ALRANZ NEWSLETTER NOVEMBER 2006
At the National Council of Women (NCW) National Conference held in Invercargill 28 September - 1 October 2006 ALRANZ was represented by Lesley Smith, Wellington NCW representative. The remit from Voice for Life (previously SPUC) recommended “that NCWNZ requests Government to initiate further research into the mental health outcomes for women following abortion.” While ALRANZ supports quality research there are established procedures for conducting research and these cannot be replaced or circumvented by “requests to Government”. After considerable debate the remit was defeated, the only conference remit not passed. Delegates were concerned that research should be carried out on all unplanned pregnancies, whether they resulted in adoption, continuing the pregnancy, or abortion and there was agreement that the mental health outcomes for all pregnant women were important. It was proposed that a broader based remit be considered at the next national meeting of the Council.
ALRANZ made a submission to the NZ Parliamentarians’ Group on Population and Development which is holding an open hearing on Youth Sexual and Reproductive Health on 4 December. The group was established in 1998 in response to the Cairo International Conference on Population and Development (ICPD) and is modelled on UK and Australian groups as part of an international network. It is an all-party group supporting the Programme of Action (1995-2015) from the ICPD and is funded by the United Nations Population Fund (UNFPA). It receives secretarial support from FPAID, NZ FPA’s International Development Unit.
Abortion Supervisory Committee
The Annual Report of the ASC for 2006 was published in October. The fact that the ASC is acting unconstitutionally with only two members has resulted in the ASC advising the Speaker of the House that all regular visits to institutions have been suspended until it has its full complement of members. This is a sorry state of affairs and another indication that a review of abortion legislation is necessary. If Parliament does not support the ASC it is acting in contempt of the legislation.
In commenting on the unprecendented drop in abortion numbers for two successive years the ASC notes that it is very pleased with this trend but neither expects that it will continue or proposes a single cause for the decrease. A rather pessimistic viewpoint from the unsupported ASC.
Fees payable to certifying consultants were increased from $87.50 to $135 with effect from 1 July 2005. This brought the annual cost of certifying consultants to nearly $5.5 million dollars, money that could be better spent in the prevention of unplanned pregnancies.
The ASC has established a new Quality Committee to advise on quality measures and to set Best Practice Standards for health services and professional competence. This is now required by all health service providers. The committee chaired by Peter Stone, Professor of Maternal Fetal Medicine, Auckland University will be acting within the confines of the existing legislation. ALRANZ believes however that the legislation creates some of the barriers to best practice and that these should be addressed.
The ASC has also appointed Ann Simmons as a nursing/midwife advisor to work with the ASC, the Quality Committee and the Counselling Advisors. Considering the important role of nurses in abortion care this is a welcome recognition of their role.
The statistics show a significant decrease in the numbers of abortions across all age groups. The fact that 98.5% are done on the grounds of mental health makes a mockery of the grounds for abortion. There are no figures provided for sexual violation as a contributor.
In August 2006 the FDA in the USA finally approved Plan B as an emergency contraceptive method to be sold over the counter without a prescription but unfortunately restricted to those who have reached their 18th birthday. Those under 18 will still be required to have a prescription. After years of delays and political interference this step was welcome news and the progestogen-only method (the same as ‘Postinor’ and ‘Levonelle’ in NZ) will be available through pharmacies this month.
Chile has recently gone several steps further. The Ministry of Health announced that the emergency contraceptive pill will be available there to girls as young as 14, without cost and with no requirement for parental consent. An appeal against this was defeated but it remains controversial. It has previously been available over the counter but the cost has meant that it has only been used by those who can afford it. The new regulations are part of a programme aimed at the prevention of unplanned pregnancies in young girls.
However in an editorial in the British Medical Journal 16 September 2006 entitled “Emergency Contraception: Is it worth all the fuss?” Professor Anna Glasier, Edinburgh, states that the easy availability of emergency contraception has not had a notable effect on rates of pregnancy and abortion in the UK. Although she has been involved in research on emergency contraception she now wonders whether it may be better to concentrate on methods that act before and during sex. The UK experience differs somewhat from the New Zealand figures where as previously noted there has been a reduction in abortions over the past two years. Emergency contraception became available over the counter in New Zealand in May 2002.
Report on Rome Congress
President Dr Margaret Sparrow has written a report on her attendance at the 7th FIAPAC (International Federation of Abortion and Contraception Professionals) Congress in Rome from 13-14 October 2006:
With co-presenter Dr Carol Shand I took part in a workshop on medical abortion where we outlined the steps in introducing mifepristone into NZ. With Italy preparing for the introduction of mifepristone in the near future, there was considerable interest in medical abortion—the abortion pill (mifepristone) followed by a prostaglandin. Since 1978 abortion has been legal in Italy but only in public hospitals. A clinical trial of medical abortion is taking place in Turin and when the drug is registered it will be available more widely.
Medical abortion providers from France and USA spoke positively of their experience in self administration of the second drug at home. Provided women are given clear instructions on what to do, they manage the experience very well. There was also discussion on the time interval between the two drugs. On current evidence there needs to be an interval of at least 24 hrs between the two drugs but it is not necessary to wait for 36 or 48 hrs as is the current practice. Because of our legislation home administration is not possisble in NZ.
