Dr Alison

KnowlesCertifying Consultant and

Abortion Provider

16:30 - 17:25 WS #83: Abortion - Where We Are Now

17:35 - 18:30 WS #95: Abortion - Where We Are Now (Repeated)

Ms Kathy

Le Haavre

FIRST TRIMESTER ABORTION

Dr Alison Knowles

Kathy Le Haavre

ABORTION

WORKSHOP 1. PERSPECTIVES FROM THE PAST , FOUNDATIONS FOR THE FUTURE.

2. FIRST TRIMESTER MEDICAL ABORTION.

3. WHAT WE WANT FROM YOU.

4. WHAT DO YOU WANT FROM US ?

Perspectives from the Past

Foundations for the Future

PRE 1978

Abortion was illegal

Abortionists were fined and went to prison

Women had backstreet abortions

Women died from abortion

Women became infertile because of unsafe abortion

Women had forced adoption

Newborns were taken off their mothers and sent to orphanages

Women flew to Australia to get abortions

1977-1978

Royal Commission on Contraception, Sterilisation and Abortion

Contraception, Sterilisation and Abortion Act 1977

Crimes Act 1961

1978 -

CURRENT

Abortion is ‘sort of’ legal

Abortion is safe

Services have developed ad-hoc

Huge variation in service delivery between DHBs

DHBs have dropped the ball and outsourced the work

Abortion rates have increased and decreased

Numbers have increased and decreased

1979

2019

PERSPECTIVES FROM THE PAST

1940 1980 2017

Aotearoa NZ

population

1,700,000 3,100,000 4,800,000

Abortions 4,000 5,945 13,285

Abortions per

100,000

235 191 276

Deaths from

abortion

22 0 0

Head of State King George VI Queen Elizabeth II Queen Elizabeth II

Governor

General

Sir Cyril Newall Sir David Beattie Dame Patsy Reddy

Prime Minister Peter Fraser Robert Muldoon Jacinda Ardern

Chief Justice Sir Michael Myers Sir Ronald Davison Dame Sian Elias

O&G trainees NZ RCOG Mainly men RNZCOG Mainly men RANZCOG 90%

women

GP trainees NZ RNZCGP 63% women

AD HOC DEVELOPMENT OF SERVICES Pre 2000 - patients from Midcentral, Bay of Plenty, Hawkes Bay,

Lakes, Tairawhiti, Taranaki, Waikato, flew or drove to AMAC in Auckland.

2000 - WDHB started a service which served Waikato, Lakes, and Bay of Plenty. AMAC workload almost halved overnight.

2000 – current - Waikato DHB outsourced the doctoring part of abortion care to a private contractor. Abortions provided in Hamilton, Tokoroa, Thames

2013 – Tauranga FP started EMA. Waikato workload reduced significantly. Thames lists alternate weeks.

2018 – Waikato DHB closed Tokoroa abortion service, Lakes DHB opened a service. Waikato workload reduced again.

BUILD IT AND THEY WILL

COME

TAURANGA FAMILY PLANNING – ABOUT 250 PER YEAR since

2013

ROTORUA WOMEN’S HEALTH CLINIC Te Aka Tauawhi Tangata

600 IN FIRST YEAR 2018

BUILD IT AND THEY WILL COMELakes DHB First Trimester Service : OUTCOMES First 52 weeks

MTOPS 151

STOPS 443

TOTAL 594

Minimum gestation 4w5d

Maximum gestation 13w6d

Mean gestation 9w0d

Mean STOP gestation 9w4d

Mean MTOP gestation 7w1d

Mean wait from referral to TOP 9.2d

Clients discharged with LARC 60%

Women under 9w who chose MTOP 58%

PERSPECTIVES FROM THE PAST tick

FOUNDATIONS FOR THE FUTURE tick

WHERE WE ARE NOW

Minister of Justice to Law Commission :

Please review:

1. Criminal aspects of abortion law

2. Statutory grounds for abortion

3. Process for receiving services

ALTERNATIVE APPROACHES TO ABORTION LAW. Ministerial Briefing paper.

MODEL A No statutory test must be

satisfied before an abortion

could be performed.

The decision to have an

abortion made by woman in

consultation with her health

practitioner

MODEL B A statutory test would need to

be satisfied but the test would

be in health legislation rather

than Crimes Act.

