Legal issues

Have a look now at the Abortion Services in New Zealand website, and at the 2017 Abortion Supervisory Committee Report, in which you will get information regarding the number of abortions, what contraception the woman was using at the time she became pregnant, and also the grounds for the abortion. What is the main ground for abortion in NZ?

You can also see that in 2017, 57% of women were using no contraception, 24% of women were using the condoms, and 9.4% were using the COC. Now that you have completed the contraception modules, what do you think might the issues have been here? What are the likely reasons that these methods fail?

From page 8 of the report you can see an overall drop in the termination rate throughout New Zealand- one reason for this is the increasing uptake of long acting reversible contraception (LARCs), which have been proven to decrease the rate of repeat terminations if they are provided at the time of a termination of pregnancy. 

Information is also provided on the number of children and young women between 11-14 year old who had an abortion. There is also information provided on the number of terminations in the 15-19 year age group. What is the legal situation in New Zealand for young women under the age of 16? Do they require parental consent for abortion? 

Have a look a the legislation in this area ie Contraception Sterilisation and Abortion Act, the Care of Children Act section 38 and Care of children: Responsibilities of guardianship from the Ministry of Justice (you can also see the slides provided for a brief overview). 

Care of Children Act 2004 Section 38

If given by a female child (of whatever age), the following have the same effect as if she were of full age:

• (a) a consent to the carrying out on her of any medical or surgical procedure for the purpose of terminating her pregnancy by a person professionally qualified to carry it out; and

• (b) a refusal to consent to the carrying out on her of any procedure of that kind

This means that parental consent is not required to provide a termination of pregnancy to a young woman. However, young women should be encouraged to talk to family members or other adults that they trust to get support if this is possible. 

Young women still have to go through the process outlined in the Contraception, Sterilisation, and Abortion Act 1977. 

The Health Information Privacy Code 1994 also outlines the boundaries of confidentiality. Medical confidentiality can be breached only if there is concern that there is a serious threat to the individual or another individual without disclosure. Examples of cases where medical confidentiality may need to be breached when considering the provision of abortion to young women include cases of violence, incest, and sexual abuse of a child. 

The Grounds for an abortion in NZ are under the Crimes Act. Here are the grounds for abortion up to 20 weeks

• Serious danger to life
• Serious danger to physical health
• Serious danger to mental health
• Risk that child would be seriously handicapped physically
• Risk that child would be seriously handicapped mentally
• Incest with parent, brother, half brother, grandparent
• Unlawful sexual relations with guardian
• Severe mental subnormality of woman or girl

The laws around abortion in New Zealand allows termination of pregnancy to be performed once agreed to by the woman and two medical practitioners known as certifying consultants. This legislation is part of the Contraception, Sterilisation and Abortion Act 1977. The provisions in the Act regarding abortion are administered by the Abortion Supervisory Committee. You can find out more about the Abortion Supervisory Committee from their website. It is important that women for whom English is not their first language are offered an interpreter for this process. 

The process involves: 

• A legally licensed premises: TOPs cannot be performed in unlicensed premises 
• An offer of counselling to each woman 
• A review by two certifying consultants who have been apointed by the Abortion Supervisory Committee 
• Consideration of post-TOP contraception 

Counsellors are required to advise patients on all of their options- including adoption and solo parenthoot and to canvass a wide range of matters. Family violence screening is also needed (we have talked about the rates of family violence in NZ in module 3). 

When the woman sees the first certifying consultant, this person will determine if she meets the grounds for abortion and discuss the options for methods of abortion. The certifying consultant will also discus and organise contraception after the TOP. The woman will then see a second certifying consultant who will confirm that she meets the grounds for abortion under law and answer any questions she has. 

Women will then usually see a nurse who will organise dates and go over some contraception teaching. This brochure provides an overview of the process that occurs at Epsom Day Unit at ADHB for women. 

Before a termination is provided, the following investigations are required:  

1. Confirmation of pregnancy with positive ßhCG
2. Speculum examination and take the following swabs :
• Endo Cervical Swab (ECS) for chlamydia/gonorrhoea/trichomonas 
• High Vaginal Swab (HVS) for trichomonas vaginalis, bacterial vaginosis or candida
3. First antenatal bloods 
4. Pelvic ultrasound 

Section 46 of the Contraception, Sterilisation, and Abortion Act 1977 

This section states that conscientious objectors are permitted by law to refuse to provide health care services around abortion and contraception. For doctors, this means that a doctor can refuse to refer a woman for abortion or provide a prescription for contraception. In 2010 a High Court ruling found that doctors were also not obliged to refer patients to another doctor that would provide the service. So, in summary, doctors with conscientious objections are legally obligated to tell patients that care is available from other doctors or clinics, but they are not obligated to refer them or tell them where to go to find these services.