ALRANZ is grateful for the number of members who have already renewed their subscription for the year and thanks those who have made a donation in addition to the subscription. Thanks also to those who have requested email copies of this newsletter which will save the Association in postage costs.

              ALRANZ farewelled past Treasurer Jan Riach at an evening get together on 15 April. Jan is leaving to be near her family in Australia and we wish her well. She was thanked for her loyal support of ALRANZ over the years, especially when branches closed and she was left to handle subscriptions from the whole country.

              ALRANZ had a small display at the 5th NZ Abortion Providers Conference held in Auckland on March 28-29 2008. A number of ALRANZ members with affiliations to various abortion providers, attended the conference. Dr Margaret Sparrow addressed the conference on what’s right and what’s wrong with the law we have had for the past 30 years and where we need to go from here.

Conference Report

              The 5th NZ Abortion Providers Conference referred to above was attended by over 200 delegates. The conference was officially opened by the Associate Minister of Health, and Minister of Women’s Affairs, the Hon. Steve Chadwick who expressed a willingness to work with the ASC to improve access and consistent standards of care. She has shown significant leadership in the area of sexual and reproductive health and it is a pity that further progress will be limited because of the impending election.

Professor Peter Stone, Auckland University Professor of Maternal & Fetal Medicine, gave the opening keynote address and raised a number of important issues and challenges. Of particular interest to ALRANZ members, was his support for the decriminalisation of abortion. He considers abortion part of women’s health, not straddled as it is between Health and Justice. Fetal issues are his specialty and he supports fetal abnormality as a ground for abortion after 20 weeks. In the past 30 years there has been a revolution in fetal medicine not only through the widespread availability of ultrasound but better neonatal care and changing patient expectations.

Professor Allan Templeton from Aberdeen spoke on his experience and research with medical abortion. In Aberdeen nearly 70% if women now choose medical in preference to surgical abortion. There has been a gradual increase since the introduction of mifepristone (Mifegyne ® , RU486) into the UK in 1991. Although rates in NZ are currently around 20% it is anticipated that the same upward trend will be observed here as more providers and patients become familiar with the method.

Dr Suzanne Poppema from the USA spoke on the development of national guidelines and standards of care for abortion services. There was general support that such guidelines be adapted for NZ services.

She also spoke on values clarification – how professionals in spite of efforts to be objective have values that influence patient interactions and decision making. She used the examples of late terminations and sex selection which even those of liberal persuasion, find difficulty accepting. Judgmental attitudes were often revealed when women requested abortion in the following situations: for fetal abnormality, after a number of previous abortions, when no contraception has been used, when women are unemotional and not demonstrating enough angst, under the age of consent, and when there was discordance between the woman and her partner on whether an abortion should take place. She suggested that the guiding principles should be autonomy, dignity and beneficence, (or non-maleficence, in other words, “do no harm”). The same principles apply to non-health professionals.

Ethical issues were also addressed in a very thoughtful and thought provoking presentation by Dr Bernie Brenner, a uro-gynaecologist from Auckland, with a special interest in philosophy and ethics.

Professor Linda Holloway, chairperson of the Abortion Supervisory Committee (ASC) appointed June 2007, outlined plans for the better collection of data. She highlighted the inequity of access to services. In her assessment, DHBs are not meeting responsibilities in areas such as Southland and the East Coast and the lack of 2nd trimester services was a concern in many areas. The other members of the ASC, Dr Rosy Fenwicke, and the Mrs Patricia Allan also attended the conference.

Dr Anna Whitehead presented the findings of an FPA audit on delays in the referral system. On average there was a delay of 10 days between first contact and referral to the provider and on average 18 days between referral to the provider and actual termination.

Dr Jade Lodge from Northland presented data that showed in that area over 60% of women wait more than three weeks from contact with GP to actual termination. This is outside the recommended time frame.

