The case against Kermit Gosnell in the state of Pennsylvania, USA is an important reminder that restrictive abortion laws open the door for people to prey on desperate women and lead to medical negligence. On Monday, Gosnell was found guilty of three counts of first-degree murder and one count of manslaughter in relation to his illegal abortion clinic. What has come to light, both in the grand jury report in 2011 and media reports of the trial, is how Gosnell took advantage of Pennsylvania’s lax monitoring of abortion clinics to operate outside the confines of the law and safe medical practice to perform abortions on some of the most oppressed and desperate women.

The majority of his clients were women of colour and those from lower socio-economic backgrounds unable to afford an abortion at a safe, registered clinic. This highlights the racial and class element to the politics of abortion, which all to often means that the most marginalized in society are those most at risk of unsafe abortions when access and availability is restricted.

Echoing the sentiments of Ilsye G. Hogue, president NARAL Pro-Choice America, ALRANZ believes justice was served by the jury’s verdict against Gosnell. However, this should not be all that comes out of the Gosnell case. In a powerful statement, Hogue said:

“From the lack of funding available for low-income women to access abortion services, to the sharp decline of reputable providers in Pennsylvania, to the gross negligence of authorities to enforce the law after complaints were filed against Gosnell, each aspect of this case must be a teachable moment for lawmakers: until we reject the politicization of women’s medical care and leave these decisions where they belong—between a woman and her family and her doctor—women will never be safe. The horrifying story of Kermit Gosnell is a peek into the world before Roe v. Wade made legal a woman’s right to make her own choices”.

Countering the stories told by the anti-choice contingent, further restrictions on abortion will not lead to fewer Gosnell cases, but more. Looking to our own abortion laws in New Zealand and the continued criminalization of women, it is a stark reminder that safe and legal abortion cannot be assured until it is a choice made freely by the pregnant person with free and easy access to all reproductive health services.

For more information and  analysis on the Gosnell case, see:

Ilyse Hogue of NARAL Pro-choice America’s full statement.

RH Reality Check:

“A Gosnell Amendment: Jennifer Rubin Plays Doctor and Legislator, and Fails” by Jodi Jacobson.

“Gosnell Found Guilty on Three First-Degree Murder Charges” by Jennifer Mason Pieklo.

“Separating Truth From Lies Around the Kermit Gosnell Case” by Amanda Marcotte 

Salon: “Megan McCardle Doesn’t Understand the Kermit Gosnell Case” by Tara Murtha

Any of the stuff you see on the table – which includes historic WONAAC and ALRANZ posters – can be had, some free, some for a donation. Visit the Highway site for order details. Thanks WSANZ and to the conference participants who stopped by to chat or support the reproductive rights cause.

Morgan Healey and Alison McCulloch of ALRANZ at WSANZ. (Credit/copyright: WSANZ/Éva Kaprinay)

Stall items, WSANZ (Credit/copyright: WSANZ/Éva Kaprinay)

A couple of the historic posters available. (Credit/copyright: WSANZ/Éva Kaprinay)

Juliette from VicBooks and Fergus Barrowman of Victoria University Press (length: 2.57)

Di Cleary, activist in the Women’s National Abortion Action Campaign (length: 8:33)

Dame Margaret Sparrow, longtime reproductive rights advocate, physician, author and former president of ALRANZ. (length: 8:14)

Alison McCulloch, author of “Fighting to Choose”: (length: 9:17)

I have been keeping up to date on progress toward abortion legislation and I feel I must warn you that creating overly complex and systemic medical ‘safe guards’ to ensure that pregnant people do not ‘abuse’ suicidal ideation¹ to access abortion will likely be unworkable, onerous (not only for the medical staff charged with this duty, but the poor woman forced to defend herself before a panel of 6, 12, who knows?) and is inhumane. I suggest you consider the New Zealand experience and the barriers we have erected to women being able to access a necessary reproductive health service (mainly because I assume you care more for the lives of women like Savita and the 4000 or so pregnant people who have to travel every year, than appeasing a virulent and well-funded anti-choice movement).

I want to be clear that when I discuss the barriers of the certifying consultant process² in New Zealand, I am not attacking the doctors and medical professionals who are forced to follow a broken system. Far from it, these are the people who have taken a bad law and ensured, to the best of their ability, that women are able to access an abortion when they need one.

Instead it is often politicians who let themselves off the hook by devolving responsibility to these medical professionals, asserting that medical judgment, which are assumed to be based solely on scientific principles of rationality and fact, are better placed to make decisions about women’s bodies than women. However, this is only happens after said politicians enact legislation that is aimed at the ‘middle ground’ (read not rocking the boat). Here is what happens when political appeasement is the goal.

