Thursday 5 February 2009

Opting out of abortion - Nurses' turn this time

Last year I had a bit of a go at the abortion laws that not enable Doctors to refuse to provide abortions and contraception advice to patients but also refuse to give a referral to other Doctors. I won't rehash my arguement that if you are going into health, especially reproductive health, you are going to be dealing with stuff you might not be 100% comfortable with and if that is a makes you squrim you need to reassess your career options.

This time around it is nurses who aren't so happy in performing surgical abortions (the ones done in the second trimester). According to the abortion supervisory committee about 5% of abortions are done after the 13th week so we are talking about small numbers.

Now I happen to be of the belief that if you are after a termination, you best get on to it sooner rather than later. But given that you need not one but two certified doctors to sign off on the process that isn't always easy. Especially for women who are living a considerable distance from an abortion provider. And with some hospitals and indeed DHBs not offering the service this sad state of affairs encourages delays. As you can see from this Map I stole from Maia, abortion access is rather piecemeal.

The black dots are towns where you can get abortion services - the coloured blocks are areas where those abortion clinics, or hospitals serve while the white dots are hospitals that are fully licenced to perform abortions, but choose not to (or more likely don't have the staff). Access gets pretty dire when you move out of the main centers, the entire of the South Island has only four abortion providers and some DHBs don't provide the procedure at all. Unless you're prepared to pay both for the abortion and the trip to Auckland to go to the only private abortion clinic in New Zealand, you go where your DHB sends you and that throws up some bizarre bureaucratic barriers.

If you are woman from Invercargill you actually need to travel to Christchurch rather than Dunedin because the Southland DHB doesn't fund it and won't contract to the closer Otago provider (where incidentally you can only get abortions on certain days of the week). This has to be a total bitch for anyone on a low wage and even more so for women who already have children that need to start worrying about childcare. So while for us lucky enough to live in the black dot areas the procedure might just involve a day off work after getting the intial sign offs, everyone else has to deal with the arranging not only the sign offs but also inter-city medical care which eats up time. And what happens once you run past the 12 week mark? You end up at Auckland where the nurses aren't so keen on performing later term abortions.

Part of the problem lies with the DHBs being dicks but the real cause is our archaic abortion legislation that insists every abortion must be signed off by two certifying consultants. So in order to actually offer an abortion service you need to have at least two certifying consultants on hand and consultants are bloody expensive. In the meantime the people that suffer are the women whose misery is being prolonged by legislation and the healthcare workers who aren't entirely happy having to perform unnecessary later term abortions.


Lucy said...

My mum is a FPA nurse, so I've heard chapter and verse on the problems with abortion access a number of times. I think the key problem here is that the requirement for two consultants treats women like they don't know their own minds. Getting an abortion is generally not going to be a lightly-made decision; why should women be forced to justify it multiple times?

What's really needed is fairly serious abortion law reform and opening up of access (especially to chemical abortion) but that's not going to happen any time soon.

Nikki Elisabeth said...

Argh. Seriously? Nurses aren't happy about it? Neither are the people having the freaking termination!

I was almost forced in to a 2nd trimester termination due to lack of appointment availability which was totally out of my control! (and this was in Wellington) I found out at ~7 weeks and was made to wait 2 weeks before I could get an appointment up at the clinic and then to schedule the actual procedure had to wait another few days.

I get that a second trimester termination affects some people more than first trimester terminations (it does for me on a personal note) but freeeeeeak THINK OF THE PERSON HAVING THE TERMINATION!

Tui said...

@Lucy, and just for general interest re: abortion law reform, I was recently at an event where Pansy Wong - new Minister for Women's Affairs - spoke, and took a few questions. Most of her speech was about domestic violence (shock: the only women's issue the Nats care about is the one they can fit into their "tough" on crime agenda, NOT that I'm trying to minimise the importance of addressing domestic violence, but). Anyway, questions were asked - a number about the handling of rape cases in the courts (including even-handed treatment of defendants and accusers: if a defendant's history is inadmissable, why is the accuser's admissable?, to which she made some vaguely reasonable response). I asked about abortion law reform, citing the judgement last year that current abortion practices in NZ were illegal, and there was some extremely interesting sidestepping. First she said that she supported the current situation, and I said that she could either support the status quo or the current law, not both; then she brought up the Abortion Advisory Committee; then I said that the AAC has been saying the same thing for about as long as the current abortion laws have been around. There was, hmm, a lot of talking around the issue and not a lot of answering, and since I find it VERY unlikely that she wasn't perfectly aware of the situation I think we may be SOL as far as abortion law reform this year, at least.

DPF:TLDR said...

I'm not sure the South Island is actually that badly represented. It's got 4 providers, compared to the North Island's 9. That's roughly proportional to its share of the total population.

Not to say that the absolute number of providers could not be improved, but I'm not sure that special attention needs to be paid to the South Island.

Danyl said...

What's really needed is fairly serious abortion law reform . . .

Don't hold your breath; there isn't an MP in the house who wants to sit through Select Committee oral submissions on abortion law.

Lucy said...

I'm not sure the South Island is actually that badly represented. It's got 4 providers, compared to the North Island's 9. That's roughly proportional to its share of the total population.

True, but distance is a big issue; for instance, women on the West Coast have to come to Christchurch. That's a *huge* deal, especially for someone who's poor or doesn't have access to a car. At the least, I would like to see a hospital on the West Coast providing abortions.

Don't hold your breath; there isn't an MP in the house who wants to sit through Select Committee oral submissions on abortion law.

I know it's not realistic in the short term. But that doesn't mean we shouldn't campaign for it anyway.

Anonymous said...

I lived near Greymouth until recently, and when I had to have an MRI it took 3 tries before we managed to get across to Christchurch to have it done. We'd book the MRI, arrange hubby's time off work, book accommodation and then there'd be a storm and we couldn't get across (this was winter of course). We'd have to rebook the scan, accommodation etc. A huge hassle, not to mention the cost of travel and one night's accommodation in Chch (rather than travel 6+ hours in a car with a 2 year old).
Imagine a West Coast woman trying to get an abortion at that time of year.

Julie said...

Sorry Tui, what does SOL mean?

DPF:TLDR said...

Lucy, in part this is part of the broader issue of health provision to isolated areas. Obviously a hospital on the West Coast would do a great deal to provide easier access to abortion for women on the Coast (although for those living in, say, Karamea or Ross, a hospital in Greymouth or Hokitika might be almost as hard to get to as one in Christchurch).

However, if there was an abortion-capable hospital in Greymouth, that would be one hospital serving roughly 32,000 people, which is less than 1% of the population. West Coasters would suddenly have easier access to abortion than anybody else in the country by a factor of at least ten. For Christchurch to have an equal level of coverage, there'd need to be 10 hospitals in the city itself, with another 4 in the rest of Canterbury.

This seems somewhat cold-hearted, but people living in isolated areas such as the West Coast often derive a lot of advantages from doing so - not least in low rents and low house prices. I'm not going to be quite so callous as to say abortion-desiring women in the Coast should take their savings from low living costs and use them to improve their access to abortions.

But I would be uncomfortable in a situation where the state was actively compensating isolated people for the costs of their isolation while leaving them free to enjoy the benefits.