Report of the Committee of Inquiry into the Various Aspects of the Problem of Abortion in NewZealand Part 5

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“She should be treated with the greatest tenderness. Usually she is more sinned against than sinning; but she carries all the blame which belongs not only to the man but also to society, which has been guilty of supine acquiescence in the surrender of standards of moral conduct.

“She has to give birth to a child which has the rights of every unborn infant; and she has to re-establish herself in the community…. It is terribly difficult for them afterwards with the child, and they need all the help they can get. It seems to me that some of them must go in sheer dread to the abortionist. My definite opinion is that something more needs to be done.”

In all fairness to the many fine organizations which are helping these girls, the Committee is satisfied that there is no lack of tolerance, sympathy, and helpfulness with them.

If fault there is, it is in the att.i.tude of the general public to this matter.

Some criticism has been directed at the St. Helens Hospitals because they are not freely open to unmarried women, but it is only right that the position should be made clear.

The actual position is that, in the majority of cases, the St. Helens Hospitals, which can only offer accommodation to an expectant mother for the period of her confinement, are _not suitable_ for dealing with single women, who require protection and care before and after their confinements as well.

There are, throughout the country, many admirable inst.i.tutions which are equipped to give this service.

Discussion before this Committee has, however, made it clear that where an unmarried mother can make adequate private arrangements for the care of herself and her infant after confinement, the St. Helens Hospitals are prepared to take her for the actual confinement period.

In regard to the maternity homes which deal with unmarried women, there has also been some criticism of the usual regulations in these homes which call for a period of residence in the home both before and, especially, after confinement.

It should be pointed out, however, that this is a wise and humane provision, entirely in the interests of the mothers and their babies; it ensures for the mother that very period of convalescence which other witnesses have so strongly advocated under other circ.u.mstances, it gives the baby protection in the most difficult early months, and it allows the helpers in the home an opportunity to make provision for the baby’s future.

Here, again, where the mother is able to make adequate provision for herself and her infant, these regulations are certainly relaxed in some of the homes concerned, and we would commend this practice in suitable cases to those responsible for the management of all these homes.

Regarding the obstetrical care given to the unmarried mothers in these homes, the evidence given indicates clearly that it is of a standard equal to that in our other maternity hospitals.

Indeed, whereas the risks of childbirth amongst unmarried mothers the world over is notoriously high, amongst the women who place themselves in the care of these homes in New Zealand the maternal mortality and the infant mortality are both exceedingly low.

In the homes of which the members of the Committee have personal knowledge the same ante-natal care (indeed, since these patients are resident in the home and under close observation, more complete care) is given and the same methods of pain relief are used.

It is only right that these rea.s.suring facts should be made public.

Regarding the provision for the children in these cases, while we are satisfied that the State and the various organisations responsible for their care deal with them in a kindly and sympathetic manner, we agree that every effort should be made to give them a fair prospect in life, to avoid any stigma, and to keep secret their misfortune.

It has been suggested by one witness that the privacy of an unmarried mother’s affairs has been interfered with the present regulations regarding the notification of births. Under the Child Welfare Act as it at present operates there is a duty on the Registrar to inform the Child Welfare Department of every birth, and the register is also open to the Plunket Society for purposes of following up.

Good as the intention of these provisions is in the interests of the babies, the a.s.sertion has been made that in certain cases the knowledge of this lack of secrecy has deterred women from allowing their pregnancies to continue, and has constrained them to seek abortion.

The Committee is not prepared to comment on this complaint, but would suggest that it be investigated, and that, if there is any justification in it, the regulations be amended so that, while fully protecting the child, full secrecy is maintained.

(4) TO MEET CHANGES IN SOCIAL OUTLOOK.

The Committee has concluded that, beyond the economic and domestic considerations already discussed, there are many changes in modern social outlook which are operating in the direction of family limitation, and which, in many cases, lead to the practice of abortion.

Can anything be done to prevent the occurrence of abortion resulting from these tendencies in modern life?

Concerning birth-control the realities of the position must be faced.

There can be no doubt that there is a widespread uncontrolled and ill-instructed use of contraceptives.

As one witness put it, “New Zealand is saturated with birth-control.”

Owing to this extensive half-knowledge there is in many cases an entirely unwarranted dependence on their reliability to the exclusion of any measure of self-discipline whatever.

The Committee is under no illusion in this matter.

With this att.i.tude prevailing in the community and provided with such a weapon–even though it is likely to explode in their own hands–women will continue to limit their families. No social legislation, however generous, will prevent it, nor, as far as the Committee can see, will legal prohibitions do much to restrict it.

Two lines of action are suggested:–

(1) To direct the knowledge of birth-control through more responsible channels, where, while the methods advised would be more reliable, the responsibilities and privileges of motherhood, the advisability of self-discipline in certain directions, and other aspects of the question could be discussed.

It is this view which has led the Committee to the recommendations it has made in the discussion of birth-control.

(2) To appeal to the womanhood of New Zealand in so far as selfish and unworthy motives have entered into our family life, to consider the grave physical and moral dangers, not to speak of the dangers of race suicide which are involved.

We can but urge all those who have to do with the education of our youth and the moulding of women’s opinion to give these matters earnest consideration, and the Committee is of the opinion that it is necessary to develop the education of young people in biology and physiology in our primary and secondary schools as a foundation for a more rational and wholesome outlook on s.e.x matters.

(5) CONTRACEPTION.

The practice of contraception is a debatable question, and one on which the most varied evidence has been given.

Witnesses opposed this practice, some on moral grounds, some with the plea for a greater natural increase in the population of New Zealand.

Others again, particularly the representatives of women’s organizations, advocated the establishment of clinics for the general instruction of married women in the practice of reliable methods of contraception. They expressed the opinion, and some of them supported their opinions with sound argument and overseas experience, that the instruction of the mothers of New Zealand in the practice of child-s.p.a.cing rather than resulting in a diminution of the birth-rate might well cause an increase in the size of many families, for, in addition to enabling mothers to plan their families, such clinics also specialize in propaganda calculated to awaken women to an appreciation of the privileges and responsibilities of motherhood.