In 1977, when the Contraception, Sterilisation and Abortion (CS&A) Act set out a process of two certifying consultants signing off on all abortions based on the limited grounds as outlined in the Crimes Act (1961), it was passed in a political context of conservative white men politicians, many of whom had close connections with the anti-choice movement.  The Royal Commission, with a mandate to investigate abortion in New Zealand and provide recommendations to the then Government, was similarly influenced by the anti-choice lobby, with its deep pockets and connections to key, sympathetic politicians. Alison McCulloch’s new book, “Fighting to Choose” (sorry folks, you’ll have to wait until 1 May for it to reach the book shelves, but see here for more info), highlights how medical evidence and pro-choice advocates were sidelined by the Commission. The latter, when they were given space to express their views, were subject to hours of interrogation and framed as radicals, out of touch with the majority of New Zealanders’ views.

The recommendations that eventuated were convoluted and reflect the skewed anti-choice ‘evidence’ that was considered by the Commission. As McCulloch points out, the Commission’s report certainly was not framed around the best interest of the pregnant persons involved. Thus, the law as it stands states that a woman must be approved by two certifying consultants, who assess her claim against the Crimes Act, before an abortion can be performed. The woman usually presents to her GP, who then refers her on down the chain of command. Often this entails multiple appointments [first to the GP, then sometimes to a radiographer if a sonogram is required, then to a clinic where the first certifying consultant assess the women, along with a counselor and then to the final certifying consultant, who is usually the operating surgeon], travel, and time. This process is not short on barriers and often waiting times from first appointment to the termination is 2-3 weeks – a long time when best medical evidence shows the earlier the termination the better (usually before 8-9 weeks gestation).

Law and practice have a tendency to drift apart when the rubber hits the road. While the intention of the CS&A was to limit abortions, force women to ‘prove’ their right for an abortion and provide sufficient ‘medical safe guards’, only the latter two have really eventuated. Why? Well, many certifying consultants have chosen to define ‘health’ in a holistic manner, with 98% (as of the 2011 Abortion Supervisory Committee annual report) being performed under the ground of mental health. The anti-choice element in New Zealand call this a de facto regime of ‘abortion on demand”. I call it a sound argument for law reform as no woman should have to claim issues of mental health for accessing a necessary medical service.

Abortion in New Zealand is an incredibly safe procedure and the medical statistics over the last 30 odd years highlight that no woman has died from an abortion. In that respect, good safe guards do exist and work. However, barriers to abortion remain and it is not an easy or straightforward process to obtain one. It is certainly not one in which women are allowed the freedom to exercise their right to bodily autonomy.

I tell you the story of abortion in New Zealand because I see Ireland falling into similar pitfalls. While not having access to the actual proposed bill (and basing my comments on media reports about what is proposed), what I envision will happen is this law will create a two tier system – those that will be sympathetic and take a ‘holistic’ approach to allowing for abortion under the heading of suicidal ideation and those that will not. Instead the latter will use their medical authority to deny women an abortion or worse they will their powers to section women and force them to carry the pregnancy to term.  This will likely create questions of fairness and consistency across Ireland, with women (I imagine) copping quickly to those doctors who will be kind and provide them with access. Or women will be too terrified to go before these panels and continue to travel overseas.

This assumes two key elements that will make the law workable; one that the psychiatric profession changes its mind and support the law. At the moment, this body of professionals does not want to be the scapegoats for what they see as a bad law. If these medical professionals are unwilling to take part and the Government steams ahead with setting out that a psychiatrist must be part of the panel(s), this will mean that no woman will be able to claim their right under the law. If this is the case, the Government will likely have to return sooner rather than later to the legal settings for an abortion, either because another woman has died or injured herself or brought a case against the state.

The second part will revolve around the autonomy of the abortion panel’s decisions. What we have learned in New Zealand is that because the decisions of certifying consultants have not been scrutinised or open to debate, medical professionals are able to make their decisions freely. Here this has usually meant greater access because doctors are not looking over their shoulders wondering if their decision will be questioned. However, how this might play out in Ireland could be concerning: either it could be used to ensure doctors are free to make sounds and empathetic decisions or it could be open to abuse by anti-choice doctors who seek to force the woman to carry the pregnancy to term.

Luckily there is away around all of this. Scrap the idea of abortion panels and setting a legal framework that insists women need ‘safe guards’ against themselves. I have another novel idea: how about instead of turning psychiatrists into ‘social police’ and putting the accountability for law reform on medical professionals you do something radical – trust women to make these decision for themselves.

