ALRANZ ABORTION LAW REFORM ASSOCIATION OF NEW ZEALAND

National President: Dame Margaret Sparrow                                   

ALRANZ NEWS

Subscriptions. It’s that time of the year again. If you would like to join ALRANZ please see the Membership page.

OBITUARY

Joyce Megget aged 95 years died in Wellington on 4 November 2009 just as the November newsletter was going to print. Joyce and her husband Ron, who died in 1996, were stalwarts of Family Planning in Wellington. Ron was president and Joyce treasurer of the Wellington Branch of FPA for 17 years. They were both committed to ALRANZ. In a memorable interview on the Holme’s Show in September 1996, celebrating the 60th anniversary of Family Planning, Joyce, at 82 years of age, and her sister-in-law, Betty Weeber, spoke about what motivated them to support family planning. Joyce, recently widowed, recalled how her grandmother had died of a septic abortion when Joyce’s mother was eight years old and how that little girl when she grew up had a number of unplanned pregnancies and was fortunate to survive the eight dangerous self-abortions she carried out using a crotchet hook. No surprise then that Joyce wanted to ensure that her daughter (and women of her generation) did not have to resort to such crude methods.

ABORTION SUPERVISORY COMMITTEE ANNUAL REPORT

The ‘new look’ annual report for the year ended June 2009 has more graphs supplementing the tables and some new information especially on where women reside and delays within the system for first trimester abortions. Key points made by the ASC are:

* The number of abortions performed in 2008 decreased to 17,940, down from 18,382 in 2007.

* The abortion ratio (number of abortions per 1,000 known pregnancies) has continued to decrease, down from 247 abortions per 1,000 known pregnancies in 2003 to 217 in 2008.

* The general abortion rate (number of abortions per 1,000 women aged 15-44 years) continues to be high in comparison with other countries such as the UK, USA and Australia.

* Lack of access to abortion services before nine weeks gestation in some areas is of concern to the ASC, as well as the limited availability of medical abortion in many parts of the country. ALRANZ put out a press release on access issues.

* The ASC would like to see more focus and research from district health boards on the use of contraception, as 53% of women having abortions in 2008 were not using any contraception.

* The ASC would like to see the funding of long-acting contraceptives revisited. ALRANZ agrees.

* The ASC has ongoing concerns about the lack of secure provision of second trimester services across the country. ALRANZ agrees.

The Right To Life v. ASC case which has been winding its way through various court hearings since March 2005 will now be heard in the Appeal Court Wellington on 4-5 May 2010.

NEW EMERGENCY CONTRACEPTIVE

A recent paper in the Lancet reports on a trial of a new emergency contraceptive which is more effective than the current regimen and can be given for 5 days after unprotected intercourse as opposed to 3 days. The new drug called ellaOne is manufactured by HRA Pharma and was approved for marketing in Europe in May 2009. The active compound is ulipristal acetate which delays ovulation.

CONFERENCE REPORT

By Margaret Sparrow who was the only one from New Zealand to attend the first International Congress on Women’s Health and Unsafe abortion, held from 20-23 January 2010 at the Imperial Queen’s Park hotel, Bangkok, Thailand.

I attended a pre-conference workshop on Values Clarification facilitated by Jon O’Brien, President of Catholics for Choice and Ann Furedi, Chief Executive of the British Pregnancy Advisory Service. Values clarification does not tell you what your values should be but provides the means to explore what your values are especially when there are conflicting values. For further information see www.CatholicsForChoice.org or www.ipas.org/publications

The conference was officially opened by the Thailand Prime Minister, Abhisit Vejjajiva, aged 45, with Thai parents but born in the UK and educated at Eton and Oxford. His attendance attracted a large number of local media reporters and it would have been very satisfying for the organisers to hear him speak on the need for his government to improve reproductive health services and reduce the incidence of unsafe abortion. The Thailand Ministry of Health was closely involved in the organisation of the conference especially through the efforts of Ms Nongluk Boonthai of the Reproductive Health Division who was Secretary General for the organising committee. The chair of the organising committee was Professor Kamheang (Kam for short) Chaturachinda. There were no protests at any stage and in the lobby of the Queen’s Park Hotel there was a prominent sign with the word abortion for all to see.

