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Mifepristone in Australasia
Conference
Report by Carolina Gnad
who attended this conference for P.A.T.H.S. as an interest group
This was an abortion providers’
conference held in Wellington 16-17 October. It was sponsored by Istar Ltd, a not-for-profit
pharmaceutical company incorporated in February 1999. Istar was formed by five doctors
to import Mifegyne (Mifepristone) from France because no established pharmaceutical
firm was willing to import it. The founding directors were all operating doctors
who considered that New Zealand women should have access to medical abortion as
an alternative to surgery.
Mifepristone (known as RU-486 in early trials) was first available in 1980 in France
and is now available in 33 countries. Early medical abortions (EMAs) have been available
in New Zealand from 2001 and are being offered in six first-trimester abortion services.
Currently the Family Planning Association is seeking approval to provide EMAs on
site.
Claims are that EMAs being available doesn’t increase the abortion rate and that
decisions for abortions or around pregnancy do not depend on the procedure employed.
Early access and less expense appear to be advantages of EMAs, and they can be done
even if the pregnancy is not located.
An abortion may be procured by using either Mifepristone or Misoprostol alone. However
these two drugs work synergistically, so used together, studies show, they increase
efficacy and decrease side effects.
Mifepristone blocks progesterone (and cortisol) receptors, and three metabolites
provide 22-33% of the antiprogesterone effect. Mifepristone affects the endometrium
and the gestational sac separates from the uterine wall. It also softens the cervix
and makes the uterine muscle more sensitive to prostaglandins (PGs). This is why
it is sometimes used in later terminations of pregnancy or inductions following
foetal death. It is also used in treatment of endometriosis, fibroids, and non-reproductive
use for some tumours and as an antiglucocorticoid.
Contraindications for Mifepristone use include: a diagnosed ectopic pregnancy, chronic
adrenal failure, long term corticosteroid use, high allergies or bleeding disorders.
Where there is an IUD in situ this needs to be removed prior to the administering
the drug and the procedure continuing.
The EMA process generally occurs as follows
-
Phase of “psychological confrontation” and coming to a decision
-
Ultrasound scan performed to determine dates and exclude an ectopic pregnancy
-
Blood tests done for a baseline HCG (Human Chorionic Gonadotrophin) level
-
Mifepristone tablets are taken (the point of no return)
-
There are different protocols but patients may go home under certain conditions
between and after receiving the two types of tablets. Patients going home must have
proper preparation, be a certain distance from the hospital, have good support,
reliable transport, a telephone and be able to speak English.
-
Misoprostol (prostaglandin - PG) tablets are taken usually 24-48 hours later. It
takes time for the Mifepristone to reach and be taken up by the progesterone receptors
but the interval is kept as short as practicable to decrease side effects. Five
per cent expel before Misoprostol is given, 24% expel 4-5 hours after, others more
than 24 hours later.
-
Usually there is heavy bleeding for about half a day and bleeding may continue for
9-14 days afterwards. Fluids are encouraged and warm packs may be used to help relieve
discomfort. Half of patients don’t request pain relief but if pain relief is needed
Paracetamol, Ibuprofen, Diclofenac or Codeine Phosphate may be given.
Complications are considered to not be serious. There may be some diarrhoea, and
vomiting which are known side effects of Misprostol. Occasionally a woman may haemorrhage,
usually due to retained products of conception (RPOCs) but less than one per cent
require transfusion. Where haemorrhage is more serious the abortion procedure may
be repeated or the option of surgical intervention (dilation and curettage) may
be taken. A small number of deaths have occurred from toxic shock associated with
a Clostridium Sordelli infection - these were dismissed as reportedly it can also
occur with IV drug use, skin transplants, Caesarian Section and normal delivery.
Follow-up occurs 2-6 weeks later to check expulsion has been successful, to exclude
complications (by another ultrasound, HCG test and clinical assessment) and for
contraceptive counselling. Figures indicate that around 1.3% of pregnancies continue
at 49 days, and at 63 days gestation around 4% of pregnancies may be viable following
EMA procedures. In these instances the medical procedure may be repeated or surgery
required.
