Why we need to fight abortion stigma 

by Katie Lavers

Medical science has improved lives. Vaccinations can prevent disease. They have been in New Zealand since the 1860’s, with smallpox vaccines being first in line. In the 1940’s and 50’s more widespread vaccination programmes began.

Likewise, modern abortion care prevents deaths from unsafe abortions. It enables women to live the life they want. A summary line from The Turnaway Study, a longitudinal study, shows this clearly:

Women who receive a wanted abortion are more financially stable, set more ambitious goals, raise children under more stable conditions, and are more likely to have a wanted child later.”

But in cases like these, the problems medical science solves become invisible to the next generation, because ‘success’ is measured by the absence of something bad rather than the presence of some new good. People do not die in droves of measles or Covid, and women can pursue their chosen careers. 

This is how interventions like vaccinations and abortion care become easy pickings for those with an agenda. People who do not want to be vaccinated and, for some reason, also do not want others to be vaccinated, make illogical claims that the vaccines have no effect – because people still get the disease. This ignores the fact they do not die from it.

Likewise, people who do not want abortions and, for some reason, also do not want others to have them, make ill-founded claims that pregnant people’s mental health will suffer if they get an abortion. This ignores data like the Turnaway study, and personal experiences like my own, that demonstrate the opposite.

Unless you are part of the tiny but dubious extreme religious or alt-right subculture who want to see less choice for women, things are getting better. According to the website ‘Our World in Data’, in 1965 worldwide, women had on average, 5 children. Today that has more than halved, and is less than 2.5. This is a great thing, and not just for the planet as a whole. It is better for everyone to have children who are wanted and planned. 

The difference between vaccination and abortion is stigma. 95% of New Zealanders have been vaccinated. 1 in 4 people with a uterus will have an abortion. These percentages show how accepted both medical treatments are.

But few talk about their abortions for fear of backlash, despite the positive, long-term impact it has on their lives. 

Other than the fact I am a breadwinner, I am annoyingly living the cookie-cutter conservative’s dream. Cis-hetero, working, white family of four. And yet, it was an abortion in my twenties that allowed me to pursue my chosen path working in education. Yes, I love children!  

We need to overcome the social stigma associated with talking about our abortions. This will ensure younger generations coming after us will understand how access to abortion care has shaped everyone’s lives for the better. Just like vaccinations. 

Katie Lavers is an ALRANZ member, and a teacher turned freelance writer.

A Testing Time Part 3 – Hormone Pregnancy Tests 

 

by Margaret Sparrow

From 1942 another type of pregnancy test was developed, not using hCG but two other hormones, oestrogen (or a synthetic oestrogen) and progesterone (or a synthetic progestogen). Either taken orally or injected, various combinations of these hormones induce menstruation but only if the woman is not pregnant or possibly if the pregnancy is not well established. There is limited evidence that it was used to induce an abortion.  No bleeding is a positive pregnancy test.

Two brands of Hormone Pregnancy Tests (HPTs) were available in New Zealand – Primodos by Schering from 1966 to 1975 and Amenorone Forte by Roussel from 1968 to 1975. Both were composed of the same hormones found in some contraceptive pills but the progestogen was in a much higher dose. It is not known to what extent these tests were used in NZ. The alternative, used by most doctors at that time, was to send a morning urine sample to the laboratory for one of the hCG tests, 14 days after the missed period.

Because of the reported risk from overseas of congenital malformations associated with the administration of these hormones during early pregnancy, both HPTs were withdrawn by the NZ Department of Health in 1975. Forty-seven years later, on 20 March 2017 the NZ Ministry of Health, responded to renewed concerns locally and in the UK and issued a statement confirming that Primodos had been used in NZ but that no fetal abnormalities had been notified to the NZ Centre for Adverse Reactions Monitoring (CARM). As a result of the publicity 10 historic cases were notified to CARM as possible adverse reactions but with the time lag it would be impossible to prove causation. The Ministry stated it would liaise with the British equivalent of CARM, the Medicines and Healthcare products Regulatory Agency (MHRA) for further developments.