On Thursday, Friday and Saturday mornings at plenary sessions we heard keynote addresses from international experts including Rebecca Cook and Bernard Dickens (University of Toronto Law Faculty), Professor Philip Darney (San Francisco), Professor Kristina Gemzell (Sweden), Dr Christian Fiala (Vienna),  Professor Malcolm Potts (formerly UK, now USA), Professor Dorothy Shaw (Canada), and Dr Helena von Hertzen (Geneva). At a conference on unsafe abortion a preponderance of speakers on health issues might have been expected but there was an equal emphasis on human rights issues. Another topic which received attention was the education of health professionals.

Professor Mahmood Fathalla from Egypt came out of retirement to give the Allan Rosenfield Oration entitled A world where no woman is denied access to her right to health and life. He submitted ten propositions including a warning to beware of the dangerous human genetic mutation Homo dogmaticus, mainly affecting men, with men in robes being highly susceptible. When discussing maternal mortality, and with his Thai hosts in mind, he reminded us that circa 560BC Queen Mahamaya died a few days after giving birth to the holy Gautama Buddha.

Professor Allan Rosenfield, Dean of the Mailman School of Public Health at Columbia University, spent six years in Thailand as Medical Advisor for Family Planning and Maternal and Child Health at the Thailand Ministry of Public Health. He was on the organising committee for the conference but died on 12 October 2009 from amyotrophic lateral sclerosis, the illness which had forced his retirement in May 2008.

Khun Mechai Viravaidya (Thailand) also paid a tribute to Allan Rosenfield who had helped him in the early 1970s to introduce his community based distribution programme of condoms and contraceptive pills for rural Thai villagers. Mechai, an economist, not a health professional, has always had a very high profile for his innovative work serving Thailand’s rural poor and spear heading the AIDS campaign in Thailand. He is now an elected Senator and his organisation PDA (Population and Community Development Association) is committed to a wide range of development projects.

In the afternoons we broke up into three conjoint sessions, and I contributed in the session on Abortion in Asia and Pacific. The other speakers were Dr Suzanne Belton from the University of Darwin, a social anthropologist who had been working with refugee women on the Thailand/Burma border and Dr S P Choong from Malaysia, a pioneer of safe abortion services in that country who is a strong advocate for MVA (manual vacuum aspiration with a syringe & cannula).

Dr Beverly Winikoff (Gynuity, USA) chaired the session on making medical abortion more accessible in countries such as Bangladesh, India and Vietnam. She also spoke at one of the plenary sessions on the possible future of medical abortion with a vision of it being much less medicalised.

I found the talk by Dr Mette Lokeland, a young doctor from Haukeland University Hospital, Bergen, Norway very interesting as Norway has a population not much bigger than New Zealand (4.8 million). Norway has abortion on request, completely free of charge and easily accessible at every gynaecology ward up to 12 weeks gestation. They have used mifepristone/misoprostol for medical abortions since 1998 and home misoprostol use was introduced in 2006 for terminations up to nine weeks. Since 1998 the percentage of all abortions performed medically has increased every year and preliminary figures for 2008 are 55.9% for all abortions and 73% for those <9 weeks. There has been a gradual transition from surgery to medication. It is unlikely that we will see this pattern in New Zealand without a change in the law which currently precludes home administration.

Dr Peter Hall, previously at WHO for 25 years and now CEO for Concept Foundation in Bangkok, spoke on making mifepristone and misoprostol more readily available for medical abortion. Concept Foundation, a not-for-profit organisation has introduced Medabon, a low cost combination pack of the two drugs, which has now been approved for use in Nepal and Cambodia and Zambia, the latter only recently. The aim of Concept Foundation is to provide essential health care products at an affordable price to low income countries where the needs are most acute.

Speakers from China are not always heard at international medical conferences so it was a pleasure to hear Dr Linan Cheng speak about her extensive experience with medical abortion in China using a quite different regimen to that used in the west. There are three manufacturers of mifepristone in China.

Martha Campbell, spoke on the web of resistance and the many barriers to safe abortion. She gave historical examples from throughout the world e.g. something as simple as vacuum aspiration had to be ‘discovered’ on three independent occasions before it became standard practice.

