PO BOX 28-008 WELLINGTON 6150

NATIONAL NEWSLETTER –FEBRUARY 2009

National President: Dr Margaret Sparrow            

National Treasurer: Kay Lavill 

Communications Officer: Alison Mcculloch                                                                                                                 website: www.alranz.org

              We are still looking for an Auckland member willing to support Eileen Slark who is our representative on the Auckland Branch of the National Council of Women (NCW). Please write to National Office PO Box 28008 if you are able to assist.

              As a follow-up to the NCW biennial meeting held in Masterton on 2-5 October, lawyer Josephine Reeves, Past-President of Voice for Life, has complained at length to the Board of Management of NCW regarding what she considered unfair procedures applied during the debate on pregnancy and mental health. (Letters to the Editor, The Circular No 519, February 2009). NCW stands firm and rejects the criticism. ALRANZ agrees. The most important issue was women’s health, not legal point scoring on meeting procedure. ALRANZ supported the wording of the remit that was passed: that NCWNZ urges further research into the mental health outcomes for women experiencing pregnancies, both planned and unplanned, and also during the post-natal phase.

              Dr Zoë During was born in Wellington on 15 February 1925 and died in Auckland on 24 Nov 2008 at the age of 83. Her high school education was at Marsden College and she graduated in medicine from Otago University. At the age of 20, three weeks after meeting him, she married European immigrant Peter Kauders and they had a happy marriage for 57 years with five children. Peter later changed his name to During, a simpler version of his mother’s maiden name. He became a soil scientist at Ruakura and during her time in the Waikato Zoë became involved in ALRANZ soon after it was formed in 1971. Her professional career as a Child Health Medical Officer in the Department of Health encompassed sex education and she was one of the first to speak publicly on abortion. Later Zoë became President of the Auckland Branch of ALRANZ. She was awarded an MBE in 1986 for services to child health.

               She wrote her autobiography, called It’s been mostly fun: the memoirs and musings of a maverick medico. She will be remembered for her keen mind and generous spirit. In place of a funeral Zoë wanted a commemorative party with music, singing, dancing and good food. Donations in memory of Zoë may be sent to Amnesty International, PO Box 5300, Wellesley Street, Auckland 1141.

              Mr John Taylor, retired obstetrician and gynaecologist, died in Auckland on 30 December 2008 at the age of 80. In 1978 he was asked to be the Medical Director of the abortion service for the Auckland Hospital Board. He remained in that position at the Epsom Day Hospital until his retirement. When he retired there was a gap in the services for second trimester abortions in the Auckland region. During his career he taught and influenced many doctors, and many thousands of women were grateful for his expertise. His career choice was influenced by the tragic death from an illegal septic abortion of a 21-year old woman in National Women’s Hospital in 1957. John was a registrar in the team that struggled for two weeks to save her life. He was also a great supporter of Family Planning and the prevention of unplanned pregnancies. He was a powerboat enthusiast and with a crew of four in 1994 set a record for circumnavigating NZ. He is survived by his wife Marie and four children. Daughter Alison has followed in her father’s footsteps and is an abortion operating doctor. Donations in memory of John may be sent to Coastguard Northern Region PO Box 2195 Shortland Street, Auckland 1140.

              The Annual Report of the ASC was presented to Parliament in December 2008. Disappointingly there was a reduction in the number of tables from 16 to 10. Figures for ethnicity and age were among those excluded but these are available from Statistics NZ and published in June 2008. However, there is no information on the grounds for authorisation (usually 98% or more on the grounds of mental health) or the procedure used, a topic of interest to researchers and abortion providers.

              In the past there have been two counselling advisors. Now there is only one. The position of nurse/midwife advisor has gone. There is no explanation for the reduction in advisory staff. These positions have provided liaison with the counselling staff and nursing staff employed in abortion clinics who need professional support. As an example a nursing issue that has surfaced publicly is the problem Auckland District Health Board has experienced recruiting and retaining nurses for second trimester abortions. This situation is not unique to Auckland.

