First published on Monday the 15th of February, 2016, this piece comes in at number 5 in the top 30 most read Villainesse stories of 2016.
In 2014, 13,137 women underwent a termination of pregnancy in New Zealand. While abortion rates in NZ have been in steady decline since 2007, let’s just get it out of the way that as long as there is sex (and, sadly, rape) happening between men and women there will be abortions. Until there is such a thing as an easily accessible, 100% failsafe form of contraception there will be abortions. Until we live in an ideal world where every pregnancy is planned and therefore wanted, where every woman has access to the resources and supports required to be able to carry, give birth to and raise a child without fear, isolation or risk of harm then there will be abortions.
Termination of pregnancy is a fact in New Zealand, and yet it remains one of our most controversial social topics; so controversial, in fact, that we as a society seem quite unwilling to talk about it. The experience of abortion itself is often considered too intensely personal for everyday discussion, and the issues surrounding it are so publicly divisive — so highly charged — that it also continues to be a political hot potato that few are willing to handle at policy level.
This tacit “don’t ask don’t tell” position is arguably why New Zealand’s abortion law has remained unchanged for the past 38 years — termination of pregnancy is still a criminal offence, except in the case where two certifying consultants approve the termination on one of ten grounds, which include cases of incest, foetal impairment and risk to a woman’s physical and/or mental health. It’s worth pointing out that rape is not one of these grounds.
The thousands of abortions performed under the current law each year would indicate that this decades-old legislation is not entirely restrictive and does allow for women in Aotearoa to access safe, legal abortion where necessary, however, this is not to say that getting an abortion in NZ is as easy as rolling up to the clinic and asking for one. Any woman who has experienced the wait times, the numerous appointments and, in many cases, the travel involved will tell you that current law throws up a number of procedural hoops and barriers to access.
Further to this, our society’s fingers-in-ears approach to the issue also creates a cultural environment that keeps women too ashamed, uncomfortable and scared to openly discuss experiences of abortion — further feeding the stigma and making the experience more mystifying than it needs to be. The basic facts may be there, but firsthand accounts and advice appear to be sorely missing from public conversation.
And that’s why this guide has been put together — a guide for women who have already made the informed decision to terminate a pregnancy and who are perhaps wanting to know more about what to expect when they’re (unwantedly) expecting. If the system isn’t about to change then let’s at least create some honest dialogue around how to navigate it safely. Let’s broaden the conversation beyond clinical-speak and emotionally charged rhetoric.
This guide has been put together with help from contributors who have had first-hand experience of getting an abortion in NZ. All contributors had first trimester terminations (prior to 12.6 weeks gestation). The New Zealand Abortion Supervisory Committee considers it best practice for abortions to be given at under nine weeks gestation, and around 56% of terminations in New Zealand are performed at under ten weeks gestation. As a reflection of both statistics and contributor experiences, this guide is largely aimed at the majority of women who are seeking first trimester terminations. Second trimester and late term abortions are a reality for some, however, and we hope to explore this topic at a later date.
This guide is also split into two parts: In this first installment we’ll discuss how to go about accessing an abortion. The second part will explore the experience of having a surgical abortion, and will discuss self-care both prior to and following a termination.
Each experience of abortion is different and the emotions attached to your decision are very much your own. This guide does not assume anyone’s situation to be traumatic, nor a walk in the park. It’s just some firsthand, practical advice and info from a group of women who have had an abortion and who have bravely and kindly chosen share their experiences.
So let’s begin…
So you’ve decided to get an abortion
For many women it’s a late period (and then desperately trying to take back every time you ever complained about ruined knickers, cramps or “SURPRISE!” blood flow), for others it’s a “not right” feeling, or a constellation of random symptoms — itching skin, strange sleep patterns, unfamiliar twinges in the lower abdomen. Something made you suspicious enough to buy a pregnancy test, and you’re now looking at two double lines on a flimsy plastic stick. If you’re still unsure about how to proceed then please don’t look to this guide to help make your decision — your choice is your own and should not be influenced by anyone else, including this here random woman on the internet. If you’ve already made the decision to terminate your pregnancy then read on for an overview of getting the process underway.
Your first step is to book an appointment with a doctor, as you cannot self-refer to the hospital. This appointment can be with your regular GP, Student Health Services, or Family Planning. Although it’s uncommon, a doctor can refuse to give you a referral based on conscientious objection — if a doctor does refuse a referral then they have a legal obligation to tell you that you are free to go to see another doctor who will be able to arrange this. The website My Decision also provides a list of GPs who are known to be conscientious objectors, so you may want to check in advance.
Family Planning clinics — with the fine work they do — often get really busy and this can mean waiting anywhere from a couple of days to over a week for an appointment. Many do offer a walk-in service on certain days though, so call your local clinic or look online to see when these days are.
