Abortion has been such a political hot potato that 40 years have passed without the law being touched. It is now back in the spotlight. Claire Trevett reports.

When she was a child, Dr Alison Knowles woke up one morning to find her parents on the front lawn pulling up hundreds of small white crosses with babies' names on them.

Her father, Dr John Taylor, was one of the leading abortion doctors in New Zealand after it was legalised in 1977, based mainly at the Epsom clinic in Auckland.

"I grew up with anti-abortionists outside my gate. They were at the front gate when Dad went off to work. The neighbours would go and water the garden and spray them with a hose.

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"I've never had a problem with self-confidence and I thought it was kind of funny. I must have thick skin."

Now, Knowles also works in the field, primarily at the Auckland Medical Aid Centre, the first abortion clinic established in New Zealand.

Pro-lifers are common outside the centre, especially during Lent. Knowles says they are non-threatening, usually praying and using rosary beads. It does not bother her, but it does trouble some of the women.

The law she operates under has not had the same generational change. It is 40 years since politicians have been brave enough to touch the abortion laws. Those white crosses on a suburban front lawn are one of the reasons why. It was simply too hot to handle, too divisive.

But politicians have to turn their minds again to it after Prime Minister Jacinda Ardern asked for reforms to treat it as a health issue, rather than keep it in the Crimes Act.

Justice Minister Andrew Little will soon go to Cabinet for approval on a process to deliver on that after the Law Commission reported back on some options for that reform.

The Commission gave three options for legal change – and a wider raft of suggestions aimed at answering calls from the Abortion Supervisory Committee as well as womens' rights and medical groups for abortion services to be more accessible.

All three options remove abortion from the Crimes Act and will no longer require two consultants to approve an abortion or for a woman to prove it would cause serious physical or mental harm to her.

They include allowing a woman to decide on an abortion for herself, however far along a pregnancy is.

The second would require a doctor to sign off on it after considering a woman's physical and mental wellbeing. Those criteria would be in health legislation rather than the Crimes Act and less stringent than at current.

The third option was a split model, allowing a woman to decide up to a certain point – such as 22 weeks – but requiring a doctor to decide if it was appropriate for later term pregnancies.

Most – but not all – medical groups and pro-choice groups favour the first option. Pro-life groups prefer the status quo.

All would be a big change from the current law. It is a crime to perform an abortion unless certain circumstances apply. They include incest and cases where there is a high likelihood the baby will be severely disabled.

In pregnancies of less than 20 weeks, an abortion is allowed if the pregnancy would result in serious danger to the mother's mental or physical health. That threshold increases after 20 weeks, so it is limited to cases where an abortion is necessary to save a woman's life or prevent serious and permanent injury to her mental or physical health. Rape is not a ground for abortion, although it can be taken into account.

In each, case two doctors who have been designated as certifying consultants must agree that one of the grounds applies. And abortions can only be carried out at clinics licensed to do so by the Abortion Supervisory Committee.

The ASC has argued for change, saying the the law is outdated, and fails to take account of modern developments such as "medical" abortions, in which women take two pills to bring on a termination. It has also argued for broader access to abortion services, including in the Greater Auckland region. West Coast and Westport have no services at all.

Before any change, politicians have to vote on it.

Little's preference is the split model. "I am of the view that this is a woman's decision and a woman's choice. And I am certainly of the view we need to have a change of the law that is reflective of the reality of people's lives today. "

Though late abortions made up less than 1 per cent of abortions in New Zealand and he did not expect mothers to suddenly demand late abortions, he did believe a different regime was warranted after 22 weeks.

"I certainly trust GPs and mothers to be able to make the decision, but equally given the likely viability of the foetus there are public policy considerations that come into it that I think a GP should be held to when they are giving advice."

It is for the same reasons that option has the most chance of success politically, given it addresses concerns manyM Ps have about abortions at a late stage of pregnancy.

The decision will ultimately be made by politicians. And if there is anything politicians do not want to talk about, it is abortion.

National Party MP Judith Collins is not silent on many matters, but abortion reform is one.
She says she does not want to venture any view at all until the details are known.

She is sceptical of the need for an overhaul, or even the demand for it.

"It's certainly not an issue people have been rushing into my office to ask me about, but we'll have a look at it."

A survey of MPs to get preliminary views got only about 30 responses. Those were mainly from Labour and Green Party MPs who supported removing abortion from the Crimes Act and were either undecided or divided between the first, most liberal, option put up by the Commission, or the split option.

Having put the promise of reform on the table during the election campaign, even Prime Minister Jacinda Ardern herself declined to be interviewed on what she thought of the Law Commission proposals.

Most said they did not want to give a position until they saw what Little proposed. Others did not want their views known because of the intensive lobbying the issue will inevitably spark.