The Committee agrees that the possession of reliable contraceptive knowledge by the married women of New Zealand would tend to augment rather than to diminish further the natural rate of increase of our population, for an additional factor to those given above lies in the large amount of sterility which follows induced abortion, that most unsatisfactory of all forms of birth-control.

The evidence laid before the Committee shows that in New Zealand every year thousands of women imperil, and indeed negate, their future prospects of motherhood by submitting to the induction of abortion.

It has been shown that abortion is a delayed, dangerous, and unsatisfactory form of birth-control, and it can quite logically be argued that if a reliable and simple method of contraception was known to all married people the abortion problem would a.s.sume very small proportions.

This is, to a large extent, true, but it must not be forgotten that both abortion and contraception have various aspects, and that apart from other objections there are practical difficulties which are not easily surmounted. There is no known contraceptive which is simple, inexpensive, and 100 per cent. reliable for the thoughtless, the careless, and the stupid.

Contraception may be considered under three headings:–

(1) The practice of contraception extramaritially, which only needs to be mentioned to be deprecated.

(2) The practice of contraception by married people irrespective of their circ.u.mstances.

Evidence was given by responsible and representative women in support of a mother’s right to say when she will bear her children, and although we agree that this privilege might well be conceded her, we are of the opinion that it is not the function of the State to undertake the dissemination of the knowledge and give the practical instruction necessary to enable the general adoption of this principle.

This general instruction can well be left to the medical profession, who should also undertake the responsibility of impressing the privileges of motherhood upon young women seeking such advice.

In recommending that such general instruction should be left to the medical pract.i.tioners, we are cognizant of the fact that many members of that profession are at a loss to know what methods of contraception can be reliably recommended to lay persons.

A sub-committee of the Obstetrical Society, consisting of members who have made a special study of this problem, has been set up, and the presentation of their report will doubtless clarify the position in the minds of the medical profession.

(3) The practice of contraception by married women who, in the opinion of their medical attendant, should have temporary or permanent freedom from the fact or fear of pregnancy.

Not only are there cases in which severe illness exists making further pregnancies dangerous, but there is also a heterogenous group including all gradations of health and economic reasons.

Report of the Committee of Inquiry into the Various Aspects of the Problem of Abortion in NewZealand Part 3

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The point of view of what we believe to be a very large body of women is ill.u.s.trated by the following evidence, which is but one of many similar expressions of opinion heard by the Committee. This witness, speaking on behalf of a group with incomes of 300 to 400 per annum, stated:–

“On present incomes, not more than two or three children at the outside can be given educational and economic opportunities. It may be said that it is quite possible to mitigate to a quite tolerable degree the strain put upon the parents by the provision of (1) adequate wages for husbands, and (2) a system of domestic help for wives. With regard to (1) it is not probable within our lifetime that everybody will be guaranteed an income adequate to the needs of a family of, say, three children–‘needs’ as viewed by educated parents. The most sympathetic administration would have its hands full for many a year coping with the problem of helping those thousands of our people who have been just on or very near the bread-line. Those worst off hitherto need help first. A man earning between three and four hundred a year should not claim Government help to breed children, when there are such numbers of people living on a much lower wage. But it must be perfectly clear to each member of the Commission who figures the matter out that a salary of less than 400 will not enable more than two children to be given such chance of development as every parent reasonably desires. It is pertinent to ask here what is the average number of children in the families of the British middle cla.s.s–which is mainly the stratum from which our legislators, rulers, and magistrates have been drawn. Do such people breed freely?

Self-respecting parents prefer to do without such Government help as family allowances; but knowing the cost of training a child they claim the rights first, to decide how many children they will breed, and, secondly, to live themselves normally satisfied married lives. Few women, moreover, of average intelligence are to-day content to be breeding-machines, and their husbands support them in that att.i.tude. With regard to domestic help, even were this, or nursing schools, or both, provided by the State, the responsibility for her children’s well-being would be still all-absorbing, at least during the first four years of each one’s growth. Students of child psychology are insistent that the pre-school period is the most important in the life of the individual and requires the most skilful attention. Natural affection is not enough; it must be wedded to care for the child’s mind. Now, w.i.l.l.y-nilly, modern life itself takes such toll of nervous energy that there are few educated women today who go through all the child-bearing period and have sufficient nerve force to welcome each child that may ‘come along’ and rear it happily. Yet without adequate nervous energy in the mother what family can develop into healthy and well-balanced useful citizens? It necessarily follows that the output of children will be limited if the parents are to do their part adequately. Quant.i.ty, the ma.s.s production of the past, must give way to quality. That involves birth-control. How is it to be achieved?”

Without necessarily a.s.senting to the sentiments expressed in the above quotation, the Committee considers that such opinions cannot but demand thoughtful consideration. Dread of large families or of close-interval pregnancies under modern conditions is undoubtedly a common reason for attempting to limit the family.

But having made all allowances for the more difficult circ.u.mstances of modern times, the more thoughtful consideration of some husbands for their wives and of some parents for their children, and a legitimate intention to maintain a higher standard of living, it seems clear that amongst a considerable section of the community the demand for the limitation of families has pa.s.sed beyond these motives into regions of thoughtlessness and selfishness.

Furthermore, an att.i.tude of pitying superiority towards the woman with many children appears to be a current fashion. Many witnesses expressed the opinion that a young and sensitive mother was frequently deterred from a further pregnancy, for which she would in other circ.u.mstances be quite prepared, or tempted to seek abortion, because of the fear of ridicule by current public opinion.

Still other women, it has been explained, are influenced by comparisons. Seeing their neighbours leading less burdensome and more pleasure-full lives, they decide to follow suit.

The modern desire for pleasure and freedom from responsibility has led many to lose sight of the ideal of the family as a service to the State and the unit of social life.

Unwillingness on the part of the wife to give up remunerative work is a factor that operates in certain cases; this may be due to the position of the wife as the support of an invalid husband and family, but in other cases the reason is obviously selfish.