Yours Sincerely,

Dr Morgan Healey

National President, ALRANZ

For further information on what is happening in Ireland, check out the following:

http://www.rte.ie/news/2013/0424/385417-psychiatrists-will-not-take-part-in-abortion-panel/

http://www.irishtimes.com/news/social-affairs/rotunda-master-says-abortion-plan-is-totally-impractical-1.1371122

http://www.thejournal.ie/abortion-ireland-legislation-doctors-883438-Apr2013/?utm_source=twitter_self

http://www.abortionrightscampaign.ie

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The pro-choice organisation ALRANZ today called for increased vigilance by the authorities in the wake of an attack on an Auckland abortion clinic worker’s car.

Television New Zealand last night revealed that a nurse had called the police after she got into her car on March 13 and found it would not run. An examination of the car concluded that the fuel line had been cut.

“Abortion care providers are valued and supported in their communities,” ALRANZ spokeswoman Annabel Henderson Morrell said today. “It is outrageous and disappointing that some in the anti-choice community in New Zealand resort to intimidation and threats.”

The most recent attack follows a threat late last year directed toward ALRANZ and the new abortion service in Invercargill. The police investigated, but those behind the threat were never identified.

Ms. Henderson Morrell said abortion care providers and patients have the right to both be safe and to feel safe.

“It’s stressful enough for abortion patients, who have to jump through hoops to access abortion care because of our antiquated laws, without their having to fear physical harm from abortion opponents,” she said.

ALRANZ appreciates most anti-choice groups make clear they oppose this kind of behaviour. “We hope they will do their utmost within their own community to ensure New Zealand does not return to the bad old days of threats, attacks and physical intimidation,” she said.

There’s been a lot said about this issue, if your fingers want to do some googling, but there is a very interesting series of posts (titled “Some thoughts on pre-natal screening and disability”) from Otago prof Colin Gavaghan, the director of the New Zealand Law Foundation Centre for Law and Policy in Emerging Technologies. Among other things, in his third post of three, (here are one and two) Gavaghan makes the link between this issue and our current law in a way that a lot of people don’t. (On the Q and A show, for instance, while all three panelists who discussed the issue seemed to support something like a “right to choose” position on abortion, no-one pointed out that’s not what our law allows.)

We’ve had a few posts about this issue before on the site, including (from 10 December 2011) Choice and ante-natal screening and a guest post that touches on the issue titled (13 December 2011) Abortion as Society’s Mirror by Alison McCulloch.

The issue of over-the-counter (OTC) contraceptive pills came up early in February after an article in the Sunday Star Times. As reporter Marika Hill wrote: “Thousands of women face the costly chore of visiting their GP for a pill generally considered safe by health professionals. Pharmacists already provide the morning-after-pill without prescription, leading some women to ask why this could not be extended to the oral contraceptive pill.” The article went on to quote Family Planning, whose national medical adviser, Dr. Christine Roke, preferred “some degree of consultation” such as a pharmacist or nurse.

The article also quoted ALRANZ president, Morgan Healey, who said she wholeheartedly agreed with having the pill available over the counter. “Most women don’t necessarily need to go to their doctor on a six-monthly or yearly basis,” she said. “It’s expensive and it creates barriers to access.” Surprisingly, the article also said this: “Even conservative lobby group Family First does not object to the idea, though it said a line should be drawn, barring teenagers from being granted easier access to birth control.” We wonder if some of FF’s more conservative Catholic supporters agree?

Last November, the American College of Obstetricians and Gynecologists (ACOG) issued a statement recommending the oral contraceptives be made available OTC to improve access to contraception.

One concern is that women will forgo preventive services if they have OTC access, but the authors of a new survey of pill availability in 147 countries pointed out that screening for things like cervical cancer or sexually transmitted infections was not a requirement for oral contraceptives anyway, and shouldn’t be a barrier for access.

In its new policy statement supporting OTC availability, ACOG said women could use a checklist to self-screen for any contraindications.

The group that undertook the survey, Ibis Reproductive Health, based in Oakland, Calif., reported that a prescription for birth control pills is needed in only 45 out of the 147 countries it surveyed. Those 45 include New Zealand, the United States, Australia and Japan. “In mapping the results, notable regional patterns in OC [oral contraceptives] prescription requirements emerged,” the authors wrote. “The United States, Canada and most of Western Europe require a prescription, while OCs are available OTC informally in much of Central and South America and legally in much of Southern Asia. Prescription and screening requirements in Africa are more varied.”

