Credibility and Risk

Credibility and Risk

by Terry Bellamak

In the days since the US Supreme Court reversed Roe v Wade, Christopher Luxon has been pressed repeatedly on the future of New Zealand’s two year old abortion law reform under a National government. 

With increasing frustration, he repeats himself only to face more questions. His effort to calm the waters is not working. Let’s consider why.

The leader of the opposition is on record stating his belief that “abortion is tantamount to murder.” He spent the 24 hours after the news about the reversal of Roe releasing successive statements promising not to touch New Zealand’s two year old abortion law, which legalised the procedure in 2020. In the final version he said:

I have been consistent since becoming leader that these laws will not be relitigated or revisited under a future National government, and these health services will remain fully funded.

The first problem with Luxon’s assurance is that much harm can be done to abortion rights without relitigating or revisiting the law. 

A hostile government could decide to require all abortion providers, rather than only those in hospital settings, to follow the Ngā Paerewa Health and Disability Services Standard. Such a move would operate as TRAP (“Targeted Regulation of Abortion Providers”) laws did in the US, by making it impossibly onerous or expensive to provide services outside hospital settings. This would reduce the number of providers and disadvantage people living away from the main centres.

Our safe areas law requires the Minister of Health, in consultation with the Minister of Justice, to apply for an Order in Council to create one safe area. A hostile government could just … not, meaning harassing people seeking abortion care would not be against the law. National’s shadow health minister is Dr Shane Reti, and its shadow justice minister is Paul Goldsmith, both of whom voted against the Abortion Legislation Act 2020 at third reading. 

Protection for minors needing abortion care from being forced to inform their parents (which could have deadly consequences for those with abusive parents) is in the Care of Children Act 2004, not the Contraception, Sterilisation, and Abortion Act 1977, which makes it fair game.

See this article for more ways a hostile government can screw around with abortion care.

The second problem with Luxon’s assurance is the forced birth movement’s history of saying whatever they have to in order to get what they want.

Crisis pregnancy centres all over the world use misleading advertising to get pregnant people through the door so they can browbeat them out of seeking abortion care. Forced birth advocates trot out the old myths about abortion causing infertility, breast cancer, and mental illness. Local forced birthers peddle the myth that New Zealand’s abortion law is the most “extreme” in the world, and allows for abortions “right up to birth.” Conservative Supreme Court justices lied to the US Senate in their confirmation hearings, saying they believed Roe was settled law, when they fully intended to reverse it.

It would be foolish to ignore this propensity in others who believe as Luxon does. Luxon may or may not be lying himself, but we must consider the possibility.

This is because of the third problem with Luxon’s assurance: the risk/exposure calculation. 

How much risk a person is willing to take on depends on how much loss a contrary outcome will expose them to. If the possible loss is small, a person may be willing to take on more risk than they would if the possible loss is great. 

What is at stake here? Our fundamental human right to bodily autonomy. Our ability to choose our own futures, to follow our dreams when those dreams do not lead to parenthood. In some cases, our very lives. The stakes are beyond huge. 

The people of Aotearoa have the right to decide how much they are willing to risk on Luxon’s word. 

The tumult in the US demonstrates the frightening truth that once we discover we have been lied to, it’s too late to save ourselves. This could be the US’s lasting legacy – an object lesson in believing people when they tell you who they are. It’s our choice whether or not we follow in American footsteps. 

 

Book Review: The Lie That Binds

Book Review: The Lie That Binds

by Margaret Sparrow

All eyes are now on the US with the prospect that Roe.v. Wade will be overturned by a decision of the Supreme Court, 49 years after it was passed. How and why has this come about? 

This book is not the latest word on the topic but I found it when I was exploring what our American counterpart NARAL Pro Choice America has to say on the situation in the US. NARAL was formed in 1969 just two years before ALRANZ. Like us they have campaigned over the years for reproductive freedom. Ilyse Hogue was born in 1969 and served as President of NARAL for eight years from 2013-2021, retiring last year. 

Before she retired she put her thoughts into writing and together with NARAL researcher, Ellie Langford, published this book which I strongly recommend for anyone who wants to understand more about the Radical Right in America. It was written before the November election which saw President Trump defeated and is entirely devoted to understanding the strategies of the opposition.

The research is meticulous and one third comprises the 1,424 references to statements made. It is not an easy read and there are some typos but for those who don’t want to read a serious examination of the strategies employed by the Radical Right NARAL Pro Choice America has produced excellent podcasts, companions to the book, which bring the main characters to life with sound recordings of their most egregious pronouncements.

What is the Lie? The lie was perpetrated as far back as the 1950s by extreme right campaigners who purported to be concerned about abortion as a personal issue, a moral issue and to protect women, but whose intention was much wider -to maintain political control and power for white, racist, religious, sexist, misogynist, males, the “moral majority” upholding traditional family values, and opposed to women’s rights, ERA, pay equity, contraception, sex education and gay rights. In reality abortion was a Trojan horse, a means of bringing in ultra conservative policies, upholding the patriarchy, supporting religious fundamentalism and maintaining white supremacy.

The Lie that Binds traces the evolution of some of the most dangerous forces in U.S. politics, designed to thwart social progress in a changing world, and thereby threatening democracy — built around the foundational lie that it is all about moral convictions and individual pregnancies. The extent of deliberate misinformation and outright lies is astonishing. When focusing on women became problematic (that is losing women’s votes) the strategy changed to focusing on the fetus.

When Roe v. Wade was introduced abortion received equal support from Democrats and Republicans. The book traces the capture of Republicans and most recently Trump by the religious right. It is realistic. It will take a long time for the stacked Supreme Court to change but judges don’t live in a vacuum and public opinion is important. There is hope for the future in the knowledge that for many years surveys have consistently showed that the majority of the American public support access to legal abortion. Currently it is about 77%.

What lessons can we learn for New Zealand.

We must be vigilant. We must call out misinformation when it surfaces, and keep on campaigning for reproductive justice, reproductive rights and reproductive freedoms. We must focus on health issues -health care delivered with dignity and compassion. These strategies will keep us on the right path to reducing stigma and inequity 

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. 

 

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.

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 There are only data collected on cisgender women at present.