While dealing with this question of social outlook, it will not be out of place to refer to an aspect which, though mentioned by only a few witnesses, is known to all social workers as a factor of increasing importance. This is the fear of war. It may take the form of (_a_) conscious visualization of the horrors of war, or (_b_) sub-conscious fear evidenced by excessive anxiety regarding the future. In either case it acts as a powerful deterrent from child-bearing, although it is doubtful whether those who are influenced by this fear would resort to abortion where contraception had failed.

Speaking of social conditions, some witnesses, under the impression that the average age at marriage was rising, attribute the increasing abortion-rate among the unmarried partly to this cause.

The actual fact is that the age at marriage has decreased of late years, but is still probably higher than would be the case if economic conditions were more favourable.

It is clear that, whether the motives be worthy or selfish, women of all cla.s.ses are demanding the right to decide how many children they will have. Methods which depend on self-control are ruled out as impracticable. Contraceptives are largely used, and, judging by the marked decline in the birth-rate in recent years, are in many cases successful. In other cases, however, they are not so, and there is then frequently a resort to abortion.

(5) IGNORANCE OF EFFECTIVE METHODS OF CONTRACEPTION AND OF THE DANGERS OF ABORTION.

The public as a whole is ignorant of the physiology of reproduction.

This results in attempts being made to prevent conception by methods which are doomed to failure at the outset. The use of defective methods owing to their comparative cheapness and the unnecessarily high cost of effective appliances are undoubtedly among the causes of such failure.

While it is not the function of this Committee to report upon the wider aspect of contraception, but to deal with it only in relation to the abortion problem, yet we would point out that the evidence given showed that, though contraception is widely practised, many of the methods used are unreliable and not founded upon physiological knowledge, and that when they fail abortion is resorted to. Abortion is a delayed, dangerous, and unsatisfactory form of birth-control. It was stressed by some witnesses that many women have no idea of the risks to life and health involved in the procuring of abortion, a medical witness mentioning, among other evils, the tendency to spontaneous abortion arising from damage to the generative organs sustained at an initial induced abortion. Other witnesses, on the contrary, maintained that these risks are well known to the majority of women, but that when faced with an unwanted pregnancy they are willing to incur any risk.

Fuller reference to these dangers appears in another section of the report.

(6) INFLUENCE OF ADVERTISING.

The attention of the Committee was drawn to advertis.e.m.e.nts appearing in certain periodicals which, while openly advocating the use of various contraceptives, referred to restraint and self-control in deprecatory terms. Abortifacients were advertised in terms which, while equally offensive, were less obvious. Other advertis.e.m.e.nts set forth the contents of certain books on s.e.x matters of a very undesirable nature.

The language of these advertis.e.m.e.nts can only be described as obscene, and their possible effects on immature and inexperienced minds can well be imagined.

A reprehensible practice is that of certain so-called “mail order chemists,” who send out price-lists of contraceptives and abortifacients indiscriminately through the post. In some cases these advertis.e.m.e.nts were shown to be of a definitely misleading and fraudulent character.

PART III.–POSSIBLE REMEDIAL MEASURES.

Having reviewed the position as it exists in New Zealand, and having set out what appear to be the main causes, it now remains to consider possible preventive measures.

(1) THE RELIEF OF ECONOMIC STRESS.

In so far as hardships resulting from economic difficulties are genuine, the Committee believes that there is a real call for and that there are definite possibilities of relief by the State.

Two cla.s.ses in particular call for most sympathetic consideration:–

(1) The wives of the unemployed, or of those precariously employed.

(2) The wives of those engaged in small farming, especially in the dairy-farming districts of the North Island.

For such women we consider that much could be done by way of financial, domestic, and obstetrical help.

_Financial Help._–In general terms all efforts at social betterment–the reduction of unemployment, the improvement of wages and relief, the reduction of taxation, direct and indirect, and the provision of better housing conditions–should undoubtedly help to make conditions more secure and more satisfactory for the rearing of larger families.

But further than this, we believe that really adequate financial a.s.sistance _directly related to the encouragement of the family_ is urgently called for.

It is perfectly clear that general financial improvement does not, itself, necessarily bring about larger families; limitation of the family is probably more prevalent amongst those more fortunately placed. What form this financial aid to the family should take requires much consideration.

The a.s.sistance is required not merely at the time of confinement, but also during the much longer period of the rearing and the education of the family.

A general extension of the maternity allowance under any national health scheme would afford some immediate financial a.s.sistance.

Income-tax exemption for children, however generous the scale, would not benefit these badly circ.u.mstanced cases, for already they are below the income-tax limit.

It would appear that further financial provision would have to take the form of a direct children’s allowance.

It is suggested that this might be put into effect by amending the present Family Allowances Act to provide that–

(1) The amount be increased;

(2) The permissible income-level be increased;

(3) That, where given, the allowance be in respect of all the children in the family; and

(4) That the age-limit of the children be increased to sixteen.

_Domestic a.s.sistance._–Equally important is the provision of domestic a.s.sistance, and here we are faced with a problem of the greatest difficulty–a national problem which is affecting women in all walks of life and of which this is but one aspect.

In many farming districts it is clear that lack of domestic help is a greater burden to the hara.s.sed mother than even financial stringency.

Many admirable efforts are being made to give a.s.sistance in this direction–in the country by the housekeeper plans of the Women’s Division of the Farmers’ Union and other organizations, in the cities by the Mothers Help Society and similar agencies.

Extension of such system is highly desirable, and the possibility of their organization on a much larger scale with Government subsidy well deserves consideration.

In many cases these efforts are limited as much by lack of personnel as by lack of funds.

Alternatively, we suggest–

(1) That the Government should inaugurate and recruit a National Domestic Service Corps of young women agreeable to enter the domestic-service profession;

Report of the Committee of Inquiry into the Various Aspects of the Problem of Abortion in NewZealand Part 6

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Here we have the mother with health undermined and reserve vitality reduced to a minimum by the strain of bearing and rearing a large family. She approaches the menopausal stresses with anxiety and apprehension, having done her duty to family and race, often having lived an exemplary self-sacrificing life, the intolerable contemplation of a late pregnancy drives her to desperate measures often for the first time in her life.

