OVERVIEW
OF UNPLANNED PREGNANCY AND ABORTION SERVICES IN
VICTORIA
ANNARELLA HARDIMAN – PREGNANCY ADVISORY SERVICE
PAS.MANAGER@THEWOMENS.ORG.AU
SOCIAL, LEGAL AND SERVICE
CONTEXT
•
Unplanned Pregnancy support services
•
Abortion providers
•
Standards of Practice and Resources
•
Legal Context
•
Notable State and national advocacy, debates, campaigns and law
reform
•
Community Attitudes
•
Research and Evidence on women’s experience of abortion
•
Context and Role
VICTORIAN PREGNANCY COUNSELLING AND
SUPPORT SERVICES
•
Established services such as RWH PAS – provided within
comprehensive S&RH services
•
FPV
•
Generic community based services
•
Health Professionals in private practice some accredited for Medicare
rebate for pregnancy counselling or mental health option (refer
professional associations’ websites)
•
National Pregnancy, Birth and Baby Helpline
•
Transparency of Advertising and “False Providers” – what has
VICTORIAN ABORTION PROVIDERS
•
MTOP and STOP services in metro and regional public hospitals with
various models of counselling and support services (RWH, Monash,
Geelong etc)
•
Private clinics with various models of counselling and support
services
Other services which are accessed via local knowledge / word of
mouth, with varying access to counselling and support services
•
Public hospitals with private lists
•
Private surgeons in private facilities
Women with higher needs tend to access providers with more
comprehensive services available
GUIDELINES, STANDARDS OF PRACTICE
•
RANZCOG - Termination of pregnancy – a resource for health
professionals 2005
•
New Zealand - Standards of Care for Women Requesting Induced
Abortion in New Zealand 2009
•
Standards of practice for the provision of counselling 1998 N.Z.
•
Best Practices in Abortion care : Guidelines for British Columbia / BC
Women's Hospital and Health Centre - Vancouver: Provincial Health
Services Authority, July 2004.
•
Children by Choice: Unplanned Pregnancy Option Counselling Best
RESOURCES
•
International Federation of Professional Abortion and Contraception Associates
(FIAPAC) runs biannual conferences in Europe
•
Royal College of Obstetricians and Gynaecologists (UK) -
The Care of Women
requesting Induced Abortion
Clinical guidelines for doctors in the United Kingdom
•
Alan Guttmacher Institute (USA)
Fact sheets on abortion in the United States.
•
National Abortion Federation (USA)
The website of American Abortion providers.
•
Planned Parenthood Federation of America
LEGAL CONTEXT – VICTORIAN
Victorian abortion law reform took place against a background of
change:
•
Women’s sector advocacy
•
Community and health professional culture and attitudes
•
Developing international evidence base
•
Organizational policy positions
Previously in Victoria:
Unlawful abortion was a crime
Lawfulness was determined by case law – the “Menhennitt rule” since
1969
THE ABORTION LAW REFORM ACT 2008
Following years of extensive community action culminating in the Victorian law reform commission’s
enquiry and subsequent recommendations to the Victorian parliament for a conscience debate, the
law was changed:
• Introduced into Victorian parliament on 19 August 2008.
• Reformed the law relating to abortion
• Regulates health practitioners performing abortions
• Amends Crimes Act to repeal provisions relating to the crime of procuring unlawful abortion
• Abolishes any common law offence relating to abortion
• Created new offences
• Introduced provisions relating to conscientious objections
LAW
• Termination of pregnancy by registered medical practitioner at not more than 24 weeks
A registered medical practitioner may perform an abortion on a woman who is not more than 24 weeks pregnant.
Termination of pregnancy by registered medical practitioner after 24 weeks
(1) A registered medical practitioner may perform an abortion on a woman who is more than 24 weeks pregnant only if the medical practitioner—
(a) reasonably believes that the abortion is appropriate in all the circumstances; and
(b) has consulted at least one other registered medical practitioner who also reasonably believes that the abortion is appropriate in all the circumstances.
(2) In considering whether the abortion is appropriate in all the circumstances, a registered medical practitioner must have regard to—
(a) all relevant medical circumstances; and
LAW CONT.
Ref:
VICTORIAN LAW REFORM COMMISSION LAW OF ABORTION FINAL
REPORT
http://www.lawreform.vic.gov.au/content/law-abortion-final-report-html-version
•
Various Australian state and territory laws:
•
ACT, Tasmania and Victoria have removed it from crimes acts,
others are still located in criminal law but define the conditions
and criteria which make it lawful.
IMPACT OF LAW REFORM
•
Effect on women
•
Effect on practitioners
•
Practice since law reform
However there is the ongoing potential for restrictive amendments
such as seen in U.S., U.K. Europe, such as:
•
Mandatory counselling, viewing U/S images, delay or cooling off
STILL TO BE ACHIEVED
•
Prevention and health promotion;
•
Best practice, training and continuing education;
•
Timely investigation, access and referral;
•
Equitable regional access;
•
Managing demand and sharing load;
•
Coordination of existing services;
•
Service development;
NOTABLE COMMUNITY DEBATES, CAMPAIGNS,
ADVOCACY AND LAW REFORM
2004 SENATE ENQUIRY INTO TRANSPARENT ADVERTISING OF PREGNANCY COUNSELLING
•
Senator Stott Despoja - extensive national enquiry via submissions and evidence but no new
policy achieved (“false providers” an ongoing issue)
• http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Completed_inquir ies/2004-07/pregnancy_counselling/index
Availability of MIFEPRISTONE
•
2006 Harradine amendment overturned (a law where the importation and marketing of the drug
was a matter of discretion for the federal health minister) following a significant campaign,
submissions and debate.