Dr Martha Silva outlined a proposal for national research to further investigate delays within the system. The earlier that abortions are carried out, the safer they are, and NZ does not do well in these stakes.

Ann Simmons, midwifery adviser to the ASC spoke about the arbitrary dividing line of 20 weeks gestation. Before that date, gynaecological nursing care recommends one nurse for five or six patients, whereas after 20 weeks obstetric nursing is one on one. There is a lack of recognition of the time and skills required in caring for second trimester termination patients.

Dr Helen Roberts gave an update on contraception. Jadelle, a new implant with two hormone releasing rods is now available in NZ and there is now a one-pill version of the emergency contraceptive pill. Postinor-2 becomes Postinor-1 (aka Levonelle-1). On 6 May 2008 a pilot for free access through Auckland pharmacies was announced.

Jan Gilby a Family Planning nurse from Hamilton spoke on training nurses to insert IUCDs (intrauterine contraceptive devices.) She is a trained inserter and advocates nurses be trained in areas where doctors are not always available, as happens in many other countries.

A Pacific overview was provided by a panel with representatives from Australia, NZ, and various Pacific Islands. Dr Christine Read spoke of the changing political landscape in Australia, where each state has its own laws. Mere Wallace explained that one of the reasons that abortion is such a sensitive issue for Maori is because abortion interferes with whakapapa. The Maori term for abortion is whakatahe which means to flow from the body. Marcella Turia, a counsellor from the Auckland Medical Aid Centre, spoke of her work with women from the Commonwealth Pacific Islands of Niue, Tokelau, and the Cook Islands and noted the significant increase in abortions in this group in the past year. Kerry Waalkens is a Tongan social worker from Middlemore Hospital. She spoke of the veil of secrecy and the power of the church. Heather Clarke from Marie Stopes International spoke of the new service they are providing in Fiji. The law is strict, abortions must be approved by two doctors, and the penalty for performing an illegal abortion is 14 years in jail. Many women resort to massage techniques or various herbals. One of the favourites is “mile a minute” which is a mixture of kava and black tea.

In her summing up at the conclusion of the conference Dr Carol Shand voiced the concerns of the conference when she suggested that action be taken on the development of guidelines for standards of care, along the lines of guidelines already produced in the USA and the UK, with the possible formation of a professional group to oversee this.

              Dame Augusta Wallace was born in Auckland on 11 October 1929 and died on 12 April 2008. She was NZ’s first woman district court judge, appointed in 1975. When the CS&A Act was passed in December 1977, she was appointed the first chairperson of the ASC, her appointment taking effect from 1 January 1978. She was responsible for the onerous task of ensuring that the new procedures would be in place by 1 April 1978. This involved the approval of certifying consultants, the licensing of premises and the approval of counselling services. She found that the time spent on ASC work intruded too much on her court work and she resigned in September 1979 before her term of office had expired. She was responsible for recommending the amendments in July 1978 which made the original legislation workable. She was replaced by Vivienne Boyd (now Dame Vivienne). The other two members of the original committee, Dr Bruce Grieve and Dr Heather Thomson continued for their full term. Dame Augusta will be remembered most, not for her work on the ASC, but for an unprovoked attack on her life by a machete wielding 16-year-old which nearly killed her when she sitting on the bench in the Otahuhu courtroom in 1990. After recovering she returned to court work until her retirement in 1993.

              Dr Earle Wilson, retired of Piha died on 10 June 2007. He graduated from Otago Medical School in 1960 and specialised in obstetrics and gynaecology. His career led him overseas and he was involved in research for the World Health Organisation. When he retired and returned to New Zealand he maintained his interest in medical abortion which had been one of his research interests and spoke on this at the inaugural meeting for NZ Abortion Providers held in Wellington, June 1995. He was a member of ALRANZ.