Again, there is the relatively young, tired, anaemic, debilitated mother, with a number of young children born at very close intervals, often denied even a half-holiday, let alone an adequate one, unable to afford suitable domestic a.s.sistance, often with poor housing or domestic arrangements, and completely exhausted with the incessant round of cleaning, cooking, and the strain of the inevitable fretfulness of a number of young children.

The Committee is of the opinion that it is the State’s duty to ensure that mothers within this group should obtain the respite that the health of themselves and their present and future families demands.

The economic aspects of these problems are dealt with in our general recommendations, but we also recommend that departments should be established, preferably in conjunction with the out-patients’

departments of our public hospitals, whither medical pract.i.tioners could refer for instruction and equipment with contraceptive appliances mothers who in their opinion should be a.s.sured of temporary or permanent freedom from child-bearing.

It might be desirable that the certifying doctor’s recommendation should be endorsed by the officer in charge of the department before admission, but that is a practical point which could be discussed at a later date with members of the Obstetrical Society and medical profession.

Though the Committee discounts the exaggerated statements that have been made at intervals about the sale of contraceptives to juveniles, and though no first-hand information on such matters was laid before the Committee, yet we are of the opinion that the sale of contraceptives to young persons should be prohibited.

(6) THE CONTROL OF THE ADVERTIs.e.m.e.nT AND SALE OF ABORTIFACIENT DRUGS AND APPLIANCES.

The Committee recommends the advertising and sale (except by doctor’s prescription) of drugs euphemistically described as for the “correction of women’s ailments” or “correction of irregularities” should be forbidded. For their alleged purpose of correcting functional menstrual irregularities they have no value; as abortifacients though usually ineffective their unrestricted sale should be forbidden. As stated previously, “their only value is as a lucrative source of gain to those people who, knowing their inefficiency, yet exploit the distress of certain women by selling them.” An example of this exploitation was obtained by the Committee. The drugs were advertised as “corrective pills, ordinary strength, 7s. 6d.; extra strong, 12s. 6d.; special strength, 20s.” A supply of the last was obtained, and a.n.a.lysis showed that they consisted of (1) a capsule containing about 12 drops of oil of savin, value about 6d., dangerous to health but usually useless for the purpose sold; (2) 9 tablets of quinine, worth about 4s., and quite ineffective; (3) 24 iron and aloes pills, worth about 6d., and equally ineffective. The gross profit on this 2s. worth of rubbish was at least 900 per cent. If it is possible to legislate to stop such fraudulent exploitation of people we recommend that it be done.

The Committee also recommends that the sale of surgical instruments which can be used for the purpose of procuring abortions, such as catheters, Bougies, and sea-tangle tents, be prohibited, except on the prescription of a medical pract.i.tioner, and that if possible their importation be placed under control.

PART IV.–QUESTIONS RELATING TO THE MEDICO-LEGAL ASPECTS OF ABORTION.

At the present time there is in many countries much criticism of the existing laws regarding abortion, and various suggestions have been made for the alteration of the law.

Such representations have, indeed, been made to this Committee.

A consideration of these matters, therefore, could not escape our attention.

THE NEW ZEALAND LAW REGARDING ABORTION.

The law in regard to abortion as set down in sections 221, 222, and 223 of the Crimes Act, 1908, is as follows:–

_Procuring Abortion._

“221. (1). Every one is liable to imprisonment with hard labour for life who, with intent to procure the miscarriage of any woman or girl, whether with child or not, unlawfully administers to or causes to be taken by her any poison or other noxious thing, or unlawfully uses any instrument or other means whatsoever with the like intent.

“(2) The woman or girl herself is not indictable under this section.”

This section re-enacts s. 201 of the Criminal Code Act, 1893. _Cf._ s.

223, _infra_.

“Other means” must be read _ejusdem generis_ with “instrument.” (_R._ v. _Skellon_ [1913] 33 N.Z.L.R. 102.)

“_Procuring her own Miscarriage._

“222. Every woman or girl is liable to seven years’ imprisonment with hard labour who, whether with child or not, unlawfully administers to herself, or permits to be administered to her, any poison or other noxious thing, or unlawfully uses on herself, or permits to be used on her, any instrument or other means whatsoever with intent to procure miscarriage.”

This section re-enacts s. 202 of the Criminal Code Act, 1893.

“_Supplying the Means of Procuring Abortion._

“223. (1) Every one is liable to three years’ imprisonment with hard labour who unlawfully supplies or procures any poison or other noxious thing, or any instrument or thing whatsoever, knowing that the same is intended to be unlawfully used or employed with intent to procure the miscarriage of any woman or girl, whether with child or not.

“(2) Every one who commits this offence after a previous conviction for a like offence is liable to imprisonment with hard labour for life.”

This section re-enacts s. 203 of the Criminal Code Act, 1893. In _R._ v. _Thompson_ [1911] 30 N.Z.L.R. 690, a person was convicted of an attempt (s. 93. p. 209, _ante_) to procure a noxious thing although the thing actually procured was innoxious.

“Knowing” has the meaning of “believing,” and a person supplying “a noxious thing” is guilty even when the person supplied, who states that he required it for procuring abortion, had no intention of using it and did not use it for that purpose (_R._ v. _Nosworthy_ [1907] 36 N.Z.L.R.

536).

If the evidence shows that prisoner intended the instrument to be used for the purpose stated, it is sufficient without evidence of intention on the part of the woman to use it or allow it to be used (_R._ v.

_Scully_ [1903] 23 N.Z.L.R. 380).

The word “thing” where secondly used in this section includes only things _ejusdem generis_ with instrument and capable of being used to produce miscarriage (_R._ v. _Austin_ [1905] 24 N.Z.L.R. 893).

_Therapeutic Abortion._–In New Zealand, as in Great Britain and other countries, the medical profession has always held that when the mother’s life is seriously endangered by a continuation of the pregnancy the termination of the pregnancy is justifiable and right.

This the law allows, not specifically but by inference.

It is probably a correct statement of the position to say that, with advances in medical knowledge and thought, even the most conservative medical opinion, apart from that which is influenced by certain religious views, holds that the indications for the termination of pregnancy have been extended somewhat to include not only cases in which the mother’s life is immediately jeopardized, but also certain cases in which her life is more remotely endangered.

