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A day at the clinic

Thursday 21st November 2013

For the security and privacy of the sources spoken to for this story, The Wireless can’t name them or identify the clinic.

Except for the posters urging me to have an STI check and a cervical smear, I could be in almost any office. But I’m not. I’m out the back of a clinic that performs abortions.

I was expecting a hospital. I was expecting white walls and shiny instruments. But when a staff member shows me around, everything looks a little old, a little rundown. The walls aren’t white, and for much of the morning, the TV in the reception area is playing infomercials. It doesn’t even have that distinctive disinfectant smell.

The table in front of me holds several taonga – precious items made especially for the clinic to help explain to patients about their fertility and reproduction. And what happens when those things go wrong.

“I don’t want to get into the choice argument,” a staff member tells me. “It just sets women up to lose.”

A nurse tells me she occasionally has reservations about what she does. She thinks it’s right, but she’s not sure. And she doesn’t tell people what she does. Some colleagues know, and her husband. But there’s a stigma for nurses that there doesn’t seem to be for doctors. Doctors get support, nurses get... well, the condemnation of their colleagues.

Much of the work at this clinic is focussed on making sure women are making the right choice – the choice they want to make. One staff member has reservations about abortion law reform – she doesn’t want women to be stranded without counselling. She’s worked in places where counselling is an afterthought, and that means women don’t always get the support they need.

Another says the law is quite helpful as it currently stands, because it requires women to have a conversation about their decision to terminate a pregnancy, and about their options. But she’s not sure many medical providers have the skill to have that conversation – and they’re not necessarily trained to do it.

She says it’s important woman have some sort of counselling. She says empathy is important, so that women can look back, and remember why they made the decision to have an abortion.  She tries to frame it as “a good woman making a hard decision”.

At this clinic, no woman goes through the procedure without a counselling session, and the staff always make sure a woman has a way to get home afterwards. By the time women get here, they have seen at least two doctors, have had blood tests and swabs.

“The discourse about abortion is, you know, silly women… Most women live really quite burdened lives. And there's not much in the health system for them,” says a staff member. She adds that most women don’t understand the power of their own fertility – how easy it can be to get pregnant, and how their bodies work. One person tells me her patients text her, if they’re worried before, after, or during the procedure. She prints those texts out, and adds them to the patient’s file.

After an initial counselling session, if the patient is sure she wants to proceed, there’s a conversation about how to achieve the termination. If it’s early in gestation she’ll be offered a medical abortion, which involves pills that essentially cause a miscarriage, and takes about 24 hours. A doctor tells me he prefers it because it’s less invasive, and it gives a woman more “ownership” of the procedure. She’ll take the first pill, go home, come back the next day, have the medicines that work on the uterus, and then “go home and have a crampy, clotty day.” They are also offered long-acting contraception as part of the procedure.

One staff member says she’s used to watching the procedure, but then, she’s used to “pelvises and blood”. A nurse says it can be painful – like intense period pain – and she’ll use that to talk to people about long term contraception, saying “let’s make sure you don’t have to go through this again”. Women sometimes leave the clinic within an hour of the procedure.

“It’s about ‘okay, your body is engaged in these activities, let’s attend to all of them’.” 

It’s a fraught thing, providing abortions. As long as women meet the criteria, it’s legal, but it’s hard to talk about. A senior staff member tells me it’s not usual for patients to treat abortion casually, but it does happen. “One woman, she had so much trouble with contraception, it really wasn’t fair, and in the end she gave up, and so she had quite a few abortions.” And rarely, she feels like women are being pushed into having an abortion by their families or friends.

The clinic is designed to be safe, although the front door isn’t locked. The receptionist tells me that most of the problems the staff encounter are with people who don’t want to wait, who want to be treated immediately. “We’re trying to provide a service that attends to what happens to people in their lives,” says the manager. She says that sex isn’t just about STIs or cervical screening or contraception, and all those things are separate from abortion. “It’s about ‘okay, your body is engaged in these activities, let’s attend to all of them’.”