Position Statement on mental health

              In the UK Report from the House of Commons Science and Technology Committee on the Scientific Developments Relating to the Abortion Act 1967, the committee recommended that in view of the controversy on the risk to mental health of induced abortion, the Royal College of Psychiatrists update their 1994 report on this issue. In that report they stated that there is no evidence of an increased risk of major psychiatric disorder or of long lasting psychological distress following abortion.

              A literature review was undertaken and College members were emailed in February inviting responses. The result was a position statement on women’s mental health in relation to induced abortion which was published on 14 March 2008.

              The new statement reads: “The specific issue of whether or not induced abortion has harmful effects on women’s mental health remains to be fully resolved. The current research evidence base in inconclusive – some studies indicate no evidence of harm, whilst other studies identify a range of mental disorders following abortion.”

              Women with pre-existing psychiatric disorders who continue with their pregnancy, as well as those with psychiatric disorders who undergo abortion, will need appropriate support and care. Liaison between services, and, where relevant, with carers and advocates is advisable.

              Health care professionals who assess or refer women who are requesting an abortion should assess for mental disorder and for risk factors that may be associated with its subsequent development. If a mental disorder or risk factors are identified, there should be a clearly identified care pathway whereby the mental health needs of the woman and her significant others may be met.”

              Right to Life claim that this is a complete reversal of their 1994 position, which is untrue. It merely states that the evidence is inconclusive. Professor Allan Templeton described the position statement as “muddled”. There is no dispute that anyone with a psychiatric disorder should be well cared for but the statement is unhelpful for the majority of healthy women who undergo abortion and suffer no psychological harm.

High Court Trial

              On 7-9 April Mr Justice Miller heard legal arguments from Right to Life New Zealand seeking a review of the functions of the ASC and the status of the unborn child. The ASC was represented by the Crown Law Office. The judge’s decision is reserved. It is difficult to see that any legal remedy is available. Apart from one radio journalist there was no interest from the media or members of the public. Dr Margaret Sparrow who attended for part of the hearing described it as an expensive form of harassment.

Parliament rejects Copeland’s Bill

              On 9 April over the road from the High Court Gordon Copeland of the fledgling Kiwi Party sought the leave of the House to introduce his Abortion (Informed Consent) Amendment Bill. A number of Labour MPs objected and according to parliamentary rules he could not proceed.

Submissions to ACART

              The Advisory Committee on Assisted Reproductive Technology (ACART) has published a summary of the submissions received: Part One – Surrogacy Arrangements involving Providers of Fertility Services and Part Two – Donation of Eggs or Sperm between Certain Family Members. These are available online at www.acart.health.govt.nz

Europe

              From Strasbourg on 18 March 2008: A report from the Committee on Equal Opportunities for Women and Men of the Parliamentary Assembly of the Council of Europe (PACE) called on member states which have not already done so to decriminalise abortion. Abortion on request is, in theory, available in all 47 member states except Andorra, Malta, Ireland, and Poland. The resolution was debated at the Parliamentary Assembly on 16 April 2008 and was passed by 102 to 69 votes with 14 abstentions. It is not legally binding but will nonetheless be influential in other bodies such as the European Court of Human Rights. It is worth repeating in full:

1. The Parliamentary Assembly reaffirms that abortion can in no circumstances be regarded as a family planning method. Abortion must, as far as possible, be avoided. All possible means compatible with women’s rights must be used to reduce the number of both unwanted pregnancies and abortions.

2. In most of the Council of Europe member states the law permits abortion in order to save the woman’s life. Abortion is permitted in the majority of other European countries for a number of reasons including to preserve physical and mental health, rape and incest, fetal impairment, economic and social reasons and in some countries on request. The Assembly is however concerned that in many of these states, numerous conditions are imposed and restrict the effective access to safe, affordable, acceptable and appropriate abortion services. These restrictions have discriminatory effects, since women who are well-informed and possess adequate financial means can often obtain legal and safe abortions more easily.

