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.

Not what abortion "on demand" looks like, folks

In the recent discussion about abortion (and big ups to the Greens for getting it on the political agenda), several commentators who identify as pro-choice have stated sentiments to the effect that we have abortion on demand now.  Except that we really clearly don't.

Getting an ingrown toe nail cut out is a medical procedure you can get on demand.  You don't need anyone else's permission, you just need to have an ingrown toe nail and find someone who can cut it out to do so for you.  The same with getting moles removed, whether possibly cancerous or not, having most forms of plastic surgery like rhinoplasty (nose job) or breast implants.

But to get an abortion, be it medical (ie by pills at an early stage of pregnancy) or surgical, two different people have to give their permission, after seeing your own doctor.  Those people have to also be certified to give you that permission.  For people with resources who are seeking terminations in Wellington or Auckland this probably isn't a big deal, and I can understand how some might think, from the outside, that it is basically abortion on demand (although to the best of my knowledge no definition of on demand includes requiring permission from other people).  However that is a) not what the law says and b) not what the practice is.

To use a rather silly example, say that getting a can of Coca Cola (Symbol of the Free West) worked the same way as access to abortion.  If Coke is on demand then you can rock up to an appropriate outlet and get one, no one else gets to say yes or no as long as you pay your $2.

If you could only get Coke in the same way as people can access abortion under NZ law then it would look something like this:

1.  Find one of the limited number of dairies that offer Coca Cola cans.  It may be in an out of the way place, there may be protesters outside (with signs reading "Coke promotes a culture of DEATH").

2.  Once you've found a Coke-supplying dairy, seek and gain the permission of a person who works there and has certification.  The certifying dairy worker will need to approve that you can have the Coca Cola for one or more of a small number of reasons that are outlined in law; most likely "thirst relief" which is found to be the reason for 98% of Coke purchases.  You may not be thirsty right now, but you know you are going to be thirsty in the future, but you will need to carefully convince the certifying dairy worker that you should have the Coca Cola for "thirst relief" now.  Other allowable reasons include high risk of diabetic coma without it.

3.  You'll then need to go through Step 2 again with another certifying dairy worker.  Hopefully there is more than one at that dairy, but if there isn't then you will have to go somewhere else.

4.  It's likely you will then be referred to another dairy, which will actually have the can of Coke.  You'll need to get an appointment there.  Again it may be in an out of the way place, there may be protesters outside (with signs reading "Every Coke Kills a Living Thirst").

5.  When you get to the dairy for your can of Coke you'll possibly be required to go through counselling to consider the consequences of drinking a can of Coca Cola and talk through other options, such as water, milk or going through with being thirsty.

6.  You will then have to undergo a dietary examination, to assess precisely how thirsty you are, any other dietary influences that may lead to complications when you drink the Coke, a full history of your drinking history, and examine your suitability for drinking Coca Cola at this time.  You'll be given advice on whether the Coke is a good idea or not.  Likely there will also be a discussion about planning your future liquid intake so that you can avoid thirst again in the future.

7.  Finally you get your can of Coca Cola.  It's possible this will happen on the same day as the counselling and examination, but maybe not.  Enjoy.

Imagine living in a small town with only one dairy, which didn't have Coke.  The nearest bigger town also didn't have Coca Cola, and you'd have to fly or drive quite a way to get some, possibly taking time off work to do so and at some personal expense in regard to travel costs.  That'd suck.

And that would not be availability on demand.

Abortion is NOT available on demand in Aotearoa New Zealand.  In my opinion to continue to claim that it is does not help get the law or the practice changed to make abortion more available.  It's not defacto on demand, it's not almost on demand.  It is only allowed with the permission of two other people, neither of whom is the pregnant person (although their consent gets the ball rolling), and only for a limited list of reasons outlined by a law set over 30 years ago.

In my opinion the best place to get practical information on accessing abortion services in Aotearoa New Zealand is abortion.gen.nz.

Edited to Add:  After I wrote this, but before it was scheduled to post, the Sunday Star Times published this article, including one person recounting her experience of accessing abortion under the current law.

Abortion on the Agenda: Thanks Greens!

