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Photo: ARTUR WIDAK/AFP/Getty Images
Photo: ARTUR WIDAK/AFP/Getty Images

OPINIONSocietyMarch 8, 2021

Why we need safe areas outside abortion clinics

Guest writer
Photo: ARTUR WIDAK/AFP/Getty Images
Photo: ARTUR WIDAK/AFP/Getty Images

This week, a bill that would ensure pregnant people seeking abortion don’t have to be confronted by angry mobs outside of clinics is expected to have its first reading. Terry Bellamak explains why safe areas are so crucial for vulnerable patients.

Last March, New Zealand legalised abortion. The new law changed many things for the better – no more seeking approval of certifying consultants, no more having to lie to come within the grounds in the Crimes Act. But due to a procedural misstep, safe areas did not make it into the final version. MPs asked too late for a roll call vote. To be fair, it was late at night.

Louisa Wall’s member’s bill, the Contraception, Sterilisation, and Abortion (Safe Areas) Amendment Bill 2020, would rectify that misstep.

Safe areas are designated spaces, at most 150 metres wide, around premises where abortions are provided where it is unlawful to intimidate, obstruct or interfere with people who are there to receive abortion care or provide it. 

If you think that sounds like behaviour that ought to be unlawful anywhere, I agree. 

People often tell me about their abortions. Almost everyone mentions harassment outside the services. Whether they encountered it or not, they anticipated and feared it. Rather than being stared at or even yelled at, they feared the escalation to violence incipient in such encounters.

Being targeted outside an abortion service feels a lot like street harassment, something almost everyone who has walked around this planet looking female has a visceral understanding of. It’s not about the stares, the whistles or the trashy come-ons. The threat of violence is foundational to the act of invading someone’s attention with sexist stares, whistles or words.

It’s bullying.

What happens at these ‘protests’?

Most anti-abortion harassment includes gory posters purporting to be aborted foetuses. These usually depict foetuses at or near full term, even though 94% of abortions in New Zealand happen before the 14th week, when foetuses don’t look much like the posters. Many people would agree they are not appropriate in a public place.

The actions of harassers sometimes take a turn for the dramatic. High-pitched cries of “Mummy, please don’t kill me”. Shouts of “murderer” or “have mercy on your baby”. Or pelting people with baby doll parts daubed with red paint. 

Sometimes they say things like “you don’t have to do this” or “Jesus loves you”. But people being harassed can recognise when they are being condemned whether the weapon is abuse or condescension.

And underlying the street theatre is the ever-present possibility of escalation to violence. Across the world, even here in Aotearoa, “pro-life” extremists have committed violent acts, including 11 homicides in the US. 

Let’s be clear: anti-abortion harassment is not about changing people’s minds or “saving babies” – it’s about using the fear of violence to make people do what you want. 

Anti-abortion folks sometimes defend their harassment by asserting they are trying to “help”, to “save them from future regret”. This is wrong on many levels. First, 99% of abortion patients believe they made the right decision, even five years later. Second, the harassment persuades very few people to change their plans, a fact acknowledged by some anti-abortion activists.

What about people who are conflicted or undecided? Does the presence of these anti-abortion activists provide them with help or information that they would not otherwise receive? 

The answer in almost every case is “no”. 

The folks who harass people outside abortion services often try to frame abortion providers as forcing people to have abortions. In reality, people who work in abortion services have no interest in providing abortions to anyone who does not want one. At some point the conflicted person will have the opportunity to tell someone at the service about their ambivalence, and be invited to go home and think some more. At the end of the day, section 11 of the New Zealand Bill of Rights Act recognises the right to refuse medical treatment.

What about free speech?

Rights and freedoms in New Zealand are subject to a balancing act. In this case, the rights of anti-abortion activists to freedom of expression and manifestation of their religion in public teaching are balanced against the right of pregnant people to privacy, and the right not to be discriminated against on the basis of sex and pregnancy. Fundamentally, it involves the right of people who are not public figures to be left alone.

The right of anti-abortion activists to express themselves is not being curtailed, it is being moved down the road no more than 150 metres. What is being curtailed is their ability to target people who are there to attend a medical appointment – which has nothing to do with them.

Freedom of expression has been exercised when you have said your piece. It does not include the right to pick your audience and make them listen by coming at them when they’re vulnerable and cannot escape. That is an abuse of freedom of expression.

Accessing safe, routine, legal health care is not a political act; it is a private act. Trying to dissuade people from doing so is not political speech; its purpose is not to argue for changes to the law, but to bully someone out of doing what they came there to do. Because the speech’s content is private, it should be treated no differently from other forms of verbal harassment.

As Dr Moana Jackson put it, “No one’s exercise of free speech should make another feel less free.”

Why can’t pregnant people just ignore the protesters?

Because that works so well with bullies. Except it doesn’t and never has.

