‘Dr N’ Case Raises Question about NZ’s Abortion Laws

16 Apr

By Sabrina Muck

Dr N, a doctor working in a rural area with 30 years’ experience, was suspended for six months for illegally prescribing the medication misoprostol (Cytotec) to four patients in a manner contrary to legal pregnancy termination procedures specified in the Contraception, Sterilisation and Abortion Act. The case was reported in the ALRANZ newsletter in August 2013. It has now made the news again (with a slight delay) because the doctor’s suspension period has lapsed and she is allowed to practice, with conditions. The original decision of the Health Practitioners Disciplinary Tribunal (including an agreed summary of facts) is available here.

In its decision, the Tribunal established that Dr N’s actions amounted to professional misconduct (for example, failing to ensure the patient had adequate follow-up support if she decided to take the misoprostol; in another case, prescribing misoprostol without first having seen the patient in consultation; and in all cases, failing to record the details on the patients’ medical notes.) Dr N did not deny these allegations but argued that she had “allowed herself to become overwhelmed by the need to help those desperately seeking her help”, and had earlier indicated that she considered she was providing a necessary service.

This blog post does not seek to comment on whether Dr N’s actions constituted professional misconduct or otherwise – that is a matter for the Tribunal. However, the case raises wider questions about the state of abortion law in New Zealand, the most obvious being access and availability, particularly to women in rural areas. It is incredibly disappointing that in 2014, medical practitioners still have to resort to these kinds of “work-arounds” because their patients would otherwise face significant travel time and costs to access a service which should be available to all women. And that’s not even taking into account the necessary referral, certification and counseling procedures a patient would need to go through, which cannot always be provided easily or promptly in remote or rural areas. The witness evidence in Dr N’s case itself shines a light on this – when questioned by a student doctor about her decision to prescribe misoprostol to a patient, she responded that it would save the patient “a massive ordeal associated with a trip…for an abortion”, and in another situation reportedly told a nurse that “it was unfair not to give the patient these pills…if [the patient] had to wait it would be too late.”

This latter comment also highlights the issue that because of the complicated procedures delays in the system are inevitable and can result in abortions being carried out later than is desirable for safety.

Our laws should not be putting doctors in a position where they may be compromising client care in an effort to help the women who come to see them. The criminalisation of abortion in New Zealand is in direct contravention of international treaties to which New Zealand is a signatory, especially with respect to the Convention on the Elimintion of all forms of Discrimination Against Women (CEDAW).  And while New Zealand may be celebrating its recent ranking as “the most socially advanced country in the world”, we would do well to remember these are still the kinds of decisions and situations facing our doctors. Reading the coverage of the Dr N case in the papers just brings to light once again the continued and on-going need for access to safe, legal medical and surgical abortion in any situation where women choose that is the right path for them.

Sabrina Muck is a member of ALRANZ and is on the Governance Collective of the Auckland Women’s Centre.

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We’d particularly welcome comments from readers outside the main centres or who don’t live near a provider about any access difficulties they’ve experienced trying to get the reproductive health care they need.

 

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On access, privacy, & safety

31 Mar

I went to university in a small town in the American South – a tiny island of moderate politics in a swathe of conservative rural counties. There was a small abortion clinic a few blocks north of down town that served several neighbouring towns and counties (87% of American counties have no abortion provider. In non-metropolitan areas, that number is 97%.). In the era of increasing limitations on access to sexual and reproductive healthcare, hours had been cut back and the doctor was only on site a few hours, one day a week.

A group of anti-choice protesters, some students and some older town residents from the nearby churches, occupied the sidewalk every week, rain or shine. The tiny plot of land only had parking for a few staff cars, so patients had to park across the street at the big stationery store. The clinic, understaffed as it was, relied on volunteer escorts to accompany patients across the street and past the protesters to the clinic.