The test : the health

practitioner who performs

abortion would need to believe

the abortion is appropriate in

the circumstances, having

regard to the woman’s physical

and mental health and

wellbeing

MODEL C For pregnancies of not more

than 22 weeks gestation – same

as MODEL A

For pregnancies of more than

22 weeks – same as MODEL B

NOW IT’S UP TO

PARLIAMENT

CONSCIENCE VOTE

IF WE DID GET DECRIMINALISATION……..

PERFECT ABORTION CARE IN AN IMPERFECT WORLD

1. AVAILABLE tick

2. SAFE tick

3. LEGAL tick

4. FREE tick

5. WOMEN CENTRED – CHOICE – ACCESS – QUALITY work in progress

Why you should consider providing

abortion care ?

CHALLENGING WORK

REWARDING WORK / GRATEFUL PATIENTS

GREAT WORK STORIES

SESSIONAL WORK / PART TIME WORK

LIMITED OR NO ON CALL / AFTER HOURS WORK

TEAM WORK – counsellors, social work, nursing, medical

CHALLENGING WORK

Doing an ERPOC awake on every women you meet

No anaesthetist – the buck stops with you – resuscitation (over sedation, anaphylaxis, haemorrhage) , difficult IV access

Past year : * phaeochromocytoma

* tubal ectopics

* scar ectopic

* methamphetamine (fidgety, talkative, aggressive, irrational)

* heterotopic pregnancy

* STOP down to under 5 weeks and up to 14.0 weeks

* post STOP/MTOP haemorrhage

* quadruplets at over 12 weeks

* fetal abnormality

* morbid obesity

* multiple LSCS / LLETZ scarring

A DAY IN THE LIFE OF…

WEDNESDAY 1. 26Y Maori 7w1d G5P3M1 (2NVD 1LSCS- whangai) PPHX1 2U transfusion.

Working part time. Partner student, completed family. Rental with 2 kids and partner. STOP + MIRENA

2. 19Y NZE/Maori 12w0d G1P0 Unemployed, applying for a course. Pregnant to BF. STOP + JADELLE

3. 27Y NZE 13w6d G3P1T1 (1NVD not in her custody 1 MTOP) High on methamphetamine, agitated, fidgety, poor concentration. Went AWOL 1 hour after miso. Didn’t reply to calls or texts. Referrer notified, SW notified.

4. 24Y Canadian. 10w5d G1P0 Working holiday, BF in Australia. STOP + No contraception

5. 39Y NZE 10w3d G2P0M1 Never wanted children. STOP + NFP

6. 31Y CookIsMaori 14w0d G8P4T1M2 4NVD(1 stillborn 27w, 1STOP, 2 miscarriages (one at 19weeks). Use oven to heat house. STOP + MIRENA

7. 25Y NZE 5w3d G1P0 Lives with partner who has 2 kids and shared custody, works fulltime in café. MTOP + COC

8. 16Y NZE 6w0d G1P0 High School. STOP + COC

9. 26Y NZE 8w1d G4P2M1 Left abusive relationship with father of children in February. Has split with FOP. MTOP + DP

After work checked MTOP HCG results from last week – one MTOP failure. Same day mife/miso @ 5w6d. HCG#1 32,000 (16May) HCG#2 60,000 (22May)

REWARDING WORK

Grateful patients – these are the very same women you care for at every

other stage of their lives.

During a day at work you hear up to 12 stories of 12 decisions, some agonising

and some straightforward, but none of them taken lightly.

You are helping patients at a very difficult time. There is nothing more

personal and private for a woman than deciding whether to continue a

pregnancy and have a baby or end a pregnancy by having an abortion.

GREAT WORK STORIES

Drugs

Abuse (physical/sexual/emotional)

Poverty

Tragedy

Crime

Migration / dislocation

Alcohol

Rape / Incest

Poor physical health

Fetal abnormality

Ambition

Depression / anxiety

Bad luck

Grief

TEAM WORK

WOMENS HEALTH CARE

INCLUDES ABORTION CARE

GPs PROVIDE MOST OF THE

WOMENS HEALTH CARE IN NZ

ABORTION CARE IS WOMENS

HEALTH CARE