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Can Stigma Be Legislated

 Trigger Warning: This piece contains discus­sions of abortion, graphic description of abor­tion procedure and the stigmas associated.

Dodging the inquisitive looks of the other play­group mums, Jennifer Hall was not about to let the big secret slip. Her recent trip to Melbourne was one she was keen to forget.

It was 1995 and Hall just had her second abortion.

The decriminalisation of abortion in 2008 saw Victoria’s abortion laws become one of the most tolerant in the world. But the social stigma of the practice has never been wiped clean.

“I did not tell anyone, none of my married friends or the playgroup mums or anybody. I told no one that that’s what I was doing because I was married; therefore I should have the child,” she says.

The Abortion Law Reform Act legalised abortion up to 24 weeks in any situation and allowed for abortions to be performed after 24 weeks with the consent of two medical practi­tioners with regard to the women’s medical, psy­chological and social circumstances.

It was a different situation in 1995 for 24-year-old Jennifer Hall who says she never disclosed the fact she was married to anyone at the clinic out of fear they would refuse her an appointment.

“I didn’t even tell them I had a husband because I didn’t want to get the complications of having to inform other involved people.

“I didn’t feel that if I told them that [I was married] it would be as easy to do,” she says.

It was twelve months after the birth of her first born.

“I’d had a little boy and he was very healthy but I was very unwell, I’d gone to 50 kilos breast-feeding. I was mentally unwell be­cause I was having issues with my husband at the time.”

When Hall confided to her husband that she would be unable to cope with another baby, she says he called her a murderer.

“He ignored me and if I spoke to him about it he called me a murderer. Then he stopped talking about it totally.”

A month after the abortion, her husband asked her when the baby was due. She says it took him several years to stop calling her a murderer.

Hall says her mother only found out about one of her three abortions decades later.

“In fact, there is no way I would tell my mother… I think years later she found out, I was in my forties when she found out I might have had one abortion in my life. But it’s not something you could talk to your parents about, like mum was just not someone I could go to for any help.”

At the time Hall lived with her family in Lara, a town with a population of just over 12 000, straddling the highway between Geelong and Melbourne.

There’s no cloak of anonymity here like in a city.

“There’s just the fact that you’ve walked into an [abortion] clinic and someone’s seen you,” she says.

But women are still travelling long dis­tances out of the fear their abortion would be­come public knowledge.

Dr Will Berenyi, a General Practitioner in the town of Mansfield in Victoria’s north-east, says confidentiality issues can make it preferable to travel instead of trying to seek services in the local district.

“People are generally in agreement that if you’re going to have a termination you don’t want lots of other people to know about it. You might be best to flick down to Melbourne for the day and flick back rather than get it done somewhere where you’re bound to meet your cousin or your aunt or someone in the operating theatre,” he says.

But having to explain away the travel out of town can be a problem in itself.

“… It is possible for [women] to access pub­lic hospital’s treatment but they’d usually need to go to Melbourne… if they go down to a pri­vate clinic and they’re backwards and forwards in a day. As far as anyone up here is concerned they could be just going shopping. Whereas if they go to a hospital in Melbourne where it takes a couple of days… it’s a little bit harder to explain to their friends where they’ve been,” he says.

Dr Berenyi says the more common option is to use a private clinic.

“What happens then is that women go along with their Medicare card and a certain amount of money and they can get in and out on the same day,” he says.

Jennifer Hall says she had no choice but to travel to Melbourne for the termination and to put herself up in a hotel.

“You have to travel. I had to get my sister to organise to pick me up and drop me off. But I had to actually get up to Melbourne, find some­where to stay the night. I had to find somewhere to stay the following night… it’s much harder to do,” she says.

But Hall admits trying to access these ser­vices locally presents a new set of problems.

“Access is difficult … in a small city, even Ballarat or Geelong places like that. Everybody knows your business, even though it seems big.”

Dr Berenyi says there is not enough public interest in Mansfield to warrant offering abor­tions locally and that doing so could be risky.

“There are no abortions available at the local hospital …if we were doing them here we’d only be doing them infrequently or not nearly as frequently so it might not be quite as safe,” he says.

The problem of the ongoing social stigma of abortion lies, in part, in the conscientious objection of medical practitioners who, through moral or religious beliefs, may refuse to do the procedure. By law, these doctors must refer the patient to someone without a conscientious ob­jection who will perform the abortion, but some don’t.

Take the recent case of a Melbourne doc­tor, Mark Hobart, who last month made explo­sive claims in the Sunday Herald Sun about a couple who aborted their child on the basis of gender.

Hobart refused to refer the couple to an abortion clinic on the basis that he would “be­come an accomplice to murder.” Hobart did not disclose his pro-life views or that he is a member of the Democratic Labor Party, a group fiercely opposed to abortion, to the journalist who broke the story, Natasha Bita.

The story ran in the print edition of the Sunday Herald Sun with Hobart described as a whistle-blower, leading to some debate as to whether disclosing Hobart’s background would have negatively affected the coverage of the ar­ticle.