Staff from various clinics and hospitals gave reports on their processes and experiences
to date around EMAs.
The conference also addressed aspects of later terminations and foeticide. What
featured most were the medical aspects and clinical considerations. I was acutely
aware of the loss and trauma we deal with counselling those after abortion and felt
there was a lack of acknowledgement of this in this forum. However I was heartened
when members of the Te Mahoe Unit of Wellington Hospital and Vicki Culling from
Sands shared some case studies and brought something of the more human experience
in and around the decision making and experiences for women, men and families.
I spoke with some midwives, nurses and counsellors and saw how views differed with
individuals. They also reflected some of the difficulties working in this area,
concurring that this is an area that is complex and fraught. It’s not an easy place
to work no matter what one’s convictions might be.
EMA as an artificially and intentionally induced miscarriage is effectively a pregnancy-baby
loss and can have repercussions for women and families which are often overlooked,
minimised or discounted.
It is our hope that services will continue to grow around
the country which inform people of the risks and acknowledge the often deeper and
longer term impacts of a termination of pregnancy, at whatever stage or in whatever
manner it is performed. We aim to provide information and equip helpers in every
sector to respond to the needs of those who may experience pain and problems
after their abortions.
For further information on the drugs mentioned and EMA visit the following websites:
www.fiapac.org
,
www.misoprostol.org
,
www.gynmed.at
,
www.womenonweb.org
Abortion from a Father's Perspective
Women make life and death
decisions unilaterally, choices must be made as a partnership, there is a power
imbalance at the moment. Men are conditioned to accept they have no say. Men feel
it is not their place to grow children..... there is a gender and culture imbalance.
Excerpts from a paper by Gerald White
Although there has been
work completed on abortion, both the effects on mothers and the community, the author
cannot find any Aotearoa New Zealand research, which has been carried out with fathers
and the effect, if any, this has had on them. This masculine perspective has, for
various reasons, not been seen with the same critical regard as with the views of
women and as a consequence, the voice of men who have been through this experience
has been not heard....
To find out the views of men who have been through this experience, it was deemed
an essential part of the process for the views of men to be sought, from an individual
interview between each respondent and the interviewer.
The first impressions received by the author upon beginning the interview process
was the amount of pain expressed by those being interviewed.....
The interviewees reported a wide range of personal and emotive experiences that
frame their responses to abortion. Their voices include “this happened over thirty
years ago, and we still feel the pain”, “it was a girl and I wanted a daughter”,
“it has an ongoing effect on both of us”, and “she said that ‘you realise if we’d
kept the child, she would now be thirteen years old.”
From each interview the feeling of tragedy was apparent, both from the verbal language
of each participant and their body language. This included tears, clenching/unclenching
of fists and tenseness of their bodies as we conducted the interview process.
During the interview process, each participant appeared to go back in years as they
recounted the events, emotions and sense of loss that happened at that time. Of
interest to the author was the fact that this loss extended to the present day,
as can be seen from the statements made by those interviewed.
The different dimensions of this loss were mentioned by each father and featured
as the following: loss of Whakapapa, no say, rights and obligations, loss, no legal
recourse.
From the wider perspective of human intellect, spiritual awareness, culture, feelings,
long term effects and individual perspective, the responses passed onto the author
of this research seem to indicate a deeply felt sense of loss. This sense of loss,
from the perspective of those interviewed, centers around individual and corporate
(ie whakapapa)... While each respondent talked about the effect of abortion on them
at the time, as time has gone on, each person has become more aware of long-term
loss and grief. Interestingly, each father has become aware of the loss to their
Maori culture and reports a sense of ‘what was, what is and what could have been.’
The responses seem to indicate that relationships between the male and female partner
at the time have been affected by the abortion.... If anything, as the years have
passed, there has been an increasing awareness of the loss, as one father reported,
“seeing my child being a parent themselves.” There is, therefore, the reality of
the loss being ongoing, having ramifications through generations as yet unborn.