Dr Rebecca Gomperts from the Netherlands, well known as the activist founder of Women on Waves, spoke on a new direction through Women on Web whereby medical abortion is provided through telemedicine to women living in countries where there are no safe abortion services. Women with pregnancies <9 weeks gestation are sent medication by mail if screening does not reveal any contraindications. Five weeks later a follow-up form is emailed. In the survey period February 2007 to January 2008 medication was provided to 2338 women and the outcome was known for 64%. The curettage rate was low in Western Europe, the Middle East, Africa, and Asia, higher in Poland, South and Middle America. She was keen to expand the service to more women in South East Asia.

Associate Professor Andrea Whittaker from the University of Queensland has a PhD in Tropical Health (Medical Anthropology). She researched gender issues among Thai women and spoke on the history of advocacy and reform in Thailand where abortion has always been viewed negatively as a Buddhist demerit or sin. The Penal Code of 1908 prohibited abortion under any circumstance and remained until 1957 when the current law came into effect. Abortion could be carried out on the ground of health but most doctors did not give this a liberal interpretation and their fears were reinforced by police prosecutions. Amendments to the medical regulations were made in 2006 and it is now possible for women to obtain legal abortions in the case of rape, fetal impairment or for maternal health reasons. However it is difficult to change the entrenched attitudes and for most Thai women it is not easy to obtain a safe abortion.

At noon on Saturday everyone assembled to pass the Declaration of Bangkok which had been drafted by the organisers. This document recognised unsafe abortion as both a public health problem and a women’s rights issue and called for a world wide effort to reduce the incidence of unsafe abortions. It was unanimously approved by the participants from some 62 countries.  Another conference will be held in two years.

After the conference we were privileged to be invited by Mechai to visit his abortion clinic situated above his famous restaurant Cabbages and Condoms. Security is tight.  Patients are given a number at reception and no names are used. The clinic has been raided by police but there have been no prosecutions.  Although costs are kept to a minimum the surroundings are pleasant, in keeping with the aim of the clinic to remove the stigma so often attached to abortion.

There is a sliding scale of fees depending on ability to pay with the usual fee about US$40. No-one is turned away. The first station is an ultrasound examination and if the pregnancy is confirmed within 12 weeks gestation the woman proceeds to counselling and MVA. Medical abortion is not yet an option. The clinic employs six doctors and does 200 cases per day. The recovery area comprises over 30 individual cubicles each with a simple bed and bedside lamp. Uncomplicated cases are expected to be in the clinic for about 20-30 minutes after the MVA. I purchased Mechai’s biography From Condoms to Cabbages. It was an inspiring read on the plane journey home.

ATTACKS ON FAMILY PLANNING

Opposition to Family Planning’s application to the ASC for a licence to initiate an early medical abortion service in their Hamilton clinic has intensified. There has been a media and internet campaign, a petition, street marches, even a call for Telecom not to give any more grants to Family Planning. The protests have not attracted many people and the mainstream media have largely ignored the campaign. ALRANZ would like to see a decision made in favour of Family Planning’s proposal as soon as possible. Women in the Waikato need improved access to early medical abortion.

OVERSEAS NEWS

Ireland

In a damning report issued in January 2010, Human Rights Watch (HWR) has condemned the Irish government for violating the human rights of Irish women by actively restricting their access to abortion services and information. The HRW report not only highlights Ireland’s harsh abortion laws – which subjects women who pursue abortions in Ireland and those who help them to the possibility of “penal servitude for life” – but the government’s “sabotage” of women dealing with crisis pregnancies.

For example, although abortion is permitted when the woman’s life is in danger, HRW “was unable to document a single case where an abortion had been legally performed in Ireland”. This is in part because the government refuses to issue legal guidelines, leaving physicians unwilling to perform any abortions for fear of prosecution. (Guidelines were finally issued in Northern Ireland in 2009, where similar restrictions apply, but were successfully challenged in court by SPUC and recalled.)

The Irish government also comes under fire for its efforts to prevent women from traveling abroad for abortions, even though this right was guaranteed under a 1992 constitutional amendment. HRW reports that as recently as 2007, a 17-year-old had to go to court to get permission to travel to the UK for an abortion. The Irish state also fails the “most basic due diligence standards” by not collecting data on numbers of legal and illegal abortions or on women seeking abortions abroad. The data that are available come from clinics in the UK, and most observers agree are likely to underestimate the numbers of women going abroad for abortions (around 6,000 a year to the UK alone).