The result, silence.

So what was the Primodos story in the UK?

1958                  

Primodos was introduced in Britain and was supplied on prescription for 20 years until 1978.

1967                  

Paediatrician Dr Isabel Gal published the first comprehensive study identifying an association between HPTs and congenital abnormalities. Dr William Inman Principal Medical Officer of the Medicine Control Agency was dismissive of her findings despite the fact that HPTs were introduced at about the same time as Thalidomide which also caused congenital abnormalities.

During the next 8 years Inman conducted his own study and during that time confidentially warned the German manufacturer, Schering, of possible legal consequences, but did not raise the issue with the public as might have been expected. Some commentators suggest that one factor may have been that these were the same hormones that were used in the contraceptive pill and publicity would have created a pill scare.

1975                  

Dr Inman published an interim report and the first public warning was announced regarding Primodos. This was heeded in NZ but not in the UK although a warning appeared on the packet.

1977                  

A second warning to doctors stated  “The association has been confirmed.” Archival documents reveal that at this time the probability of birth defects after taking Primodos was estimated to be 1 in 5. Inman’s evidence was destroyed eliminating its use in future case investigations.

1978                  

Primodos withdrawn in the UK.

The Association for Children Damaged by Hormone Pregnancy Tests (ACDHPT) was formed to advocate for some 800 affected families.

1982                  

ACDHPT, using legal aid, prepared to take a case to court but a causal link was too difficult to prove and the case was too costly to pursue. Inman gave evidence for Schering.

2006                  

Schering was sold to Bayer who then became responsible for any litigation.

2014                  

MHRA published an assessment of historical evidence on Primodos and congenital malformations and found the results inconclusive.

2017                  

An Expert Working Group commissioned by the UK Government concluded there was no association. In the opinion of ACDHPT this was a whitewash and PM Theresa May responded to the clamour by commissioning an independent review, not only of  Primodos but also the use of sodium valproate (a drug for epilepsy) in pregnancy and vaginal mesh.

2020                  

“First Do No Harm” The report of the Independent Medicines and Medical Devices Safety Review, chaired by Baroness Cumberlege, concluded that there was an association between Primodos and adverse effects and that Primodos should have been withdrawn in 1967, immediately after the publication of Dr. Gal’s Study. Recommendations were made to improve safety in the future. And so the campaign continues…

For further information see the website of ACDHPT

Dame Margaret Sparrow was a medical doctor, abortion provider, and president of ALRANZ for many years.

Endo Shouldn’t Be Like This

Endo Shouldn’t Be Like This

by Rimu Bhooi

It’s Endometriosis Awareness Month, and I’m sitting in bed, recovering from a concoction of medications in my system – Morphine, Sevredol, Bisacodyl, Ondansetron, Pregabalin, Panadol, Norethisterone, Nortriptyline, Omeprazole, Codeine, and Sertraline. 

I’d like to say that recovering from hospital is a random occurrence, but this is my life these days: a walker to help me make it to the loo; a pill container and a constant supply of pain meds; a microwave in my bedroom for wheat packs; and, hospital visits galore. 

Ever since I was diagnosed with Endometriosis three years ago, I have lived much of my life from bed. I genuinely thought things would get at least a little easier, but I’ve learnt that Endo is a beast unto itself.

The fainting and pelvic pain began when I was about ten. Then came the headaches, dizziness, painful periods, and pain. It took seven years of asking my GPs to help, being confused by how mates could carry on while bleeding, trying to convince the adults around me that I really didn’t feel well and was in a lot of pain. Finally, after I turned 20, I started making some actual headway on getting answers. I had a private gynaecology consult, and a referral was sent to the Waikato Hospital. I was put on a waiting list for surgery. I was hospitalised so many times between the pain worsening and the actual surgery. It began taking over my life, and now I know it’s something I’ll live with forever. 

