What Could Go Wrong?
Getting an abortion in New Zealand is a needlessly complicated, time-sensitive process. There are many points at which your abortion experience could go wrong, potentially leaving you with a life-long commitment to parenting that you never wanted or intended.
You might not immediately realise you are pregnant.
Individual people can have very different experiences of pregnancy at all stages. People with irregular menstrual periods and no morning sickness might not realise they are pregnant until they are quite far along.
All contraception has a non-zero failure rate, even with perfect use, and perfection is not something human beings are noted for. Certain medications, like some antibiotics, greatly reduce the efficacy of hormonal birth control. People have conceived while on oral contraception, and even with IUDs in place. If you have contraception and find yourself nauseous, you will likely suspect food poisoning before you think you might be pregnant.
For most women, there are 30 to 40 years between menarche and menopause. If a woman is sexually active, she will likely be on contraception for much of that time. But all contraception has a rate of failure. This is why one in four women in New Zealand and many other OECD countries will have at least one abortion in their lives. Statistically, a woman who ends up with only a few scary late periods is quite fortunate.
Abortion is a time sensitive medical procedure. The earlier you find out you need one, the better off you are. But you can’t act on what you don’t know.
You might live in an area far from the main centres. You might not have the money for a GP visit. You might be in a small town, where everybody knows each other’s business, and you might not feel safe having other people know about your abortion. You might not feel safe telling your partner or other family members.
There might be only one GP in town, and you might know that one is opposed to abortion care, and the next nearest GP might be far away. They might also turn you down. You might need to travel some distance to find a sexual health clinic or a Family Planning clinic.
Accessing abortion requires a lot of visits to different health care providers. If you have children, you will need to either bring them along or find someone to watch them. If you are working, you will need to ask for time off, which may affect your earnings and your budget, leaving a financial hangover that could last for months.
You may need to travel between various health care providers, so if your area does not have good public transit and you don’t have a car, you might need someone to lend you theirs or drive you.
It may not be possible to get the help you need without informing people you might not feel safe telling about your pregnancy.
You might live in the catchment area of the West Coast DHB, which does not provide an abortion service. That means you will need to travel to Christchurch to access services. You may have to front your travel costs, to be reimbursed later by the DHB.
Barriers like these are bad enough in a familiar urban centre. But getting all these tasks accomplished in an urban centre that is unfamiliar to you will add more time and trouble to the overall annoyance.
Some abortion services have managed to streamline the process, especially in urgent cases. Some have even made it possible to get all your tests and appointments done in a couple days. Most people do not have that experience.
Everyone has to jump through hoops to access abortion, but hoops that are an annoyance to people in urban areas may be insuperable barriers to those in remote communities.
Not eligible for free health service care
If you are not eligible for free care under the NZ health service, and you do not have a spare $750 - $2500 lying around for emergencies, you have a problem. If you can’t afford to fly home, or if that would not help because abortion is illegal or hard to access in your home country, then you might seek help from one of the web-based services that provide abortion pills.
A recent study showed the pills you get on the internet are likely to be the real thing, and therefore, effective. The author of the study and her cohorts sent away to 20 different internet sites offering abortion pills. All the pills they received were mifepristone or misoprostol. Although the sample size was small, and past performance is no guarantee of future results, the study is reassuring.
The biggest danger for women in NZ sourcing pills from overseas, is the risk that Customs will find and confiscate the pills.
Unlike in some jurisdictions, giving yourself an abortion with internet-sourced pills in NZ is not a crime. Procuring the pills for yourself could lead, at worst, to a $200 fine. Procuring the pills for someone else, however, carries a maximum penalty of 7 years. That would apply to a mother procuring pills for her daughter. Recently, a woman in Ireland was prosecuted under these circumstances.
Delays in getting appointments
The average wait between the initial referral and the termination procedure is 25 days. Lack of resources, and the sheer number of steps in the process both contribute to the delays.
Some pregnant people experience delays getting the initial referral to an abortion service, before those 25 days even start being counted. In an interview with ALRANZ in 2016, Dr Simon Snook described what the providers of the 0800 ABORTION service observed:
The biggest thing we’ve noticed is the stories that we are hearing from different women showing that the majority of women who are calling our service are doing so because of considerable issues for them with accessing referral through the conventional methods. Now whether they’re perceived issues or real issues is different in different cases, but what’s apparent is we appear to be filling an unmet need for a certain group of women. Obviously for those women who find the conventional method of GP or Family Planning referral are continuing with that and are having no problems. And we’re sort of picking up those other cases. There’s lots of individual stories whether they be issues with practitioners who have been obstructive or just personal issues for them in accessing a referral in a safe or confidential manner or indeed just the logistics of getting to appointments for people who live very rurally. So there are lots of individual stories but all of them show that these would have been women who would have found it very very difficult to access a service without us there.
The service Dr Snook is referring to, 0800 ABORTION, ended for lack of funding from the previous government.