It wasn’t just about supporting patients. Fatal attacks had occurred at two other clinics in the state and at others around in the country. Although Dr George Tiller hadn’t yet been murdered while ushering at his church, he had been shot and his Kansas clinic bombed in two separate attacks. Eric Rudolph, who planted bombs at the 1996 Atlanta Olympics, two clinics, and a nightclub, had recently plead guilty after five years on the run. Arson and bomb threats occurred nationwide; dealing with threats and suspicious packages was standard training protocol for new staff.

At our clinic, escorts were briefed on buffer zone laws. The security guard kept a small, worn notebook, where he recorded details about each and every protester – arrival and departure, their behaviour, who brought their children, a record of calls to the police to report harassment. Some silently prayed well behind the line, but others frequently harassed patients.

My class schedule often conflicted, and so I didn’t spend as many afternoons at the clinic as I should have. Escorting was emotionally draining for us – I can only imagine what patients must have felt walking through a crowd of scorn and judgement, flanked only by a couple of young students. Yet many still stopped us as we led them into the reception area, turning to smile or quietly whisper ‘thank you.’ It broke my heart every time.

One of my first afternoons, I was there with two other friends. Holidays were coming up and students were heading out of town, so the protesters were down to the locals – the middle-aged man with his horrific sign and the Catholic woman with the line of children and rosary beads. We were chatting about our weekend plans when a car pulled up and stopped in the drive. We tensed – there were no appointments left that day – and glanced nervously at one another.

A thirty-something woman got out of the car carrying a little vase of carnations with a ‘Thank You!’ helium balloon tied to the vase. She walked over to us and said within earshot of the protesters, ‘Thank you. You were there for my sister when no one else was. You don’t hear it enough, but there are a lot of people who are grateful for what you do. Please pass this on to everyone inside.’ Dumbstruck, we smiled, clumsily strung together words to thank her, but she was back in her car and pulling away.

And so we cried. For her generous gesture, her sister, every patient, every doctor, every receptionist, every partner, friend, or family member who held a hand or offered a ride, every woman who suffered an unsafe abortion, for those who have felt the heartbreak of discovering a foetal anomaly, for a culture where our first reaction to an unexpected visitor was fear, and for a society where a trip to the doctor had become a political act requiring courage, security, and personal risk just to get in the door, never mind the complexity of the decision to choose abortion itself.

I know that New Zealand is not the United States and I sincerely hope the import of American anti-choice rhetoric stops with harassment, misinformation, and ribbons. But shame, stigma, and ill-informed judgement hurt even when not accompanied by pipe bombs.

Safe, private access matters, not just to patients, but to everyone. The receptionists, the nurses, the janitorial staff who clean the building, the staff and customers of neighbouring buildings – everyone who ensures that women have the ability to make private decisions about their own health. Choices about fertility, pregnancy, and abortion are complex and challenging in the best of circumstances. Women do not enter into them lightly and it is insulting to assume otherwise.

The Family Life International ‘vigil’ outside Wellington Hospital insensitively affects patients, staff, and visitors to the hospital, the majority of whom have nothing to do with abortion services and are likely facing their own challenging situations. It is difficult enough to be admitted to hospital or visit loved ones who are ill without being bombarded by chanting and stigma.

I do not contest FLI’s right to judge and disagree with the choices of others – I believe that informed discourse is the foundation of a free society – and while I personally doubt the efficacy of shaming others into supporting one’s view, I respect their decision to choose these tactics. I do, however, question their sincerity in promoting ‘a spirit of unity’ by disrupting the lives of innocent hospital patients and staff. There is a time and a place for respectful debate, and there is a time to allow individuals to seek medical services in private.

This was written by an ALRANZ member and reflects the author’s individual opinion. Please get it touch if you would like to share your own experience or thoughts on our blog. 