3. The Assembly also notes that, in member states where abortion is permitted for a number of reasons, conditions are not always such as to guarantee women effective access to this right: the lack of local health care facilities, the lack of doctors willing to carry out abortions, the repeated medical consultations required, the time allowed for changing one’s mind and the waiting time for the abortion all have the potential to make access to safe, affordable, acceptable and appropriate abortion services more difficult or even impossible in practice.

4. The Assembly takes the view that abortion should not be banned within reasonable gestational limits. A ban on abortions does not result in fewer abortions, but mainly leads to clandestine abortions, which are more traumatic and increase maternal mortality and/or lead to abortion “tourism” which is costly and delays the timing of an abortion and results in social inequities. The lawfulness of abortion does not have an effect on a woman’s need for an abortion, but only on her access to a safe abortion.

5. At the same time, evidence shows that appropriate sexual and reproductive health and rights strategies and policies, including compulsory age-appropriate, gender-sensitive sex and relationships education for young people, results in less recourse to abortion. This education should include teaching on self-esteem, healthy relationships, the freedom to delay sexual activity, avoiding peer pressure, contraceptive advice, and considering consequences and responsibilities.

6. The Assembly affirms the right of all human beings, women included, to respect for their physical integrity and to freedom to control their own bodies. In this context, the ultimate decision on whether or not to have an abortion should be a matter for the woman concerned, and she should have the means of exercising this right in an effective way.

7. The Assembly invites the member states of the Council of Europe to:

(1) decriminalise abortion within reasonable gestational limits, if they have not already done so;

(2) guarantee women’s effective exercise of their right to access to a safe and legal abortion;

(3) allow women freedom of choice and offer the conditions of a free and enlightened choice without specifically promoting abortion;

(4) lift restrictions which hinder, de jure or de facto, access to safe abortion, and in particular take the necessary steps to create the appropriate conditions for health, medical and psychological care and offer suitable financial cover;

(5) adopt evidence based appropriate sexual and reproductive health and rights strategies and policies, ensuring continued improvements and expansion of non-judgemental sex and relationships information and education and contraceptive services by increased investments from the national budgets into improving health systems, reproductive health supplies and information;

(6) ensure that women and men have access to contraception and advice on contraception at a reasonable cost, of a suitable nature for them, and chosen by them;

(7) introduce compulsory age-appropriate, gender-sensitive sex and relationships education for young people (inter alia, in schools), to avoid unwanted pregnancies (and therefore abortions);

(8) promote a more pro-family attitude in public information campaigns, and provide counselling and practical support to help women where the reason for wanting an abortion is family or financial pressure.

Ireland

              The Council of Europe’s Commissioner for Human Rights, Mr Thomas Hammarberg from Sweden, visited Ireland in November 2007. Irish authorities informed him that there were currently no plans to legislate for abortion on the grounds established in the case of ‘X’ in 1992 or ‘Miss D’ in 2007. ‘X’ was a 14-year-old suicidal victim of rape whose parents had to appeal to the Supreme Court for her to leave the country to have an abortion. Miss D was a 17-year-old state ward, carrying an anencephalic fetus, who had to apply to the High Court to leave the country for an abortion. In his report he urges the Irish authorities to ensure that legislation is enacted to resolve this problem and that medical services be provided in Ireland to carry out legal abortions in line with the jurisprudence of the Supreme Court.

United Kingdom

              The House of Commons is set to consider legislation on human embryonic stem cell research. The most controversial piece of the legislation would formalise parliamentary approval for the creation of human-animal hybrid embryos for stem cell research. Embryos would be prevented by law from developing past 14 days. Both abortion rights supporters and opponents expect that the debate will trigger efforts to modify the country's abortion law, which has been in effect since 1990.

Both sides have launched petitions and are lobbying members of Parliament to change the country's abortion law. Antis are calling for a reduction in the time during which women can legally receive an abortion from 24 weeks' gestation to 20 weeks' gestation. Supporters of abortion rights want to maintain the current 24-week limit on abortions. British Prime Minister Gordon Brown of the Labour Party favours keeping the 24-week limit. David Cameron, leader of the opposition Conservative Party, favours lowering the limit to 20 weeks' gestation. Antis are calling for the elimination of a provision that allows abortions of fetuses with genetic abnormalities and they also want to require physicians to provide information about alternatives to abortion.