***

Exceptionally confronting for the women they are performed on, abortions can also be dif­ficult for even the most experienced of medical practitioners.

Russell Boustead, a sonographer who oper­ates ultrasound equipment at Barwon Health in Geelong, says many doctors have an objection to abortion and this stance increases the diffi­culties of accessing an entirely legal service.

“…There are some doctors who will not perform an abortion full stop. I mean that’s be­cause of their own beliefs …and it’s their choice.

It’s probably more difficult if you were in a re­mote location because a patient doesn’t have the choice of doctors,” he says.

Boustead says he found the experience of being present at an abortion distressing.

“I’ve been present at first trimester abor­tions where they’ve needed ultrasound for guid­ance and it’s not an easy thing to watch. It’s a difficult thing, not only for those having the abortion, but for people performing it as well.”

Boustead says any abortion, particular­ly after the first trimester, can be fraught with complications, which can affect the number of doctors willing to perform them.

“Any abortion is a serious issue of course, but the further you get into the pregnancy, the more complications and the more difficulty you have.”

“They usually have to collapse the skull of the foetus and they often inject potassium chlo­ride into the heart to stop the heart… it’s a very ugly business,” he says.

Public understanding of abortion, and the doctors who perform them has not been helped by horror stories that have recently played out in the media.

In 2008-09 James Latham Peters, an anaesthetist with an addiction to the drug fen­tanyl, a narcotic used for general anaesthesia, infected 55 women with Hepatitis C as they un­derwent abortions at Croydon Day Surgery. He was sentenced earlier in March this year to 14 years imprisonment with a minimum non-pa­role period of 10 years. Peters pleaded guilty to 55 counts of negligently causing serious injury to his patients after he injected himself with fentanyl and re-used the syringes to administer the remaining anaesthetic to the patients. In April, Peters filed an application to appeal his sentence in the Supreme Court.

Public perception of abortion in the state is driven by cases like James Latham Peters’.

There has never been a campaign to raise public awareness of abortion, nor the staggering statistic by Family Planning Victoria which es­timates that 34 per cent of Australian women aged 20-29 who have been pregnant have had the procedure.

Compared with other states, South Aus­tralia, Western Australia and the Northern Territory, there is a distinct lack of abortion sta­tistics publicly available in Victoria. The most recent findings into the number of late term abortions annually performed in the state come in a 2009 report by the Consultative Council on Obstetric and Paediatric Mortality and Morbid­ity (CCOPMM), which count 410 performed during that year. The statistics do not count abortions performed before 20 weeks gestation. Since 2009 no annual reports have been made available to the public by the CCOPMM.

In 2009 the Herald Sun released state Health Department figures attained through Freedom of Information laws, showing 16084 women had terminations in Victoria during 2008-09 – a decrease of 12 per cent since 2005- 06. The figures were recorded after the abortion law reforms of October 2008. Although esti­mates of the number of abortions have appeared in the media no statistics have been published since.

It is difficult to change public perception of abortions when a minute’s negligence can have horrific consequences.

***

Pippa* used contraception, took the morning after pill and got her period twice but still ended up at the Alfred Hospital where her pregnancy test came back negative. It was only through a test measuring the hormone levels in her blood that Pippa finally found out she was pregnant. By this time she was already 9 weeks along.

At 10 weeks she had the termination, but several weeks later Pippa was rushed to the emergency room of the Royal Women’s Hospital in an ambulance after experiencing heavy blood loss.

“One night I just lost the most incredible amount of blood I’ve ever seen in my life, it looked like some horrific crime scene,” she says.

An internal ultrasound revealed the first termination was incomplete; parts of the foetus hadn’t been removed.

“I don’t know what on earth happened at that initial termination, why it wasn’t success­ful.”

During her second abortion Pippa says the doctors treated the procedure as though the foe­tus was still alive.

“Even though they knew they weren’t dealing with a living foetus at this point, they just treated it the same just to make sure that they got everything this time. They knew I was pretty delicate and sort of traumatized by this point so they got me in [for the second abortion] in a couple of days.”

Pippa was afraid her friends would think less of her if they knew she’d had an abortion, so she kept quiet.

“You conjure up images of a teenage slut or someone that’s promiscuous and that was so not me… I would hate anyone to… possibly see me in that light.”

But unlike Jennifer Hall, Pippa had the support of her mum who as it turned out, also had an abortion.

“She was actually more understanding than I ever thought she would have been. She did actually say that she’d had one when she was younger… once I knew that, I knew I didn’t have to say it. There was that unspoken under­standing.”

Now the Federal Government is debating whether to subsidize the non-surgical abortion drug RU486 by adding it to the Pharmaceutical Benefits Scheme. RU486 is only available in a limited number of clinics and the cost makes it unattainable for a number of women. Access to medical abortion in Australia is sill restricted by access and expense.

The social stigma of abortion has yet to be publicly addressed. In 2013 another woman is dodging the inquisitive questions of her friends, not about to let the big secret slip.

*name has been changed for privacy reasons

Emma Nobel

The author Emma Nobel

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