Although the rights of women are well protected by legal and privacy laws, the rights
of men are, to a large extent, ignored when it comes to abortion.
Longstanding and continued damage has been perpetrated against fathers who have
lost their children to abortion. This damage is in the areas of spiritual, cultural,
paternal, and genealogical. This damage then transfers to the next generation where
the unborn child will be missed by their brothers and sisters, uncles and aunts,
cousins and grandparents. Damage has been done to relationships since the abortion
where spousal disagreements as to the cause and effect continue to the present day.
The spiritual connectivity has been broken at the time of abortion, with those of
the past being cut off from those of the future. The entire community misses out
on what these individuals, the aborted children, could have contributed to their
whanau/family, community and the gifts these children would bring to the world.
“Making Pregnancy Safer” Conference
18th November 2009, Auckland
This conference was organised
by the Perinatal and Maternal Mortality Review Committee (PMMRC) of the Ministry
of Health. The aim of the PMMRC is to identify areas in maternity and newborn care
where improvements can be made in order to prevent mortality. With this aim in mind,
the committee set up the PMMRC database to review all perinatal and maternal deaths
in New Zealand in order to instigate a system of audit and feedback.
Cindy Farquhar, Chair of the PMMRC, presented the process and main findings of the
Perinatal and Maternal Mortality in New Zealand 2007: Third Report to the Minister
of Health. In 2007 there were 65,602 total births (>20 weeks gestation). In that
year 677 babies died (510 foetal deaths - terminations of pregnancy and stillbirths,
134 early neonatal deaths - <7days, 33 late neonatal deaths - <28 days post partum).
Most terminations of pregnancy (TOPs), it was explained, would have become foetal
deaths as there were foetal abnormalities. There were in that same period 11 maternal
deaths, comprising 5 direct (pre-eclamptic toxaemia, post partum and intrapartum
haemorrhage), 5 indirect (other conditions) and 1 unclassifiable cause.
A range of other material was presented by various speakers - Jeremy Oats talked
about the Victoria situation and statistics; Lesley McCowan spoke about small babies
and improving outcomes; Karen Evison talked about improving smoking cessation approaches
in pregnancy; Vicki Culling from Sands shared around support for family and clinicians;
Lesley Barclay presented midwifery and keeping women safe; Jenny McDougall spoke
about managing post partum haemorrhage and developing National Guidelines; Martin
Sowter presented training in Emergency Obstetrics; Lucille Wilkinson on Management
of hypertensive disorders of pregnancy, and Vicki Masson shared about AMOSS, a new
trans Tasman project measuring maternal morbidity....
P.A.T.H.S. had the privilege of having an information table at this conference and
complementary attendance. It was a good opportunity for us to network and gain insight
into perinatal and maternal mortality issues.
Talking around the work of P.A.T.H.S. and connecting with practioners dealing with
pregnant women and their families was invaluable. We shared our experiences and
concerns, and others were forthcoming about their experiences with those with past
abortions or TOPs who they work with and the impacts on health and pregnancy. Some
seemed disinterested or guarded but by and large practitioners were receptive.
“Choice” and Fully Informed
Consent
Abortion is supposedly
all about choice, and free choice at that. However “I felt I had no choice” is a
common refrain of the post abortive women who come for help.
The journey of healing for
those affected by loss and trauma after abortion can open up new awareness. The
perceptions and understanding of the situation - the circumstances, the relationships
and the expectations through the time of the pregnancy, around the decision making
time and with the termination of the pregnancy, can differ greatly then to now.
The process of revisiting the abortion experience, unpacking feelings and looking
at the reality of what actually happened, enables clients to see things that they
had not seen at the time. When they fully explore the context of the abortion, all
the influences and contributes, many recognize how it was a decision based on fear
rather than reality, a pressured pragmatic response to what felt like an intolerable
situation rather than an affirmative choice, consistent with their beliefs, ideals
and best aspirations.
