It's Time to Free the Pill

Back in the 1960s, when the Pill became available in Aotearoa New Zealand, the New Zealand Branch of the British Medical Association (the precursor to today’s NZMA) decided it would be unethical for doctors to let unmarried women get their hands on it. Doing so, it was argued, would be akin to doctors giving extra-marital relationships a stamp of approval, and the NZMA wasn’t about to do that.

If you thought doctors keeping us from the Pill for our own good was a thing of the past, think again. Sure, it’s no longer under the guise of protecting our moral purity – (most) doctors have (mostly) given up on that argument. Now, it’s all about protecting our health.

As recently as 1996, both the Royal College of General Practitioners and the NZMA opposed the reclassification of the Emergency Contraceptive Pill so it could be purchased in pharmacies. “We have concerns that in a pharmacy the patient may be disadvantaged from receiving the greater advice that would occur in a general practice consultation,” the college’s chairman, Professor Gregor Coster, was quoted as saying in an article in the British Medical Journal.

Fast forward to 2016, and a new front in this seemingly endless struggle is focused on efforts to get the Pill, aka oral contraception, liberated from doctors’ prescription pads and made available over the counter. The most recent round began in 2014, when Pharmacybrands Ltd (now Green Cross Health, which represents 300 community pharmacies and has an equity interest in 80) and Pharma Projects Ltd, (now Natalie Gauld Ltd.) made an application to Medsafe’s Medicines Classifications Committee to reclassify the Pill so it could be sold in pharmacies without prescription, though only by specially trained pharmacists, following the model that’s now used for the Emergency Contraceptive Pill.

 That application was turned down in the face of stiff opposition from general practitioners and the NZMA: the latter said they didn’t think prescription only access was a barrier to the Pill and wanted to make sure doctors continued to provide “the advice and counselling about its use and about sexual health in general”, while the College of GPs, apparently felt “as if they are being excluded from an important part of primary health care”. (Never mind that the actual users of this “important part of primary health care” were – and continue to be – excluded.)

On the plus side, the New Zealand Committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (is that a long enough title for you?) backed the reclassification saying it was “strongly in support of any responsible development designed to improve access to quality contraceptive advice and service”.

Guestie: No Shame

By Terry Bellamak

Guest Post

It’s been a week since the MyDecision website launched. The response has been surprising and weird. The Dom asked lots of anti-abortion people for comment, though the site is not just about abortion. Most of those folks have tried to frame MyDecision as a ‘name and shame’ operation.

I find that mystifying. What exactly is shameful about having it generally known that you have taken a moral stance?

There are, however, a few possible reasons why a provider might actually feel defensive about ‘conscienciously objecting’.

First, it is impossible for a health care provider to tell a patient he or she will not provide a service on CO grounds without implying that the patient is morally inferior to the provider. That premise may have sounded reasonable back in 1977 when the law was passed, but in 2014 it’s just bizarre. Who thinks like that anymore?

Second, the way CO is applied here in New Zealand, the patient’s interest in getting care is sacrificed to the provider’s interest in leaving out the parts of their profession they find objectionable. Think about it. You make an appointment, ask for a service, the doctor tells you no. The doctor is not required to refer you to someone else, so you may have to start the process of finding a doctor and waiting for an appointment all over again, but you may be a few dollars poorer if you just paid for a consultation in which you received nothing of value. The doctor benefits but the patient pays the freight. How is that fair?

I would feel embarrassed if my exercise of conscience insulted and burdened my patients, so maybe CO health care providers feel that way too. If so, MyDecision can help. We have a page especially for providers who agree that ethical CO requires disclosure. Providers can put their names on the voluntary list, along with what services they do and do not provide. This list exists to support ethical CO providers who agree that the status quo is unfair.

Even providers who do not report themselves are not criticised. They are listed without comment. Patients need this information to avoid wasting their time and money on providers who won’t give them the services they need. I have yet to hear a convincing argument why patients should be kept in the dark about health care providers’ CO intentions.

The site’s ultimate purpose is consumer protection.

Some coverage so far:

Dominion Post: Database lists GPs opposed to abortion

Marlborough Express: Health Website Not 'Sinister'

SunLive (Tauranga): Anti-abortion listing stuns centre

My Decision. Kei a au te Whakataunga.

It’s been a long time in the making, but today marks the public launch of a new web project aimed at informing people about health care professionals who object to or refuse to provide reproductive health services, like contraception, abortion, non-directive and non-biased counselling, pharmacy products and so on.