There were many papers on both medical and surgical abortion the majority of contributors coming from Europe.
There was considerable interest in manual vacuum aspiration, a low tech method suitable for early abortions and done under local anaesthesia. At one of the display stands new equipment was demonstrated having been developed in order to comply with strict sterilisation standards in the USA. This method could be used more in NZ. There were a number of experienced practitioners outlining the benefits for staff and patients.
Dr Rebecca Gomperts from Amsterdam, founder of Women on Waves spoke at a workshop on the activities of this non-profit organisation operating a mobile reproductive health clinic on board a commissioned ship outside the territorial waters of countries where abortion is illegal. The most notable campaigns have been Ireland in 2001 (no change here, women referred to UK), Poland in June 2003 (abortion available on very strict criteria) and Portugal in August 2004 (there will be a referendum early next year). Television coverage of the campaigns showed how risky this activity can be. The organisation now has a new on-line abortion help service, Women on Web, to help women obtain a medical abortion. For further information see their websites:
www.womenonwaves.org
www.womenonweb.org
Katerina Lindahl, secretary-general of the Swedish Association for Sexuality Education (RFSU) spoke on a women’s right to safe abortion within the European Union. She outlined the current situation for women in Europe ranging from countries with very strict laws to those like Sweden which are liberal and discussed the political and legal obstacles encountered. To bring about change two strategies are often used—abortion as a right or abortion as a health issue. Both have their advocates. She will be visiting NZ later this year and is well worth hearing if you get the opportunity.
Dr Christian Fiala from Vienna was a speaker earlier this year at the 4th Abortion Providers’ Conference in Wellington and was one of the principal organisers of this congress. He used examples from our NZ legislation in a paper entitled “Are the laws patient centred?” Clearly in many instances they are not e.g. the views one must hold to become a certifying consultant. He gave many instances in Europe where a “cooling off” period is mandatory after counselling and before operation. At least we do not have this in NZ and if we did there would be even fewer abortions carried out <8weeks. As it was he included the figures from NZ in a table demonstrating the variation in early abortions <8 weeks gestation, NZ featuring poorly in these stakes.
Niall Behan, Chief Executive of the Irish Family Planning Association gave a sobering address on “Voices from countries with illegal abortion”. In an examination of anti-choice tactics he noted how there has been a shift to what he termed “sweet stuff strategy” - focusing on the needs of women e.g. women have a right to better options than abortion or abortion depicted as a danger to women’s health. In countries where abortion is illegal individual women are now more willing to pursue their government through the courts to vindicate their rights. This has happened not only in Ireland but notably in Poland, Mexico.
I was invited to give an address at the dinner on the Friday evening. This was a very grand affair held on the terrrace atop one of the great monuments of Rome, Il Vittoriano. I called my address “Then and Now” focusing on the frequency of unsafe and illegal abortions in the past and how it is estimated that each year 19 million women still undergo unsafe abortions. Due to a faulty microphone it wasn’t my best presentation but next day I was heartened when Dr Shalom Press came up to me and presented me with a signed copy of “Absolute Convictions: My Father, a City, and the Conflict that Divided America” written by his son Eyal Press (reviewed in the May 2006 ALRANZ newsletter). Eyal is a New York based journalist. His father Shalom was a colleague of Dr Barnett Slepian, the abortionist, who was shot by a sniper’s bullet while standing in his kitchen in a quiet suburb of Buffalo, New York on 23 October 1998. His killer was anti-abortion activist James Kopp who evaded arrest for 2½ yrs but was eventually found in France in 2001 and in 2003 was sentenced to 25 years to life imprisonment.
The book is about how the murder affected his family and in particular his father, an immigrant to the USA from war torn Israel. Dr Press never gave up providing an abortion service for the women of Buffalo even though he had threats against his life, had to live for several years under heavy police protection, and wear a bullet proof vest to work. It was a pleasure to meet this quiet unassuming Jewish obstetrician and gynaecologist in his 60s who attended the congress with his wife Carla.
Dr Erich Geiringer would have approved of the choice of his 1976 song “The Knitting Needle Bill or The Trip Abroad” for the entertainment slot at the gala dinner not many streets away from the Vatican.
After the conference I visited London and had lunch with Dr Gill Greer now Director-General of the International Planned Parenthood Federation (IPPF) and Dr Marcel Vekemans who had represented IPPF at the Rome Conference. His address in the closing session entitled “Who is afraid of a woman’s right to self-determination?” was one of most warmly applauded among a number of memorable speeches for its strong advocacy of women’s rights. He produces a weekly newsletter on abortion and I am now on his mailing list.
I also spent a rewarding time with Dr Wendy Savage Co-ordinator and Press Officer for Doctors for a Woman’s Choice on Abortion also involved with Abortion Rights.