If you don’t know much about Endo, I’ll explain: it’s a chronic whole-body inflammatory disease. Tissue similar to the lining of the uterus randomly grows in other places, commonly in the pelvis, but it has been found in every organ in the body. This tissue thickens, breaks down and bleeds like normal period tissue, but it’s in the wrong place. It has nowhere to go. This can cause pain with periods, urination, bowel movements, sex and PMS. Endo symptoms are wide-ranging like diarrhoea, constipation, nausea, sub-fertility or infertility, fatigue, recurrent UTIs, abnormal bleeding, and even chronic pain throughout the body.

There is no cure, but the best management appears to come from a mix of medications, supplements, complementary therapies, good nutrition, sleep etc. The only way to diagnose Endo is through laparoscopic surgery. On average, globally, the wait time for diagnosis is seven to ten years, a devastating and tragic statitstic. One in ten people with uteruses have Endo, 120,000 people in Aotearoa alone. Yet very few know about it, and what they do know is mixed with misinformation. I have been told to ‘go on birth control to heal it,’ ‘get a job and that’ll help,’ ‘stick it out, it’s normal,’ and even ‘just get pregnant!’ None of these ‘helpful tips’ is true because there is no cause, no cure, and anyone telling you otherwise doesn’t know what they’re talking about. It is chronic. It can be removed during excision surgery and still come back. It comes with co-morbidities. 

For me, those co-morbidities are mostly gynaecological. I was recently diagnosed with Adenomyosis, but I also have Hypertonic Pelvic Floor dysfunction, depression, anxiety, chronic fatigue and pain. Endo rules my life, and I’m only just coming to grips with the full extent of its effects on my life, study, and work. 

When reflecting on all this, and on just how much time, money, and energy I’ve spent fighting for a diagnosis and then fighting for treatment and pain relief, I’m sad, but mostly I’m just really angry. We deserve better; we deserve support and answers. Endo is debilitating and disabling, but it doesn’t have to be. We need people to listen to our experiences and change the medical system, so that it centres patients and helps us. Instead of, you know, leaving us sobbing on the floor in the foetal position, wondering what we did wrong.

The Right to Choose is not Enough: A Cautionary Tale

The Right to Choose is not Enough: A Cautionary Tale

by Tracy Morison

Abortion on request has been legal for more than 25 years in South Africa. Yet, despite the country’s highly liberal laws, every year pregnant women die needlessly due to complications from unsafe, illegal abortions. These deaths make up about a quarter of the official avoidable pregnancy-related deaths counted by the Government, and they have increased in the last decade. Unfortunately, it is quite likely that some deaths related to unsafe, illegal abortion go unreported, so the number could be higher. Official estimates suggest that more than half of all abortions are informal, illegal and unsafe.

 Abortion stigma is a major barrier to access. Public sector nurses frequently chastise patients seeking an abortion rather than giving birth or for ‘using abortion as contraception’, or publicly humiliate them, or disregard their privacy and confidentiality. Some women would rather risk using a private but illegal service than become a social pariah among their communities or families, especially if they are young. 

“The underlying causes of morbidity and mortality from unsafe abortion today are not blood loss and infection but, rather, apathy and disdain toward women” 

(Grimes et al 2006, The Lancet).

Worse, the facilities that are supposed to offer services just don’t. Sometimes this is because no one is willing to offer services. As conscientious objectors they don’t have to. Sometimes there is a lack of political will to provide the support needed to keep a controversial healthcare service running, at the risk of alienating conservative voters.

At last count less than half of the clinics the government says should be available actually are. Some are under-resourced and some cannot find staff who do not conscientiously object. Clinics that are open are overburdened. A recent news article reported that pregnant women had to queue overnight at one clinic. Many people  simply don’t have the time, money, or freedom to travel to get public care or to access private care. Their only option then becomes an illegal abortion, which is sadly far more accessible. South African activists say that this situation is maintained by a conspiracy of silence.

The point of the story is this: the right to choose alone is not enough. They remain words on paper if they cannot be exercised.