Called My Decision/Kei a au te Whakataunga the site grew out of failed efforts to get the people who should be doing the job of keeping patients informed, such as the Medical Council of New Zealand, to do it. There’s a lot of background about the long road travelled on this issue here in Aotearoa New Zealand over at Alranz’s blog, but this is broader than abortion rights (and not an Alranz project, though they’re supporters. By way of probably obvious disclosure, I’m involved in this project).

Below, you’ll find the media release that went out this morning, and at the end of this post, a couple of interesting links to recent discussion about the issue of conscientious objection/refusal to treat/conscientious obstruction (supporters of reproductive justice are coming up with some interesting ways of describing whatever this is).

We hope people will spread the word across social media, networks, etc. There are some downloadable fliers on the site itself. And, of course, let the site know about providers who object.

My Decision. Kei a au te Whakataunga.

www.mydecision.org.nz

MEDIA RELEASE                                                    FOR IMMEDIATE RELEASE

17 August 2014

NEW WEBSITE LISTS DOCTORS WHO OPPOSE CONTRACEPTION

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 (www.mydecision.org.nz), the project invites people seeking services like contraception or abortion to report any experiences of hostile or unhelpful health professionals to the website.

But 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.

Further Reading:

WhyWe Need to Ban ‘Conscientious Objection’ in Reproductive Health Care, by Joyce Arthur and Christian Fiala.

Conscience 'not always a force for good': women seeking contraception or abortion neednurses with 'conscientious commitment', rather than moral objection. by Rose Stewart, in the NZ Nurses’ Organisation Journal.

Grrrrrrr!

Anger, oh how often you have visited me lately, let me count some of the ways:

• The frequently women-hating reaction to Labour daring to suggest that they make take some deliberate, transparent and necessary structural steps towards lifting their number of women MPs.  
• Trevor Mallard baiting another MP in the House by calling him "cougar bait."
• People who don't lay out their arguments properly and then don't come to the meeting to discuss the issue so you never really know where they stand before you make the decision.
• Changing a law because some state agencies broke it and the solution to that problem is somehow to make it legal, with the consequence that a whole heap of people who should have privacy no longer will.
• Promulgation by supposed lefties of the antiquated idea that women are precious flowers who should not be sullied by the putrid compost of politics and the stale water of being politicians or something like that, this metaphor is tortured enough already without actually trying to get it to make sense.
• Reflecting on how unfair and wrong and conservative New Zealand's abortion laws and provision actually are, yet again.
• Cancer.  Always.  
• The increasingly dirty SkyCity pokies for convention centre deal.  
• Doctors who want to be GPs but don't want to prescribe contraception.  It's your JOB, yo.

Ok, enough ragey bullet points from me - what's angrifying you?

Guest post: Abortion access being undermined in NZ

Reproduced from the November ALRANZ newsletter with permission from the really rather awesome author, Alison McCullough.

The Abortion Supervisory Committee’s annual report has been released. The report includes
the abortion stats previously released by Stats New Zealand in June (See ALRANZ’s August
Newsletter for a report on those, downloadable at www.alranz.org), plus a few extras and the ASC’s
commentary. A PDF of the report is available for download at www.alranz.org under “The Latest”
column.

As ALRANZ wrote on their blog, the impression the report gives is of a system that is increasingly unworkable, with fewer certifying consultants who, the ASC reports, are facing distressing amounts of harassment (as are patients and others associated with abortion care), and all this as timeliness of abortion care and uptake of early medical abortion are barely budging. No matter what the situation on the ground is for providers and women, though, you can be sure that Parliament will do nothing to fix any of it.

The ASC report addresses the harassment of certifying consultants and patients in general,
and of Invercargill staff in particular. Here’s what the report says:

 “We are … concerned about the impact of being known as a certifying consultant in some locations.  During the last year the Committee has heard distressing reports from certifying consultants where they, their families, patients and wider public have been the subject of harassment.  Particularly distressing are reports of women seeking fertility assistance who have been harassed when they were mistakenly thought to be seeking pregnancy termination.”
 

It’s important that the ASC is talking about this, though it’s pretty hard not to draw the
conclusion from that last sentence that it’s of less concern to the committee if women seeking
abortions are harassed than, say, women mistaken for those seeking abortion. Way to go to reinforce
abortion stigma ASC!

And here’s what the ASC had to say about Invercargill:

“It has also come to our attention that harassment of medical staff is taking place in Invercargill resulting from services now being offered at Southland Hospital. We are disappointed that this is occurring.”

“Disappointed”! Strong words. Not. And no mention of what the ASC intends to do about
this.