See www.abortionrights.org.uk
After London I went to Vienna where I was the guest speaker at the opening of the contraception/abortion museum curated by Dr Christian Fiala and housed in the same building as his GynMed Clinic, a private abortion clinic. If anyone is in Vienna it is worth a visit as the world’s best collection of memorabilia on contraception, pregnancy testing and abortion. Up to date technology is used for the touch screens which offer a wide selection of short video films. His clinic is easy to find as he has purchased the advertising space on the spine of the Vienna telephone book!
In Mumbai I was met by Dr Mahinder Watsa, a past President of FPA India and at 82 still contributing a daily column as a sexual therapist to the Times of India, answering questions from troubled correspondents. He introduced me to the medical team at FPA and we shared information. I also met Dr Soonawala who had helped me gain practical experience in vasectomy 30 years ago in 1976. He also is still practising and was able to tell me about the use of medical abortion in Mumbai. India has several manufacturers of mifepristone and it is available cheaply. I was presented with two books, both publications of IPPF “The Light is Ours” an autobiography of Mrs Avabai Wadia, a founding member of IPPF and “Education in Human Sexuality”. In Vadodara, north of Mumbai I was the guest of sexual health physician Prof Ben Verma and his wife Prof. Amita Verma, now retired but still active in women’s rights issues.
Overseas News
Australia
Dr Suman Sood, 57, on trial in the NSW Supreme Court for procuring an illegal abortion was found guilty on that charge but not guilty of manslaughter. This is the first prosecution for illegal abortion in NSW for more than 25 years. In May 2002 she gave prostaglandin tablets to a woman seeking an abortion at 23 weeks gestation without fully assessing her case. She avoided a prison term but she has been banned from practising in NSW for at least 10 years and placed on a two-year good behaviour bond. Dr Sood also faced 11 other complaints brought to the Medical Tribunal which clearly demonstrated ongoing concerns about her professional competence.
Stem cell research got the green light after the Senate passed a bill in November 2006 legalising therapeutic cloning for stem cell research. The bill narrowly passed by 34-32 on a conscience vote, with a number of MPs absent. The legislation still has to be passed by the House of Representatives but this is not expected to change the decision.
Australia is reviewing its ban on foreign aid for abortion services, imposed a decade ago in response to lobbying from the now retired anti-abortion senator Brian Harradine. Supporters argue that the policy ignores the thousands of deaths a year in neighbouring countries caused by unsafe abortions. The rethink is part of a wider review of foreign aid.
Senator Natasha Stott-Despoja introduced a private member’s bill, the Transparent Advertising and Notification of Pregnancy Counselling Services Bill in an attempt to prohibit misleading and deceptive advertising by pregnancy counselling services. The bill did not pass but it brought these issues to the fore. In March the government announced a $50 million package designed to cut Australia’s abortion rate, including a 24-hour advice hotline for pregnant women and a Medicare rebate for pregnancy related counselling. This was introduced by Minister of Health Tony Abbott in the wake of losing his control over the ban on RU486.
In September 2006 five Melbourne doctors who played a part in aborting a 32-week-old fetus were cleared of wrongdoing. The Medical Practitioners Board of Victoria found no evidence of unprofessional conduct. The case dated back to February 2000 when an abortion was carried out on a suicidal mother who was told her child had dwarfism. The complaint was laid by anti-abortion Liberal Senator Julian McGauran and the protracted legal battles were unwarranted harassment.
Professor Caroline de Costa, Cairns is the first obstetrician and gynaecologist in Australia to use mifepristone for early medical abortion. In the interim, until an Australian supplier is found, the pills have been obtained from NZ.
Voters in the mid-term elections sent a strong message to President Bush and the Republican Party not only on the war in Iraq but on abortion in several States, stem cell research in Missouri and same-sex marriage in Arizona (although not in seven other States). The verdict on abortion rights was particuarly clear. In Oregon and California voters defeated measures that would have required parents to be notified before a girl under 18 could get an abortion. In South Dakota the tough new law to ban abortion was resoundingly rejected by 56%. It was designed to pose a direct challenge to Roe v. Wade the landmark 1973 Supreme Court decision legalising abortion. NARAL Pro-Choice America President Nancy Keenan described the South Dakota result as a triumph for the fundamental values of freedom and privacy over divisive attacks against a woman’s right to choose.
Canada
In August 2006 in a class-action lawsuit the Quebec Superior Court ordered that the Quebec government reimburse more than $13 Million to nearly 45,000 women who had to pay for abortions between 1999 and 2005. The judge ruled that the province misinterpreted its own medicare law.
Nicaragua
In October 2006 Nicaragua voted to outlaw abortions, including operations to save a pregnant woman’s life, after a campaign by the powerful Catholic Church. The main political parties supported the bill in the run up to a presidential election bringing accusations of vote catching. Barring a veto from the President, the law will take effect in 30 days. The bill will overturn a 130-year old policy permitting abortions in exceptional cases. The current maximum sentence of six years will stand, thwarting an attempt to increase penalties for up to 30 years. Protesters said that the law would be a death sentence for women with ectopic pregnancies.
Poland
In October 2006 the President and the Prime Minister rejected a constitutional amendment that would ban all abortions in the country. Since 1989 under Polish law abortion is banned except under very strict criteria.