•
2012 Marketing approval – TGA – registered for use in Australia
CONT.
DEVELOPMENT OF A STATEWIDE PAS
2006 - DHS funded a research project to develop a model of a statewide service – to date unfunded
Conference - ABORTION IN VICTORIA
“The Melbourne Declaration”
Endorsed by the participants of the “Abortion in Victoria: Where are we now? Where do we want to go?”
Conference, The University of Melbourne, 30 November 2007.
•
Effort should be made to improve sexual health and reduce the need for abortion.
•
Abortion services should be accessible to all women.
•
Abortion services should conform to world’s best practice.
CONT.
PHAA Conference “Advancing Sexual and Reproductive Wellbeing in
Australia” “The Melbourne Proclamation 2012”
•
Develop a comprehensive and integrated framework
•
Improve health literacy and education
•
Develop an effective workforce; Develop systems for data monitoring
•
Research in areas of knowledge gaps
•
Fertility control accessible and affordable
•
Promote lifelong sexual and reproductive wellbeing
•
Coordinate strategies at primary care level
•
Improve socio economic determinants of S&RH in at risk populations
•
Create and enact legislation
http://www.phaa.net.au/documents/DR0208%20Melbourne%20Proclamation.pdf
(2
ndnational S&RH conference is in Melbourne September 2014)
COMMUNITY ATTITUDES
•
Majority of GPs approve of abortion – 87% of GPs surveyed by MSI in 2009
•
Majority of Australians support abortion (de Crespigny LJ Wilkinson DJ, Douglas T Textor M, and
Savulescu J 2010 ‘Australian attitudes to early and late abortion’
Medical Journal of Australia
,
vol.193, pp.9-12.)
•
de Costa, C, Russell, D, and Carrette M. eMJA 2010; 193 (1): 13-16 Views and practices of
induced abortion among Australian Fellows and specialist trainees of the Royal Australian and New
Zealand College of Obstetricians and Gynaecologists found broad support among responding
specialist obstetricians and gynaecologists and trainees for the availability of induced abortion in
Australia.
RESEARCH ON WOMEN’S EXPERIENCES OF
ABORTION
The Newcastle Institute of Public Health (Bonevski & Adams, 2001) reviewed clinical studies and reports published in Australia and internationally over the past 30 years on the psychological consequences of abortion.
• The overwhelming indication was that legal and voluntary termination of pregnancy rarely causes immediate or lasting negative psychological consequences in healthy women
Major (2000) investigated 882 women in the U.S. (and 50% were followed for 2 years) re pre-abortion and post-abortion depression and self-esteem, emotions, decision satisfaction, perceived harm and benefit, and posttraumatic stress disorder.
• It found that most women do not experience psychological problems or regret about their abortion 2 years post-abortion, and those who did tended to be women with a prior history of depression or other mental health issues. American Psychological Association (2005) concluded that abortion is a safe medical procedure that carries relatively few physical or psychological risks and yields positive outcomes when the alternative is unwanted pregnancy.
RANZCOG (2005) conducted a literature review of the psychological consequences of termination of pregnancy and concludes that psychological studies suggest that there is mainly improvement in psychological wellbeing in the short term after termination of pregnancy, there are rarely immediate or lasting negative consequences
RESEARCH CONT.
“We Women Decide” – Ryan Ripper and Buttfield 1994 – Women’s experience of seeking
abortion in Queensland, S.A. and Tasmania 1985 to 1992 found:
•
For most women abortion is neither a negative, harmful or traumatic procedure – the
majority of women were pleased they had made the decision and experienced no regret or
grief; and believed:
•
Abortion should be considered as part of the health system not outside it;
•
It should be viewed as a normal health service, not as a criminal issue;
•
There will always be a need for abortion;
•
Provider attitudes were of great significance in shaping women’s experience of abortion;
GRETCHEN ELY (2007) EXPLORED THE RESPONSES OF 104 AMERICAN
WOMEN WHO HAD AN ABORTION.
Women wanted, and felt their experience was positive when they were received:
•
A feminist / woman centred context;
•
The opportunity for counselling to address the negative societal attitudes and
political rhetoric surrounding abortion;
•
Honesty and friendliness;
•
Normalisation and acceptance;
•
Knowledge and information;
•
Non judgemental environment;
WHAT’S YOUR ROLE?
This evidence informs every one of us regardless of role of the essential, lasting, powerful impact of the quality of initial responses and the basic skills of offering acceptance, respect, information and control.
The context of our work and our particular skills will inform our roles and responsibilities as will the needs and circumstances of each unique woman.
Women will want and all health professionals can provide these responses:
• Clinical role: counselling, nursing, medical depending on profession;
• Information provision role: accurate, evidence based, timely;
• Advocacy and Referral role: relating to access, problem solving, locating resources.
MORE SPECIALISED / AS REQUIRED
Options based decision making counselling role: As with many other life tasks, many women negotiate the decision making using their own skills and resources. Others will seek additional support to help make a decision. Counselling can acknowledge and validate the range of issues which may be impinging on the woman’s decision.
Abortion Counselling role (once decision is made): Opportunity to explore her feelings or fears about the procedure, gain practical information about risks, what to expect later, supports.
Crisis intervention: A crisis may be experienced in relation to intense emotions, major life disruption, or the
intersection of the unplanned pregnancy with relationship, social or family issues or it occurs in the context of other life crises and cannot be separated out.
Risk assessment role: Based on the evidence, we may assess a woman to be facing risk factors which may need to be resolved or planned for prior to proceeding with a TOP. May require problem solving, risk assessment, immediate advocacy, referral, “case management” and safety planning.
Post Abortion Counselling role: In relation to grief, loss, sadness and guilt. It should always be offered, although infrequently wanted unless complex issues exist.