Quoted in a report in the New York Daily News, one of the authors of the study, Dr. Daniel Grossman, said, “Perhaps in places like China and India that have pills available over-the-counter formally without a prescription might be consistent with strong national family planning programs”. The same article quoted another researcher who suggested the lack of a prescription requirement might also reflect “a general approach to making health care more accessible in countries where it is less available”.

The debate over OTC contraception follows last year’s discussion around a National Council of Women remit calling for free contraception for all women. (ALRANZ would extend that to everyone!) That issue was covered in the lead article in our (PDF) November 2012 Newsletter.

Reprinted from ALRANZ’s February 2013 Newsletter. Want to get the Newsletter hot off the press? How about joining us. Click here. We’ll be posting the full newsletter online soon. 

The Law

Seble  Cherie’s Statement

What’s Next

Isabel Stanton died on Monday 18 February in Auckland. Isabel was an early member of ALRANZ, and its inaugural president for four years from 1971 till 1975.

Isabel Stanton, from a 30 August 1973 profile in Thursday magazine.

Isabel Macky was born in Dannevirke and went to Teachers Training College when she was 17. She worked as a teacher from 1944 to 1946. In 1948 she married Allenby Stanton, a lawyer. Allenby’s father became a Supreme Court judge and one of his sisters was Alice Bush, a physician, advocate for family planning and early member of the Family Planning Association. Isabel and Allenby had five children. Allenby died in 2003.

In an interview for Margaret Sparrow’s book Abortion Then and Now: New Zealand Abortion Stories From 1940 to 1980, Isabel said her interest in the issue of contraception and abortion came from her background as a social worker and marriage guidance counsellor. “I was concerned for the need for children to be born to mothers who wanted them,” she said.

According to a profile in 1973 published in Thursday magazine, Isabel’s initial involvement in ALRANZ was accidental. She was a member of the Family Planning Association, and was asked to speak about contraception to the steering committee setting up ALRANZ. “I was impressed with the tremendous sincerity and honesty of the group,” she told Thursday.

Isabel and others involved in pressing for abortion law reform in New Zealand in the 1970s were speaking out at a time when few did so. Back then, ALRANZ charted a more moderate route, while feminist activist groups like WONAAC (the Women’s National Abortion Action Campaign) pressed for more radical goals. To that end, Isabel was seen as a perfect fit for ALRANZ, lauded for being, as Thursday put it, “faultlessly respectable”. She was a married woman, a mother and an elder in the Presbyterian church. As she herself told Thursday, “They wanted a president who was a woman, who had children and who could speak…and who would look decent on television. Little did they know how little coverage they would get.”

In her first year as president, Isabel spoke about once a week on behalf of ALRANZ. “I was speaking about abortion at public meetings, to politicians, to journalists, to professional groups, and on television,” she said in Abortion Then and Now. “When I spoke to men’s service organisations such as Rotary clubs, I don’t know how many times I was told, ‘That was a very good speech for a woman.’”

In 1973, when the Thursday article was published, Isabel reported that she was getting around one call a day from women seeking abortions. At that time, legal abortion was extremely difficult to obtain in New Zealand, and Isabel told Thursday she would simply tell the woman about the law, and pass along information about Australian providers. It was all she – and ALRANZ – could legally do.

Dr. Rex Hunton, the medical director of the AMAC clinic, and Isabel Stanton, outside the clinic in December 1977 after it was forced to close because of the new abortion law.

Isabel was also involved in the pioneering AMAC abortion clinic in Auckland, which was set up in 1974 and helped spark a national debate that led to the Royal Commission on Contraception, Sterilisation and Abortion, then to the current abortion laws. Her involvement with AMAC was as a counsellor, trainer and supervisor, as well as helping the Board of Trustees. When the 1977 law forced the AMAC clinic to close (see photo) in December 1977, Isabel joined with those who helped women travel to Australia for abortions. Later, she became the counselling adviser for the Abortion Supervisory Committee.

The Thursday article included this telling anecdote: “[Stanton] remembers one occasion when she addressed a church organisation and the minister stood out against her. There were many older women present – who had lived through the Depression days when women died having illegal abortions because they could not afford to feed another mouth. ‘Afterwards all the women came up to me and shook my hand in sympathy and wished me luck,’ she said.”

ALRANZ would like to express its greatest sympathies to Isabel’s family and friends. We are honoured to continue her work, and the work and so many like her who fought so hard for so long, often in the face of considerable hostility, for the right of all women and men to chart their own reproductive destinies.

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There are a whole bunch of posts under the From Our Files category.