The point of the story is this: the right to choose alone is not enough. They are just empty words on paper if the right cannot be exercised. The government must be held accountable for maintaining a system that supports people’s ability to exercise their rights and make choices about their reproductive lives.

So far, in Aotearoa New Zealand, we have seen some promise of this in the development of the new Telehealth Abortion service, DECIDE, which will increase access to care by allowing early medical abortion at home. Also promising is the strong cross-party support shown in the passage of the safe areas Bill—which will regulate harassment and intimidation of people accessing and delivering abortion care.

The right to abortion as healthcare was a hard-won right and one that cannot be taken for granted. It is imperative that services are literally, and not just theoretically, accessible; that service standards are upheld, offering patient-centred care; and that the rights of those who object to abortion do not trump the rights of others who choose it. It is up to us to speak up if something is not right or to report problems and concerns. It is up to us to ensure that we do not become part of a conspiracy of silence that makes our right to choose meaningless.

____________________________________________

 There are only data collected on cisgender women at present.

 

A Testing Time Part 2: Modern Pregnancy Tests 

A Testing Time Part 2: Modern Pregnancy Tests 

by Margaret Sparrow

Human Chorionic Gonadotropin (hCG), is a pretty special hormone excreted by the placenta to maintain a pregnancy. It can be detected in blood at low levels and also less sensitively (but more conveniently) in urine, especially that first morning sample when urine is more concentrated. There are two subunits (alpha and beta) and it is the beta subunit which is used in most pregnancy tests.

Immunologic tests are so called because hCG is an antigen which can trigger the production of antibodies. It is these antigen-antibody reactions which are the basis of various tests. Some tests depend on the detection of antigen, others the antibodies.

The door to immunologic pregnancy tests was opened in 1960 when two Swedish researchers (Wide and Gemzell), published the results of a technique called haemagglutination inhibition which detected antibodies to hCG. It was done in a test tube using red blood cells from a sheep which clumped together (agglutinated) in a special pattern when urine containing hCG was added. It took 60-90 minutes to read and was very accurate when taken one week after a missed period. Amazingly, Leif Wide made this discovery when he was a medical student studying under Dr Gemzell. As early as 1961 the method was introduced into Uppsala University Hospital. In 1962 a similar test used a drop of urine on a slide. Instead of red blood cells, latex particles were used to demonstrate the clumping pattern.

Initially tests were done in laboratories, then in doctors’ surgeries, then eventually in the privacy of home.  Organon in Holland was the first to patent a home pregnancy test kit in 1969 and during the 70s these were gradually introduced elsewhere. The first home tests were pretty unreliable and one looked more like a child’s chemistry set with its vial of purified water, an angled mirror, a test tube, an eye dropper and red blood cells taken from a sheep.  It took until 1971 to have home tests available over the counter in Britain, Europe and Canada, until 1977 in USA and later still in NZ in 1980. 

During the 70s and 80s many innovations were marketed with the aim of making the tests more user friendly – simpler, less expensive, more convenient, and more accurate earlier in the pregnancy. A giant leap forward was the use of coloured dyes which bonded to the antigen or antibody and travelled to the test and control zones which appeared like magic as coloured lines. Instead of test tubes or slides we were enticed by elegant test kits or a strip or wand to hold in the stream of urine.

Another significant advance was the introduction of quantitative tests which measure the level of hCG in International Units/ml. Quantitative tests have many other uses but as far as abortion is concerned they are very useful in determining whether the abortion has been successful.  Levels will remain higher than expected if there is an incomplete abortion with pregnancy tissue remaining or if there is a continuing pregnancy. Women are advised to have a post-abortion check in about 2 weeks. At this time a free blood test is available through a laboratory or a low sensitivity test can now be provided to do at home at a reasonable price. This test will only be positive when the level is over 1000 International Units/ml. It is very useful now that early medication abortion can be provided by telemedicine. (Thanks to the law changes!)