Assisting the post-abortive woman to understand the head-heart disconnect that occured
during the crisis of pregnancy when she was considering abortion is signficant.
It enables her to appreciate her limited functioning at the time. The heart said
“Don’t do it” but the head said “It’s the only thing I can do”.
Insights into the effects of the hormonal state of pregnancy and the crisis state
on the mind and emotions are critical for the hurting post abortive woman to come
to terms with her decision.The normal reaction to fear is characterized by a fight,
flight or freeze response and she discovers how the fear response impacted her ability
to access deeper consciousness and process consequences. The realisation often comes
how she and those around her, were drawn to what appeared to be the best solution
to the immediate problem, the most practical and efficacious way to escape anxeity
and stress of what is perceived as an intolerable situation. The decision was about
survival.
Our experiences with post abortive women show that when faced with the options and
alternatives, abortion can appear to be the right thing to do at the time, even
if it goes against who she is most deeply. Some maintain this position afterwards
without great seeming distress. However for others the reality of the abortion surfaces
soon, or even decades later, in unexpected and painful ways.
Some of the stories we hear from post-abortive women speak of how they felt let
down by the systems and processes they encountered and engaged in. There is often
regret and anger around having not been made fully aware of or prepared for the
likely impacts of their decision.
One woman’s comments were “The system did not really support me emotionally and
I certainly didn’t make an informed decision. Alternatives were mentioned but not
fully explored. They talked a bit about the procedure and the possible complications
of the surgery but didn’t share anything about possible effects on me or my life.
They didn’t really seem to care how I felt for that matter. They saw me and my problem
and were willing to fix it but they didn’t really see me and what was going on for
me. I said I wasn’t sure about having an abortion and that this didn’t feel right
but they supported all my reasons why it would be difficult to have my baby, until
I felt it was okay to have the abortion. The way I was feeling I just needed the
sickness and desperate feelings to go away.
Now afterwards I can’t believe I had the abortion. It was so not what I wanted.
I wanted this child more than anything. I was so alone and everyone around me thought
it strange for me to want another child. No one supported my pregnancy. I had longed
for another baby for so long. I don’t understand how I felt what I was feeling.
All I know is that I panicked and now I can’t forgive myself.
I have had post-abortion counselling with P.A.T.H.S. and understand and accept some
of the way things happened. I still feel angry but I can see my way clear. Life
is worth living and I have a family that needs me and who I love dearly.
I am pregnant again and am relieved to not be feeling so sick, nor to have the same
kind of overwhelming and desperate confusing and conflicting thoughts and feelings.
I am asking for and finding the support too I need this time.”
Some post abortive women believe they deserve to suffer for the “choice” they made.
But was it a choice in the true sense of the word? Is a decision made in crisis
a real “choice”? Consider the qualifiers for choice - free will, fully informed
consent and lack of pressure or coercion. Some may believe this is available and
present to all through the abortion process, but sadly this appears to not always
the case. Take fully informed consent for example.
Fully informed consent around abortion, is not just the giving of details about
the procedure and immediate potential post-operative problems, nor a simple cost-benefit
analysis of options. This may be adequate for a tonsillectomy or an appendicectomy
which are simply about the physical removal of anatomical parts needing removal.
Termination of any pregnancy, at any stage for whatever reason, involves the ending
of a little developing human life and it occurs in relationship. For abortion consent
to be fully informed then surely it needs to include accurate information about
what is being removed, and exploration of the potential psychological, spiritual
and relational impacts? We are increasingly aware and accepting of the impacts on
a mother and her relationships following miscarriage and stillbirth and other pregnancy
losses, but fail to acknowledge and prepare people for the effects from the artificially
induced pregnancy loss of abortion.
Post abortive women who avail themselves of counselling and support often bemoan
the fact that they were not aware of how abortion would be so final, nor how is
could cause such anguish or mental dissonance, emotional pain, grief and guilt or
that it could leave them bereft and scarred. Most complain they were unaware of
the risks and felt ill prepared to deal with the impacts.