              The ASC has appointed a Standards Committee to develop guidelines for the provision of abortion services while DHBs are also reviewing abortion services. Ethical guidelines will be published by the Medical Council of NZ in 2009. These initiatives are commendable if they lead to improved services for the women of NZ. (See the following article on access, which shows how much more needs to be done.)

              There were 195 certifying consultants and 128 of these were in the specialist category. Fees payable to certifying consultants in the year ending 30 June 2008 were $5,048,096 (GST exclusive). This was a modest increase from the previous year when the fees payable to certifying consultants totalled $5,026,000 (GST exclusive). This is an average cost of nearly $26,000 (GST exclusive) per certifying consultant.

              An article was published in the Australian and NZ Journal of Public Health (Vol 32 No 6, 2008) by Martha Silva and Rob McNeill, from the University of Auckland, entitled Geographical access to termination of pregnancy services in New Zealand.

              They found that women who live in regions that do not offer local TOP services must travel an average return-trip distance of 442km. Six regions do not have a first trimester service within the region (Bay of Plenty, Gisborne, Manawatu-Wanganui, Tasman, West Coast and Southland). Three of these have a higher than average proportion of Maori population (Bay of Plenty 26.3%, Gisborne 44.4%, and Manawatu-Wanganui 19%). According to the 2006 census Maori represent 14.6% of the total population of NZ. The region with the greatest travel distance is Southland where women who go from Invercargill to Christchurch travel 1,130km in a return-trip. Although Dunedin services are closer they are unable to accommodate Southland patients.

              The conclusions from this research are worth quoting in full. “The results of this study demonstrate that first trimester TOP services are relatively difficult to access for over one-sixth of the women in NZ. Women in areas with no services must travel considerable distances to access TOP services.

              Of particular concern for the indigenous population of NZ is that women in three of the regions with highest Maori population are required to travel some of the longest distances to access services, which presents an additional burden to an already stressful event and an already disadvantaged population.

              It is of note that medical TOP (referring to the use of mifepristone and misoprostol to induce TOP) was introduced in NZ after the Ministry of Health approval in August 2001, and since then has been adopted by four clinics [now six] in NZ. The increased provision of medical abortion as a safe and acceptable method of pregnancy termination could potentially broaden the service access points to some of the areas where there is no surgical service available.

              There is an international trend to concentrate abortion services in metropolitan areas and into the hands of fewer doctors, as fewer doctors are being trained and are willing to provide the service. With the finding of this study showing that services are already relatively difficult to access for a large number of women, any further concentration of services into the biggest urban centres will only increase inequity in access to services.

              As part of this country’s commitment to addressing health disparities, there is need for action to be taken to ensure equity of access to TOP services for women throughout NZ, with means of achieving this including ensuring that all DHBs provide a local service (both surgical and medical TOP); and where not available, fully cover travel and other expenses incurred by women accessing services elsewhere. Further research to explore TOP services accessibility and quality assurance is also needed.”

              Virginia Braun has published the results of her research in Social Science & Medicine (Dec 2008) and the title of her paper is “She’ll be right”? National identity explanations for poor sexual health statistics in Aotearoa/New Zealand.

              The study involved 38 women and 20 men aged 16-28 years who took part in focus groups looking primarily at lay explanations for the increase in sexually transmitted infections but the research has implications for other sexual health statistics such as unintended pregnancies.

              In her analysis she found that the predominant explanation related to accounts of national identity. Among this group of young people NZers were characterised as binge drinkers, poor communicators, self-sufficient, stoic, conservative yet highly and complacently sexual, ‘laid back’ with a lack of personal concern about sexual health risk.

              This suggests a need to consider whether and how national identity might be meaningfully invoked and deployed in sexual health promotion initiatives. This shifts some of the responsibility for sexual health beyond the individual fully embedded in their culture and acting according to its dictates.

              In December 2008 another article from Professor David Fergusson on the long-term Christchurch cohort study was published, this time in the British Journal of Psychiatry entitled Abortion and mental health disorders: evidence from a 30-year longitudinal study. The researchers, Fergusson, Horwood and Boden, found abortion was linked to anxiety disorders and substance abuse but abortion accounted for only a small proportion of mental health disorders in the general population (1.5 – 5.5%).