At your first appointment the doctor will ask you some questions and possibly get you to take another urine pregnancy test. The questions are fairly standard — just things like when your last period was and if you’ve been pregnant before. Once a positive test is confirmed they’ll then take a cervical swab (or provide you with the tools and instructions to take one yourself, as is becoming increasingly common) to test for STIs, before referring you for bloodwork and ultrasounds. Maternity healthcare is free in New Zealand, even if you are not continuing with the pregnancy. This first appointment and all subsequent appointments, scans and any other related appointments shouldn’t cost you anything, although an Auckland doctor reported that some Auckland radiology providers like Auckland Radiology Group, Ascot and SRG (Specialist Radiology) may charge a fee (sometimes called a ‘part-charge’) for the ultrasound scan. Double-check this with either your referring doctor or directly with the radiology practice to make sure you’re aware of any unexpected costs up front.
For those who live in or near Auckland there are two private clinics. The first is called Auckland Medical Aid Centre (AMAC), while the second is Surgery on Shakespeare, on Auckland’s North Shore. These are the only private abortion providers in the country. Although having the actual procedure in these clinics costs money (more on this later), they do offer a free referral service for NZ residents, though you should double-check this at the time of booking, in case of any policy changes since this article was researched. This service allows you to get an initial consult, bloods, swabs and ultrasound onsite in one half-hour appointment. From there you can either book in with them or ask them to refer you to the public service.
You’d think that finding out about a pregnancy early = getting a termination early, however, as one contributor found, this is not the always the case:
“I found out I was pregnant just before my period was due — I just knew something was up. I literally went to the doctor that day but was told that it was too early to be certain (the test was only showing a very faint positive) and that I had to come back in a week to take another test before they would book me for an ultrasound”.
While there’s no specific law stating that an ultrasound must be performed, the majority of DHBs do insist on the pregnancy being confirmed in this way. This is both to establish gestational age and to rule out the possibility of ectopic pregnancy. Unfortunately a pregnancy only becomes visible on ultrasound at around five to six weeks, so if you’re earlier than this you may have to wait. If your pregnancy test is showing positive (no matter how faintly; modern pregnancy tests almost never display false positives) then do go to a doctor to get the ball rolling. If they deem an ultrasound to be necessary then insist on them making a booking that day, or giving you the details to make the booking yourself, even if it’s for one or two weeks away. Any unnecessary delay at this end may cause further delays down the track.
The fact that we have a safe, free abortion service in New Zealand does not mean that this service is not without its hurdles — the biggest being access. Access (including wait time) in the public system is, frankly, quite shit, with our abortion laws necessitating a rigidly held sequence of appointments, and also appointing only a small number of clinics to service the entire country. Contributors to this story spoke of waiting up to a month to receive their abortion; experiences reflected by a 2009 study that found that New Zealand women waited an average of 25 days between their first contact with a medical professional and the abortion procedure itself.
Abortion.org.nz has a great resource that allows you to locate your nearest abortion provider, and you can also reach them on 0800 ABORTION. As one representative of the site explains, however, for many women access to both ultrasound and abortion means having to travel:
“Living somewhere that doesn't have a provider is really problematic. Recently started services in Tauranga and Dunedin have made a huge difference, but there are still big gaps on the map. For example, women in Whanganui or Palmy [sic] don't have a local provider, and have to travel to Te Mahoe clinic in Wellington.”
*Editor's note (19/01/17): Women living in and around Palmerston North can now access abortion through The Women's Clinic. Medical abortions are performed in Palmerston North, while surgical abortions are referred to Wellington. Women can access The Women's Clinic by self-referring through 0800 ABORTION or by obtaining a referral from their GP.
If your local DHB cannot provide the service, and you’re unable to arrange transport to the nearest provider, then discuss transport with your doctor. Free transportation and accommodation is often available and can be arranged through your DHB social worker. If you need to take time off work or uni then a medical certificate can also be provided — this will NOT mention the reasons for your absence and you are in no way required to give your employer or education provider any details beyond what is stated on the note.
Back to that ultrasound: you are not obligated — legally, morally or otherwise — to view the ultrasound image. Obviously this choice is up to you and ideally the technician should give you the option to view the image or not, however, as one contributor writes, this is not always the case:
“[The technician] just kind of went straight into it and was like ‘there it is!’ like she assumed it was a wanted pregnancy. It was pretty awkward because she started talking about me coming back later to confirm the heartbeat and I had to tell her that no, I wouldn’t be because I was having an abortion.”
If you don’t want to see the ultrasound image then make this clear at the start of your appointment. Many of the contributors to this story did choose to view the image, for reasons ranging from general interest to “feeling like it was the right thing to do.” One contributor recalled this as an emotional experience, however, others reported feeling relief or surprise to see “not much more than a small, dark blur,” as one woman described it.