Those for whom the decision for abortion actually contradicted their personal beliefs
and moral code often present with major distress. For others, as they have grown
and changed they look at what happened in the abortion differently and can find
it hard to reconcile the past abortion with who they are now. And for a few, there
is the added human tragedy that this was the only child they have ever had and they
let that chance go by. This is not denying that numbers appear unaffected – if that
is the case for them, that’s all very well and good. But there is a whole group
of others for whom there are issues and problems afterwards. Most suffer in silence.
There some research around risk factors which indicate an increased likelihood of
someone having a negative abortion reaction. There appears, however, to be no real
screening for or discussion around these with those considering an abortion. It
makes perfect sense later to the post-abortive women but “no-one told me” is a not
uncommon refrain.
Information about foetal development is another area that seems fraught. Some women
share afterwards how they were either not given information about foetal development
or did not see the screen or pictures from the scans if they were performed. Although
some, when asked, prefer to not look, even they can later regret that decision.
Others when they asked questions around the stage of growth of their babies felt
they were dismissed as if it wasn’t important to know or the reality was trivialized
by the label of the foetus as a nothing – “like a 10 cent piece” “no more than a
bunch of cells” “a blob of tissue” “unformed at this early stage” “nothing really
there”. The acknowledgement of the life lost and willingness to use the term baby
appears to be permissable for therapeutic terminations and pregnancy losses for
natural reasons. How come it isn’t accorded for abortions in general? The clinical
and medical approach tries to protect woman it seems from the human reality. Women
who talk to us confess to having submitted unwittingly to a procedure that has altered
them and their lives permanently.
At the time admittedly it may have appeared to be a relief and helpful to not have
the information of the development of their lttile ones, or to not have to face
that aspect and deal with it, thus making it easier to proceed with an abortion,
but later it can create frustration and anger. Deliberate attempts by medical staff
to trivialise that life and its humanity, is later seen by some as a deception and
blatant insult. This can cause rage in some post abortive clients, which requires
an inordinate amount of work to deal with. But there is no rage greater than that
directed at self, often with dire results.
When thinking around the subject of informed consent one naturally focuses on the
counselling that is offered to all considering an abortion, as is required by law.
Counselling is often directed to abortion referrers and providers and tends to focus
on an abortion decision rather than necessarily being about making a pregnancy decision.
The subtle focus difference can be significant in the decision making process and
raises question - is there a vital step missing? There is concern in some circles
how so few people actually take up the offer of counselling at all. We concede that
many attempting to make a decision around an unplanned pregnancy at the time do
not wish to receive information or counselling.
Some women share after their abortions how once they made up their mind, determining
the abortion would be the most effective way to restore stability, they often sought
only that which would confirm and affirm them and support that decision. Understandably
they got upset with people who attempted to offer them help, and didn’t want to
have any information or to talk it through with anyone – they wanted it over and
done with and wanted things back to normal as quickly as possible. However later,
some see it as a disservice and realise that having had that information or being
invited to confront the reality then, as painful as it might have been, would’ve
been preferable to the agony that they are now experiencing, dealing with the loss
and trauma of the abortion and their part in it.
There appears to be little encouragement or incentive generally to take time to
really consider the options and explore alternatives and implications. The experience
some describe is how they felt like once they found out they were pregnant and expressed
ambivalence, it was like they were on a conveyor belt and even if they wanted to
get off they didn’t know how and felt they couldn’t. This is scary stuff! And for
us picking up the pieces afterwards it is very sad and perturbing to hear about
that sense of disempowerment through the systems and processes that can and does
occur.
To my mind fully informed consent is an ethical issue and a human right. Are we
doing it well enough? How might the pregnancy decision-making processes be improved
within our health services? These are good questions to ask and discuss. We need
to be talking about these things more, not just in medical and counselling circles,
but all areas of our community. For this is about people, ordinary people like you
and me, our friends and family. It affects us all.