Health care providers, meaning doctors, nurses, and pharmacists, are allowed by law to refuse care on grounds of ‘conscientious objection’ if that care is for contraception or abortion. Refusal is not permitted under any other circumstances. It’s like Parliament is trying to tell you something.
Conscientious objectors often characterise their interactions with patients to whom they refuse service as ‘non-judgmental’. How is it possible to refuse service on the basis that you find the requested service morally objectionable in a way that does not implicitly represent the patient’s morals as lower than the provider’s?
An article in the NZ Herald said that women felt dismissed by doctors, and received ‘lectures’ about the moral implications of their decision. For example:
"B" needed an abortion when she was 19.
She was sure of her decision, but when her regular doctor wasn't available, she made an appointment with the other GP at the centre.
What happened next left her in tears.
"She sat me down for maybe 25 minutes, gave me a massive lecture on all the other options, and told me abortion was a terrible thing.
It made it 100 per cent worse. I was set on what I wanted to do, and fine with it.
Then I went from being sure of myself, to being pretty upset.
I've never had a doctor talk to me like that about anything else."
Eventually, the doctor told B that she wouldn't do the referral.
"That would have been fine, but that was all she needed to say.
But instead of that she was so full on, put a real guilt trip on.
That incident did delay me by about a month, so it ended up being a pretty urgent situation.”
Referral to a service
Once your GP or Family Planning has referred you to your DHB for abortion services, your experiences will be different according to the different DHB’s polices on abortion.
DHBs sometimes deviate from the Contraception, Sterilisation, and Abortion Act 1977 (CSAA) in the provision of abortion, making it harder to access.
For instance, the Waitemata DHB developed a unilateral policy of not referring abortion seekers at 18 weeks gestation to the certifying consultants in their service to determine their case as required by law. Instead, they ‘suggested the patient could seek care in Australia at their own expense.’
This happened recently to two women in Auckland. News coverage referred to them as ‘Kate’ and ‘Erica’.
DHBs have a responsibility to ensure people in their catchment areas can access core services. Abortion is a core service. Standard 5.1 of the Standards of Care for Women Requesting Induced Abortion in New Zealand sets out the responsibilities of various parties:
Every medical practitioner who is consulted by a women who wishes to have an abortion shall arrange for the case to be considered in accordance with the [CSAA].
Two certifying consultants must consider each case and issue a certificate which shall be forwarded to the holder of the licence for the institution where the abortion is to be performed. (emphasis mine)
These are the people you must convince that you want an abortion, not just because you don’t want to be pregnant, but because your mental health will be compromised if you carry the pregnancy to term.
Two certifying consultants must approve every abortion. Their first responsibility is to make sure your case falls into the grounds specified in the Crimes Act.
Most certifying consultants use the WHO definition of mental health, and take the reasonable view that being forced to carry an unwanted pregnancy would inevitably be detrimental to a person’s mental health. But they still need to hear you say the words. If you try to brazen it out with honesty, you might be refused.
Certifying consultants are also responsible for making sure the person asking for an abortion is not being coerced. If a pregnant person is not sufficiently enthusiastic about the abortion, or says the wrong thing when truthfully describing their decision process, they could find themselves denied an abortion.
This almost happened to Vivien (not her real name):
"I stated clearly that I knew a baby would have a very negative impact on my mental health and I wasn't in a position to raise a child. When I was asked if my decision was influenced by people in my life - I said that of course it was - I wouldn't feel comfortable bringing up a child on my own or with a partner who really didn't want to have a child. I explained that my partner was very distressed by the thought of having a baby. Their response to this was almost angry - 'so whose decision is it, yours or your partner's' - and I tried again to explain that it was my decision, but of course what comes into that is the prospect of raising a baby in an unhappy situation, without adequate support and knowing that the father would have felt that this was a burden.
I was asked if I wanted the abortion, and trying to be honest, I said that no, I didn't want an abortion, but I also really didn't want a child and so this was my only option. I remember their response being openly hostile, as if they were trying to prove that I shouldn't have an abortion. It was more the manner of the interview that I found challenging - there was no care or sympathy, and it felt like I was under attack. It seemed as though they were angry with me and were trying to prove me wrong."
And then there is the possible presence of anti-choice protesters.
A study came out in September 2015 from Aston University in Britain, which examined how abortion seekers perceived abortion protesters. Not surprisingly, the study found abortion seekers found protesters’ conduct intimidating and upsetting, and it made them anxious and fearful. Even when the protesters were silent, patients felt their presence to be intrusive and threatening.
This is not surprising given that every person who looks female has probably experienced street harassment. Protesters engage in the same behaviour as street harassers: yelling at women, trying to get their attention, trying to make them fearful. This is why women experience abortion clinic harassment in the same way as street harassment.
Very few pregnant people actually change their mind about going through with an abortion based on an encounter with the anti-choice protesters. Even anti-choicers acknowledge this fact.
Anti-choice protesters raise the emotional cost of seeking an abortion.