving single women and LGBTIQ couples legal access to assisted reproductive treatment or removing the requirement for separated but not yet divorced women to seek consent from their spouse for treatment, this government has a proven track record when it comes to these issues.

In 2020 we removed the need for those seeking access to IVF to undergo police checks before accessing treatment, removing the discriminatory distinction between those who can conceive naturally and those who cannot. Assisted reproductive treatment clinics still need to ensure the welfare and best interests of the child intended to be born are paramount when deciding to treat a woman, and this guiding principle continues to be important to the way that we address this matter beyond all else.

This government is working hard to ensure Victorians have an IVF system they can trust and rely on by removing any remaining barriers to access, including financial stress, which has been combated by our commitment to create a public IVF system in Victoria. As part of the Victorian 2021–22 budget $70 million was invested to establish public fertility care services, which will help up to 4000 Victorians every year, saving them on average $10 000 each. When people accessing this service need our support the most, we will be there to provide it, making it a little bit easier on them at what is undoubtedly one of the toughest times in their lives.

IVF and other assisted reproductive treatments can be a life-changing experience for so many, granting people the gift of parenthood. However, it is clear that for too many people fertility is fraught with challenges and heartache. I know this all too well, having watched my sister start her family through IVF. As I said at the start of my contribution, behind everything that goes on in legislation there are those stories. If I could just talk for a moment or two about the story and the journey that my sister went on, it was at a time of her life when it was incredibly difficult for her to access fertility treatments. She was living in regional New South Wales, and just that access to those services was so hard and so complicated. However, after an incredibly long period of trying and finally falling pregnant she gave birth to my most wonderful nephew. His name is Miles Maguire, and I think he is now a young man of 15 years of age. Unfortunately I have not seen Miles for quite a while, because he does live interstate, but the joy that this young man gives my family and gives his cousins, my children, as well as our parents, is just second to none.

That is what this bill is ultimately about. It is about creating families, it is about giving joy to other people and it is about making sure that people who do want to become parents have that opportunity to become parents and enjoy the richness but also the frustrations that at times that can deliver. But that is part of life’s journey. We all have, and I know you yourself, Deputy Speaker, as now a grandmother of five—

The DEPUTY SPEAKER: Seven.

Ms HORNE: Of seven. You certainly can appreciate those life journeys along the way. I cannot imagine how Grandma is going to survive the next school holidays with those seven little ones underfoot. But it is nothing but a joy, is it not? So with this in mind I know firsthand just how hard it is for families struggling with fertility and the importance of making sure that we remove any remaining barriers to access for as many people as possible.

In April 2018 the then Minister for Health, the member for Altona, initiated a review into our assisted reproductive treatment laws led by Michael Gorton, AM. This was the first review of its kind in over a decade, and during that time community standards and technologies had evolved significantly, making it an extremely timely review. Following the landmark Gorton review this government is considering all 80 recommendations to identify further reforms, and I am so proud that this bill will result in the implementation of a further 10 priority recommendations, getting us further down the path to a fairer and more equitable system.

This bill contains a suite of reforms based on reducing discrimination, improving access, providing more certainty for Victorians accessing assisted reproductive treatment and facilitating fair and just allocation of care under these circumstances, meaning intended parents will not be discriminated against on the basis of their sexual identity, and it will improve and modernise language in the Assisted Reproductive Treatment Act 2008.

Right now, if two women are in a relationship and are seeking assisted reproductive treatment to start their family in Victoria, the current 10-women limit that exists means under the law a female couple are treated as two separate entities for the purpose of accessing treatment instead of being viewed as one family unit. It is outdated and can inhibit these families from having genetically related children. Shifting to a 10-family donation limit will ensure that LGBTIQ couples and families using surrogacy can continue to use the same donor, even if each child is carried by a different woman. Changing this limit to no more than 10 families will mean that family units have greater freedom and surety to plan for the future and raise their young families, allowing more families to have related children using the same donor. It will also mean these families can rightly be treated as they are—which is families—for the purpose of accessing IVF treatment, and it brings our IVF system in line with community values on this matter.