It will be a conscience vote, and there will be differing views in most parties. But the National Party is likely to have the most MPs opposed to any major change, partly because of MPs' own beliefs as well as its more conservative support base.

National Party leader Simon Bridges' own position on abortion has moved somewhat since he said he favoured the status quo when the issue was first raised.

He is now open to removing it from the Crimes Act, but still very cautious about what would be in place instead.

He does not want change that would result in an increase in abortion – sticking to the "safe, safe and legal" creed he nicked from former US President Bill Clinton. Clinton made those comments when the Democratic Party was shifting to a significantly more liberal stand on abortion.

Bridges' use of it does not necessarily signal the same for National. He prefers some test to apply, especially for later term pregnancies, saying he is very reluctant to see "abortions at will" at that stage.

Other MPs are worried about the divisiveness of the issue.

The 1970s were the high water mark for abortion protests as Parliament debated the issue.

National MP Mark Mitchell is the grandson of Frank Gill and has stark memories of those years.

Gill was Health Minister in the National Government after 1975 and strongly opposed abortion.

"I spent most weekends at my grandfather's house washing horrible slogans off his fence," Mitchell recalls. "I was a primary school boy and some of the stuff was really hateful. It left a big impression on me."

Frank Gill, former health minister and father of National MP Mark Mitchell, meets women representing 11 women's groups in 1976. Photo / Evening Post
Frank Gill, former health minister and father of National MP Mark Mitchell, meets women representing 11 women's groups in 1976. Photo / Evening Post

He says issues such as abortion and euthanasia spark debates within families themselves. "It is important we are brave enough to have these conversations but they can be so polarising."

Mitchell is waiting to see what bill the Government puts up before making a decision himself.

A fear of sparking that kind of debate again is likely one of the reasons the issue has not been touched by politicians since the 1970s.

But the issue hasn't been quiet for campaigners.

Pro-choice supporters protest outside the Court of Appeal in 2010. Photo / Ross Setford
Pro-choice supporters protest outside the Court of Appeal in 2010. Photo / Ross Setford

In 2012, anti-abortion group Right to Life's battle for a review of abortions was dismissed by the Supreme Court.

It had argued many abortions were wrongly approved on mental health grounds and called for the Abortion Supervisory Committee to investigate.

An earlier High Court ruled in the group's favour in 2008, but the Court of Appeal overturned the decision.

Pro-choice campaigners protested outside the courts, calling for women to have easier access to abortion.

Every Thursday morning, Kate Cormack goes along to the abortion clinic in Hawke's Bay and waits with others for the women to arrive.

It is abortion day.

Cormack, a spokesperson for Voice for Life, calls this "outreach".

She said the group hands out information on abortion and talks about other options.

"It's been really successful, we've had more than 34 children and mothers receive help and go on to have the child."

"We call it outreach because we are really there to engage with the public. It's different in every area. So many people come up and thank us afterwards."

The practice of standing outside clinics has been criticised in other places, such as Thames, where pro-lifers were giving out baby dolls.

The Law Commission report raises the prospect of a "safety zone" around such clinics to ensure women coming in are not bothered, although the protesters are already required to stay off private property.

Cormack says that would be a shame and the ones affected would be those women who did want another option. "It's very subjective issue."

Voice for Life is a pro-life organisation that began as the Society for the Protection of Unborn Children. It has changed its name and expanded its scope to include the euthanasia issue, which is also before Parliament. These are busy times for Voice for Life.

The groups opposing reforms are strong in their beliefs, well-organised and not quiet about it. The majority of the submissions to the Law Commission were from pro-lifers, for example, many of whom had signed form submissions issued by groups such as Family First.

Cormack has a message for MPs, saying some seem to believe society has "moved on" and reforms would happen without a fight.

"People underestimate the pro-life movement in New Zealand, so I think some MPs are going to get quite a shock," Cormack says.

"Abortion is a huge issue with New Zealanders. We have concerns about why this is even on the table now. It's not something New Zealanders have been asking for, so why is it happening?"

The group believes there needs to be better recognition of the right of the fetus – and more emphasis on other options such as adoption or support to keep the baby.

A Voice for Life protester walking among the display of baby booties placed on the front lawn at Parliament, in July. Photo / Mark Mitchell
A Voice for Life protester walking among the display of baby booties placed on the front lawn at Parliament, in July. Photo / Mark Mitchell

In July, Voice for Life protestors turned up at Parliament and laid out 13,285 pairs of booties on the lawn to illustrate the number of abortions in 2017.
New Zealand's abortion rate has been steadily dropping since 2006, attributed to advances in contraception, especially long-term contraception. It is lower than that of the United Kingdom.