              In an invited commentary in the same issue of the journal, Irish psychiatrist Patricia Casey said that the finding that induced abortion is a risk factor for subsequent psychiatric disorder in some women raises important clinical and training issues for psychiatrists. She said that it also highlights the necessity for developing evidence-based interventions for these women.

              However three other psychiatrists, Margaret Oates, Nottingham, Ian Jones, Cardiff, and Roch Cantwell, Glasgow, provided an alternative commentary and reached a different conclusion. They said that evidence suggesting a modest increase in mental health problems after abortion does not support the prominence of psychiatric issues in the abortion debate, which is primarily moral, ethical, and legal not psychiatric.

              In the last newsletter we reported on the findings of the American Psychological Association Task Force on Mental Health and Abortion which found no evidence to support a link after one abortion. Prior mental health emerged as the strongest predictor of post-abortion mental health.

              Abortion, Motherhood and Mental Health: Medicalizing Reproduction in the United States and Great Britain by Ellie Lee. New York: Aldine de Gruyter 2003. A review of this book was first published in the July 2004 newsletter but an ALRANZ member has suggested that it be repeated as it is still a valuable resource for those concerned about the current debate on abortion and mental health. Ellie Lee is a senior lecturer in social policy at Kent University and co-ordinator of Pro-Choice Forum in the UK. In this book she contrasts post-abortion syndrome with postnatal depression, and in so doing examines modern day abortion and motherhood within the USA and Britain. Numerous studies have failed to provide any evidence of widespread post-abortion syndrome whereas postnatal depression is a serious disorder affecting at least 10% of mothers. This well-balanced book examines how and why pregnancy and its various outcomes affect women and how society responds to these issues.

              In November 2006 the IPPF created an international expert panel on sexual rights with a mandate to guide and support the IPPF in developing a Declaration of Sexual Rights. In May 2008 the Declaration was presented and adopted by the Governing Council, replacing the 1994 Charter on Sexual and Reproductive Rights. A copy of Sexual Rights: An IPPF Declaration is now available from the IPPF website www.ippf.org  There are seven guiding principles which provide a framework for the ten sexual rights which are human rights related to sexuality.

              The seven guiding principles are:

1.  Sexuality is an integral part of the personhood of every human being, for this reason a favourable environment in which everyone may enjoy all sexual rights as part of the process of development must be created.

2.  The rights and protections guaranteed to people under age eighteen differ from those of adults, and must take into account the evolving capacities of the individual child to exercise rights on his or her own behalf.

3.  Non-discrimination underlines all human rights protection and promotion.

4.  Sexuality and pleasure deriving from it, is a central aspect of being human, whether or not a person chooses to reproduce.

5.  Ensuring sexual rights for all includes a commitment to freedom and protection from harm.

6.  Sexual rights may be subject only to those limitations determined by law for the purpose of securing due recognition and respect for the rights and freedoms of others and the general welfare in a democratic society.

7.  The obligations to respect, protect and fulfil apply to all sexual rights and freedoms.

              The ten articles (in brief) are:

1.  Right to equality, equal protection of the law and freedom from all forms of discrimination based on sex, sexuality or gender.

2.  Right to participation for all persons, regardless of sex, sexuality or gender.

3.  Rights to life, liberty, security of the person and bodily integrity.

4.  Right to privacy.

5.  Right to personal autonomy and recognition before the law.

6.  Right to freedom of thought, opinion and expression; right to association.

7.  Right to health and to the benefits of scientific progress.

8.  Right to education and information.

9.  Right to choose whether or not to marry and to found and plan a family, and to decide whether or not, how and when, to have children.

10. Right to accountability and redress.

              Safe abortion is covered by Article 9, which states that “all women have the right to information, education and services necessary for the protection of reproductive health, safe motherhood and safe abortion, which are accessible, affordable, acceptable and convenient for all users.”