This view is supported by the social thought of to-day.

This is not to say that the occasions for this operation are frequent; they are, indeed, infrequent.

The general standards which guide the medical profession in this matter are very strict, and are conscientiously conformed to by the majority of its members.

It is also a well-recognized rule of the profession that such operations should only be performed after consultation between two medical pract.i.tioners.

With this change in medical outlook, however, there has been no corresponding alteration in the law, which, as it stands, is as uncompromising as ever, and allows of no interference except to save the _life_ of the mother.

It is a fact that the law is _interpreted_ liberally, and no doctor who has acted honestly in the belief that the mother’s health was seriously endangered has ever been challenged.

Nevertheless, it has been urged by a large body of the medical profession, especially of those most intimately affected by the question, that there are possible dangers in the situation, and that the law should be altered to indicate more specifically the rightful position of the doctor in this matter; in other words, it is advocated that the present interpretation of the law should be incorporated in the law itself.

Much is made of the fact that an honourable pract.i.tioner occasionally finds himself in the unsatisfactory position of having actually to break the letter of the law in doing what according to accepted medical standards is in the best interests of the patient.

As safeguards against the possible dangers of a widening of the law, it has been suggested that new regulations should be introduced governing the practice of therapeutic abortion.

It has been recommended that operations should only be performed after adequate consultation, and that written certificates should be given by both parties to the consultation; that in certain cases the consultant should be a specialist; that all operations should be performed in public or licensed hospitals; that every therapeutic abortion should be notified to the Medical Officer of Health, to whom also the two certificates should be forwarded; and that every operation not performed under these conditions should be subject to strict investigation.

It has also been recommended by some that there should be a general notification of all abortions.

Those who are opposed to any alteration of the present state argue that any specific legalization of therapeutic abortion to save the serious impairment of health as well as to save life might lead to abuses of this sanction. They point out that even at the present time doctors differ considerably in their views and in their practice, and they fear that such divergences in thought and practice might be seriously exaggerated.

Report of the Committee of Inquiry into the Various Aspects of the Problem of Abortion in NewZealand Part 7

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As to the suggested safeguarding regulations, there is by no means general agreement in the medical profession concerning their advisability or their value.

The Committee, having investigated the matter very fully, is satisfied that any disability under which the doctor rests in terminating a pregnancy for genuine, accepted therapeutic reasons is only theoretical.

No actual instance was brought before the Committee in which a doctor had been penalized or even subject to question when acting in good faith, nor was any evidence presented to show that any patient had suffered by reason of a doctor refraining from operating through fear of possible legal consequences.

Both medical and legal witnesses competent to speak on these medico-legal aspects were definite in their a.s.surance that, under the existing law, no doctor acting in accordance with the accepted standards of the profession was in any danger.

The only person who need have any fear was one who ignored guidance of the existing standards of his profession, and to this extent the law was, at least in part, a deterrent against laxity of practice.

The Committee considers that, as it stands, the law has shown itself adaptable in practice to all reasonable changes in medical thought.

Further, the Committee was impressed by the possible dangers which might be a.s.sociated with any alteration in the existing law.

While it is undoubtedly true that the majority of doctors are straightforward and honest in their interpretation of the indications for therapeutic abortion, it was made clear that even at the present time there are some who are inclined to terminate pregnancy for reasons which would not be accepted by most.

It would be quite impossible to lay down a hard-and-fast list of indications.

There are definite grounds for fearing that any alteration in the law would lead, in certain quarters, to a widening of the interpretations far beyond the intention of the alteration.

Under any alteration it would be exceedingly difficult to control the merging of the therapeutic into the social and economic reasons.

For these reasons, then, the Committee is not prepared to suggest any alteration in the law regarding therapeutic abortion; the Committee believes, however, that some benefit might accrue from the compulsory notification of all abortions to the Medical Officer of Health.

_Abortion for Social and Economic Reasons._–Having received certain representations in favour of this practice, and having examined a large ma.s.s of evidence on this subject, the Committee is utterly opposed to any consideration of the legalization of abortion for social and economic reasons.

The Committee does not hesitate to state its first objection on moral grounds.

That the deliberate destruction of embryo human lives should be allowed for all the varying and indeterminate reasons suggested by different advocates would lead the way to intolerable license.

We would draw your attention and that of the public to the extreme views which are held by some of the most active advocates of legalized abortion.

In its most blatant form this advocacy is based on the argument of woman’s right to determine for herself whether a pregnancy shall continue or not.

“The right to abortion should be taken quite away from legal technicality and legal controversy. Up to the viability of her child it is as much a woman’s right as the removal of a dangerously diseased appendix.”

This is the view of Miss Stella Browne in her essay on “The Right to Abortion”[2] and of others who hold similar opinions.

[2] “Abortion Spontaneous and Induced.” Taussig.

Is any comment necessary?

The representative of one of the largest women’s organizations in New Zealand who gave evidence before the Committee advocated the introduction of legislation permitting abortion under certain circ.u.mstances after a woman had had two children, subsequently qualifying the suggestion by the words “if contraceptives fail.”

In the case of such ill-considered opinions, the Committee believes that it would be impossible to limit the practice if the law were in any way relaxed.

Of course there are others who confine their advocacy of legalized abortion to cases in which there are elements of real tragedy and which appeal to public sympathy, but, granting that there are many cases in which social and economic conditions create situations of great hardship, nevertheless the Committee is fairly convinced that abortion is not justifiable; the remedies lie in the removal of the causes and the alleviation of these difficult situations by social legislation and other measures, and in the education of the public conscience.

The Committee is also opposed to the legalization of abortion for social reasons on account of the very considerable risks to health which are a.s.sociated with the practice.

Medical witnesses were agreed that, while the immediate risk to life in surgically performed termination of pregnancy was slight, there were very definite possibilities of more remote disabilities, and that such sequelae occurred in a considerable proportion of cases.

In the case of a genuine therapeutic abortion these risks are outweighed by the dangers of the condition calling for the termination of pregnancy, but were the operation to be performed freely for social reasons the effect in the community might be very serious.

World-wide interest has been aroused in the matter through the experience on Soviet Russia, where, for a number of years, abortion for social and economic reasons was legalized and extensively practised.