Readers will recall that the seven-year-long Right to Life v ASC case finally ended on 9
August of this year when the Supreme Court dismissed RTL’s appeal. In its decision, the Court ruled
that the ASC did not have the power to scrutinize individual doctors’ decisions regarding approval of
abortion but that the ASC could ask consultants how they were approaching their decision-making in
general. This report is the first comment we’ve had from the ASC on that case, and it writes:

“The Committee notes it already makes regular enquiries of all certifying consultants. At the time of annual reapplication consultants report on qualifications, continuing professional education, peer support, intended years of service and the nature of the practitioner’s practice. Other enquiries will continue to be made as issues arise.”

The ASC is not saying much here, but this seems to suggest that it thinks it’s already doing
what the court said it should do.

The ASC notes the continued downward trend in abortion numbers overall, and points
particularly to the sharpest decline being in child to teenage groups. It expresses concern that there is
no decline in abortions sought by women who have had two or more previous terminations:
“Key to reaching these women will be further increasing the availability of various forms of
long-term contraception as well as increasing access to publicly funded tubal ligation or ablation so
that unwanted pregnancies are avoided. It is concerning to note that the number of publicly funded
tubal ligations performed has been declining.”

Cue the media focus: According to a report in the DomPost, reality TV shows are helping
push a decline in teen pregnancy. The ASC says this is because “extensive reality television
programming depicts the struggle most young people have in attempting to raise a child of their
own…”

It goes on to say, that “the decline is also likely a result of younger New Zealanders
practising safer sex and having less sex overall”. Apparently not watching so much reality TV are
the 20-24 year olds. There’s a new graph this year on “no contraception by age group.” In other
words, what were the ages of the 52% of women who had abortions and said they’d been using no
contraception? According to the report, the biggest group, at 32%, were 20 to 24 year olds; the next
biggest, at 20% each were under-20s and 25-29 year olds.

When it comes to timeliness, Northland and Southland are still coming in last, meaning
women in those districts are accessing abortion care much later than those elsewhere. (The median
gestation in those districts for first trimester abortion is nearly 10 weeks! That is not a good stat, and
that’s the median, meaning access is much later for some women.) Here’s hoping the Invercargill
service will help improve that stat for Southland. But what is going on in Northland?

Finally, there are 170 certifying consultants, down from 175 in the previous year’s report,
and the amount spent on certifying consultants was $4,427,120, also slightly down on the previous
year.

Problem solved

As you have probably heard, and raged about , the government's current plan is to target young women who are on benefits (or whose parents are on benefits) for long-term contraception.

Colin Craig objects for the following reasons: 

"Why should, say, a 70-year-old who's had one partner all their life be paying for a young woman to sleep around? "We are the country with the most promiscuous young women in the world. This does nothing to help us at all."

Meanwhile Right to Life is really concerned about women getting tubal ligations.  They're worried for the following reasons:

It undermines the nature and purpose of marriage and sexuality. It goes against the dignity of sexual relations as intended by our Creator. It prevents the total gift of self because it excludes the potential for fertility.

Tubal ligation is the mutilation of a woman’s body and a violation of her human rights. Women have a right to the protection of the State.

Tubal ligation is an assault on the integrity of a woman’s body.

It is bad medicine, pregnancy is not a disease. There is no disease for which ligation would be a treatment. It is a medical procedure which is intended to destroy healthy organs.

I have the perfect solution to this:

A cage fight.

We lock all the people who think that certain women should have contraception forced on them and those who think women can't consent to sterilization or don't really know what contraception is, but know they're against it.

While they're fighting it out with each other those of us who believe that all people should have control of their bodies, and be able to select whatever contraception, or non-contraception, best works for them, without any financial obstacles, can take over the world.

talking to pregnancy counselling services

do you believe in coincidences? well i have one for you. a few weeks ago i was contacted by someone from pregnancy counselling services, asking if i could present to them about any particular issues regarding muslims their counsellors should be aware of. so this saturday morning, a friend came with me to present to the group a muslim perspective on issues around unwanted pregnancy.

we had split it up so that i did the "theory", in terms of religious beliefs and requirements, while she covered the more practical aspects. i went through the sources of muslim law, before talking about contraception, abortion, marriage, motherhood. some of these things are more difficult than others.

marriage and motherhood are pretty straightforward, with a very high value placed on both. but on the issues of contraception and abortion, things aren't as clear-cut as people think. views on contraception range from the liberal to the conservative - the most conservative believing it isn't allowed at all; the liberal view being that it is allowed as long as both parties agree.

abortion is generally thought to be forbidden, but i've read and heard various views on this. it certainly isn't forbidden in all muslim countries, and at various times in history under different regimes, it has been sometimes allowed and sometimes not allowed. there is actually no mention in the qur'an of abortion, and it is really a matter of interpretation.

