The Effects of Decriminalising Abortion

The Effects of Decriminalising Abortion

by Terry Bellamak

New Zealand is finally discussing abortion law reform. One of the first items of business on the government’s agenda is taking abortion out of the Crimes Act. This promises to make abortion easier to access, reduce delays, and reduce the unwarranted stigma around a procedure that is safe, routine health care.

Some folk have expressed a concern that taking abortion out of the Crimes Act will somehow make abortion less safe for people who decide to receive abortion care. 

In its comprehensive report on law reform, the New Zealand Law Commission considered the matter and concluded that fear was unfounded, for the following reasons:

  • All other health services are sufficiently protected by the health regulatory regime and by general offences in the Crimes Act. There is no reason abortion should be any different.
  • There are two groups of people whose actions are currently criminalised in relation to providing abortion care. Both would still meet with serious consequences for providing abortion care improperly even after abortion is taken out of the Crimes Act.
    • Health practitioners who provide abortion care without being qualified to do so, or who do not meet proper standards of care are subject to professional disciplinary action, and could also be charged with regulatory offences under the Health Practitioners Competence Assurance Act or the Medicines Act. If they are negligent or fail to get informed consent from their patient, they could be charged with a criminal offence.
    • Unqualified people who attempt to provide abortion care can be charged with regulatory offences under the Health Practitioners Competence Assurance Act or the Medicines Act, and their conduct may also constitute assault, injury, or wounding depending on whether the woman suffers actual bodily harm, and thus could be charged under the Crimes Act. 

It’s difficult to see how safety would be compromised if abortion care were regulated the same way as other medical care. Abortion care is very safe, and the earlier it is received the safer it is. Eliminating the delays our current laws promote would enable people to get abortion care earlier and thus more safely.

The report also makes the point that: 

 

Criminal offences are used to punish conduct that causes social harm and is considered morally reprehensible or inconsistent with important social values.

This treatment is inconsistent with treating abortion care as a health issue. Our current legal regime hypocritically criminalises abortion care while simultaneously fostering the practice of providing abortion in most cases, albeit in a manner that is cumbersome, patronising, and needlessly punitive.

By leaving this ridiculous system in place for over 40 years, Parliament has established it as the status quo. To try and pass off abortion care as morally reprehensible or inconsistent with important social values, Parliament would be making a liar of itself.

Taking abortion out of the Crimes Act will make abortion care safer, not less so.

2019, Here We Come

2019, Here We Come

by Terry Bellamak

2018 was a big, amazing year for ALRANZ. 

We all saw Ireland amend their constitution to allow the Oireachtas to legislate to allow abortion. We got a preview of terrible amendments to watch out for as we progress our own law reform process, like pointless waiting periods and restrictive time limits. 

We saw Queensland legalise abortion, and got a preview of some good ideas to replicate here, like a government-sponsored online fact checker, to keep the debate fact-based.

We saw Argentina debate a bill liberalising abortion, saw pro-choice activists come closer to success than anyone expected, and saw them make plans to come roaring back in the New Year for another try.

We saw ALRANZ start a human rights complaint with the Human Rights Commission, saying our abortion laws discriminate against women and those who are or can be pregnant. Our case will go before the Human Right Review Tribunal in due course. 

We saw the Law Commission deliver a report on abortion law reform that was not perfect, but was better than just about anybody expected.

We saw the Minister of Justice choose the supposed path of least resistance when he came out in favour of Model C, which has a time limit of 22 weeks, beyond which a pregnant person must seek permission to exercise sovereignty over their own body.

We saw polls that show a clear, growing majority of New Zealanders support abortion on request.

2019 will need all our efforts to ensure New Zealanders get the freedom to decide for themselves whether or not to become parents.

If we don’t make law reform happen now, we will likely wait a long time for another chance.

First up will be the Minister of Justice’s presentation of the Law Commission report to Cabinet, possibly with draft legislation, in January or February.

