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Antiquated abortion law a $20 million ‘box ticking exercise’

Monday 10th July 2017

The decriminalisation of abortion in New Zealand will save the taxpayer millions, a leading doctor says.

The Ministry of Justice has spent $20,711,714 paying certifying consultants to sign off on abortions between 2012 and 2016.

Photo: Jimi Filipovski / Supplied.

The Government has spent more than $20 million since 2012 paying specialist doctors to sign off on abortions. 

But one specialist has called the process “cruel”, and says a 40-year-old law necessitating the exercise needs to change.

Under the Crimes Act, it is illegal for a woman to have an abortion in New Zealand unless it has been approved by two highly-paid specialist doctors, called certifying consultants.

But one such doctor, Helen Paterson, an obstetrician and gynaecologist at Dunedin Hospital, says the question of whether an abortion should or should not be performed ought to be matter for the woman and her GP to decide. 

She says a change in law will save the taxpayer millions. 

More importantly, Paterson says, it will make the currently “dysfunctional” process of having an abortion less time consuming and stressful for women. 

Dr Helen Paterson is a certifying consultant in Dunedin.

Photo: Supplied.

The Ministry of Justice has spent $20,711,714 paying certifying consultants to sign off on abortions between 2012 and 2016.

In the 12 months to June 2016 alone, the figure was $3,716,766.  

Spread evenly between the country’s 159 certifying consultants, that’s $23,376 per doctor each year, for an exercise that Paterson says takes between 10 and 15 minutes. 

Consultations cost $146.50 by interview or examination and $63 by telephone. The money is paid by the Ministry of Justice either directly to the consultant, or to the private practice they are part of.

“I am coming in and talking to the women. Literally all I am going to do is need her to sign a piece of paper,” Paterson says.

***


AT WHAT COST? 

*$20,711,714 spent on certifying consultants signing off abortions since 2012. 
*$3,716,766 was spent in the 12 months to June 2016.
*13,155 abortions were performed over that period.
*10-15 minutes is the time it takes for a consultant to sign off on an abortion.
*$146.50 for an interview or examination with a consultant or $63 by telephone.

***

The Minister of Justice Amy Adams says the costs are necessary and in accordance with the law. 

And Dr Carol Shand, who worked in the fields of women’s health and sexual health medicine for more than 40 years, says though the law needs reform, the money paid to certifying consultants inadvertently allows clinics to give women the best medical service possible.

But president of the Abortion Law Reform Association of New Zealand (ALRANZ), Terry Bellamak, says the process is costing the taxpayer millions of dollars that don’t need to be spent. 

“Money that’s going towards certifying consultants is money that’s going towards a box ticking exercise. It’s empty, it’s wasted.” 

Last week Paterson wrote to the Abortion Supervisory Committee, which oversees the appointment of certifying consultants, saying her views on abortion have changed. 

“I intend to work towards the decriminalisation of abortion and the reform of New Zealand’s abortion laws,” she wrote.

This puts Paterson’s job at risk, as her view is outside of the law, which says certifying consultants must lie somewhere between two “extremes” of opinion on abortion: That an abortion should not be performed in any circumstances; and that the question of whether an abortion should or should not be performed in any case is entirely a matter for the woman and a doctor to decide. 

But Paterson believes the system discriminates women and sacrifices patient care in order to satisfy the “archaic requirements of a 40-year-old law,” which needs to change.

ALRANZ president Terry Bellamak says money that’s going towards certifying consultants is money that’s going towards a box ticking exercise.

Photo: Supplied.

She called the system dysfunctional, and said it was her responsibility to make New Zealanders aware of this. 

For women living outside of main centres, the requirement for approval of two certifying consultants can be not only inconvenient, but stressful and costly. 

“If you live on the West Coast, you have to travel to Christchurch, have your two certifying consultants sign your form, stay overnight probably, possibly two nights. I’m pretty sure if you ask those women if that was easy, from a standpoint of just the practicalities, they wouldn’t feel that that was easy,” Paterson says. 

“For the actual process, someone described to me a situation of having to see seven people and explaining why she wanted to have an abortion. She saw a GP, she then saw someone for an ultrasound. Then had a counselling visit. She saw two certifying consultants, unfortunately the person doing the termination wasn’t one of those certifying consultants, and she had to see the anaesthetist. 

“That’s not easy.” 

Green Party social development spokeswoman Jan Logie says the party trusts women to be able to make a decision with her GP. 