Post Abortive Fathers
& Father’s Day
Abortion is so much seen
as a women’s issue that sometimes men are overlooked. Soon it will be Father’s Day.
What does this day mean for fathers who have lost children to abortion?
A father’s pain from abortion
cannot be ignored. Legally they have no rights in terms of what happens to their
offspring but reactions for men are as real as they are for women.
Recently I sat with a man whose partner has had three terminations. The effect for
him as a man, and as a father was apparent. Raw grief and rage, helplessness...
Confronting his own sense of failure and inability to do something more.... Having
a great love for children and wanting his own.... Aware he himself needed to sort
out his own shit, but also deeply feeling the pain of lost fatherhood.
Men are an integral part of the abortion story yet have no voice. Whatever their
part in the abortion, they too can carry pain with them and through their lives.
They may develop problems with
anger
- frequent outbursts, violent behaviour,
increased risk taking behaviours, anger towards self, partner or women in general.
Resultant
helplessness
may exhibit as confusion about his role as a man,
feeling inept or finding it hard to function as a man e.g. questioning ability to
support and nurture family.
Increased
anxiety
can create difficulty sleeping, disturbing dreams or nightmares,
poor concentration, excessive worrying. There may be
relationships
issues
- isolation (physical or emotional), trust issues, difficulty communicating, promiscuity,
impotence or sexual problems.
There may be symptoms of grief and/or guilt including frequent feelings of unexplained
sadness, frequent thoughts of self-condemnation, shame or guilt, discomfort or avoidance
of babies and small children, crying spells, feeling of choking or tightness in
throat, feeling numb or dead inside, alcohol or drug abuse, thoughts of suicide....
It is particularly significant if a man has experienced these problems only after
his abortion experience. Men may experience these types of symptoms or problems
and not realise they could be related to a past abortion until they openly talk
about it.
The taboo talking about an abortion experience applies equally to men as to women,
but it is perhaps even harder for many men. Most men, being practical and strong,
expect to be able to cope. But the issues involved are complex and emotions deep,
and the fear of confronting themselves can be huge. The post-abortive father needs
understanding and support to enable him to share his experience and to express what
it was like and has meant for him and his life. Father’s Day can be an emotional
trigger which ought not be overlooked.
So this Father’s Day let us remember post-abortive dads everywhere. May you find
peace in remembering and embrace your little ones with love.
A Perspective on Tolerance
What silences the post-abortive
parent who may be suffering with negative emotions and pain? One thing could be
tolerance. How so?
Tolerance
traditionally means simply to recognise and respect others’ beliefs,
practices and so on, without necessarily agreeing or sympathising. But today’s definition
is vastly different.
According to Bob Hostetler, based on the assumption that all truth is relative,
this new tolerance means we need to consider every individual’s beliefs, values,
lifestyle and truth claims as
equally valid
. So not only does everyone have
the equal right to his beliefs, but all beliefs are also equal, demanding praise
and endorsement of that person’s beliefs, values and lifestyle.
This new tolerance gets complicated. In a belief system where the sole virtue is
tolerance, then the cardinal sin is intolerance.
Since tolerance is based on the assumption that all truth is relative, it becomes
not only permissible but also imperative to be intolerant of those who do not agree
that truth is relative. To the relativist, then, it is not inconsistent to be intolerant,
for example, of those who insist that absolute moral standards do exist (which is
considered by modern society as being inherently “intolerant”). Yes it is confusing.
But, tolerance for abortion and intolerance of problems afterwards, can silence
those adversely affected and be an obstacle for them seeking help to deal with resultant
issues and pain associated with the experience. Permission is not granted those
suffering after an abortion, to grieve or talk about their experiences - they are
discounted, criticised and discredited. “We” need to push through this so called
(in)tolerance and break the silence!