It’s worth pointing out that all contributors to this story were between five and eight weeks gestation at the time of their ultrasound, and at this early stage there’s very little to discern unless you know what you’re looking for. If you’re further along in pregnancy then the ultrasound may be a more confronting experience so, again, the choice of whether or not to view the image is 100% up to you.
Once the pregnancy and gestation date is confirmed via ultrasound your doctor will be able to book you in for “Appointment One”. This is a consultation with the first of the two certifying consultants, both of whom must independently approve your abortion in order for it to be performed legally. Again, there is a often a waitlist for this appointment — amongst contributors the wait time between the ultrasound and Appointment One ranged from 7-16 days. Wait times may also be affected by public holidays, in particular around the Christmas/New Year period.
The appointment usually takes place at the clinic where the termination itself will be performed and you’ll need to set aside at least half the day (longer if you’re having to travel), as there is a fair bit of waiting around.
Before seeing the first certifying consultant you’ll meet with a nurse, whose role is to gather all the relevant information around your circumstances, including your reasons for wanting a termination. Around 98-99% of all legal terminations in New Zealand are approved on the ground that continuation with the pregnancy would cause “major risk to a woman’s mental wellbeing”, an exception that falls under section 187A of the Crimes Act 1961. This requirement is a major point of contention within our current abortion law, with advocates for change — such as the Abortion Law Reform Association —arguing that it’s hypocritical and demeans women who have made a conscious, informed choice to terminate, by putting them in a position of having to lie about their own mental wellbeing.
If your situation falls under this ground (which, statistically speaking, it’s likely to) then it should be made clear that you do not have to have existing mental health issues to have an abortion approved under this part of the law — the premise is basically that being made to carry, give birth to and potentially raise a child when you don’t want to would cause extreme emotional and mental distress, whether there are existing mental health issues or not.
With that said, do be prepared for some probing questions around both your physical and mental health history, as well as your employment status and current living situation. You will also be asked about your relationship with the other person involved in all this — are you in an ongoing relationship with this person? Is the relationship stable? Would this person be supportive if you chose to continue with the pregnancy? You may be asked to give some details of the “father”, such as his first name, age and occupation.
Contributors said that they found some aspects of this questioning to be unexpected or uncomfortable — one recalls being worried that her partner’s “good” job would somehow exclude her from being eligible for a termination, another felt like she was “seeing all [her] current life failures basically listed out,” an experience she found “fairly demoralising.”
“They’re not really there to chat about what’s going great in your life.”
Where mental health risk is used as grounds for approval (which, again, is in 98% percent of cases) there does appear to be a lurking and unspoken onus put on women to lay bare the ways in which their lives are too shitty to bring a baby into. An allusive question here, a nursely head nod there; as far as the law is concerned this is the maximum level of trust given to a woman in deciding what’s best for her own life.
Realistically, however, the key, deciding factor in all of this is that the decision to terminate is one a woman has made herself and that she is sure of. The only likely way you would be denied a termination is if one or both of the certifying consultants feel that you are unsure of your decision, or that you are being pressured or coerced into your decision. It’s for this reason that your partner or support person will be asked to remain in the waiting room during both your initial consultation with the nurse and subsequent consultations with the two certifying consultants—your decision must be yours and yours alone.
During this meeting you’ll also be asked if you want to speak with a counsellor. Abortion providers are legally obligated to offer this and, as Dr Margaret Sparrow from ALRANZ told me, at least one clinic — Te Mahoe, In Wellington — will insist that you do. If you are unsure of, or struggling with, your decision then this is a good opportunity to talk it through with an impartial party, however, if you don’t want to, and your abortion provider does not make it a requirement, then you are not obligated to take the offer up.
Following this consultation the nurse will hand over their notes to the first certifying consultant, which they’ll go over while you sit in the waiting room. The meeting with the first certifying consultant is much shorter—they’ll basically just go over the same info and also discuss contraceptive options with you. If you choose to have an Intrauterine Device (IUD) inserted immediately following your abortion then they may give you a script and ask you to pick it up yourself prior to the date of the abortion.
Once the first certifying consultant has signed off on your decision you’ll be given a date for Appointment Two, which encompasses consultation with the second certifying consultant, followed by either the surgical procedure or the first stage of the medical procedure. Te Mahoe (Wellington DHB) and Epsom Day Unit (Auckland DHB) do not allow Appointments One and Two to be completed on the same day, nor on consecutive days — this is a hassle in general but is particularly problematic for women who are needing to travel, as wait times between Appointments One and Two range between two and seven days.
Lyndhurst Clinic (Canterbury DHB) does offer a one-day service for women who are travelling from out-of-town. The aforementioned Auckland Medical Aid Centre also offers a one-day service (to all patients), however, this is a private, non-funded clinic and there’s a fee of $1100. Obviously this fee will be prohibitive to many but for those who can access the money the cost may be worth it in terms of being able to get life back to normal as soon as possible.
Next up in Part Two: Getting prepared for Appointment Two, the actual procedure, and what happens afterwards.