It’s fascinating and maddening how the anti-abortion folks act like abortion patients are the ones acting outside acceptable norms by thinking they are entitled to walk into a doctor’s appointment without being verbally harassed.

Why do abortion patients have to be brave enough to face down bullies in order to get care? No one else has to.

Should people have to demonstrate personal courage and resilience in order to receive safe, legal abortion care? No. That should not be how we apportion medical care in New Zealand. 

Putting the onus on pregnant people to deal with the harassment by pretending it is not happening perpetuates the stigma that has surrounded abortion for so many years. Eliminating that stigma was one of the reasons New Zealand amended the law last year to treat abortion as what it is – health care.

Why do they do this?

What could possibly motivate people to harass other people when it is clear how unwelcome their presence is? I believe the answer may lie in the historical works of Dame Margaret Sparrow on abortion in New Zealand.

A recurring theme in the stories she recounts is the hostile reaction of doctors and nurses to women who were injured receiving illegal, unsafe abortions. They were dismissive, unsympathetic, and downright cruel to women who were brought to hospital bleeding, in agony. They withheld pain meds, forced them to wait in chairs or on stretchers placed in public corridors, and repeatedly told them they had brought this upon themselves. They were meting out what punishment they could.

But today when a person receives abortion care they meet with kindness and professionalism. No punishment is forthcoming from the medical profession, or the justice system.

The only punishment for people getting abortion care in modern times is what they receive from anti-abortion harassment in the walk to the door. 

I believe that impulse to punish is the motivating factor for most people who lie in wait for abortion patients. Else why would they still be doing it in the face of overwhelming evidence how their presence distresses the people they target?

This is not to discount another possible motivation – scaring providers away from offering abortion care in the community. Who wants a mob of screaming busybodies with gory signs outside their place of employment?

In a few weeks, anti-abortion forces will go along to the select committee considering the safe areas bill and tell it, “Oh no, anti-abortion violence only happens in other countries. New Zealand is different.” Alas, New Zealand is not different. 

How many people have to be harassed, chased, assaulted for parliament to admit New Zealand exceptionalism is no defence against an ideology that believes people should be forced to bear children against their will, by any means necessary?

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If parliament does not provide for safe areas, it will be making a value judgment that the right of anti-abortion activists to yell “murderer” and bully people out of accessing legal healthcare is more important than the right of patients to receive healthcare without harassment. It would not be the first time the human rights of a group primarily composed of women was made to give way to the “rights” of those who want to control and harm them. 

Please tell your MP and your party of choice to support the safe areas bill. 

Terry Bellamak is president of ALRANZ Abortion Rights Aotearoa.

Keep going!
A woman is vaccinated against Covid-19 in Papeete, French Polynesia, on January 12, 2021. (Photo: SULIANE FAVENNEC/AFP via Getty Images)
A woman is vaccinated against Covid-19 in Papeete, French Polynesia, on January 12, 2021. (Photo: SULIANE FAVENNEC/AFP via Getty Images)

OPINIONSocietyMarch 8, 2021

I’m a doctor and a woman of colour. Here’s how my profession can tackle vaccine hesitancy

Guest writer
A woman is vaccinated against Covid-19 in Papeete, French Polynesia, on January 12, 2021. (Photo: SULIANE FAVENNEC/AFP via Getty Images)
A woman is vaccinated against Covid-19 in Papeete, French Polynesia, on January 12, 2021. (Photo: SULIANE FAVENNEC/AFP via Getty Images)

As a doctor with an ear to minority ethnic communities, Carolyn Providence has bad news: for many, vaccine hesitancy is perfectly rational – and it’s next to impossible to shame people out of it.

I’ve been thinking a lot about what happens when trust between communities and healthcare systems erodes and fractures. There is good evidence that distrust is most prevalent in minority ethnic groups, in marginalised groups, and those of lower socioeconomic status. Excellent New Zealand-based research in 2019 confirmed deeply entrenched health inequities for Māori. However, to date, there is no large-scale survey on attitudes to healthcare with different ethnic groups. A lot of what we know comes from personal experiences.

Some communities often appear to disengage with traditional providers, which can reinforce their sense of powerlessness. In the early days of my hospital practice in New Zealand, a colleague advised me that prescribing antibiotics to some Māori at discharge was simply an exercise in futility, as “they did not believe in it” and would not “engage”. At the time I struggled to process this information in light of my own knowledge of best practice. As a woman of colour, I frequently felt disempowered within my own professional circles, which I eventually correctly ascribed to experiences of ostracism and gender bias. My hope was that my own troubling experiences could inform my work tackling the apparent disempowerment in the communities I served.

New Zealand’s vulnerable communities are at much higher risk of poor outcomes due to health inequities – and it turns out a pandemic will ruthlessly exploit these preexisting inequities. Vulnerable communities say they find themselves in a much more precarious position today. Yes, NZ has had a world-leading response in eliminating the virus, but we have not correspondingly eliminated medical mistrust. Voices of disinformation have grown louder and more strident. Polarisation risks becoming entrenched.