The operations were performed in special hospitals and by skilled operators.

At first it was claimed that when the operation was done openly and carefully the risk to life was exceedingly small. It was stated, for instance, that in 1926 artificial abortion was carried out on 29,306 women in Moscow with no mortality, and that in a total of 175,000 operations in Moscow there were only nine deaths.

But now come most significant reports of the after-effects to these operations, which state that 43 per cent. of these women suffered from some definite illness as a result of the operation, and that “the most enthusiastic Russian advocates of legalized abortion are appalled at the growing evidence of serious pelvic disturbances, endocrine dysfunctions, sterility, ectopic pregnancy, and other complications following in the wake of artificial abortions.”[3]

[3] “Abortion Spontaneous and Induced.” Taussig.

A recognition of these remoter dangers has undoubtedly been an important factor in bringing about the complete reversal of the previous policy in Russia, where abortion for social and economic reasons is now illegal.

The opinion of A. M. Ludovici, admittedly an extreme exponent, may well be considered when, in “The Case against Legalized Abortion”[4] he writes:–

“If only the disingenuous propaganda in favour of legalized abortion would cease, and if only those who carried it on refrained from dinning into the ears of an uninformed gallery of women the alleged safety and harmlessness of abortion carried out under the best hospital conditions, there would be less eagerness to face the ordeal of criminal abortion.

“So long as ignorant women are led to believe that abortion, when skilfully performed, is as easy and harmless as having a corn extracted, they will naturally infer that it can be done just as harmlessly in secret as in public, especially if they are a.s.sured that the surrept.i.tious abortionist is skilled, as presumably they always are, and are, moreover, kept in total darkness concerning the kind of operation that is necessary for the interruption of pregnancy.

“If, however, they knew the truth, which is that artificial abortion, even under the best hospital conditions, is a precarious undertaking, so frequently leading to invalidism as never to be ‘safe’; if, moreover, we spread the truth about Russia’s legalized abortions, and put a stop to the false reports circulated by ill-informed enthusiasts regarding the ease and safety of skilled induced abortion, we should be going a long way towards reducing criminal or surrept.i.tious abortion to vanishing-point.”

[4] “Abortion,” by Stella Browne. Ludovici and Roberts.

_Sterilization._–Brief mention must be made of _sterilization_–an operation whereby further pregnancy is prevented–which has been put forward by certain witnesses as a method of preventing abortion.

Just as therapeutic abortion is, in certain cases, legitimately performed by medical pract.i.tioners, so has the operation of sterilization a recognized place in medical treatment of exceptional cases in which a woman’s life is likely to be endangered or her health gravely impaired by further pregnancy.

It can, indeed, be reasonably argued that in such cases sterilization is very definitely to be preferred to the very unsatisfactory alternative of repeated therapeutic abortion.

Nevertheless, any general extension of this practice would, in the opinion of the Committee, be open to serious abuse.

The Committee sees a tendency in some quarters to extend the indications for this operation far beyond the bounds of generally accepted medical opinion.

The att.i.tude of the Committee towards this matter is therefore the same as towards more specific legalization of therapeutic abortion.

_The Prosecution of the Criminal Abortionist._–A very disquieting aspect of this problem is the relative immunity of the criminal abortionist from punishment. Conviction for the crime is rare, even in cases where guilt appears to be proved beyond all reasonable doubt.

The Committee has sought to discover the reasons for the failure to obtain conviction.

It is apparent that the police authorities are faced with many difficulties. In the first instance conviction is largely dependent on the evidence of a woman who, in the eyes of the law, is an accomplice to the offence, and corroboration of her evidence may be demanded.

It has been suggested by certain witnesses that, if the woman were legally exempt from penalty, there would be less reticence about giving evidence and a greater fear on the part of the abortionist.

On the other hand, it has been stated to the Committee that where such an indemnity is actually given, this very fact operates against conviction.

The Commissioner of Police gave information that–

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“Juries are loth to convict in such cases and appear to be impressed by the argument usually advanced by counsel for the defence that, as it was at the solicitation of the woman that the offence was convicted, she is the princ.i.p.al offender, and they adopt the view that unless she also is charged it would be unfair to convict the abortionist. The fact that if the woman was charged she could not be called as a witness, and that, without her evidence, there would be no case, does not appear to weigh with them.”

It would therefore appear that legalized exemption of the woman would not be a remedy.

The very serious statement has been made that–

“In many cases professional abortionists have the a.s.sistance of one particular doctor who attends their patients when medical skill becomes necessary. The doctor either treats the patient successfully or sends her to hospital on his own personal note, and in neither case does the ident.i.ty of the abortionist come to light.

There is reason to believe that in many such cases the a.s.sistance of the doctor is given knowingly and in collaboration with the abortionist contrary to the rule laid down in Sydney Smith’s ‘Forensic Medicine,’ 3rd edition, page 362, that ‘It is no part of a doctor’s duty to act as a detective, but it is equally certain that it is no part of his duty to act as a screen for the professional abortionist.'”

The Committee would earnestly draw the attention of the responsible medical authorities to the suggestion that there are even a few members of the profession who are prepared to “cover” the abortionist when difficulties arise.

It is quite well realized that there are many occasions on which the general pract.i.tioner quite innocently comes in contact with these cases: that is an entirely different matter.

It is a further complaint of the police that they are hampered by the fact that rarely are they notified of a case of criminal abortion until the woman’s condition is so critical that it is impossible to obtain a statement from her, and if she dies the evidence she might have given is lost. Without such evidence there is little chance of successfully prosecuting the abortionist.

To overcome this difficulty it has been advocated that, where a patient is admitted to hospital and is suspected to be suffering from the effects of criminal abortion, it should be the duty of the responsible medical officer of the hospital to notify the police forthwith and supply all the information in his possession.

This suggestion, however, involving as it does the confidential relationship between doctor and patient, is open to serious objections.

It is proposed to consider the position of the medical pract.i.tioner in relation to criminal abortion more fully in a subsequent section.

Finally, it is evident that the general public as represented by some members of juries do not regard this crime with the same seriousness as does the law.

