Telemedicine abortion service to expand access to care

by | 31 Oct, 2022 | Our Blog

 Whomever you are and wherever you live in Aotearoa New Zealand, you have the right to end a pregnancy if you want or need to. One way to do so is through early medical abortion, which uses pills and allows for self-managed abortion at home. This option has been available via telehealth for some time but has become more common in recent years, especially since the start of the COVID-19 pandemic. 

 A new service called DECIDE, launched in April by the Ministry of Health, is helping to expand existing telehealth services and close overall gaps in access to abortion care. DECIDE provides consultations and medications for early medical abortions, along with related services, including consultations, information, referrals, counselling, and after-care support. This service cannot replace in-person care, which will always be necessary in certain cases, but helps to enlarge access to safe and timely abortion. This is a great step forward for equitable sexual and reproductive healthcare. 

 There is a growing evidence base on telehealth abortion services, especially due to its increased of rollout across the globe due to COVID-19 restrictions. International research shows that telehealth abortion care is extremely safe and effective. Self-managed medical abortion conducted by telehealth is just as safe and effective as when the procedure is completed in person at a doctor’s office, clinic, or hospital. This option is not associated with higher risks of complications compared with pills accessed in-office. In fact, only 2% of medication abortions result in complications, and most of those are minor. Plus, most patients report being satisfied with their experience.

The research also suggests several advantages to telehealth abortion services, namely:

  • allow more privacy and autonomy (avoid harassment, conscientious objection, disclosing choice if unsafe)
  • help ensure timely care
  • greater flexibility reduces burdens of cost, travel, and time
  • reduce pregnancy-related deaths

 

 Telehealth services are especially beneficial to those who may not otherwise be able to access abortion care. This may be due to low resources, disability, caregiving or work responsibilities, or geographical distances, especially if disclosing an unintended pregnancy is difficult or unsafe. Indeed, researchers report that barriers limiting abortion access most profoundly affect communities that already face health care and social inequities and can therefore widen existing socio-economic inequalities.

 It is also important to note that access to early medical abortion through telehealth ensures timely care. While abortion is among the safest medical procedures, the earlier it is done, the fewer complications there could be. Reducing wait times for abortion, which has been a major problem in the past, can also help alleviate some of the stresses associated with unintended pregnancy.

The country is already seeing higher rates of earlier access to abortion and the final rollout of the DECIDE services will hopefully maintain this trend and contribute to more equitable access to sexual and reproductive healthcare for all.

“Abortion Reversal” is Dangerous

by | 29 Sep, 2022 | Our Blog

by Terry Bellamak

In mid-September Pharmac decided to fully fund progesterone. The change is expected to increase access to hormone replacement therapy for symptoms of menopause.

Progesterone has another, more sinister unapproved use, as part of anti-choice movement’s dance of misogyny. They call it “abortion reversal,” and say it is for all those pregnant people who take the first pill, then suddenly change their mind (reinforcing the myth of female indecision and fickleness).

In 2012 Dr George Delgado, an anti-abortion doctor in California, released his study of six women who took progesterone after having taken mifipristone, to stop their medical abortions. According to Delgado, four of the six continued their pregnancies.

In 2019, researchers from the University of California at Davis tried to replicate Delgado’s findings in a randomised, controlled trial. Safety concerns, however, caused them to end the study after just 12 patients had been enrolled. Three of the enrolled patients experienced severe haemorrhage requiring hospital care.

The American College of Obstetrics and Gynaecology says “abortion reversal” is not backed by science, and calls it “unproven and unethical.” The Society of Obstetricians and Gynaecologists of Canada warns that it can cause serious complications for patients. The American Medical Association calls it “patently false” and “unproven.” No reputable medical association supports this unapproved use of progesterone.

In New Zealand, the Ministry of Health advises patients can change their minds about abortion right up until the abortion begins. At that point the abortion cannot be reversed. This advice accords with the advice of respected international medical bodies.

So why are we talking about this?

Because there may be anti-abortion doctors in Aotearoa who might be willing to gamble with their patients’ health by prescribing progesterone for this unapproved “abortion reversal.” Any doctor who behaves so recklessly should face sanctions from whatever medical body they belong to, be it the College of General Practitioners, the Royal Australia New Zealand College of Obstetrics and Gynaecology, or the Medical Council of New Zealand.

Right now, after Pharmac’s announcement, would be the best time for these medical associations to spell out what sanctions would be taken against practitioners who are found to have prescribed progesterone for this purpose. Considering the risks, those sanctions should be serious.

ALRANZ Abortion Rights Aotearoa calls upon the College of General Practitioners, the Royal Australia New Zealand College of Obstetrics and Gynaecology, or the Medical Council of New Zealand to denounce the unapproved use of progesterone for “abortion reversal” and to state the penalties they will impose on doctors who gamble with their patients’ health in this way.

 

Credibility and Risk

Credibility and Risk

by | 29 Jun, 2022 | Our Blog

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 | 18 Jun, 2022 | Our Blog

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 | 7 May, 2022 | Our Blog

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.