This bill will also allow a surrogate’s partner to be reimbursed for costs incurred as a direct result of the surrogacy, an important step in making it fairer for all involved. A pregnancy is a big deal for those around the surrogate as well as for the surrogate themselves. This government previously broadened the range of expenses that surrogates can be reimbursed for, and while surrogates have been able to get some of the associated costs reimbursed for over a decade in Victoria, this reform will allow their partners to also be reimbursed for costs such as missed days of work to attend medical appointments for the surrogate, travel expenses and similar costs. This government stands with Victorians in expanding access to IVF and surrogacy, making it fairer and easier. I will leave my contribution here, as I congratulate the ministers for leading the charge on the important reforms and bringing and delivering them for Victorian families.

Following speeches incorporated in accordance with resolution of house of 14 September:

Ms COUZENS (Geelong)

I am pleased to contribute to the Assisted Reproductive Treatment Amendment Bill 2021.

I want to thank the Minister for Health on this significant amendment. The Andrews Labor government is committed to strengthening Victoria’s assisted reproductive treatment laws, and this bill is an important next step to make assisted reproductive treatment fairer and more accessible to Victorians.

Victoria has always been at the forefront of assisted reproductive treatment innovation—we led in-vitro fertilization and donor treatment procedures in the 1970s and 80s, and Australia’s first IVF baby, Candice Reed, was born in Victoria in 1980.

And 40 years on from that, we are establishing public IVF and Australia’s first public sperm and egg bank, to give more Victorians the chance to start and build their families without having to worry about their bank balance.

Starting a family should not rely on the size of your bank balance.

When we announced the move to establish public IVF I received many messages from people in the Geelong community, and many were very emotional and excited about this opportunity.

Jillian said ‘Great news Christine, money should never be a criteria for being blessed with a precious little baby, well done Labor’.

Kristel said ‘This is going to bless so many people. It’s devastating the struggle to get pregnant. You go through life thinking you’ll be good until it’s time to start trying and you discover it’s not so easy. So, thank goodness this is now happening. Thank you’.

Ebony said ‘omg! This is going to change so many lives’.

There were many descriptive words such as brilliant, awesome, amazing, hopeful, and many more. People in Geelong clearly understand the significance and life-changing opportunities of this bill.

As a global leader in assisted reproductive treatment, it is not surprising that around 30 per cent of treatment cycles in Australia each year occur in Victoria.

The Infertility (Medical Procedures) Act 1984 came into operation on 1 July 1988 and was the first legislation worldwide to regulate assisted reproductive treatment and associated human embryo research.

And now, with the Assisted Reproductive Treatment Amendment Bill 2021, we continue with our commitment to provide a robust framework and adequate safeguards to ensure Victorians accessing assisted reproductive treatment are protected and supported on their fertility journey.

These changes build on the work of the Andrews Labor government and previous Labor governments, from giving single women and LGBTIQ couples legal access to assisted reproductive treatment, to our landmark ‘right to know reforms’.

We have seen reforms that recognise the needs of donors, intending parents and people conceived through donor conception—reforms that have navigated developments not only in technology and medicine, but also in our society more widely. Reforms that recognise that all Victorians, including Geelong constituents, deserve an equal chance at accessing treatments, free from discrimination and supported at every turn.

We also recognise that in spite of all of these advancements, there is still more work to be done.

Following the landmark review into assisted reproductive treatment by Michael Gorton, AM, this government is closely considering all 80 recommendations to identify further reforms in this space, and to ensure that we maintain a high-quality, honest system.

Our staged approach to implementation means that we can properly consider how each recommendation will work in practice and provide the best outcomes for Victorians accessing assisted reproductive treatments, donor-conceived children, donors and service providers.

I am proud that this bill will result in the implementation of a further 10 priority recommendations, with a strong focus on reducing discrimination, improving access, and providing more certainty for Victorians accessing assisted reproductive treatment.

We know that for any Victorian accessing assisted reproductive treatment it is an emotional rollercoaster, full of the highest highs and the lowest lows.

But for some Victorians, this journey is also tarnished by uncertainty, discrimination, and barriers to access. For some, this journey is simply too difficult to navigate.

For LGBTIQ couples seeking assisted reproductive treatment, the barrier of the current ‘10-woman limit’ is outdated, discriminatory and in practice often prevents these families from having genetically related children.