The health system was already stretched, and money needed to be used more efficiently. 

“We could easily, quickly save that money by decriminalising abortion,” Logie says. 

“It’s 2017, one in four women in this country have had an abortion, I think it shows that most New Zealanders accept that having an abortion should not be a crime and it doesn’t belong in our Crimes Act.” 

But for change, there needs to be political will, and Logie says this is something that’s lacking in the current Government. 

Greens MP Jan Logie.

Photo: supplied

Prime Minister Bill English, an active Catholic, is well known for his opposition to abortion. 

On Friday, he again reiterated that he is not seeking to change New Zealand’s abortion laws, telling Family First “the law is how it is and we're not proposing to change it. 

"Most people have a different view than I do about abortion. That's not just reflected in the law, but sort of the practice of it". 

Justice Minister Amy Adams says it is important that women who need an abortion can access one. 

But she said there were no plans to reform or rework current legislation, as she said the law was working "broadly as intended." 

"The Government has a busy legislative programme focused on issues that affect large numbers of New Zealanders, such as family violence, money laundering and vulnerable children, to name just a few," Adams said.

"Any costs associated with certifying consultants are necessary and in accordance with the law."

Although she supports reform, Dr Carol Shand says the current law works well in places where there are doctors who are supportive, and make sure it works for women.

“A law designed to suppress abortion has been used to provide some very good quality services.”  

“It’s not as horrific as some critics would like us to believe. The payments to the certifying consultants have inadvertently funded the services, because they've paid the doctors.” 

Before legislation was introduced in 1977, there was a significant number deaths related to illegal abortions. Since then, there have been none, Shand says. 

She says consultants don’t just approve abortions, but also do preliminary tests and preparations to ensure the process is safe.

In Wellington, a woman’s doctor refers them to a service. There, they see a counsellor to talk through options. Then they will see two doctors over two days. These doctors check all information to provide a safe operation is available, and the process gives women time to consider the information she has been given. An appointment is made with the operating doctor, who is usually the second certifying consultant, and the operation takes place. 

“In most places it’s a very comfortable service for women,” Shand says. 

“Though the law isn’t ideal, clinics use it to give women the best medical service possible.”

***

THE LAW EXPLAINED:

Under the Crimes Act 1961, it is illegal for a woman to have an abortion, unless two certifying consultants have determined that continuing pregnancy will put her life at risk; that the child, if born, would be “severely handicapped”; if the pregnancy is the result of incest; or if the woman is “subnormal.”

Professor Dame Linda Holloway, chair of the Abortion Supervisory Committee said some wording in the Act was “outdated and clumsy.” 

“It’s an indictment that we’ve got a statue like that on the book that's not been corrected.” 

Holloway said that anti-abortion groups had taken advantage of outdated and confusing legislation to (unsuccessfully) take legal action against the committee, costing the Ministry of Justice $470,359.49 in legal fees since 2004. 

She has called for changes to the law. 

Under the Contraception, Sterilisation and Abortion Act 1977, certifying consultants are appointed by the Abortion Supervisory Committee. Those selected must have views on abortion that fall between the views that: 

an abortion should not be performed in any circumstances, and:
that the question of whether an abortion should or should not be performed in any case is entirely a matter for the woman and a doctor to decide.
 
Dr Helen Paterson says her view, that a woman and her GP should be able to decide, puts her position as a certifying consultant at risk. 

She calls the requirement for the approval by two consultants “cruel,” especially for women who are sick and require an abortion.

“In those situations, as a second certifier, I am coming in and talking to the women. Literally all I am going to do is need her to sign a piece of paper. My requirement is to see that she does want to have an abortion. So, for a woman who actually doesn’t want to have an abortion, really, but needs to have one, she has to meet me and say that she wants to have something that she doesn’t really want to have, just to make it legal.” 

Correction: An earlier version of this story put the cost of a consultation at $282. This was inaccurate, and has been updated. 



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“The comments from ALRANZ's Dr Paterson are inconsistent with your accurate explanation of the law. Abortion is not illegal in New Zealand, it is only subject to some safeguards.

Although some of those safeguards may be expensive, they are worth it. The purpose of safeguards is to ensure that the law is as consistent as possible with our international obligations to protect every person's inherent right to life (Article 6(1) ICCPR). ” — Jessica Marwa


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Susan Strongman is an Auckland-based journalist at The Wireless. She is interested in social issues, human rights and people, but likes to spend her spare time with her cats.
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