OVERVIEW OF UNPLANNED PREGNANCY AND ABORTION SERVICES IN VICTORIA

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1 OVERVIEW OF UNPLANNED PREGNANCY AND ABORTION SERVICES IN VICTORIA ANNARELLA HARDIMAN PREGNANCY ADVISORY SERVICE

2 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.

3 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 happened since the Senate enquiry?

4 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

5 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 Children by Choice: Unplanned Pregnancy Option Counselling Best Practice Manual 2010

6 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 Information on the abortion process in the United States.

7 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

8 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 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 Duty to perform an abortion if necessary to preserve the life of the woman

9 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 (b) the woman's current and future physical, psychological and social circumstances.

10 LAW CONT. Ref: VICTORIAN LAW REFORM COMMISSION LAW OF ABORTION FINAL REPORT 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.

11 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 periods etc.

12 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; Data collection, monitoring and research.

13 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) ies/ /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 Marketing approval TGA registered for use in Australia 2013 PBS listing achieved

14 CONT. DEVELOPMENT OF A STATEWIDE PAS 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 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. Women having abortions and abortion providers should be free from harassment.

15 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 (2 nd national S&RH conference is in Melbourne September 2014)

16 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): 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. Newspoll in December 2013 found 85% of Victorians supported a woman s legal right to choose

17 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 postabortion 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 postabortion, 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

18 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; Decision making should rest with women rather than health professionals.

19 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; Opportunity to guide the session and feel in control of the issues discussed.

20 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. But know how to decide to engage with broader external issues outside the context of their skills and roles

21 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.

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23 THANK YOU ANY QUESTIONS?.