A bill will undoubtedly make it to select committee. That’s where the rubber hits the road for us. We will need everyone’s help to make the committee aware of the problems with the current law, and the defects of the less-desirable options from the Law Commission report. 

There are some of you who have stories to tell the select committee. I hope you will seriously consider telling them, in a written submission or in person at an open or closed meeting of the select committee. 

If anyone has any questions about that, or might prefer to tell their story at a closed meeting, please contact us here at ALRANZ – we are happy to mediate to whatever extent we can, and preserve your anonymity while we (and you) gather information upon which to base your decision whether or not to speak.

We hope the final vote will be in 2019.

Thanks so much for all your support over the past year. Here’s to victory in 2019!

ALRANZ and the Transgender Community

ALRANZ and the Transgender Community

Recently, the ALRANZ Executive Committee received questions regarding where we stand on the inclusion of transgender and non-binary people in reproductive rights activism.

With this in mind, we’re happy to clarify that our policy is one of inclusiveness of trans and non-binary people in all our events, advocacy and outreach.

We advocate for the right for anyone who can get pregnant to have safe and straightforward access to abortion should they want it. We think it’s possible to hold all these things true, that: abortion is primarily a women’s issue, not all women can get pregnant, and not all people who might need an abortion are women. We try and reflect this in our language, which aims both to centre women and to be inclusive of our trans and non-binary community.

The fight for reproductive health rights is one that primarily affects women, but sexual and reproductive rights are human rights, and do not need to come at the cost of alienating other marginalised groups.

We have also been asked specifically by people who do not share this kaupapa whether they will be excluded from our events based on their beliefs.

Our answer is this: If you want to bring a placard with a uterus to an event ALRANZ is hosting or involved with, go for it. But if you want to come to an event specifically to make trans folk feel uncomfortable or to promote a purposefully exclusive idea about what being a woman should involve, please stay home.

The pro-choice position is predicated on the idea that a pregnant person knows the most about their individual situation and knows what is best for them, when/if to involve others, and whom to involve. We reject the idea that the state (or a doctor, politician, priest, or whoever) understands someone’s lived experience better than they do, and is therefore more qualified to make decisions for them.

We also apply this principle to people’s gender identity; no one has the right to police the validity of another person’s experience.

Abortion is just one aspect of choice and doesn’t exist in a vacuum. We advocate for everyone to be free to choose whether and when to become a parent, but more fundamentally, to also freely and safely express their sexuality. To be defined by our beliefs, ideas, and actions instead of our bodies. This is a human right, no matter what’s in your pants.

Many trans and non-binary people have historically shown up for the pro-choice cause. We are thankful for this solidarity, and we are here to return it.

In solidarity,

The ALRANZ Executive Committee:

Terry Bellamak

Jess Ducey

Dr Morgan Healey

Nicole Skews-Poole

A.S.

Scott Summerfield

Thomas Blakely

Safe Access Zones, Please

Safe Access Zones, Please

Students from Wellington Girls College have started a petition calling for safe access zones around Wellington Hospital, to prevent harassment by anti-choice protesters.

In a TVNZ article about it, a law professor says:

[T]he real issue here, of course, is that creating a no-protest zone sets a precedent for other protests to be banned, and I think that is a dangerous road to head down.

ALRANZ respectfully disagrees.

The purpose of safe access zones is to stop the targeted harassment of people who decide to receive abortion care. Some people feel intimidated, others angry, at the cheek of these elderly men with gory signs who know nothing whatsoever of their circumstances, presuming to think they know better than the pregnant person does.

In the first place, there is no suggestion of banning protests. Rather, the location of protests would be regulated.

This is manifestly not for the purpose of banning or preventing protests. The protesters would not be required to protest only at 2 AM outside Wellington city limits. They would be free to protest wherever they want, except within the safe access zone.

They could even protest in places that attract politicians who could actually change the laws they oppose, like Parliament. Very few politicians at the hospital.

