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.


Sept. 28: Global Day of Action in NZ


By Morgan Healey, ALRANZ President

On the 28th of September 2014, ALRANZ celebrates the Global Day of Action for Access to Safe and Legal Abortion. This is a campaign that began two decades ago in Latin America and the Caribbean and has gone global, with activists around the world drawing attention to restrictive and dangerous abortion laws in their countries. This year’s focus is on stigma and challenging the shame and silence that so often accompanies abortion, even when it is legal.

As the organisers of the 28th of September, the Women’s Global Network for Reproductive Rights (WGNRR) in partnership with the International Campaign for Women’s Right to Safe Abortion and La Campaña 28 LAC, stated:

The stigma surrounding abortion is complex and pervasive, as well as produced, reproduced and reinforced at individual, community, institutional, cultural, and legal levels. Entire communities stereotype, ostracize and discriminate against individuals who need and seek abortions, as well as women human rights defenders attempting to help individuals to access this human right.


It is our job as reproductive rights and justice activists to join in the global chorus to eradicate stigma – not just today but every day. This is not necessarily an easy task. Pervasive is an apt word as stigma manifests itself in subtle and insidious ways.

One example is the act of conscientious objections, where medical professionals are allowed to refuse treatment or care as the result of their own moral objections to abortion. Too often the focus is on the medical professional and their ability to exercise their right to not perform a medical procedure that they disapprove of. But what happens to the pregnant person forced to find help and assistance elsewhere? Is their care delayed? Does it create further stress and anxiety? Does it leave them more vulnerable in an unsafe relationship or environment? And how does this reinforce stigma?

This is the crux of the stigma issue – it not only erects barriers to care but it leaves women feeling as if their choices are amoral, wrong and detrimental. They carry the weight not only of their own lived experiences and the consequence of their choices, but also the gendered expectations of societies that associate ‘womanhood’ with ‘motherhood’. Being defined by your anatomy, which is also harmful to people who do not associate their sexed body with a certain gender (i.e. those who operate outside of and challenge cisgender culture), allows for the constant surveillance and policing of their reproductive choices. Stigma happens at both the macro and micro levels, with the (re)production of discourses that shame women while ensuring they self-regulate their actions, mostly by silencing their abortion experiences.

Turning back to conscientious objection, a false dichotomy is created whereby the virtuous doctor, governed by their ‘moral’ principles is juxtaposed with the errant pregnant person. This power imbalance is important in the perpetuation of stigma and the associate of abortion with shame and silence – it allows those in professions that are often revered and looked up the ability to define the line between good and bad. It provides a legal basis for discrimination and, as Joyce Arthur and Christian Fialla have argued for dishonourable disobedience.

This is one of the reasons the My Decision project is so important and why ALRANZ has chosen to focus on it for the 2014 global day of action – it names and allows for self-identification of those who would refuse care. It is shifting the discourse from a focus on women traversing the public health sphere to search for care and instead calling on medical professionals to provide information in relation to the reproductive health care they provide. It seeks to break down the barriers pregnant people face when they look to access these services and puts the onus back onto those who would object to be open and transparent about their beliefs.

myDecision_flyerFbTile copy

My Decision alone will not end stigma, but it is a vital tool in the attempt to counter the impact. Please join us today in trying to dismantle abortion stigma.

If you would like to be involved in or want more information on My Decision go to

For information on the 28th of September campaign go to

Check out this media release quoting Family Planning and ALRANZ’s Morgan Healey: NZ Abortion Legislation Restrictive.




My Decision. Kei a au te Whakataunga.

My Decision. Kei a au te Whakataunga


MEDIA RELEASE                                                   FOR IMMEDIATE RELEASE

17 August 2014


A new grassroots project aimed at sharing information about doctors and other medical professionals who hinder reproductive health-care access because of moral or religious reasons is being launched today online.

Called My Decision/Kei a au te Whakataunga (, the project invites people seeking services like contraception or abortion to report any experiences of hostile or unhelpful health professionals to the website.

myDecision_flyerFbTile copyBut the site is not just for patients. My Decision spokesperson Terry Bellamak said organisers were also inviting doctors and others who “conscientiously object” to some services to list what options they do and do not offer.

“From the standpoint of consumer protection, it makes no sense to keep potential patients in the dark about their health care providers’ intentions. ‘Conscientious objectors’ who agree can demonstrate their good faith by registering on our site,” she said.

Ms. Bellamak said the project, which has been a year in the making, was sparked in part by the 2010 court judgment that expanded conscientious objection rights of doctors, and the Medical Council’s subsequent decision not to mount a challenge, nor to publish doctors’ conscientious objection status on their website.

Since then, there have been several worrying cases, including one in Blenheim last year, when a woman was denied contraception by a doctor who was reported as saying he didn’t “want to interfere with the process of producing life“.

“In the spirit of the old ‘Hot and Cold Doctor files’ compiled by women’s health activists in the 1970s, we decided we’d have to do this work ourselves,” Ms. Bellamak said.

For more information:




Contraception, Abortion: Whose Decision?

An excellent but disturbing article recently appeared in the Otago University student mag Critic written by chief reporter, Josie Cochrane, about yet another health-care professional who apparently seems to think he has the right to pass judgment and offer “advice” on the sex lives of customers.

According to the article, “ECP Struggles: Pharmacy Leaves Women Feeling Judged,” a young woman seeking emergency contraception at a Dunedin pharmacy was told the “best method of contraception was to hold an aspirin pill between my knees”. The woman has complained about how she was treated to the Health and Disability Commissioner.

The Otago Daily Times followed up Critic’s article with one of its own, “Complaint to HDC Over Treatment”, giving Critic due credit – oh, and referring to the Emergency Contraceptive Pill as “ESP”??

Readers who keep up with reproductive justice issues may recall a related case out of Blenheim last year of a doctor who refused to prescribe the birth control pill because the young woman seeking it hadn’t yet done her “reproductive duty”; and instead advised she use the “rhythm method” of contraception.

Two prochoice activists, Helen Wilson and Alison McCulloch, followed up later in the year with a helen-alison-copyprotest outside the clinic as part of the Prochoice Highway tour, which made it into the Marlborough Express. (Sorry about the poor quality pic! Photo of a computer screen. The sign reads “Free Condoms! Women’s Bodies; Women’s Choice: ‘Rhythm’ (and blues) not for us!”)

How You Can Help

Some readers may already know that a group of pro-choicers is working on a project aimed at shining the light on “conscientious objectors” like these, who deny people the reproductive healthcare they want or need. It’s called “My Decision” and will comprise a website with a database of health-care professionals who refuse to provide certain reproductive health-care services, be they doctors, pharmacists, crisis pregnancy counseling centres … whoever. Users will be able to confidentially submit stories to the site and see what providers have been reported by other users or by the providers themselves. Conscientious objectors can provide information on what services they do and do not offer. It’ll be a bit like the old “hot and cold files” that women’s health advocates used to have, only online.

The My Decision website and is still being built, but in the meantime we would very much like to hear from readers who know of people or places that restrict reproductive healthcare access. And if you’re somewhat web confident and would like to help moderate the site, please let the group know. You can email your stories or offers of help to: mydecisionnzgmailcom