Watch What They Do

Watch What They Do

by Terry Bellamak

This week in the USA, someone leaked a Supreme Court majority decision that reverses Roe v Wade, the decision that establishes a constitutional right to an abortion. Now Americans are incandescent with outrage at the dumpster fire their democracy has become. When we consider our happy, sensible little country in comparison, Kiwis might be feeling a bit smug.

We shouldn’t.

We legalised abortion only two short years ago. By now the law change has the feel of inevitability that Roe used to have. But it almost didn’t happen.

If Winston Peters had buried the hatchet with National instead of in it, Bill English would have remained Prime Minister. He would not have lifted a finger to advance abortion law reform – he would have moved heaven and earth to prevent it. We would still be lying to certifying consultants, saying that we were mentally disturbed to get their discretionary approval to end unwanted pregnancies.

Who is in power makes a huge difference to fundamental human rights. Every country on this planet is just a few bad politicians away from disaster.

Just ask Poland. It used to have fairly liberal abortion laws, but their unpopular right-wing government instituted a draconian abortion ban that has left doctors afraid to abort dying fetuses that are killing the person carrying them. People have died.

Even the support of large majorities doesn’t help. A large majority of New Zealanders favour abortion rights. The National Council of Women’s Gender Equality Survey found 74% of New Zealanders support the right to choose abortion. But that is no guarantee. Abortion rights are popular in the USA too – 70% say abortion should be between pregnant people and their doctors. 

People in the US thought their right to abortion was secure, but they were wrong. New Zealand must not fall into the same complacency.

You might say we are safe because opposition to abortion is driven by religious extremists in the USA, and we don’t have nearly as many here. 

I would submit religion is not so much the issue as authoritarianism, and we have more of those than we thought, as the occupation of Parliament demonstrated. We also have some former and current MPs who were willing to pander to the occupiers. 

Losing fundamental human rights is the last step in a long series of steps. The early steps barely register – we are halfway to the end before we realise we are going somewhere. 

Maintaining our reproductive freedom requires vigilance in the face of the media and politicians telling you not to be paranoid, those red flags are just decoration.

What would an erosion of abortion rights look like here? No one knows for sure.

It could start with a government hostile to reproductive rights quietly under-resourcing abortion care. Or perhaps encouraging the placement of anti-choice people in the health care system’s upper management, where they could undermine provision in quiet ways, like moving the abortion service to a different building which would require the service to request a new safe area. The service would be unprotected for the 3 – 6 months it would take to create and approve another safe area.

It could move on to nibbling away at the edges of abortion rights, perhaps starting with the least popular or most controversial. Perhaps ending telemedicine abortions. Perhaps reinstating the rule that the second set of medicines must be taken at the service, which requires another trip to the service. 

Always quietly, with as little fanfare as possible so that few people notice. They will always make the change sound reasonable, and promise nothing else will change and abortion rights are safe. Just like in the USA.

This is why we need to pay attention to the political class. When the leader of the opposition, Christopher Luxon, says abortion rights would be safe under a National-led government because deputy leader Nicola Willis is pro-choice – even though he considers abortion tantamount to murder, that’s a red flag. Don’t listen to what they say – watch what they do.

Now that we have abortion law reform, we need to make sure we keep it. 

 

The Long Game

The Long Game

by Terry Bellamak

To see what the world would look like if anti-abortion types had their way, look no farther than the USA.

Like Oklahoma, which just passed a bill making all abortions illegal except to save the life of the mother. The governor is expected to sign it.

Like Tennessee, which is moving forward with a bill that would allow a family member of a rapist to sue the rape survivor for $10,000. If fact, all the rapist’s family members could sue the survivor, and get $10,000 each.

Like Texas, which has banned abortions from 6 weeks on, and has just arrested and charged Lizelle Herrera with murder for ‘illegal abortion’. She is being held on a half million dollar bond.

Anti-abortion types talk a good game about ‘loving them both’, meaning both pregnant person and foetus. I guess charging someone with felony murder is what love looks like to them. Antis have droned on for years about how they don’t want to criminalise people who receive abortion care, just those who provide it. So much for that.

For the past 40 years, Americans believed their constitutionally protected access to abortion was safe, because it was settled law. But the US Supreme Court has the power to laugh at settled law, even at the cost of trashing the rules of precedent.

Here is New Zealand, access to abortion as health care is also settled law. Abortion care is embedded in the health care system, not kept at arm’s length like it is in the USA. The leader of the opposition has ruled out changes to the law if his party makes it into government next year.

But antis play the long game.

That’s why ALRANZ isn’t going anywhere. We will be right here, now and into the future, speaking out about things that need improving as the Ministry of Health implements abortion law reform and establishes systems to provide abortion care. We will be right here defending New Zealanders’ access to abortion should a government hostile to abortion be elected. We will be right here, talking about reproductive rights and breaking down abortion stigma.

The fight for fundamental human rights is never really over. That’s why we’re here. We play the long game too.

Why we need to fight abortion stigma 

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 

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.

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.