If two women are in a relationship, they should not be treated under the legislation as two separate women for the purposes of building their family. They should be recognised as just that—a family.

Unlike those opposite, this government is in the business of equality, and we will continue to make the necessary changes so that no Victorian feels excluded, unsafe, or discriminated against on their fertility journey.

We know that the current laws that allow donors to revoke consent up until an embryo is transferred into a person are a great source of anxiety, uncertainty and distress for many people undergoing treatment.

This law is outdated, it does not reflect our community values and our understanding of donor relationships, and it is not present in any other jurisdiction in Australia.

In addition to this uncertainty, the removal of consent after embryos have been created often results in the recipient’s own eggs going to waste after, in many cases, tens of thousands of dollars going towards their creation.

Victoria is the only jurisdiction that allows donors to withdraw consent at any point—a law that has been described by some as ‘cruel and crushing’.

For some Victorians, going through this ordeal once is so emotionally and financially damaging that they cease their assisted reproductive journeys entirely.

This amendment is about ensuring that Victorians who are undergoing the emotional rollercoaster of assisted reproductive treatment do not have to face the anxiety of not knowing if consent will be withdrawn past a certain point, or the heartbreak of going through this experience.

This bill will amend the act to provide more Victorians with better access to low-cost treatments.

Changes expand the range of individuals who can perform artificial insemination, including nurses and other health professionals under the supervision and direction of a doctor in an assisted reproductive treatment clinic.

The bill also removes a barrier that requires counselling prior to artificial insemination to occur only in a registered clinic—this will enable doctors outside of registered clinics to provide artificial insemination services, as they are already permitted to do under the act.

These changes will particularly benefit single women, LGBTIQ Victorians and rural and regional Victorians seeking the less invasive treatment option of artificial insemination.

Treatments will be available closer to home, and the costs of more complex assisted reproductive treatment procedures can be avoided for some Victorians who will seek out more accessible artificial insemination procedures.

Quality and safety, and patient-centred care, will remain central to our assisted reproductive treatment system with the introduction of these changes.

Almost 15 years ago, the Assisted Reproductive Treatment Act 2008 gave rights to surrogates to be reimbursed for reasonable costs associated with the surrogacy arrangement. These expenses were limited to medical, travel and legal expenses.

In 2019, amendments to the act in response to Gorton review findings expanded on these costs, recognising that the costs incurred as a result of surrogacy often go beyond these three categories and can also include insurance premiums, counselling expenses, lost earnings, accommodation and childcare.

This bill goes beyond the Gorton review recommendation in response to feedback from stakeholders that highlighted the costs that are often incurred by the partner of a surrogate.

We know that a pregnancy is an experience often shared with others, and this also applies to surrogacy arrangements, where a surrogate’s partner may cover legal fees, travel costs, and take time off work to attend appointments and other milestones.

These changes will ensure that a partner of a surrogate is also able to receive reimbursement for these costs.

This bill also further builds on the rights of surrogates, expressly clarifying that a surrogate has the same rights to manage their pregnancy and the birth of the child as any other pregnant person.

This recognises the fundamental human rights of surrogates to bodily autonomy and to make decisions relating to their own bodies.

This amendment is central to our values in Victoria surrounding surrogacy, and the understanding that surrogates are more than their ability to carry a baby.

I am proud that the Andrews Labor government has also responded to a number of recommendations regarding access and affordability through our commitment to establishing public fertility care services, with a funding injection of $70 million to make starting a family a reality for so many Victorian families.

This funding will also see the establishment of our first public sperm and egg bank, going some way to improve access and make the process of starting or building a family simpler for many Victorians.

To all who have shared their stories, in this chamber and in my community of Geelong, thank you.

I commend the bill to the house.

Ms CRUGNALE (Bass)

Every day I give thanks for my two sons. My adorable warriors, no longer short in stature and growing daily into fine young people. Never for a moment do I regret having them in my life. They teach me to be a better person.

I also recognise that there are those who chose not to have children. They are my friends, my family, and I listen to their stories. I understand their reasons, and their lives are complete—full and rewarding. They are happy with their decision.