              It is fitting that this document coincides with the 60th anniversary of the signing of the Universal Declaration of Human Rights, the first universal statement setting out the basic principles of the human rights and fundamental freedoms to which all peoples in every nation are entitled.  The President and Chair of the Human Rights Commission was Mrs Eleanor Roosevelt and the declaration was adopted at a United Nations General Assembly meeting in Paris on 10 December 1948.

              Two further discussion documents have been released by the Advisory Committee on Assisted Reproductive Technology and the closing date for submissions is 16 March 2009.

              The first is Consultation on the use of in vitro maturation in fertility treatment. ACART wishes to recommend to the Minister of Health that eggs matured in vitro become an established procedure without the need for review by an ethics committee. The reasons for this recommendation are clearly explained.

              The second is Draft guidelines on the use of donated eggs in conjunction with donated sperm. ACART has considered the feedback from a previous discussion document and has now prepared the draft guidelines for public and professional comment.

              ALRANZ welcomes input from members. If members with to make a personal submission copies of the discussion documents can be found at www.acart.govt.nz or they can be obtained from the ACART secretariat at PO Box 5013, Wellington.

Global trends in abortion laws

              An article on Developments in Laws on Induced Abortion: 1998-2007 by Reed Boland of the Harvard School of Public Health and Laura Katzive of the Center for Reproductive Rights, appeared in the September 2008 issue of International Family Planning Perspectives. The article can be accessed from www.guttmacher.org 

              Changes over the last decade reflect continuation of a worldwide trend toward greater access and broader recognition of human rights. Abortion laws have been liberalised in 16 countries and only two have gone against this trend and eliminated all grounds - El Salvador in 1998 and Nicaragua in 2006.

              An additional 10 countries maintained their existing grounds for abortion but adopted changes to increase access to abortion. An important driving force behind this trend has been the growing concern among regional and international human rights bodies about the negative impact of abortion restrictions on women's health and well-being.

              In 2003, the African Union adopted a protocol to guarantee the right to abortion in cases of sexual assault, rape, incest, or a pregnancy’s threat to the mental and physical health of the pregnant woman. As of 2007, 21 countries had ratified or signed on to the protocol.

               At the regional level, some of the most notable changes in abortion policies occurred in Latin America.

In 2006, Colombia’s constitutional court struck down the country’s blanket prohibition of abortion to permit termination of pregnancy when a woman’s life or health is endangered, as well as in cases of rape, incest or severe fetal impairment.           

              In 2007, Mexico City changed its law to permit abortion without restriction up to 12 weeks’ gestation. Five additional Mexican states also added grounds on which abortion is permitted or not punishable.

              Procedural and legal barriers have increased in eastern and central Europe since 1998, although the region’s laws remain among the most liberal in the world. Hungary and Latvia have established requirements that make obtaining an abortion more onerous (parental consent, counselling and waiting periods). Though abortion on the grounds of social or demographic characteristics in the second trimester remains legal in Russia, the country defined these indications more narrowly, eliminating, among other grounds for the procedure, having a low income, being unmarried or having too many children.

              In contrast, all changes in the past 10 years in East and South Asia and the Pacific were towards liberalisation. In 2002, Nepal’s law was changed to permit abortion on request during the first 12 weeks of pregnancy, and thereafter in cases of rape, incest or fetal impairment or if there is a threat to the woman’s life or physical or mental health. In addition, two territories and one state in Australia liberalised their policies.

              In the USA federal law there was a move towards restrictiveness when in 2007 the Supreme Court upheld the Partial-Birth Abortion Ban Act of 2003. [However, the article does not include the numerous State restrictions, about 400 in 2007 alone.]

              The authors note that the trend towards liberalisation of abortion laws should not mask the serious threats to reproductive rights that are present in many parts of the world. However, they believe this trend will be hard to reverse, particularly as more countries continue to recognise the impact of abortion restrictions on women’s human rights.