In the second place, freedom of expression is not an absolute right. Some human rights are absolute, meaning their breach can never be justified, like the right not to be tortured, and the right not to be enslaved. Freedom of expression can be subject to a balancing exercise against the rights of others.

Freedom of expression is also self-reflective. This means your right has been properly exercised when you have said your piece, or carried your sign – it does not require the state to supply you with the audience of your choice.

Let’s say you believe vaccinations cause autism. You can speak your piece on a street corner, and carry your sign up and down the footpath outside the headquarters of a pharmaceutical company. But it is not part of your freedom of expression to accost someone trying to get their children vaccinated or get a flu jab.

It is open to the state to balance the rights of private people seeking private health care against those who want to disturb and confront them at a vulnerable time. The state has a valid interest in protecting people from such harassment while they are going about their business.

In the third place, would preventing this kind of harassment even be controversial if the people bearing the brunt of it were not women seeking abortion care? Pregnant women who are seeking health care our society has stigmatised for years?

The protesters apparently hope the rest of society agrees with them that these women do not deserve the protection of the law. Over the years, in places like the USA and Australia, police seem to have agreed with the protesters that the usual laws against assault and harassment don’t apply in the case of these women. That usually doesn’t change until a specific law, like one creating safe access zones, is passed.

It is long past time receiving abortion care, like receiving any other kind of health care, is seen for the private act it is, and protected accordingly. We hope Parliament will give due consideration to these students’ petition in the coming debate on abortion law reform.

ALRANZ Analysis: The Law Commission Reports Back

ALRANZ Analysis: The Law Commission Reports Back

During the last election campaign Jacinda Ardern declared her intention to reform New Zealand’s abortion laws by decriminalising the procedure, and changing the law to treat abortion as a health matter.

Last February, her Minister of Justice, Andrew Little, directed the Law Commission to report back to him in eight months with options for abortion law reform.

The Law Commission has finally reported back to the Minister. Their report contains three options for the reform of New Zealand’s abortion laws.

Before we get into the options, let’s briefly recap what’s wrong with the current system:

  • Paternalistic– the decision whether someone can get an abortion rests with the certifying consultants, not with the pregnant person, which violates their right to bodily autonomy
  • Complicated– you need to follow a convoluted process to get an abortion, which includes tests, counselling, and getting the approval of two certifying consultants
  • Punitive – you have to lie about your mental health status to meet the grounds in the Crimes Act (98% of abortions are granted on the mental health ground)
  • Arbitrary– approval is discretionary, not a matter of right, and people have been denied abortions
  • Discriminatory– only women and other pregnant people must undergo a complicated, uncertain process to access safe, routine health care
  • Creates delays– it takes 25 days on average from the initial referral to the procedure, and health practitioners are allowed to refuse requests for abortion referral and contraception

The Best Option

Model A allows pregnant people to receive abortion care for any reason, at any gestation. It is best because it treats abortion like any other form of health care.

This option places the decision to seek abortion care in the hands of the pregnant person where it belongs, rather than in the hands of random certifying consultants. It eliminates much of the discrimination that permeates the provision of abortion in New Zealand.

This is important because just like every pregnancy is individual, so is every abortion. The pregnant person is the person best placed to decide whether to receive abortion care; no one else knows her circumstances better.

Pregnancy can be gruelling and unpleasant, even when you really want the baby. Forcing someone to undergo pregnancy and childbirth who does not wish to do so is horrific. According to the UN’s Special Rapporteur on Torture, it is torture.

Model A makes no mention of gestational limits. This benefits vulnerable families, because abortions that happen late in a pregnancy are overwhelmingly wanted pregnancies undermined by some crisis. The last thing a family in crisis needs is an unnecessary legal process. But more on that when I discuss Model C.

By greatly simplifying the process, this option is likely to help with the delay that currently exists related to ticking the legal boxes. Other delays around limited access, however, will require investment from the Health Ministry to alleviate.