U.S.A.

              Improved contraceptive use was seen as the key factor in the fall in teen pregnancy rates from the all-time high in 1990 to a historic low in 2004, according to a new report by the National Center for Health Statistics, a division of the Center for Disease Control (CDC). But future gains may be jeopardized by the fact that the proportion of U.S. teens receiving any formal instruction about birth control methods has declined sharply.

The CDC data reinforce the need for comprehensive, medically accurate sex education programs for teens that include information about consistent, correct contraceptive use. Well conducted studies overwhelmingly show that abstinence-only programs do not work, leading 17 states to opt out of the federal funding for these programs.

The Guttmacher Institute which has researched the issues says that policymakers should stop pouring money into programs that are proven ineffective and should instead support the nation’s youth with proven strategies such as dedicated funding for comprehensive sex education programs.

              On 2 April 2008 The Democrat-controlled House of Representatives voted 308-116 to pass the President’s Emergency Plan for AIDS Relief, which authorises $50 billion for the U.S. global HIV/AIDS program over the next five years. Unlike the 2003 global AIDS bill, the new legislation does not stipulate the percentage of spending that must be used to promote abstinence. A compromise was reached between House leaders from both parties and the White House. It removes a provision that one-third of HIV prevention must be spent on abstinence-only programmes, but the bill still requires programmes to ensure a focus on abstinence, monogamy, and fidelity. Countries that spend less than 50% of funding on such programmes will be required to explain the decision to Congress. During the debate Republicans said that the new measures would help to fund abortions abroad.

The decision by some Roman Catholic bishops to give Holy Communion to politicians who support abortion rights during recent masses celebrated by Pope Benedict XVI during his recent tour of the USA created controversy. Several Catholic politicians who support abortion rights - including House Speaker Nancy Pelosi (D-Calif.), former New York City Mayor Rudy Giuliani (R), and Senators Chris Dodd (D-Conn.), Edward Kennedy (D-Mass.), and John Kerry (D-Mass.) were invited to the masses. Vatican sources said the pope has not retreated from his long-held position that pro-choice politicians should be deprived of communion. The Pope did not make the decisions on who should be invited.

              In March 2008 the Supreme Court ruled that female prison inmates have a constitutional right to abortion. The case involved an Arizona woman requesting a first trimester abortion who was refused transportation by the corrections officials. A state court ruled in the woman’s favour and that decision was upheld by the Supreme Court. A similar case from Missouri is expected to reach the Supreme Court in the coming months.

India

              Although it is 14 years since laws were passed prohibiting sex selective abortion, the practice continues and in 2001 the number of girls had declined to 927 for every 1000 boys. This figure was quoted by the Prime Minister in a speech on 28 April 2008 when he called for stricter enforcement of the laws. Others suggested that the focus should be more on addressing the inequality of women in Indian society.

Italy

              On 22 April 2008 the Italian Health Ministry issued a report which found that nearly 70% of Italian gynaecologists refuse to perform abortions on the grounds of conscientious objection. This is an increase from 59% in 2003. The proportion of anaesthetists refusing to participate in abortions has increased over the same time period from 46% to 50%. This makes abortion more of an obstacle course for Italian women. Most abortions are carried out in hospitals and are lawful up to 12 weeks gestation.

Chile

              On 22 April 2008 10,000 people marched in Santiago to protest a court decision to end a national government programme that provided free emergency contraception to women and girls ages 14 and over. Those opposed to the scheme argued in court that it was abortifacient and abortion is illegal under any circumstances. The Health Minister who supported the scheme said that the ban will only apply to National Health Service clinics, not cities. Some mayors have said they will distribute it free.