              This information has been included in the updated Factsheet Facts on Induced Abortion Worldwide (October 2008) an excellent summary produced jointly be the WHO and the Guttmacher Institute. It is available from the Guttmacher website www.guttmacher.org

U.S.A.

              President Obama issued a statement on 22 January, the 36th anniversary of Roe, seeking common ground in the abortion debate by focusing on the prevention of unintended pregnancies. However, because of a number of anniversary events he delayed rescinding the ‘global gag rule’ until the following day. The global gag rule, also known as the Mexico City policy, prohibited overseas organisations from receiving US family planning assistance if they used their non-US funds to provide abortion information, services or counseling, or even if they engaged in any abortion rights advocacy.

              Tragically, the policy may have only increased the need for abortions by reducing access to family planning services in many developing countries. The global gag rule was first imposed by President Reagan in 1984, rescinded by President Clinton in 1993 and then reinstated by President Bush in 2001.

              Obama also committed the US to restoring support for the United Nations Population Fund (UNFPA), which promotes voluntary family planning in more than 150 developing countries. 

              Obama’s reversal of both policies will strengthen the global fight against maternal and child mortality. However, even with these policy changes, direct US funding for abortions overseas will continue to be prohibited under the Helms Amendment whereby no foreign assistance funds may be used to pay for carrying out abortions.

              The President dropped family planning from his economic stimulus package but is expected to lift Bush’s 2001 restrictions on federal funding for embryonic stem cell research.

              The recent diagnosis of pancreatic cancer in liberal Supreme Court Justice Ruth Ginsberg, 75, may mean changes ahead. She is the only female on the nine member Court appointed by President Clinton.

              The FDA has approved a new cheaper version of the female condom, an under-used method partly due to the cost when compared with the male condom. The new type, developed by the Female Health Company, is made of a nitrile-based synthetic rubber instead of polyurethane. The new product will be particularly useful in aid programmes for HIV/AIDS prevention.

              An article in the New England Journal of Medicine (20 November 2008) by Associate Professor Zita Lazzarini contains a warning in the title: South Dakota’s Abortion Script – Threatening the Physician-Patient Relationship. With her background in law and public health the author is extremely critical of South Dakota’s abortion legislation passed in July 2008.     The law requires a physician to inform a woman seeking an abortion that ‘the procedure will terminate the life of a whole, separate, unique, living human being with whom she has an existing relationship.’ Women must sign each page of a detailed consent script that includes misleading information on the purported risks of abortion. The physician must answer all the woman’s questions in writing. The author concludes that the statute forces doctors to violate their obligation to solicit truly informed consent and thereby detracts from the essential trust between patients and doctors.

U.K.      

              Jonathon Porritt, who spent his childhood in NZ when his father was Governor General, chairs the government’s Sustainable Development Commission. He says curbing population growth through contraception and abortion must be at the heart of policies to fight global warming and couples who have more than two children are being irresponsible. He is 58 and has two daughters.

Australia

              The Rudd government has signalled it will not be pushed into following a US decision to lift a ban on foreign aid money being used on abortion-related services. The ban was instituted under the Howard government at the behest of then independent senator Brian Harradine. Considerable pressure is being applied to reverse the ban, which could be done by the Minister of Foreign Affairs without the need for legislative change.

              An article in the Medical Journal of Australia (19 Jan 2009) provides a 12-month audit of the Melbourne Pregnancy Advisory Service, Victoria’s largest public pregnancy advisory service. The researchers found a diverse range of circumstances among the 3,827 anonymous records for women using the service and noted 16% women reporting violence and 10% with mental health problems.

India

              India's National Population Stabilization Fund has opened a call centre to provide reliable information to anonymous callers about reproductive health, family planning, or contraception. The call centre, which began operating in June, is the first of its kind in the country where such issues are socially taboo. India seeks to limit the country's population growth to sustainable levels.

Uruguay

              There has been a backlash over President Tabare Vazquez’s veto of a law that would have liberalised abortion in the first 12 weeks. In vetoing the law he went against Socialist Party policy and has offered to resign as leader of the party. Pro-choice members intend to reintroduce a bill in the next session.