A heavy responsibility rests on the public in allowing the present position to continue.

The Committee cannot but take a serious view of the repeatedly demonstrated difficulties in securing convictions, even in the face of apparently conclusive evidence, of persons charged with inducing abortion, and consider that the time has arrived when careful consideration should be given to the condition of the law relating to such crimes and to what steps are necessary to discourage effectively their practice. With that object in view the Committee respectfully and earnestly directs the attention of the Government to the position that has arisen, and the serious social, physical, and moral consequences which are likely to follow if effective steps are not taken to enforce the clear intention of the law.

_The Position of the Medical Pract.i.tioner in Relation to Criminal Abortion._–The duties and responsibilities of medical pract.i.tioners in connection with cases in which the performance of an illegal operation is suspected or known to have occurred are of great public importance.

Two main questions arise–(1) The duty of a doctor before the death of a patient or in a case where a fatal result is not expected, and (2) his duty in a case where the patient has died.

Concerning the first issue there are very conflicting opinions.

As already pointed out, it has been urged by the Police Department that in every case where a patient is admitted to a hospital and is suspected to be suffering from the effects of induced abortion or attempted abortion it should be the duty of the Medical Superintendent or Senior Medical Officer of the hospital to notify the police forthwith, and supply all information in his possession which would a.s.sist in establishing the ident.i.ty of the offender and bringing him to justice.

The widely accepted view of the medical profession, supported by high legal authority, is that the bond of professional secrecy as between doctor and patient is so important that it would be entirely wrong for a doctor, without the patient’s consent, to give information to the police before her death.

It has been insisted that, were it to be compulsory for the doctor to notify the police on the strength of information obtained in his professional capacity, patients would refrain from obtaining the necessary medical help under these circ.u.mstances, thus accentuating the problem of deaths from abortion rather than limiting it.

It has been stated that already in one centre a disinclination to enter hospital has been expressed by patients because they feared that the police would be informed.

It is agreed, however, that the doctor should attempt to persuade the patient, especially if her condition is serious, to make a statement to the police.

The actual legal position in New Zealand was made quite clear by the law officer of the Crown when asked by the New Zealand Obstetrical Society in 1932 for an opinion.

This opinion, as published in the _New Zealand Medical Journal_ (Obstetrical Section), 29th October, 1932, was as follows:–

“A doctor is under no legal obligation to inform the police as to the cause of the illness of a person which has been due to an illegal operation, either in a case where the patient recovers or in a case where the patient dies. He is, of course, under an obligation to insert in the certificate of death which he furnishes under the Births and Deaths Registration Act, 1924, the cause of death, both primary and secondary. In that certificate, where the death was the consequence of an illegal operation, he should insert the nature of the operation as the primary cause of death. He need not, of course, describe it as an illegal operation, but he would describe the type of operation and the reason why such operation was the primary cause of death–_e.g._, owing to incompetence or ignorance, if that be the case.

“In giving this ruling I am, of course, referring merely to the legal obligation–_i.e._, the duties imposed according to law.

Speaking generally, there is a moral duty on every person having knowledge of a serious crime which is an offence against morality as well as against law, to a.s.sist the police as far as possible in its detection and suppression. The confidence of a patient may be a legitimate ground for excluding that duty in some, or even in most, of the cases of this kind. But no doubt there are certain cases where the duty is clear. Instances are the case of a young and inexperienced woman who has reluctantly submitted to the operation at the hands of a person who is known as a practised abortionist, or where the operation has been done by violence and against the will of the subject. These, however, are questions of morality upon which varying opinions may be held, and upon which I do not desire to be taken as expressing a final opinion.”

This legal opinion has not been challenged, though it has been criticised.

Although the Committee appreciates the difficulties under which the police are working, the evidence of other witnesses has led them to agree that any extension in the direction of compulsory notification to the police before death, and against the patient’s wish, is open to serious objections and is therefore not advisable.

Regarding the second issue, there is general agreement that there is a duty on the doctor to a.s.sist the police, and that this should be done by withholding a certificate of death and informing the Coroner.

The position has been more clearly defined as a result of a recent amendment to section 41 of the Births and Deaths Registration Act, as contained in section 12 of the Statutes Amendment Act, 1936:–

“12. (1) On the death of any person who has been attended during his last illness by a registered medical pract.i.tioner, that pract.i.tioner shall forthwith sign and deliver to the Registrar of the district in which the death occurred a certificate, on the printed form to be supplied for that purpose by the Registrar-General, stating to the best of his knowledge and belief the causes of death, both primary and secondary, the duration of the last illness of the deceased, the date on which he last saw the deceased alive, and such other particulars as may be required by the Registrar-General, and the particulars stated therein shall be entered in the register together with the name of the certifying medical pract.i.tioner.

“(2) The medical pract.i.tioner shall at the same time sign and deliver to the undertaker or other person having charge of the burial a notice on the printed form to be supplied for that purpose by the Registrar-General to the effect that he has furnished a certificate under the last preceding subsection to the Registrar.

“(3) In any case where, in the opinion of the medical pract.i.tioner, the death has occurred under any circ.u.mstances of suspicion, the pract.i.tioner shall forthwith report the case to the Coroner.

“(4) Every medical pract.i.tioner required to give a certificate and a notice as aforesaid, or to report to the Coroner as provided by the last preceding subsection, who refuses or neglects to do so is liable to a fine not exceeding five pounds.”

Recently a consultation on this matter was held between the Minister of Health and members of the Council of the New Zealand Branch of the British Medical a.s.sociation.

The a.s.sociation expressed the opinion that the resolutions of the Royal College of Physicians (England), which were laid down as a result of a similar controversy in Great Britain, const.i.tuted the most satisfactory guide in these difficult and responsible situations, and informed the Minister that steps would be taken to make the position clear to all its members. The resolutions are as follows:–

“The College is of opinion–

“1. That a moral obligation rests upon every medical pract.i.tioner to respect the confidence of his patient; and that without her consent he is not justified in disclosing information obtained in the course of his professional attendance on her.