Yet there is a third group of people, and my heart aches for them. We have heard the detailed journey and extraordinary story of our Minister for Women, whose contribution is a must listen to all. Members in this chamber have brought their personal journeys to this chamber floor, their experience, their raw emotions.

They are the people who dream of being a parent, some realised, some not, some still trying. I know them too, and hear their stories of hope, of patience, and of longing to hold their child. I have not walked in their shoes.

An estimated 25 000 women access assisted reproductive treatment in Victoria each year, seeking out services that can help to achieve their quest to have a child with or without a partner, the pure emotion of their longing colliding with the technical science of the procedures they undertake. They may not be successful in their journey, but as a government I am proud that we are doing everything we can to assist them and make it easier.

That is why this legislation is so vital. Firstly, it addresses current discrimination, particularly against single women, same-sex couples and LGBTIQ people, making it easier to access for all Victorians regardless of sexuality, gender identity or relationship status—doing away with the 1950s notion of who a family should be, or what a family should look like.

As Michael Gorton, AM, noted in the introduction to his 2019 Final Report of the Independent Review of Assisted Reproductive Treatment, it is now more than 20 years since leading fertility specialist Professor John McBain challenged Victorian legislation that limited IVF to married women. It is 13 years since the landmark legislation, the Assisted Reproductive Treatment Act 2008, was introduced into Parliament by another great Attorney General, Rob Hulls. It only just passed the upper house by one vote.

Michael Gorton’s introduction is a heartfelt message. He talks of the compromise reached in the original legislation and the frustration this caused—in his words—to ‘patients, surrogates, donors, donor-conceived people, clinics, doctors, counsellors and regulators’.

This current legislation will make it easier to access treatment by removing unnecessary barriers, reducing the cost and increasing accessibility for those who live in rural and regional Victoria.

This is such an emotive subject, particularly around the issue of deceased loved ones. It is not our place to be judgemental—it is our place, and our duty, to treat all Victorians with fairness and compassion. The posthumous use of eggs and sperms raises such complex ethical issues and the government will consider all aspects of them—ensuring that the expressed wishes of the deceased person are upheld.

It will offer respectful terminology. A person providing that key cell called a gamete, to have a child through surrogacy, will no longer be a ‘commissioning’ parent, a label better suited to someone ordering furniture or bespoke artwork. This person will now be an ‘intending’ parent. There is kindness and respect in this language. A person who provides eggs or sperm for use by their partner will be identified as a partner, not a donor. As indeed they should be.

Another recommendation is the alteration of the ‘10-woman limit’ to 10-family limit. Currently the act restricts the number of gametes donated by one person to 10 women. This limits the opportunity for both women in a same-sex relationship to bear children using gametes from the same donor. Similarly, men in a same-sex relationship are discriminated against as they cannot use the same donor with a different surrogate, if the limit has been reached.

Changing this to 10 families means that same-sex couples can have genetically related children. Feedback supports this end to discriminatory practice and values the worth of families being able to have biologically related siblings. The review sensibly recommends reviewing this number in five years, in the event of an increased donor supply.

Among the many organisations and people consulted along this journey is the much respected Australian Nursing and Midwifery Federation union. Their input supported the amendment to enable nurses to carry out the relatively simple procedure of artificial insemination at a registered clinic—safely, and under the supervision of a medical doctor—making the process cheaper, and more accessible for rural and regional families.

Another key issue addressed in this bill is that of surrogacy rights. It is right and proper that surrogates are not paid. Who could determine the appropriate sum of money involved in carrying a pregnancy for another woman? However, it is not right and proper that a surrogate woman and her partner should be out of pocket for expenses that are incurred. This legislation redresses that.

Intending parents will be required to reimburse the surrogate couple for expenses. Consultations with the former Department of Health and Human Services identified legal costs and loss of earnings as a burden to a surrogate couple, resulting from taking unpaid leave. These agreed costs will now be paid by the intending parents.

The legislation further protects the surrogate by confirming that she can manage the pregnancy and birth of the child and has the same rights as any other pregnant person. This is in response to feedback to the Gorton review. Some surrogates felt they had to comply with demands for more invasive treatment because the intended parents requested it and were paying for medical expenses. The peak organisation representing LGBTQ+ parents and their children—Rainbow Families—support this amendment.