Just before I start in on the momentous news of the Greens’ policy on abortion, a tiny bit of history. As many of you know, our current laws, which were passed in 1977, place abortion firmly in the Crimes Act, and were based on a 400-plus page Royal Commission report. I spent a whole chapter in my book “Fighting to Choose” pulling it to bits, in between choking on my coffee, but here I’ll just pick out one bit that I found particularly gob-smacking, and that I think has relevance to the 2014 Green-inspired debate over abortion.

The report (and subsequently the law) ended up deciding which reasons for having an abortion would be legal (not criminal) and which would not. (You can look them up in the Act itself  if you’re interested, go to section 187(A)1.) The Royal Commissioners had to do a lot of fancy footwork to pull this off (and tripped over themselves numerous times) but one thing they did not do was ever find out the actual reasons people have abortions. Here, I quote directly from the report: “In New Zealand no authoritative study has ever been made of the reasons why women seek abortions.” (p. 201)

Just wow! You’re making a criminal law about something you don’t know the first thing about. If that doesn’t simply say: Sorry, no moral agency for you. No having your very own personal reasons that relate to your very own life. We, MP’s with a “conscience vote”, will decide what reasons are acceptable, even though we actually have absolutely no real knowledge of why any of you do it. (Latest scare-mongering from the antis is that at least some of us are doing it because we don’t want to have babies with female sex organs. They want to outlaw something – sex selective abortion – that we have no evidence is even happening. More on that below.)

So far as I know, the “no authoritative study” of the reasons is still the case. They still don’t know, but still want to say what the reasons “should” be, by law. (Reminder: the Royal Commission decided against recommending that rape be a ground for abortion because women would lie about being raped. A majority of 1977 MPs agreed.)

Which brings me (I know, when was I going to get here?) to the Green Party policy, and why it’s a big deal. It’s basically saying (my words, not theirs) that the Greens believe the state should not treat abortion as a criminal matter that, for the vast majority of us, can only be excused if we can get two certifying consultants to state that we are not mentally sound enough to go through with our pregnancy. And that is what the antis are busy calling “extremist”. Under the policy, abortion care will remain regulated, as every other medical procedure is – it’s not like we have a medical Wild West out there for health care that isn’t in the Crimes Act – i.e. pretty much everything else.

But aside from that really obvious ways it’s a big deal, there are lots of less obvious ones. A couple:

Pregnant and Headless

Or: Pregnant, Headless, Thin, White and Definitely Middle Class. 
Or: (In the language of Stockphotoland) “Headless Person Holding On to Exposed Pregnant Belly While Wearing Tight Top.” 
Or: In which I investigate the rise of stock photography in online "news" and the made-for-marketing "society" it reflects. 
Or: How Click-Bait Narrows Our Horizons 
Or: My Adventures in Stockphotoland

Intro: A Festival of Torsos

I started thinking about stock photography representations in online news, and of women in particular, a couple of years ago after noticing how many articles about reproductive health issues on the two main commercial news web sites (nzherald.co.nz, owned by APN and stuff.co.nz, owned by Fairfax) were illustrated by stock images of very pregnant torsos – whether those torsos were relevant to the article or not. Some weeks, it seems like there was a pregnant-torso-worthy story almost every day. Here's a selection:

Ready, Set, Go: The Prochoice Highway

This post is a bit long and comes in two parts. First, a bit about the Prochoice Highway; and then this thing I’ve been burning to write about for a while on abortion shaming and stigma, (I've called it "Against Public Displays of Cruelty") and our acquiescence to it. The two are, of course, related:

The Prochoice Highway 

For about a year, myself and a few others have been working on putting together an information campaign and book tour around reproductive justice issues called the Prochoice Highway, or, full title: The Prochoice Highway: On the Road for Reproductive Justice.

For me, a major impetus was writing my book Fighting to Choose: The Abortion Rights Struggle in New Zealand, (VUP, 2013); for others, I think it was just wanting to make some positive pro-choice activism, since so often we seem to be playing defence. Oh, and me bugging them for help! [Which we still need, Go Here!] Most of the financial support has come from WONAAC, the Women’s National Abortion Action Campaign (ngā mihi maioha to those women and for everything they've done over the years) while ALRANZ has contributed time, energy and resources; but the person who has done perhaps more work on this than anyone else is Zenaida Beatson, the genius behind the poster, badge, Tee, postcard and other designs and the amazing 2014 Body Politics Calendar that is going to be printed next week. (Yup, Zenaida does all that in her “spare” time.)