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An open letter to New Zealand abortion providers

21 Mar

To New Zealand abortion providers,

The Abortion Law Reform Association of New Zealand (ALRANZ) would like to thank you for all the amazing work you do, often unseen and unacknowledged. While we do not write these types of letters nearly as often as we should, those of us who pursue a pro-choice agenda admire and respect the enormous role you play in ensuring and enabling access to abortion services. We know that providing these services is all to frequently done at a cost to your own safety and wellbeing. We honor your bravery; bearing the brunt of anti-choice bullying, threats and spurious attempts to make clinic/medical providers into villains. Continue reading

FLI imports “40 Days for Life” to New Zealand

16 Mar

You’ve probably noticed the increased presence of anti-choice protestors outside Wellington and Auckland hospitals. This began on Wednesday 5 March, the first day of Lent, as part of a campaign called “40 Days for Life.” This campaign originated in the United States and is being coordinated in New Zealand by Family Life International New Zealand (FLI).

The 40 Days for Life campaign centres on prayer, fasting and community outreach. Its proponents claim abortion hurts women and that women need to be “defended” from the practice. Their goal is to “end abortion.”

ALRANZ condemns this campaign. Abortion is a private medical decision and patients and clinical staff have the right to seek and provide medical services without being subject to harassment.

The right to seek safe and legal abortion is recognised across the world. New Zealand has been reprimanded for its restrictive abortion laws by the United Nations CEDAW Committee, an international declaration protecting the rights of women and recognised by 99 countries. Criminalising abortion does not reduce the number of abortions, it only increases the number of unsafe abortions.

While we support everyone’s right to express their views, patients have the right to accurate information about all of their pregnancy options. FLI and the 40 Days for Life campaign support so-called crisis pregnancy centres such as the John Paul II Centre for Life in Dunedin. It was recently revealed that these centres present false information about abortion. Supporting pregnant people is admirable, but lying about abortion undermines women’s autonomy. ALRANZ supports a woman’s right to access comprehensive information about all pregnancy options so that she is able to make the decision that is right for her.

The 40 Days for Life campaign is a continuation of the import of disturbing American anti-choice tactics into New Zealand. It stigmatises and shames people who are accessing and providing a necessary health service. It aims to shut down the provision of abortion services, access to which is a recognised human right and is sought by thousands of people in New Zealand every year.

The campaign is set to run in Wellington and Auckland until 13 April.  Volunteers have offered to organise escorts if the protestors violate their agreement with Wellington Hospital – get in touch with Coley if you’re able to help.

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Contraception, Abortion: Whose Decision?

28 Feb

An excellent but disturbing article recently appeared in the Otago University student mag Critic written by chief reporter, Josie Cochrane, about yet another health-care professional who apparently seems to think he has the right to pass judgment and offer “advice” on the sex lives of customers.

According to the article, “ECP Struggles: Pharmacy Leaves Women Feeling Judged,” a young woman seeking emergency contraception at a Dunedin pharmacy was told the “best method of contraception was to hold an aspirin pill between my knees”. The woman has complained about how she was treated to the Health and Disability Commissioner.

The Otago Daily Times followed up Critic’s article with one of its own, “Complaint to HDC Over Treatment”, giving Critic due credit – oh, and referring to the Emergency Contraceptive Pill as “ESP”??

Readers who keep up with reproductive justice issues may recall a related case out of Blenheim last year of a doctor who refused to prescribe the birth control pill because the young woman seeking it hadn’t yet done her “reproductive duty”; and instead advised she use the “rhythm method” of contraception.

Two prochoice activists, Helen Wilson and Alison McCulloch, followed up later in the year with a helen-alison-copyprotest outside the clinic as part of the Prochoice Highway tour, which made it into the Marlborough Express. (Sorry about the poor quality pic! Photo of a computer screen. The sign reads “Free Condoms! Women’s Bodies; Women’s Choice: ‘Rhythm’ (and blues) not for us!”)

How You Can Help

Some readers may already know that a group of pro-choicers is working on a project aimed at shining the light on “conscientious objectors” like these, who deny people the reproductive healthcare they want or need. It’s called “My Decision” and will comprise a website with a database of health-care professionals who refuse to provide certain reproductive health-care services, be they doctors, pharmacists, crisis pregnancy counseling centres … whoever. Users will be able to confidentially submit stories to the site and see what providers have been reported by other users or by the providers themselves. Conscientious objectors can provide information on what services they do and do not offer. It’ll be a bit like the old “hot and cold files” that women’s health advocates used to have, only online.