I return to the beginning of this address, when I spoke briefly about the often long and difficult journey that is travelled in assisted reproduction. The hours that are spent in consultation, in counselling and in procedures. The travel expenses, the loss of income and the economic costs that can run into the thousands, if not the tens of thousands.

It is the role of government to lead, not to follow. It is the role of government to make changes that help its citizens, not to react and respond to populist causes. I say a very special thankyou to our Andrews Labor government for the allocation of funds in the 2021–2022 budget.

A pledge of $70 million over three years to establish public fertility care services, providing those Victorians the chance of becoming parents when and where they need it. Included in this is $3.5 million to deliver Australia’s first public sperm and egg bank.

Obviously, careful planning is key to service provision and submissions will be called for over the next few months. More services will be progressively offered from next year as a result of an allocation of $50 million, and $20 million will help existing public health services make improvements and purchase equipment.

Like other public health services, public fertility care will be free for most people, and expanded to regional Victoria. My electorate of Bass says thank you—whether in the outer metropolitan suburb of Pakenham, or the regional towns of Lang Lang and Bass.

Because infertility doesn’t have a postcode, it doesn’t have a socio-economic status or a cultural background. It just has heartache and another Mother’s Day or Father’s Day of longing.

Thank you to everyone who helped bring about this legislation, especially to former Minister for Health, the member for Altona, for beginning this work and to the current Minister for Health for continuing and introducing this legislation to our Parliament.

Ms EDWARDS (Bendigo West)

I’m pleased to make a contribution to the Assisted Reproductive Treatment Amendment Bill 2021.

I would like to acknowledge and thank the Minister for Women for her carriage of this bill to this house and for her courageous and heartfelt contribution to the bill.

Personal stories are extremely difficult when you are a member of Parliament, but the minister has given all of us a genuine and lived experience view of what it is like to undergo ART (Assisted Reproductive Treatment). Her honest and heartfelt journey along this challenging path is truly inspiring and eye-opening for many, and I sincerely thank her for her contribution.

Can I also acknowledge the work of the former health minister, the member for Altona, for her determination to bring about positive change for so many in this field of medicine.

Victoria has always been at the forefront of ART innovation both here in Australia and indeed internationally. This bill builds on the strength and commitment of Victoria’s ART laws to make them more accessible, inclusive and to provide a robust framework with important safeguards to protect those who are using ART in this state.

The reforms in this bill reflect changing community expectations and the importance of legislative change to accommodate those expectations.

The bill highlights and recognises the great diversity of people who seek ART in Victoria.

Four of the amendments are focused on reducing discrimination and opening up the opportunity of ART to all Victorians irrespective of gender identity, sexuality, marital or relationship status.

Importantly, the bill removes unnecessary barriers and makes treatment more accessible, particularly for people who live in rural and regional areas.

It is over 10 years since this Parliament passed the Assisted Reproductive Treatment Act 2008. Since then, much has changed not just in terms of social evolution but also massive strides in reproductive medicine, health regulation and within the reproductive treatment industry itself.

The report by Michel Gorton, AM, in 2018 provided a comprehensive set of recommendations, and the Andrews government is continually looking at ways to amend the 2008 act to reflect those recommendations.

Several amendments have passed this house to reflect the Gorton review and changes needed.

The report also highlighted the cost associated with accessing ART. In response the Andrews government has committed to establishing public fertility care services with an investment of $70 million over three years.

Many years ago, back in 1988, Linda Kirkman, a Bendigo woman and friend of mine in the Bendigo Nursing Mothers Association (now the Australian Breastfeeding Association) gave birth to her niece—her sister Maggie’s child.

Alice was conceived from her mother Maggie’s egg, fertilised by a sperm donor, gestated in Linda’s womb.

This was the first time in Australia that IVF surrogacy occurred—or gestational motherhood, as Linda prefers it to be called.

These women were absolute trailblazers in this field, but their journey and that of their partners and family was traversed with little support and with a need to navigate through the comprehensive social, legal, medical, ethical, and emotional and psychological minefield that was in front of them.