This is an option worthy of the first Western nation to recognise women’s right to vote. It represents a conscious acknowledgement that women’s bodies belong to themselves, not to the state.

The Worst Option

Model B leaves the final decision whether a person can get an abortion in the hands of one health practitioner, who will provide the abortion. The practitioner must be satisfied the abortion is appropriate in the circumstances, having the pregnant person’s mental and physical wellbeing as the primary concern. There is no limit to the matters that can be taken into consideration, so they may include social or financial considerations.

By leaving the decision in the hands of a health practitioner rather than the person whose physical body it concerns, Model B still actively discriminates against women and other pregnant people, because there is no health care men or non-pregnant women routinely seek that requires a practitioner’s legal approval.

Model B requires a practitioner, who probably does not know the pregnant person, to determine the appropriateness of abortion in her circumstances, as though they would know better than she would. This is insulting.

Model B necessitates maintaining the pointless bureaucracy we currently have around ensuring the approval has been legally recorded. This may perpetuate the delays we see in the current system.

Model B may inadvertently invite litigation after the fact. Some women experience religious conversions that entail denouncing previous abortions. Litigious anti-abortion groups may allege a given practitioner knew or should have known an abortion would lead to the woman’s later psychological distress, in a ploy to make them wary of approving abortions.

Under what circumstances would an abortion be refused? The fact that this is unclear means the law is still arbitrary and unpredictable.

Or would every abortion be approved? If so, then the exercise is pointless. If you already know the answer to the question, why bother asking?

It is hard to see this model as anything but a sop to those who believe women should not make decisions themselves.

The Meh Option

Model C is like Model A up until the 22nd week. Then it turns into Model B. This means the decision whether to get an abortion in is the hands of the pregnant person up until the outcome is a foregone conclusion.

This option is an improvement on the status quo. But, given that pregnancies that continue for 22 weeks are wanted pregnancies, and families who must terminate them are in crisis, it is difficult to see what the benefit to society might be in forcing families facing tragedy to undergo a pointless legal process in order to access health care.

Less than 1% of pregnancies end in abortion after the 22nd week. So this option throws a very small number of pregnant people under the bus. But when you consider their circumstances, it just seems cruel.

Would there ever be a case in which approval would be denied? One would expect it is even less likely under Model C than under Model B. Why are we bothering, then?

Like Model B, Model C panders to folks who want the system to look as though it might refuse an abortion, but does so by making only families in the most vulnerable of circumstances pay the price.

Features That Could be Part of a New Law, Whatever Option is Chosen

Instead of making abortion a separate offence, we could use the existing legal framework to penalise unqualified people performing abortions, like most jurisdictions in Australia do. Abortion is extremely safe, and can be regulated like other health care.

Pregnant people could access abortion services directly, without a referral from their GP, or any other doctor. This would eliminate the bottleneck caused by the refusal to treat on ‘conscience’ grounds. It could also eliminate some of the delay around access.

Early medical abortions could occur at the patient’s home. Early surgical abortion could occur in settings like doctors’ surgeries or clinics. Currently they are provided in full-on surgical theatres, unnecessarily in the vast majority of cases, and at great expense.

Trained health practitioners who are not doctors could provide abortions. International research has shown properly trained nurse practitioners and midwives achieve the save high degree of safety as doctors.

Counselling could be offered, but not made mandatory.

The legislation could include safe access zones around facilities that provide abortions, so that clients could not be targeted for harassment within that zone.

Providers who refuse treatment on the basis of ‘conscience’ could be required to refer the patient to someone who will provide the service, as in Queensland’s new law.

What is Missing

Refusal to Treat

While the right to self-refer to an abortion service solves one part of the problem, refusal to provide contraception remains an issue. This impacts the abortion service because contraception is the most effective means of preventing abortion.

The referral requirement could require pharmacies to ensure there is at least one person working at all times who will dispense contraception, including emergency contraception.