The My Decision website and is still being built, but in the meantime we would very much like to hear from readers who know of people or places that restrict reproductive healthcare access. And if you’re somewhat web confident and would like to help moderate the site, please let the group know. You can email your stories or offers of help to: mydecisionnz[at]gmail[dot]com

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From Our Files: MPs – Dodging Abortion for 40 Years

12 Feb

In an election year, we thought readers might enjoy this article from Truth, 2 June 1974, showing that pretty much nothing has changed in 40 years when it comes to politicians and abortion. You can enlarge the image by clicking on it. (Find other posts in the From Our Files series by clicking here.)

Truth_June_1974

 

 

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Roe v Wade, and Political Will

22 Jan

Roe v Wade and the importance of pro-choice political will

by Morgan Healey, ALRANZ president

Each year, on the 22nd of January, pro- and anti-choice activists remember the seminal Supreme Court of the United States’ (SCOTUS) decision in the case of Roe versus Wade. It essentially legalized NARALabortion in the US up to the point of viability, largely understood to be 24 weeks. Many states prior to 1973 had already made abortion legal in certain situations. The importance of Roe was that SCOTUS ruled that abortion was a private matter and thus a right protected under the US Constitution.

Here in New Zealand the fight for abortion has been less violent and vitriolic. As Alison McCulloch outlines in her important book, ‘Fighting to Choose’, the 1970s and 80s was a hotbed of activity around the issue of abortion, in particular the Royal Commission and its recommendations, leading to the 1977 Contraception, Sterilisation and Abortion Act (which continues to be one of two pieces of legislation governing abortion in NZ). However, an important point remains – unlike the US, with its many controversies and ongoing struggles – abortion is still criminalized in NZ. While that does not mean pregnant people are dying in the streets (NZ has a very high standard of safety when it comes to abortion), it does mean that women are not allowed to make the decision themselves, ceding that right to two certifying consultants, who verify if that person meets any of the grounds under the Crimes Act. This has become the status quo for abortion in NZ –  a medical profession that has made a bad law work, a civil society that seems to assume abortion is ‘legal’ and the political will to sit back and remain silent. If it ain’t broke, why fix it? We could end up with something worse, right?

I have never bought into that argument, mainly because I think it is a dangerous attitude to have. While pro-choicers sit back and rest on our laurels, knowing many (and I can’t highlight this enough) women can and do access abortion, what are the antis up to? For an insight into that, I want to return to my narrative of abortion politics in the US….

Continue reading

I’m pro-choice because…

20 Jan

We’ve been collecting photos of people around New Zealand with their pro-choice messages. This photo of ALRANZ executive committee member Kes was taken in Wellington at a Pro-Choice Highway event.

Image

Kes says:

Just one of the reasons I am pro-choice is that the decision made by someone who is pregnant unintentionally is partly values-based (as well as based on circumstances such as finances etc.). Abortion is one option and the decision to choose it is up to a person’s unique world view and values system. Just as with any other option, people who choose to have an abortion should be supported in this and their decision respected.

If you would like to share your pro-choice message with us, send your photo to info@alranz.org or post it to our Facebook page.

 

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Fact vs. Fiction, Again

12 Jan

It’s probably no accident that the Abortion Supervisory Committee’s (ASC’s) annual report always comes out at the start of the silly season and, this year, was tabled on a Friday (13 December). The media caught up with the report last week when the Sunday Star Times (SST) ran a Fairfax story headlined “Abortion Rate at Lowest in 20 Years” (Never mind that the stats showing the decline were made public in June by Statistics NZ. This happens every year.) What we wait for in the ASC report is not the stats – though the report does have some extra data and it’s much more user friendly – but the commentary. (A bit more on that below.)

The SST’s story included some comment from an anonymous Voice for Life spokesman who, among other things, claimed that abortion was “incredible [sic] harmful to the woman and a violation to life.” ALRANZ president, Morgan Healey, promptly sent a letter to the editor challenging that claim, which appeared in the SST today:

 Letter to editor SST 12 Jan 2014

ASC Report

In its commentary, (and you can download a pdf of the ASC report here), the ASC addresses some interesting issues (albeit apologetically at times), providing further evidence that often cited anti-choice rhetoric is nothing more than fiction.