Women in their 20s are the largest group seeking abortions – 29 per cent of all abortions in 2016 were for women between 20 and 24 while a further 25 per cent were 25 to 29 years old. The numbers of teen abortions have dropped from about 4200 in 2006 to 1,500 in 2016 (12.4 per cent).

Those aged between 11 and 14 represented 0.2 per cent.

Opposite the pro-life protestors at Parliament was Abortion Law Reform Association head Terry Bellamak, who is advocating for broad reform.

Terry Bellamak, president of the Abortion Law Reform Association of NZ. Photo / Mark Mitchell.
Terry Bellamak, president of the Abortion Law Reform Association of NZ. Photo / Mark Mitchell.

Bellamak says the protests of the 1970s died down only because the way the certifying consultants applied the law ensured most women could access abortions they wanted.

"The political class just didn't want to touch it, they didn't want to go there. I think they felt there was no up-side for them, because no matter what they said about abortion someone was going to be angry."

This is a rare chance for reform – and Bellamak is hoping politicians will make that count given it is unlikely to be touched again for some time.

"Right now, in New Zealand it takes from the time your GP refers you to the time you actually get the procedure, on average it is 25 days. That is huge. That's way longer than other OECD countries."

She says opponents to the law reforms are mainly motivated by religion.

"That is problematic in a secular democratic society like ours. It's not the business of the state to privilege one set of beliefs over another set."

Many medical groups and pro-choice groups favour the Law Commission's model which does not impose a legal test for doctors to step in to decide on an abortion at any stage.

Dr Knowles is one of them.

"I trust women to make the right decision for them. But to be honest, all three options are a massive improvement on the way it is now."

She says the New Zealand system and measures such as requiring a GP's referral is very slow and removing some of the hoops would help ensure women could get abortions earlier. The earlier an abortion happens, the safer and less stressful it is for all concerned.

"Nobody wants to deliver a large, large fetus that is almost viable when they could have aborted a little sac that looks like a cotton wool ball at six weeks. Early care is better care."

Knowles believes a rigorous informed consent rules were strong enough to ensure women had time to make the decision that suited them. But there was never a guarantee a woman would not regret her decision later in life.

"We all do things we regret in life. You might marry a dud. You might have too many wines and drive home. There are heaps of shitty things we do in life, and very occasionally a woman might regret having an abortion."

The Medical Association has a different view – chair Dr Kate Baddock agrees with removing the requirement for two consultants to certify an abortion and for abortion to be more accessible, but believes there should still be a test for doctors to apply contained in health legislation.

It is an effective way to build in 'way points' during a woman's decision-making.

"It's a very final decision to make and women ought to be able to have the time and the resources to help them make the right decision for themselves.

"I've seen too many circumstances, having been a GP for 30 years, where a woman, no matter what decision they make, end up regretting it. And I think if there were a better process and counselling were available, those women might have ended up making the decision they wished they had made."

There are also doctors who believe the law should stay as it is.

They include a group of doctors who refuse to consult or refer on abortion services based on the "conscientious objection" rights in the Contraception, Sterilisation and Abortion Act.

The main arguments put up for keeping the status quo include claims a change will result in a spike in abortion numbers, and in particular concern about allowing "on demand" late-term abortions if there is no specific regulation.

Many of those involved in the medical profession also reject arguments about late abortions.

Those working in the field say there is nothing "at will" about a late-term abortion.
They are very rare and usually the result of devastating news for a mother, such as her own life being at risk from the pregnancy, or the 20-week scan showing the baby has a serious health problem and is unlikely to live after birth.

Those in favour of reform also want to see more widespread changes in practice, to make abortion more accessible for women who do not live close to one of the practices licensed to offer it.

That was also an issue the Law Commission addressed, proposing changes to allow more doctors and services to offer abortion, and to widen the scope of those who can prescribe medical abortion pills, such as to midwives and nurse practitioners.

There would be practical issues around this - any such moves would require more resourcing for training and upskilling. Baddock advocates greater access, but says there would be a cost. There is already a GP shortage and adding to the duties of already stretched GPs would exacerbate it.

There are also arguments for counselling to be mandatory.

Studies on the mental health impacts have been used on both sides, highlighting both the impacts of having an abortion and having one declined.

The Law Commission report considered those studies, finding there was little that was conclusive and it depended very much on the individual circumstances involved.

Meanwhile, women wait to see what will happen.

I choose this

Erena Lagas has an easy, bell-like laugh. She is involved in her church, has a husband she loves and a son.

But it was not always this way. Behind her is a life of drugs, alcohol, abuse and prostitution.

She has had two abortions and was one of the women who featured in a full-page newspaper advertisement to argue for care in the reforms alongside Family First.

Her first abortion was when she was 18. She had little contact with her family after leaving home at 14 and was in an on-off relationship with a violent man.

"I was horrified. My first thought was 'what am I bringing the baby into?'"