I share some of their story now so that we can be reminded of how far we have come in the ART field and pay a debt of gratitude to them for showing the way and for their love and commitment to each other, to their children and partners, and for courageously and with resolve leading the way with ART and surrogacy:

Success in such a potentially hazardous venture as surrogate motherhood depends on more than the skills of IVF doctors and scientists. Linda, Maggie, and their husbands had considered every aspect of what might happen; mentally walked through each moment in the near and distant future; envisaged all kinds of possible outcomes. It was like embarking on one of those interactive books with choice points and alternative endings: turn to page 10 if Maggie becomes a mother and page 15 if Linda decides she can’t go through with it. They thought and talked about what would happen during IVF, such as whether Linda would ever go with Maggie to early morning clinic sessions, and whether Linda would have hormone treatment or use her natural cycle. What if IVF failed? If Linda became pregnant, would they accept screening tests for abnormalities? How would complications with the pregnancy be managed? What would it be like at the birth of the baby? Who would hold the baby first? What if there were twins? What if the baby were disabled? What if Linda felt too attached to the baby to relinquish it? What if Maggie and Sev died before or soon after the birth? How would they all feel at various milestones (decisions about schooling, teenage rebellion) as the baby grew up? What if the adults differed in aspects of the child’s upbringing? Every imaginable permutation was pondered and discussed many times until they felt confident in their understanding and agreement.

From the outset Maggie and Sev adopted the attitude that Linda was giving them an extraordinary opportunity, but if she felt unable to proceed or couldn’t relinquish the baby it would not be a loss. Their relationship with Linda and Linda’s well-being were paramount. This was fundamental to ensuring that Linda was able to make choices without duress, including backing out of the arrangement at any point. The whole extended family was committed to Linda’s well-being, and if this meant that Maggie and Sev remained an aunt and uncle and not a mother and father, so be it.

…

Linda’s attitude to the pregnancy was one of ‘all care but no responsibility’. Her intentions in gestating this baby were of profound significance in the outcome: to produce a niece or nephew, not a daughter or son. All the same, the possibility of attachment to the baby had to be accepted.

…

The pregnancy wasn’t uneventful; one of their contemplated fears came true. At 29 weeks gestation, Linda haemorrhaged and was admitted to hospital with a diagnosis of placenta praevia. She remained in or near a hospital for the next seven weeks, until the premature birth by caesarean section, and for a week afterwards. From the outset Maggie spent every day with Linda, plus every night once Alice was born. When Linda left hospital, she and Maggie spent several weeks together, mostly to help Maggie as a new mother but also because they’d been together so much it was hard to part.

Linda’s support included helping Maggie to establish breastfeeding, a process that began (with the advice of lactation consultants) as soon as Linda’s pregnancy was confirmed. Where possible, it’s every child’s right to be breastfed; Alice didn’t need to be deprived because of her unusual arrival in the world. Maggie eventually lactated without the use of drugs, helped by a small group of wonderful new mothers who donated breast milk while Maggie’s supply developed.

Linda and her sister Maggie did not have any law or legislative frameworks to work within. In fact, their journey and their experience has helped to create what we now have and continue to add to—and that is legislation such as this, before us today, that supports all people to participate in ART and surrogacy.

I commend the bill to the house.

Ms KILKENNY (Carrum)

I am very pleased to be able to contribute to the debate on the Assisted Reproductive Treatment Amendment Bill 2021.

While I was preparing for today’s contribution on this bill I read over some of the contributions on this bill made in this place this week. Not only were they considered, thoughtful and informative but some of them were very personal as well. And I want to particularly acknowledge and thank the Minister for Women, the member for Tarneit and the member for Footscray for choosing to share their personal stories with us all.

And I must say it is a powerful thing, and a humbling thing, when members of this place can speak directly, with firsthand and personal experience on issues such as assisted reproductive treatment in Victoria. And when they do, we can have even more confidence that the changes being proposed really are going to make a difference, and have a positive impact, in the lives of people who use these services.

And again, this of course serves to further reinforce the absolute imperative that our places of Parliament reflect the diversity in our communities.

The bill before us continues the really important reforms to assisted reproductive treatment in Victoria. The bill before us continues the implementation of more of the recommendations set out in the final report by Michael Gorton, AM, following his independent review of the Victorian assisted reproductive treatment framework in 2018.