But the refusal to treat still discriminates against women and other people who can become pregnant, because contraception, like abortion, is routine health care used primarily by them. More must be done to rebalance the burden of a health practitioner’s ‘conscience’, so that the weight falls more on the practitioner, and less on the patient.

Safe Access Zones

The report considers, then rejects the idea of safe access zones for New Zealand, saying they have not been shown to be necessary.

But this is not because Kiwis are so nice – it’s structural. Because of the current law around licences, most abortions occur in hospital settings, where it is difficult to target people seeking abortion care.

If the Ministry of Health wants to improve access, and intends to rely on community-based clinics and doctors’ surgeries to do so, they would do well to consider that such clinics may be reluctant to provide care, knowing they will soon have a group of old men with gory signs right outside their door. The Government would do well to consider providing a solution in the new legislation.

Conclusion

Model A is the option that affords the greatest opportunity for progressive change, because it goes farthest toward treating abortion like every other form of health care. It should form the basis of an abortion law reform bill. That bill should include all the features the Law Commission identified as possible elements of law reform, independent of the three models.

With this report, the Law Commission has delivered a valuable analysis and a clear way forward for the Government. It now rests with the government to turn this advice into a law New Zealand can be proud of, one we can point to in years to come as evidence that New Zealand continues to honour its legacy of treating women as adults.

 

Safe Access to Abortion Requires Safe Access to the Clinic

Safe Access to Abortion Requires Safe Access to the Clinic

by Scott Summerfield, ALRANZ Executive Board

You are on your way to the hospital. Something has come up, and you only have a short time to seek medical help before your life is changed forever. You are anxious, a million thoughts running through your mind, but you are resolved. You know you need to do this. You drive past a corner occupied by protesters. They have banners and signs that after a quick glance you know are directly targeting you. An older man catches your eye briefly; he knows nothing, but the look for you is a full on assault. It carries judgement, scorn, belittlement. You park, get out of the car, and walk past the protesters again into the hospital. One of them has given you a leaflet. Saying nothing, it goes into your bag. The hospital doors slide shut behind you, closing out the world and the protesters. What they are saying may affect you for months to come.

Are you:

  1. A man getting a vasectomy?
  2. A man taking his child for chemotherapy?
  3. A woman seeking a surgical abortion at 9 weeks?
  4. A woman coming to get an influenza vaccination?

The answer is clearly c). It is only ever c). People seeking abortion services are the only ones whose attempt to procure personal health treatment is met with protest outside clinics and hospitals. Prayer vigils and placards telling them they are making a terrible mistake, that their choice is immoral, and worse. This will in almost all cases only affect women. Protests against women accessing abortion are frequent, calculated and cruel. This is about harassment.

These protests and protesters cause harm when they harass women seeking an abortion. A 2015 UK study demonstrated that women feel intimidated, fearful, uncomfortable in the presence of protesters. The Abortion Supervisory Committee in New Zealand has raised this matter with Parliament, in 2013, stating that “Harassment of those seeking or providing abortion services remains a significant concern to the Committee.”

And it is certainly harassment. Anti-abortion protest is explicitly about controlling the choices of women. The anti-abortion movement here, and internationally, is not a peaceful one, utilising shock, invasive imagery, threats, abuse, and even violence. With abortion law reform, it’s entirely possible that abortion services in New Zealand may move away from the anonymity of hospitals to specialised clinics, which will make the protests more targeted and likely much more aggressive.

Preventing harassment and intimidation of people seeking abortion services must be undertaken through government legislation because, frankly, nothing else will work. Three states and two territories in Australia have implemented safe access zones where it is illegal to protest outside an abortion clinic. Safe access zones exist in parts of Canada, the USA, the UK, and are likely to be introduced in Ireland.

Our government is committed to abortion law reform. Safe access zones outside abortion clinics and hospitals must be a part of this reform. Until we can ensure that women and others in need of abortion services from a clinic or hospital can access those services without intimidation, harassment, judgement, or even violence, we will not have safe access to abortion in this country.