The Family Planning clinic doctor saw her shocked face and asked whether she wanted information on abortion. "It was purely my reaction to the pregnancy stick. I was horrified, but I was also very, very scared. Like anybody in panic, they will take that first path given to them. It was the abortion route and I ran for it."

A later specialist tried to give her information, but by then she just wanted it done.
"I shoved it to the back of my head and my heart, get drunk and move on."

The second was two years later.

By now she was living in a brothel in Auckland and mixing with gangs. Her partner was not violent – but was about to be sent to prison. "Again, not the greatest role model for a child."

Unlike the first abortion, she was conscious throughout. "I still remember it vividly. It was the most traumatic of the two."

It was another two years before she started to change her life.

It happened after a violent attempted rape that went to court. "I put up such a fight. I woke up the next day and realised that if I had fought so hard to live, then what the hell was I doing with my life, living so riskily, ready to die. My wakeup call was that I had fought so hard to live."

She left her partner, settled in Tauranga and met her husband a year later. She got
involved in church. She did not dwell on the abortions for some time.

She remembers falling pregnant with her son and chosing to go through the pregnancy without even thinking about it. It brought back the memory of her abortions.

"It was that moment of 'wow' I choose this. It brought a whole lot of things to the surface that I hadn't dealt with and didn't realise were there."

Her position is more nuanced than a simple yes or no to choice.

She does not think abortion should be overly restricted but believes more information and a lot more support is needed afterward.

The law is disturbing

The debate about abortion is often depicted as being about a woman's choice. But there are rare cases where the choice is one of life and death for the mother.

Penny and her husband Max were devastated after a life-threatening health issue arose nine weeks into Penny's second pregnancy and attempts to address it failed. An abortion was the only option left.

The couple went to the GP to get the referral. They had been going to her for years.
It was at that point they learned their GP was Catholic and would not help because of a religious objection.

Because of the urgency of their situation she did refer them to another GP at the same clinic, but Penny says she made it clear she did not usually take that step.

"Even though they knew this was a crisis and it was going to have to happen, we were having to put forward our case – to save my life. Is there any other life-saving procedure that sits within the Crimes Act and that you have to jump through hoops to access?

"I actually found the stigma and the judgment was more detrimental to my recovery than any of the health issues I had."

She had people tell her they would never have been able to choose between their baby and their life "and saying if one of us is going to go, we both have to go".

"I have taken on all this to save my family and my friends the grief of losing me. And I apologised to people and society for a long, long time and then I just thought 'this is ridiculous'."

Abortions on the grounds of physical health and danger to life made up just 0.5 per cent of all abortions in 2016, compared to the 97 per cent carried out on mental health grounds.

Penny's husband says that when their doctor referred them, it made him wonder about people in rural areas where there might only be one GP.

"I appreciate people have their right to their own moral positions, but to essentially refuse to perform a certain type of service and not make that known to their patients in advance was fairly disturbing.

"Quite frankly, people who have moral objections to medicine should choose other careers and I have very little sympathy for them.

"[The law} is an ass and it is a law that effectively prohibits people getting healthcare. It's based on essentially Christian moral ethics, whereas in almost every other facet of public life we are moving away from having priests and popes tell us how to live and how to think."

Penny is now involved in the campaign for abortion law reform and in a support group for mothers who have ended wanted pregnancies.

"They had nurseries set up, they had names picked out. No woman wakes up at 34 weeks and thinks 'oh, I must just go and have an abortion today'.

"The reason I tell my story is because before this happened to me I probably had set in my head that 'oh yeah, women who have abortions are just teenagers or didn't use contraception'. Then when you've gone through it yourself you realise there's this whole raft [of situations]. It's just not my place to judge."

Where they stand

National Party leader Simon Bridges: Open to taking it out of Crimes Act, wants controls around late-term abortions.

Act Party leader David Seymour: Wants reforms, woman should decide however far through a pregnancy is.

Green Party co-leader Marama Davidson: reform, Green Party caucus has to discuss best option but her longheld view was that pregnant people could be trusted to make decisions with the right support.

Justice Minister Andrew Little: reform, woman decides unless pregnancy is more than 22 weeks.

The options

The Law Commission recommendations, which could be changed by Government.

1. Retain the law

2. Woman decides on abortion, in consultation with health practitioner

3. Doctor decides on abortion, considering women's mental and physical wellbeing. That test would be set out in law.

4. Woman decides unless pregnancy is more than 22 weeks pregnant. After that, doctor decides.

The process

1. Cabinet decides on a process – before Christmas

2. Justice Minister Andrew Little puts up legislation – early 2019

3. MPs get a conscience vote on it soon after. If it passes first reading, goes to select committee for public submissions and any changes. That will likely be a dedicated select committee.

4. If sufficient support, passes by end of 2019