“2. That every medical pract.i.tioner who is convinced that criminal abortion has been practised on his patient should urge her, especially when she is likely to die, to make a statement which may be taken as evidence against the person who has performed the operation, provided always that her chances of recovery are not thereby prejudiced.

“3. That in the event of her refusal to make such a statement he is under no legal obligation (so the college is advised) to take further action, but he should continue to attend the patient to the best of his ability.

“4. That before taking any action which may lead to legal proceedings, a medical pract.i.tioner will be wise to obtain the best medical and legal advice available, both to ensure that the patient’s statement may have value as legal evidence and to safeguard his own interest since in the present state of the law there is no certainty that he will be protected against subsequent litigation.

“5. That if the patient should die he should refuse to give a certificate of the cause of death, and should communicate with the Coroner.

“The college has been advised to the following effect:–

“1. That the medical pract.i.tioner is under no legal obligation either to urge the patient to make a statement, or, if she refuses to do so, to take any further action.

“2. That when a patient who is dangerously ill consents to give evidence, her statement may be taken in any of the following ways.”

[The procedure employed in taking this statement is then specified.]

The Committee is also of the opinion that if the medical profession closely follows this guidance and that of the amended section 41 of the Births and Deaths Registration Act, the public interests will best be served.

SUMMARY AND CONCLUSIONS.

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I. The Committee is convinced that the induction of abortion is exceedingly common in New Zealand, and that it has definitely increased in recent years.

It has been estimated that at least one pregnancy in every five ends in abortion; in other words that some 6,000 abortions occur in New Zealand every year.

Of these, it is believed that 4,000, at a conservative estimate, are criminally induced either through the agency of criminal abortionists or by self-induction, either of which is equally dangerous.

It is clear that death from septic abortion occurs almost entirely in such cases.

Such deaths have greatly increased in recent years, and now const.i.tute one-quarter of the total maternal mortality: in some urban districts it amounts to nearly half of the total maternal mortality.

New Zealand has, according to comparative international statistics, one of the highest death-rates from abortion in the world.

II. The Committee, after taking evidence from witnesses representing all sections of the community, has formed the conclusion that the main causes for this resort to abortion are:–(1)Economic and domestic hardship; (2)changes in social and moral outlook; (3) pregnancy amongst the unmarried; and (4) in a small proportion of cases, fears of childbirth.

These matters are fully discussed.

III. Consideration has been given to the possible remedying of these causes.

(_a_) In so far as economic hardship is the primary factor, certain recommendations have been made regarding financial, domestic, and obstetrical help by the State.

(_b_) To lessen any fear of childbirth where this exists, it has been recommended that the public should be informed that New Zealand now has a very low death-rate in actual childbirth and that relief of pain in labour is largely used. At the same time the Committee has advocated that further efforts in the direction of pain relief should be explored.

(_c_) For dealing with the problem of the unmarried mother, the Committee considers that the attack must be along the lines of more careful education of the young in matters of s.e.x, prohibition of the advertis.e.m.e.nt and sale of contraceptives to the young, and a more tolerant att.i.tude on the part of society towards these girls and their children.

(_d_) The Committee believes, however, that the most important cause of all is a change in the outlook of women which expresses itself in a demand of the right to limit–or avoid–the family, coupled with a widespread half-knowledge and use of birth-control methods–often ineffective. These failing, the temptation to abortion follows.

The Committee can see only two directions in which abortion resulting from these tendencies can be controlled:–

(1) By the direction of birth-control knowledge through more responsible channels, where, while the methods would be more reliable, the responsibilities and privileges of motherhood, the advisability of self-discipline in certain directions, and other aspects of the matter would be discussed.

The Committee believes that it is through the agency of well-informed doctors, and, to a certain extent, through clinics a.s.sociated with our hospitals, that this advice should be given.

It is not, however, considered that this is a matter for the State except to a limited degree.

(2) To appeal to the womanhood of New Zealand, in so far as selfish and unworthy motives have entered into our family life, to consider the grave physical and moral dangers, not to speak of the dangers of race suicide which are involved.

This, it is considered, is a matter for all women’s social organizations to take up seriously.

IV. Certain further measures of a more general nature came under the examination of the Committee.

The prohibition of the promiscuous advertis.e.m.e.nt of contraceptives, and of their sale to the young; the licensing of the importation of certain types of contraceptives; the restriction of the sale or distribution of contraceptives to practising chemists, doctors, hospitals, and clinics; the prohibition of the advertis.e.m.e.nt, or of the sale, except on medical prescription, of certain drugs and appliances which might be used for abortion purposes; these measures are recommended.

The specific legalization of therapeutic abortion (by doctors for health reasons) as a safeguard to doctors was fully examined but is not recommended.

The Committee is satisfied that the present interpretation of the law is such that, where the reasons for the operation are valid, the doctor runs no risk of prosecution.

The risks of an alteration in the law are great.

Legalization of abortion for social and economic reasons was also put forward. The Committee has discussed the matter, and strongly condemns any countenancing of this measure.

Though it may be conceded that legalized performance of the operation by doctors in hospitals might reduce the incidence of surrept.i.tious abortion and deaths from septic abortion, we do not accept this as any justification of a procedure which is a.s.sociated with grave moral and physical dangers.

With regard to sterilization, the Committee adopts the same view as towards the specific legalization of therapeutic abortion.

It is believed that, where the reasons for the operation are in accord with generally accepted medical opinion, there is no bar to its performance.

We see, however, tendencies in the direction of extending this operation far beyond the bounds of this accepted medical opinion.

For this reason we do not recommend any alteration in the present position.

The failure to obtain the conviction of the criminal abortionist, even in cases where the guilt seems beyond all doubt, has been discussed as a matter of serious concern, and the Committee can only bring before the public its responsibility, as represented by members of juries, for the virtual encouragement of this evil practice.

Finally, the Committee, while fully conscious of its inability to place before you a complete and certain solution of this grave problem, or one which will satisfy all shades of opinion, believes that a definite service will have been done through this investigation if full publicity is given to the facts of the situation as here revealed, and if the public conscience is awakened to the fact that, although State aid and legal prohibitions may do something to remove causes and to deter crime, the ultimate issue rests with the att.i.tude and action of the people themselves.