what isn't contentious is the notion that the soul enters the fetus at the end of the first trimester. on that basis, some jurists say abortion is allowed before the first trimester. others say it is allowed only in the first 40 days. there are those who say it isn't allowed at all. any abortion after the first trimester would only be considered allowable if the life of the mother was at risk, or if the fetus was so severely deformed that to carry on would entail significant hardship on both the child that is born and the family that is faced with the burden of care.

for abortions in the first trimester, even many conservative scholars would say it's allowed for "valid reasons". one reason, for example, is that a woman is allowed to have a two-year gap between pregnancies, and should she fall pregnant before that gap, then she can have an abortion.

because these issues aren't clear cut, i've come to the conclusion that a woman's decision to have an abortion is between her & God. the state should provide safe abortions, and leave her to her own conscience. abortions should be provided in a timely fashion, and particularly for women who do believe it has to occur in the first trimester, they shouldn't be hindered because of loopholes created by the state, or because the state doesn't provide sufficient funding for adequate health services.

the fact is that no human being can look directly into the heart of another. no-one has the lived experience or the exact same personality as another. what is bearable for one person is unbearable to another. i don't see how we can judge one against the other and say "so-and-so can manage, therefore you should also be able to manage in a similar situation". because no two situations are exactly equal and no two people are exactly the same.

when it comes to counselling, my message to the counsellors was that they were there to help and support the woman who had contacted them. they needed to be guided by her - to understand her fears, to find out the kinds of pressures she might be facing. most of all, they should provide all the options, and leave any judgement at the door.

i felt really uncomfortable at the questioning of one of the women there - she couldn't understand how a family could shun a young, unwed pregnant woman and was quite condemning. what she was failing to understand was the cultural and social pressures, and the wider consequences faced by the family. when a culture is set-up a certain way, it's totally understandable that individual actors within it are going to act in the best interests of themselves and their loved ones. this can involve competing interests within the family: what might be in the best interests of the pregnant woman might not be in the best interests of the family as a whole and particularly of other siblings.

her failure to grasp that or to even understand the source of the pressure (ie societal) didn't make me very hopeful that she could provide appropriate advice to someone who was in need of help. women who call the service are going to be feeling scared, feeling guilty, feeling conflicted. and what they really don't need is someone giving them a critique of their culture or criticism of their families at a time they're feeling particularly vulnerable. not to say that this particular counsellor (or any other) would do that, but the thing is that when you feel a contempt for something or someone, it tends to show through, much as you try to hide it.

in an ideal world, every pregnant woman would be well-supported and provided full information so that she could make a free choice without feeling guilty about it. but we don't live in that ideal world. not anywhere. we live in the world we have, try to change it for the better as best we can, and in the meantime support people knowing that they have to deal with all kinds of injustice.

there was one other main message i gave to the group: that religion and culture are two different things. religious beliefs are often influenced by cultural practices and the latter sometimes trump religious beliefs. sometimes people following a religion don't even know the difference between practices and traditions arising from local culture, and those arising from religious requirements. when so much is open to interpretation, i find it really hard to be dogmatic. others apparently don't have any qualms.

but if i'm going to be asked for advice, then this is what i'll say: err on the side of compassion. provide support and safety for the living women who find themselves in difficult circumstances, and be slow to judge. that is all.

Abortion - why it needs to be legal (A Presentation)

Please find below (indeed below the Read More) the presentation I gave today on why abortion needs to be legal, and why we need a pro-choice law change. Many thanks to Kristy, Alana and Soraiya for organising it, and Nicole for pressing buttons, and everyone for coming along. Especially Nikki for being my friendly face in the crowd, and also big thanks to Deborah for proofing it from afar.

As you read please bear in mind that I was writing it to speak to the slides (which I've inserted as pics above the section of the speech that goes with them), and also that I've never done that before.

Here goes...

Choices

You may have noticed the latest thread about abortion to explode into discussion about a woman’s right to choose whether or not to continue a pregnancy. Everyone who blogs here is pro-choice, although precisely how we choose to define that might differ from person to person. What I’m going to write about in this post is my personal view. Other bloggers may agree with it, I don’t know, and they may well indicate by comments their agreement, disagreement or otherwise. We shall see!

I want to write a bit more broadly about choice and bodies, in the context of women and obviously with reference to abortion as that is the major area of societal discussion about women’s power over their own bodies.