His report, titled Helping Victorians Create Families with Assisted Reproductive Treatment: Final Report of the Independent Review of Assisted Reproductive Treatment, was released by the Minister for Health in July 2019.

The landmark review by Michael Gorton, setting out a package of reforms and 80 wideranging recommendations, is part of a major push to make sure ART services in Victoria are more accessible, safer, and of a higher quality, as well as free from discrimination, for thousands and thousands of Victorians.

Victoria’s ART industry has much to be proud of. The industry has literally supported tens of thousands of Victorians to create families. We have seen significant clinical improvements to fertility care, world-leading research into in-vitro fertilisation (IVF) practices as well as improved health outcomes for persons born through ART.

So much has changed over the past decade or so—particularly around social attitudes, reproductive medicine, health regulation and the desire and commitment for ART to be focused on person-centred care, with greater transparency, disclosure and information around procedures, treatments and evidence-based responses to better equip patients to make informed choices.

The number of Victorians accessing ART services has been growing over the past decade. Legislative changes have assisted with this, removing barriers for women and families wanting to access ART.

The Assisted Reproductive Treatment Act 2008, introduced following a three-year review by the Victorian Law Reform Commission, gave single women and same-sex couples legal access to ART in Victoria and enabled altruistic surrogacy. The legacy from these reforms lives on.

And more recently, following the Gorton review the Andrews Labor government has already implemented several recommendations of the final report.

In 2020 amendments were made to remove the requirement for a woman and her partner to undergo police checks before accessing treatment. This was in response to significant stakeholder and industry feedback that this requirement was utterly offensive.

Removing that requirement removed the discrimination levelled only at women accessing ART services—a requirement that never existed for people who conceive without ART.

In 2019, the act was amended to remove a discriminatory requirement that required a married woman who was separated from her spouse to seek her spouse’s approval to access ART using donor sperm.

Further, the Gorton review identified cost as the single biggest barrier to accessing ART in Victoria. An initial IVF cycle can cost an average of $5500. This is just unaffordable for so many Victorians. This year’s budget will address this, delivering $70 million to establish public fertility care services, meaning 4000 Victorian patients will be able to access the program for free each year starting next year. The funding also includes $3.5 million to deliver Australia’s first public sperm and egg bank.

This funding will help transform the whole system for so many thousands of Victorians who have been locked out of accessing what has become a critical medical service.

The bill before us continues this great work—implementing a further 10 recommendations identified in the Gorton review for priority implementation and improving access for so many Victorians.

The changes to be introduced will include allowing existing families to have related siblings related to their existing children using the same donor. Currently, donors can’t donate to more than 10 women. However, this has been found to discriminate against women in same-sex relationships. So there will be a change to a 10-family limit to make sure same-sex couples and families using surrogacy can continue to use the same donor.

The bill will also reduce discrimination by enabling all people whose partners have died to use their eggs, sperm or embryos in accordance with their deceased partner’s wishes to have a child through a surrogacy arrangements.

There will be changes to language to clarify that a person who provides eggs or sperm for use by their partner, whatever their gender identity, sexuality or relationship status, is identified as a partner, and not a donor.

This is important. Language can be a powerful discriminator. It can also be insensitive. So the term ‘commissioning parents’ will be replaced with ‘intended parents’.

The bill will also see changes to who can perform certain services. Nurses and other health professionals within registered ART clinics will be able to carry out procedures and doctors outside registered clinics will be able to carry out artificial insemination for the first time. This will help reduce costs and give more Victorians better access to services.

And, as we heard so powerfully from the Minister for Women, there will also be greater certainty for people undergoing IVF through changes that would only enable donors to withdraw consent up to the time the eggs or sperm are used in treatment or to create an embryo.

These are important changes. And they are profound changes for thousands of Victorians.

We know from the lived experience of so many Victorians that undergoing fertility treatment is an incredibly emotional and deeply challenging experience.

The reforms we are implementing will help to alleviate some of the uncertainty, whilst at the same time will operate to strengthen our laws in order to make ART fairer and more accessible to Victorians who are hoping to create a family.

I commend the bill.

Mr FREGON (Mount Waverley) (16:42): I move:

That debate be adjourned.

Motion agreed to and debate adjourned.

Ordered that debate be adjourned until later this day.