Compared to the rapid uptake of rapid antigen tests for Covid, why did it take so long for pregnancy self-testing to become available? The problem was not the tests but judgmental attitudes. Could women really be trusted to carry out instructions? Wasn’t it better to have the diagnosis from a doctor? What about false negatives and false positives? Women would not understand about reliability. What about counselling? What about support if the result was not the desired result? What about privacy? Who should provide the tests – doctors, laboratories, pharmacies, family planning clinics, mail order? And so on….

 It was a coincidence that the introduction of pregnancy testing came at the same time as the sexual revolution of the 60s to 80s.  This was a time of great social change which came to be associated with permissiveness (free love), women’s liberation, abortion law reform, gay rights and the erosion of medical authority. Self-testing gave women greater autonomy and contributed to a realignment of the power dynamics between doctors and patients. The humble pregnancy test sits alongside the birth control pill introduced in NZ in 1961 as a significant agent of change.

Dame Margaret Sparrow was a medical doctor, abortion provider, and president of ALRANZ for many years.

Pro-choice Motherhood

Pro-choice Motherhood

by Julie Fairey

When I first contemplated becoming a mother I worried. I worried about all sorts of things; would I be any good at it, would I hate it, would I be able to get pregnant at all. And I worried that it would change my attitude to abortion.

You see my journey to supporting the right to abortion, that essential medical care that needs to be available to anyone with a uterus, was a bit fraught. I had gone to a Catholic school where my classmates wore the little feet badges on their lapels. It wasn’t until I was about 16 that I learned anti-abortion was not a universally held view. I evolved my position quite slowly from that shocking first time overhearing some other girls talking about abortion as if it wasn’t a Big Bad Thing. By the time I was in my late twenties, looking to become pregnant myself, I had gone through “well I support it but only up to a certain point” to “I guess I support it for others but I could never do that” to “Ok this is a required medical procedure that anyone who needs it should be able to access”.

But the nagging sense from those early years remained, based on being told I’d feel differently once I had children of my own. So I worried, that the experience of pregnancy, childbirth and become a mother would unmoor me from my firmly held pro-choice views.

I could not have been more wrong.

I’ve been pregnant four times. The first ended in an early miscarriage; not physically traumatic luckily for me. When I told a colleague about it they remarked jovially that was just a missed period, and while that was a heartless way to put it, they were correct that what I miscarried did not look or feel to me like a baby at all.

My three subsequent pregnancies have resulted in three live births, three children I parent today as I write this (from Covid isolation!)

And each of those experiences, in particular the pregnancies, have made me more and more pro-choice. All three included bad morning sickness (not just in the morning) and loss of weight in the first trimester. Fair to say I am not one of those people who blooms in pregnancy, even in the second and third trimesters. I find it a great trial; one I’m prepared to undertake because of the likely outcome, but something no one should have to do unless they choose to.

And my final pregnancy produced a particular challenge that reinforced my views, as I went into early labour at 30 weeks (that’s at the three quarters mark for those who don’t think in gestational timeframes). While the outcome was positive for both of us, there was several months of hospital time for my child, which meant a lot of hospital time for me, and the first year was filled with beeping alarms and various tests. I was happy to do all of this because I chose it. I could not imagine going through all of that when I didn’t want to.

If I get pregnant again, I will need an abortion. My last experience, at 38, was much harder than the previous ones, even putting aside the early end. I’m just too old to do it again; others won’t be at this age but for me, for my body, I know that I am. So again, my experience becoming and being a mother, adding to my family, has strengthened my conviction that abortion is absolutely necessary, at the choice of the pregnant person.

Becoming a mother wasn’t the threat to my pro-choice views that I thought it might be. Instead I’ve been a mother speaking up for choice, in case others shared the same illusion I used to that motherhood and supporting abortion rights were incompatible.

Being a parent should be a choice you can make freely and joyfully, not an inevitability you begrudgingly have to accept. Long may we continue towards making that a reality for all.

This blog is part of the #40DaysForFacts campaign. Follow on social media. @alranztweets / https://www.facebook.com/ALRANZ