The Highway is setting off on 15 September, heading to Northland, and as I’ve been Tweeting and FBing lately, we really hope to network with people and groups across Aotearoa NZ who are interested in reproductive justice issues and who might like to meet up with us for a chat, or help organise something (from a coffee to a potluck to a public meeting) or who might have local intel on good places to set up the stall. So please, if you know of good peeps anywhere, get in touch! As much as it is aimed at raising awareness about Aotearoa NZ’s backward and punitive criminalised abortion laws -- and all the baggage those bring with them -- this is a listening/discussing/kōrero tour.

The move toward reproductive justice and away from “choice” is a hotly debated one, and you’ll notice that with its title, the Highway has a bit of a dollar each way. But the more I read about reproductive justice, which has been spearheaded by women of colour, the more I like the way it allows the discussion to be made a lot broader. (A friend pointed me toward a great publication by the US group Asian Communities for Reproductive Justice on this issue. Pdf warning: This link is to a pdf. And another good resource is Sister Song: Women of Color Reproductive Justice Collective) Just last weekend, for example, I met up with a group of people wanting to do some work around what I’ll loosely call the policing and criminalisation of pregnancy, of pregnant bodies, of pregnant women. When you start looking at what’s going on it turns out it’s going on everywhere: in the public square, in medicine, in the judiciary, in state agencies, in legislation aimed at preventing child abuse, the list is long and a bit depressing. (I wrote a bit about the issue a while ago in Werewolf and here about a related "careless driving" case.)

This is part of the reproductive justice orbit, and it is related to abortion because it stems from the same resistance, which has a long history, to fully respecting the autonomy and lived experience of women around reproductive health decisions, be that decisions around abortion, contraception, sterilisation; or around choosing to be a single parent, around antenatal care and so on. As Sister Song puts it, the justice lens shifts from a narrower focus on legal access to include analyses of racial, economic, cultural and structural constraints. Queer and trans people face particular reproductive health discrimination and oppression, too, that "choice" isn't really rich enough to address, but reproductive justice can.

So much to discuss, so little time. (If anyone knows of any good writing about reproductive justice in the context of Aotearoa NZ, please add links in comments.) 

'Careless Driving Causing Death'

There’s a case before the courts in Wellington that has more than enough heartache to go around: A collision between two vehicles in Newtown last June. Injuries on both sides. A much-wanted pregnancy lost. A grieving couple. Then, a husband charged with careless driving causing death. As I said, more then enough heartache to go around. For what sets this case apart – and is at the heart of some intense local and overseas media interest  – is that the death was of the couple's 31-week fetus.

According to a police Summary of Facts, this is what happened: Last June 24^th, Bililinge Gebretsadik was driving through Newtown with his pregnant wife, Seble Cherie, in the passenger seat, when his car, a Nissan Tiida, collided with a Mitsubishi Challenger four-wheel drive, (for those who know the city, this took place at that awful intersection of John Street, Adelaide Road and Riddiford Street).

The police allege the collision happened because Gebretsadik failed to stop at a red light, something Gebretsadik is challenging. According to the police, an 80-year-old passenger of the Mitsubishi was injured, suffering whiplash, high blood pressure and “general all over body soreness as a result of the collision”. Meanwhile, in the Nissan, both front air bags deployed. Seble Cherie fractured her left ring finger and “sustained bruising across her abdomen with pain and tenderness to this area”.

Seble Cherie was taken to Wellington hospital where the vital signs of the fetus were monitored. After some deterioration, and within 4 hours of accident, an emergency caesarean section was performed, the baby was resuscitated and taken to the neonatal unit, but it was ascertained to have no brain function. Within three hours of the birth, the baby died. As a result, Bililinge Gebretsadik was charged with three counts of careless driving under the Land Transport Act, including one of careless driving causing death. The maximum penalty for the latter is 3 months imprisonment, a $4,500 fine and disqualification from driving for 6 months. The maximum penalty is below the bar for a jury trial; Gebretsadik has pleaded not guilty on all three charges.

Besides the personal tragedy suffered by those involved, this case also raises important questions about personhood under the law, with its attendant implications for reproductive rights. Gebretsadik’s lawyer, John Miller, says he thinks one of the reasons the police are pursuing the case (against the wishes of Seble Cherie, more on that below) is that it’s seen as a test for defining what it means to be a “person” under the Land Transport Act.