Former New Zealand Public Party leader Billy Te Kahika is among New Zealand’s most prominent anti-vaccine conspiracy theorists (Photo: screenshot)

Using cognitive science tools, we can start to make sense of the situation. Poverty, lack of educational opportunity and historical suppression are powerful forces that drive those affected to stick together, especially in the face of an existential threat like a pandemic. The sense of threat can be nullified by congregating with others who look exactly like you while keeping away from those who do not. This tendency has always been present, from our evolutionary infancy to today. Even with the advent of mass communication, the human brain is still hard-wired for recognition of self in others. In marginalised communities that get most medical information from within, clashes often simply reflect mistrust of outsiders.

It is tempting to leave it to conventional medical providers such as GPs and district nurses to directly rebut misinformation.  However if a group bonded by shared experience falls prey to conspiracy narratives, it will tend to stick with them. Much research has gone into the cognitive mechanisms that turn theories into strongly held beliefs. Heuristics are mental shortcuts which are formed not on the basis of logic or analytical thought, but on feelings and intuition, and are crystallised by “groupthink”. They produce biases, a fixed way of thinking. Biases function to anchor beliefs where like-mindedness provides an existential advantage and social survival is the goal.

Should we simply counter misinformation with a deluge of facts? Cognitive science again suggests it’s not that simple, providing clues as to why adherents often stick to conspiracy theories in the face of overwhelming evidence to the contrary. As a pioneering 1957 study showed, when people encounter contradictory evidence to an existing belief it tends to create in them such discomfort that they re-interpret the evidence in a way that supports the existing belief. We can see this “cognitive dissonance” at work when those who propagate misinformation claim that any such contradictory evidence is simply proof of efforts to suppress them. Resistance seems futile.

A photo of a man being ‘treated’ as part of the Tuskegee Study of Untreated Syphilis in the Negro Male – in truth, participants did not receive the proper treatment needed to cure their illnesses. (Photo: cdc.gov, date unknown)

And there is an even greater hurdle to overcome in countering medical misinformation: the instances when theories touted as conspiracies are subsequently revealed to be the truth. It is hard to over-estimate the damage to susceptible populations wrought by these revelations; it can take generations to rebuild some of that trust. I’m currently undergoing a thorough re-education in the ways medicine was used against colonised and subjugated peoples. There are the Tuskegee Studies of Untreated Syphilis on African Americans from the 1930s to 1970s. The barbarous experiments determining human pain thresholds on Aboriginal Australians in the 1920s. We hear claims, currently under investigation, of non-consented sterilisations carried out on immigrant women seeking asylum in the US. Examples like these are vital context for the drift towards vaccine scepticism within tightly bonded but marginalised communities facing a disease that disproportionately infects and kills them.

So what then are some more effective methods of countering vaccine hesitancy? As health care providers we understand that to counteract false narratives effectively one must come from a place of shared experience and empathy. Use logic alone, and you will fail every time. Advertising campaigns are good; human engagement is much better. Leveraging the power of the diversity already within our health workforce can bring untold benefits. Health policy designers must meticulously match the cultural needs of communities to providers, including non-Pākehā, non-Māori communities. For example, in my own community, vaccine information provided in a town hall setting is less likely to be well received than the same information provided as part of a social gathering with food, music, childcare and a focus on storytelling. People respond instinctively to stories and it is imperative that messengers correctly relay and interpret the stories through a lens not of “them”, but “us”.

Having borne witness to appalling inequity in delivery of healthcare to Māori, I now have a more holistic perspective on minority ethnic health provision. I hear the fears under the cognitive dissonance. I recognise the loss of agency behind the faulty heuristics. I empathise through the mere fact of being an under-represented member of the very health sector within which I practice.

Buzzwords like “cultural competency “and “sensitivity training” are good – but more is needed, and quickly. Empowerment is critical, but it must go both ways. Medical providers should be empowered to take a more activist role, not simply to rubberstamp political decisions. Doctors and nurses of all ethnicities should be resourced to utilise the communication methods which more effectively reach their intended audiences. I’m talking especially about social media (where most medical misinformation thrives) and the lay press. Let’s hear healthcare workers regularly reaching out to their respective communities, in their own dialects and languages.

Individuals should be encouraged to raise their voices. Every single healthcare worker can now be an advocate for the community they represent, and it is imperative that this force be recognised and harnessed. It’s crucial that there be institution-wide education on basic principles of communication with respect to vaccination. Those who teach must first be taught.

I now understand how conspiracy theories are co-opted by powerful operatives with their own agendas. These seeds of misinformation have had a fertile ground of health and income inequity, racial discrimination, medical mistreatment and institutional neglect from which to take root. But both individuals and organisations have the tools and opportunity to address the problem. Let’s start now.

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