SOWING SEEDS OF HEALING
You can promote post-abortion
healing without even talking to people about their past abortions and you don’t
have to become a trained counsellor or an expert in post-abortion issues. You can
sow a few words of compassion and healing into your everyday conversations which
can reach those who may be affected by a recent or past abortion, or encourage others
to think around the issues and break down the barriers that make it hard for those
needing or seeking help to come forward.
In a simple, conversational way, where possible
-
Show
understanding
- announce that you have come to a whole new understanding
of the abortion issue, including why people choose abortion and how it affects them
-
Express your
compassion
for women and men who have had abortions, knowing
how they often face the fear that others are judging or condemning them, and that
they may be experiencing feelings of doubt and regret
-
Offer
hope
- describe how you have heard of this programme that can help
women and men find peace and work through issues associated with past abortions,
including dealing with secrecy and shame.
For example, you might simply say:
“I read an interesting article that gave me a whole new understanding of why women
have abortions. I never really understood before how much pressure many are under
to have an abortion. I also didn’t realize before how much they can feel judged
and condemned by others. That fear of judgement can really make it hard for them
to come forward for help or to heal. It can be quite a process for some women to
deal with the loss or trauma from an abortion and sometimes they benefit from outside
help. The good news is that is help for women and men who are dealing with post-abortion
problems.”
That’s it. You have planted the seeds.
(Adapted from the Elliot
Institute publication “Hope and Healing”)
A REAL LIFE STORY
I had a termination .....
All my friends seemed to
be able to hook up with someone and I was really beginning to wonder why I found
it so hard. I didn’t want to make a fool of myself but no guys seemed to be keen
to make a move.
You can’t go through life without somehow getting some sexual experiences
and I certainly didn’t feel that I could leave uni without having crossed that bridge.
Eventually it happened -
it wasn’t the memorable experience I thought it was going
to be and it certainly wasn’t like in the movies.
In a way, nothing changed.
I still didn’t have any kind of special relationship with anyone and now there were
a couple of guys who knew how hopeless I was. Basically, I just wanted to finish
uni and get away.
The problem was,
I didn’t finish uni.
When my period didn’t come, I couldn’t
believe it. I’d been careful but obviously it didn’t work.
I didn’t want to hear
about options I just wanted the whole thing to go away.
I knew that Family Planning would sort it out - so I went there. I really wanted
to use a false name, but it didn’t matter in the end. They just asked me the basic
questions, did the urine test, gave me the news and then asked me what I wanted
to do - was there anyone I wanted to tell. No there wasn’t. They said they could
book me in for the termination and gave me an appointment note to take to the clinic.
The only good thing I could think of, is that no one I knew would see me going in
or out of the clinic, and I could just go home, take it easy for a few days and
get on with things.
It didn’t happen that way though. I didn’t somehow miraculously settle in work for
my exams, I didn’t want people talking about me so I didn’t tell any of my friends
and it was too late to tell anyone in my family. I had some counselling through
the clinic, but that was a joke. There were only a few sessions and they certainly
didn’t raise difficult questions or get into anything with me that was going to
take any time. My last contact with Family Planning was when they gave me a free
box of condoms and told me to take care.
It has taken a long time to begin to think about any of this, and
I can honestly
say that I have never really settled in my life.
I know that my behaviour
back then was unsafe and reckless but I didn’t care.
That experience is still somehow part of me - it’s the part that shapes my life but
no-one can know about it.
Having the termination is not something you can
really feel proud of and even when you hear people say that they support a ‘woman’s
choice’, you know that really they don’t.
I have never felt totally confident in my relationships since
and have learnt
that when you do tell someone about a termination, they either don’t understand
what a massive thing it is or they can’t cope with it. They can never think of you
without having that in the back of their minds.
Now I don’t tell anyone anything. I’m not unhappy with my life. I have never married
or had children which I don’t think is a bad thing - it’s not for everyone. But
I have never really done anything big with my life either, which is a disappointment.
This story is a snapshot and reflection and has no ending per se for it is an ongoing
journey.....
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P.A.T.H.S.
Newsletter Excerpts - 2009