1. New abortion services don’t increase the number of abortions.

Abortion services have in recent years been set up in areas where, previously women had to travel considerable distances to access abortion care: Southland (at Invercargill) and the Bay of Plenty (at Tauranga) and Tairawhiti (at Gisborne). The new Southland and Tauranga services in particular were met with the inevitable opposition and scare-mongering from anti-abortion advocates. ALRANZ and others continue to argue that these services change nothing around the legal and administrative hoops people seeking abortions have to jump through, they just ensure the service is a bit closer to home, thereby reducing stress and making life for women just that little bit easier.

The ASC report backs that up by stating:

Another concern raised is that the establishment of new licensed institutions, especially in smaller centres, may result in an increase in abortion numbers for women within these regions. Two relevant examples can address this. In both the Tairawhiti and Southland regions, where new local licences were issued in recent years, the number of terminations carried out in 2012 was significantly fewer than the number carried out in 2011, not greater.

The data show the current declining number of abortions extends nationwide. We have seen no evidence that increasing the number of licensed clinics is likely to increase the number of abortions.

2. Sex Selective Abortion: Trying to whip up a controversy

Anti-abortion advocates in the UK have had some success whipping up a furore over sex selective abortion, and it seems they’ve tried to do the same here – so far, with no success. Here’s what the ASC report has to say:

In the past we have received correspondence from writers expressing concern about the possibility of sex selection abortion in New Zealand and, to that end we have discussed this with certifying consultants. The feedback received supports our view that requests for abortion on the grounds of sex, which is illegal, is not an issue in New Zealand.

In 2012, 92% of induced abortions were carried out in the first trimester of pregnancy (up to and including 12 weeks gestation). The sex of the foetus is rarely known by the 12th week of pregnancy and therefore cannot be a reason for termination in these cases.

3. Harassment

This happens everywhere. Many people are often surprised to learn how ubiquitous this is in Aotearoa NZ, and how many women seeking abortion care have to run the gauntlet of anti-choice protesters. We’ll be interested to see what “support and preventative measures” the ASC comes up with. Here’s what they have to say:

Harassment of those seeking or providing abortion services remains a significant concern to the Committee, especially as disturbing reports of violence at overseas abortion clinics continue to surface.

We have continued to work proactively with the Police in response to reports of protests near licensed institutions and harassment of abortion clinic staff, other hospital staff and patients. While we recognise the right to peaceful protest, we will take all practicable steps to address any perceived harassment, either separate from or as part of any protest activity.

In addition to ensuring that services are not affected as a result of harassment, the safety and autonomy of medical staff and patients is paramount. Our aim is to ease the concern and vulnerability of staff around the country and we are considering what support and preventative measures can be put in place to prevent further harassment.

Update: Just your regular harassment and abortion shaming, for example, at Epsom Day on 15 January 2014:

1513692_712216615478692_2047408060_n

 

There’s lots of other interesting commentary and info in the report, so have a read. Here’s that link again.

ENDS

Voice for Life loses appeal

27 Dec

Just a quickie post with a couple of items of news in the holiday season.

1. Voice for Life Bay of Plenty lost its appeal to the Advertising Standards Authority. VfL had appealed an October decision by the ASA that upheld a complaint by ALRANZ over full-page ads that ran in local BOP papers. Here are some links for background:

(i). to a summary of the latest ruling dismissing VfL’s appeal

(ii). to our media release in October in response to the initial successful complaint

(iii). to the original decision in October by the ASA upholding our complaint

2. The Abortion Supervisory Committee’s annual report was tabled in Parliament on 13 December and you can download a copy (PDF) by clicking here. The commentary makes for some interesting reading.

To all our supporters, a happy holiday season and 2014! Be safe! Enjoy!

P.S. Update: Our latest newsletter, November 2013, is up at our Web site.

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