Demand Driven

The Abortion Supervisory Committee are pushing for more use of the abortifacient, RU486. They say that it is being used in only 6% of abortions while the “standard” overseas is 20 – 30%.

Now I don’t have a problem with RU486 being used instead of a surgical termination of pregnancy (leaving aside the whole abortion issue and why the ToP is being done). It is certainly safer than a surgical procedure and, if done before 9 weeks, just as effective (if effective is the right word in this context). However, I do wonder if the ASCs interest in RU486 use is not being driven by the desire of the Abortion Law Reform group to institute true “abortion on demand” in New Zealand, without the attendant debate that should go with it. This quote from Abortion Law Reform Association president, Dame Margaret Sparrow, is quite revealing:

“Sparrow wanted GPs to be able to prescribe the abortion pill, as they could in other countries.”

These “other countries” all have abortion on demand. There is, in fact, no other way effectively to give GPs prescription rights to RU486 except by allowing abortion on demand. There is no way a GP is qualified to make the decision as to whether continuing the pregnancy is a serious mental health risk (the “criterion” for most abortion approvals). Of course, it could be argued that the current abortion clinics are not exactly applying strict professional judgement in most cases, so why not let the GPs make the same inadequate judgement call? But that is a ridiculous argument akin to “it’s broken already, so why don’t we break it some more?” I’m traveling at 120kph in this 100 zone; why don’t I travel at 160?

Sparrow is also asserting that the reason why the change from surgical to medical procedures is taking so long is because:

“it [medical abortion] required the approval of two certified consultants and two trips to the clinic for the patient.”

This clearly cannot be the reason why there has not been a shift to medical abortions. Surgical abortions also require two certified consultants and two trips to the clinic. While the procedure for medical abortions could be streamlined a little, the reason for the lack of use of RU486 is the lack of experience with it in this country, not how hard it is to get hold of.

It is for this reason that I am dubious about Family planning clinics holding stocks of RU486. It is not as if this is like the Morning After Pill, where timing is critical. I see no need for it to be available from Family Planning Clinics at all. I have no difficulty with the second consultant dispensing it from his/her own stock but family planning clinic stock can only be a prelude to demanding GP-initiated prescription rights again.

Consider these facts at the end of the article:

“* 53 per cent of women who had abortions last year were not using contraception.”

So the real problem here is not the ease of abortion, but the lack of contraception – contraception that is freely available and costs little or nothing except the will to use it. If family planning were actually doing their job of properly promoting contraception, instead of rooting for abortion (sorry – unfortunate turn of phrase there!) then the need for “one stop shop” abortions would be greatly diminished.

“* 98.7 per cent of abortions were carried out on mental health grounds.”

Which tells us that the vast majority of abortions are procured under extremely dubious circumstances. All these proposals are doing is making the grounds even shakier.

“* 196 certifying consultants were paid nearly $5 million in fees for abortions last year.”

Which is an average of $25,500 per consultant. That is not an insignificant sum, especially when you consider that many of these consultants see very few “clients”, so that some doctors are earning very much more than this. The question that always crosses my mind is, when one makes a significant portion of one’s living approving abortions, how much pressure is one under to approve the abortion, regardless of merit or criteria? And how much interest does one take in promoting contraception, knowing that it will certainly reduce your income? (and yes, I am aware that that same motivation could be ascribed to all of us doctors – and probably with some justification)

Quite frankly, I think that the last thing New Zealand needs at the moment is for abortion to be made easier. Safer – most certainly; easier – no. Abortion is a decision that needs to be considered carefully and fully. It should not be a quick-fix you can obtain on the spur of the moment from your corner dairy (7-11 for my US readers).

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