By Barbara Docherty
“One day my daughter didn’t come home on the bus.” Chilling for any parent. In this instance and without parental knowledge or consent, a mother’s 15-year-old daughter had been taken during school hours to another town for an abortion.
This was only revealed to the family when the daughter attempted suicide, after a year of depression, self-hatred, anger, alcohol and substance abuse. To make matters worse her daughter will face infertility after an apparent “botched abortion”.
It’s always a risk writing in any form about this subject. Damned if you do and damned if you don’t when it comes to the pro and anti groups and even some health professionals themselves (stay away from politics and moral judgments they say).
So I’ll come clean and say, while we have very messy abortion laws in New Zealand, I am much more concerned about what is happening to the health of our very young women. I’ll use the word “chilling” again. And this is why.
Impact of the Health Information Privacy Code
It is a well known fact that abortions are mainly carried out because of possible permanent injury to a woman’s (or girl’s) mental health.
It is also now widely known that parents of 11 year olds or older must sign consent forms for basic first aid care and dental treatment in schools, but an abortion (it is said approximately 50 each year) can be carried out without the knowledge or consent of parents even though they are legally responsible until their child is 18.
The Health Information Privacy Code means school counsellors are unable to share information with a parent or the school, and an 11 year old can make an abortion decision herself. Imagine at the age of 11 having tests and scans, seeing two certifying consultants and expected to sign a form saying she understands and consents without parental support and guidance and the likely mental health ramifications?
Abortion: hard to face
This conundrum stretches out to general practice and all of primary healthcare. One way or another these young women attend school (school nurses), or youth services, general practice, public health nurses, and yet abortion continues to be incredibly hard to talk about and we just continue to duck and dive as if it has nothing to do with general practice or primary healthcare.
But it does. It always has but you’d never know it. Abortion, now one of the most common medical surgical procedures that women of childbearing age face, continues to have this secret file on it which, even though classed as a medical treatment, has little to do with illness. It’s mostly performed on well women unless it is mental illness which we are studiously avoiding to confront.
Practice nurses say they have no interest in the politics or morality of the abortion issue. And is it really the role of a school nurse to take a student to an abortion service? No more than stealthily taking her to an alcohol or other drug service and not advising the parent their daughter is drinking to excess.
Follow-up for mental health issues
With an average of nearly 4000 induced abortions in 11 to 19 year olds over a number of years, what post-abortion follow-up for mental illness occurs in general practice? It appears very little or nothing.
It’s hard to believe that over a period of time, which usually includes interactions with a number of health professionals, mental health issues associated with abortion are not being detected.
In general practice where these young women no doubt have a number of visits pre and post-abortion (immunisation would likely be one) the questions don’t seem to be asked, and the connections between alcohol misuse, anxiety, illicit drug use and abortion are not being made.
In the absence of a national notification system for abortion and messy laws which are not helpful, does this excuse health professionals from not having the conversations?
I don’t think so. We have known for several years now about the significant findings of the reputable professor of psychology David Fergusson from Otago University.
He identified that, while 90 per cent of abortions were supposedly legally justified on mental health grounds, these decisions were made “on the basis of diagnostic criteria for which they have no evidence”.
Abortion linked to increased anxiety, alcohol and drug use
He added that having an abortion was in fact associated with increases in anxiety, alcohol misuse, illicit drug use and suicidal behaviour and regardless of what side of the abortion fence you sit on, these facts “speak for themselves”.
So why is primary healthcare unable to use this evidence in a meaningful way without worrying about the circuitous arguments for and against abortion?
And where are the stats on abortion-related mental illness?
In truth, New Zealand is a country awash with guidelines but with no guidelines for health professionals on this one. Do we actually have figures or any stats at all on how many women are being treated for mental health issues directly related to abortion?
Does any DHB keep such information? And if not why not? The known co-relation with suicide, alcohol, substance abuse and abortion should now be enough for GPs to investigate any of these mental health issues further with their young female patients.
This week the mother of the 15 year old petitioned government to pass legislation that would ensure parents are notified of their teenage daughter’s pregnancy, prior to any decisions or referrals for abortion “and that any consent sought for the medical procedure be fully informed as to procedure, possible repercussions, and after-effects”.
I hope it succeeds for the sake of all young pregnant women and their parents.