I stated my view of a woman’s right to choose in respect of abortion in a comment on the aforementioned thread, and I’ll quote it again here:

The bottom line for me is that we need to respect the right and power of women to control their own bodies. This extends to unequivocally and without restriction giving individual women the right to choose whether or not to terminate a pregnancy. They are the people best placed to make the best decision about whether or not to have a child; they know all their own circumstances, which you can never fully know from outside. And sometimes individual women will make choices about their bodies, about their fertility, about their reproductive plans, that others disagree with or wouldn't make in the same circumstances. That's ok; if we just respect that the woman concerned is the person best placed to make a decision that affects her first and foremost then that helps us get by without angst and public judgeyness.

I’ve come to this view of choice through thinking about abortion, and probably the biggest influence on my thinking in this area has been reading and hearing Maia’s thoughts on the matter over the last five years or so. I think this idea about choice extrapolates to other issues in regard to women’s bodies.

This is why I will never support making it illegal for pregnant women to drink alcohol. We should definitely have significant public education campaigns about the dangers and effects of consuming alcoholic beverages during gestation. We should be aiming for a society where everyone has a level of education, and sufficient access to this kind of information, that they can make informed choices for themselves. If a woman still chooses to drink during pregnancy, knowing all that, then we should respect that choice. Just like we shouldn’t restrict access to caesarean sections, or plastic surgery. These are decisions a woman is making about her own body and her own health.

Respecting doesn’t mean agreeing – it means respecting that they have the right to make that choice, for themselves. You don’t have to agree to everything other people do. If that was the case, and everyone had to agree with me, then we would not have a Prime Minister who is prepared to trade basic democratic rights for two pandas.

How does this view influence my behaviour? I’m not perfect and I can be judgey too. What I try my very best to do is to not be judgey to someone’s face. I might have a quiet rant to my partner about an unwise choice I think a friend is making, but I acknowledge that I don’t know everything that they have considered in making that choice, I can’t possibly know because I am Not Them. I might make a different choice if I were in the exact same situation, but I am still Not Them. Sometimes I’ll write something here (often weeks or months later) about the broad pressures around that choice, the things that bug me about it from a wider context, but I try really hard not to write in a way that criticizes individual women* for making that choice. Empathy, that thing Paul Henry lacks, is what I'm striving for, although sometimes I fail.

I have to say that taking this approach is a lot less stressful than wanting to Fix everything for everyone all the time. This is my general approach to feminism too, and why I get a bit annoyed at claims that Feminism HQ somehow doesn't respect women's agency. There is no Feminism HQ, and anyone who claims to be from there should have their credentials checked for signs of being written on Psychic Paper. But that's a whole other ranty post right there.

Getting back to the point, we all make choices everyday. Some good, some bad, some so heavily restricted by circumstances as to not really be true choices at all. I hope that one day we can live in a society where the abortion rate is lower than it is now, but only because that will show that contraception is more available and effective than it is now and that people have more reproductive rights.






* I’m sure someone will come up with some examples of posts I’ve written where I have criticized individual women, particularly women who have made negative statements about other women or about feminism or feminists. What I’m talking about in this post is specifically about choices that women make for how they run their own lives, and even more tightly mostly about their own bodies. I think it’s healthy to critique each other in the public statements that we make about life in general (which is one of the reasons I tend to be quite liberal about comments here). But we head into tricky territory when we judge harshly the choices individuals make about their own lives (see entire rest of post above).

An article we will never see on the front page of the Herald

Anti-vasectomy doctors have gone to court to challenge new Medical Council guidelines [PDF] on how physicians with personal objections to vasectomy must deal with patients.

The doctors filed an application in the High Court last week for a judicial review of the guidelines, titled "Beliefs and Medical Practice". They are believed to be opposed to vasectomy on the basis that sexual intercourse is primarily for procreative purposes, and that any interference with this is a deliberate violation of God's design of human beings.

The Medical Council is withholding the guidelines until the case is decided.

Their main objection is understood to involve a new section in the guidelines covering the way doctors who object to contraception must deal with patients.

It requires them to tell male patients considering controlling their fertility, so that they do not have any further children, that vasectomy is one of the options.

The law already allows doctors to refuse to provide contraception or abortion services on grounds of conscience, although they must tell patients they can consult another physician.

The guidelines also cover other areas where spiritual, cultural or religious beliefs could conflict with patients' rights.

They say doctors should set aside their own beliefs where necessary and that they must make the care of the patient their first concern.

The Health and Disability Commissioner and the Resident Doctors Association approved the new section in their submissions on the draft, saying it was helpful to include specific advice.

Adapted from last week's Herald article, which I blogged a news bite about on Friday. The bit in italics is not in the draft guidelines at all, although a similar point about abortion is.