Ireland’s information laws are also harshly criticised. Under those laws, HRW reports, “it is unlawful, and an offence subject to summary conviction, to give information in any way which would be deemed to ‘encourage or advocate an abortion in individual circumstances.’” These laws are not aimed at protecting women’s right to information, HRW notes, but according to official guidelines on the Act, “to limit circumstances in which women seek to have abortions”. The state’s refusal to crack down on rogue crisis pregnancy counseling agencies is also highlighted.

HRW argues that the availability of safe abortion in neighboring EU countries “has played a significant role in allowing the Irish government to abdicate its responsibility to protect the human rights of women who require access to abortion”.

As well as clearly outlining the current situation in Ireland and charting each and every human right (and treaty) violated by that state of affairs, the HRW report includes the voices of women on the front-line of the struggle – women who found themselves at the mercy of rogue counseling agencies, women trying to get information about their own pregnancies, women whose fetuses were not going to survive and who had to seek abortion overseas, poor women and refugee women, including one who had to borrow a passport in order to travel for an abortion.

As the report notes, the discourse surrounding abortion in Ireland is condemnatory. The women and doctors quoted by HRW wouldn’t give their names, and government officials refused to be interviewed for the report.

In fine local fashion, a week after the report was issued, the bookmakers Paddy Power opened a book on when an abortion referendum might take place. “The bookie’s odds suggest no referendum is imminent with 2015 or later the odds on 2/5 favourite.”  You might not be able to actually get an abortion in Ireland, but you can place a bet on when that might change.

The HRW report is available for download at:

http://www.hrw.org/en/reports/2010/01/28/state-isolation-0

U.S.A.

The anti-abortionist, Scott Roeder, 51, who murdered Dr George Tiller in his church last May was convicted of premeditated, first degree murder by a jury in Wichita, Kansas on 29 January. The jury took only 37 minutes to reach its decision. The accused will be sentenced on 9 March and faces a term of life imprisonment. The defence argued that the charge be reduced to one of voluntary manslaughter as Roeder believed his killing was justified to save the lives of the unborn. The judge directed the jury that this was not an option but the defence has stated it will appeal the ruling.

President Obama is having great difficulty getting his health insurance reforms accepted in Bills before the House and Senate. Early in the debate abortion politics almost sabotaged the reforms with Obama having to compromise by declaring that no federal dollars will be used to fund abortions. Even that has not satisfied opponents.

 A study published in the Archives of Pediatric and Adolescent Medicine compared an abstinence-only programme with three other health programmes and found that, after two years, sexual activity was less in the abstinence-only group. The researchers carried out their study on 662 young teens (11-13 years) from black schools and cautioned that the results might be different for older teens. Their programme was very different to some others with that label. There were no moral overtones, condoms were not disparaged and the message was to wait until you are ready rather than wait until marriage.

Haiti

The William & Flora Hewlett Foundation has provided and emergency grant of $500,000 to IPPF to provide reproductive and basic health services to women in need following the earthquake. IPPF will be working with local Family Planning groups to restore contraceptive services. Unplanned pregnancies (and the need for abortion) are a known consequence of disrupted lives.

Italy

The abortion pill mifepristone has finally been approved for use in hospitals for medical abortion despite protests from the Vatican and some MPs. The Vatican has warned that excommunication is a possibility for those doctors and women who use the abortion pill. Italian law permits abortion on request in the first 12 weeks of pregnancy.

Finland

All women in Finland undergoing induced abortion from 2000-2006 with a gestation of 9 weeks or less were followed up for six weeks to determine the frequency of adverse events. Medical abortion was chosen by 52% and this group had more adverse events than those having surgery. However the study published in Obstetrics & Gynaecology concluded that both methods are generally safe.

UK

Professor Wendy Savage has been shortlisted by the BMJ Group as one of their ten lifetime achievement awards. Voting is open until 27 February. Wendy received the nomination for making a unique and substantial difference in Obstetrics & Gynaecology. From 1973-76 Wendy was a specialist at Cook Hospital, Gisborne and pioneered an abortion service for that area. The recognition is well deserved.

Fiji

The Fiji Times reported on 8 December that a 35 year old mother of five haemorrhaged and died following an alleged botched abortion, before she could receive hospital treatment. Last September the NZ Parliamentarians Group on Population and Development held an open meeting on maternal health in the Pacific and the report Making Maternal Health Matter will be launched on 23 February. Although ALRANZ made a submission on the topic, abortion was not discussed at the meeting which is disappointing in the light of this tragedy.