E.28
______
Report of the ABORTION SUPERVISORY COMMITTEE
2006
______
Presented to the House of Representatives pursuant to Section 39 of the Contraception, Sterilisation, and Abortion Act 1977 E.28 2
CONTENTS
Page
MEMBERSHIP OF THE COMMITTEE 3
INTRODUCTION 3
VISITS 3
MEETINGS 4
COMMENT 4
ADMINISTRATION 5
QUALITY DEVELOPMENT 5
STATISTICS 6
3 E.28
MEMBERSHIP OF THE COMMITTEE
Dr L Rothwell Dr P Reid
INTRODUCTION
This report for 2006 is the 29th Annual Report of the Abortion Supervisory Committee to Parliament and fulfils its statutory requirement under section 39 of the Contraception, Sterilisation, and Abortion Act 1977 when it reports on activities for the year.
The Supervisory Committee has in the year from 1 July 2005 to 30 June 2006 held meetings on a total of 13 days. In addition it spent 1 day on visits to institutions.
The three year term of appointment of the Supervisory Committee expired on 30 September 2004. Dr Rothwell and Dr Reid both indicated they were available for reappointment. They have not yet been reappointed. The Committee has been without a third member since March 2005.
VISITS
2003 2005
Whangarei Area Hospital Auckland City Hospital Hutt Hospital Epsom Day Unit Masterton Hospital National Women’s Hospital, Greenlane Palmerston North Hospital Waikato Hospital Nelson Hospital New Plymouth Hospital Manuka Street Trust Hospital, Nelson Wairau Hospital, Blenheim Dunedin Hospital Southland Hospital
2004 2006
North Shore Hospital Surgery on Shakespeare Auckland Medical Aid Trust North Shore Hospital Middlemore Hospital Brightside Hospital Tauranga Hospital Rotorua Hospital Whakatane Hospital Tokoroa Hospital Gisborne Hospital Hawke’s Bay Hospital Royston Hospital, Hastings New Plymouth Hospital Ashburton Public Hospital Timaru Hospital
E.28 4
MEETINGS
The Supervisory Committee met with: The Hon Rick Barker, Minister for Courts The Hon Mark Burton, Minister of Justice Officials from Statistics New Zealand Officials from Medsafe, Ministry of Health Officials from the Crown Law Office Officials from the Ministry of Justice Prof Peter Stone, Head of Department and Professor of Maternal Fetal Medicine University of Auckland Representatives from The Royal Australian and New Zealand College of Obstetricians and Gynaecologists The Supervisory Committee’s Counselling Advisors Attended the 4th Abortion Providers’ Conference in March 2006
Certifying consultants
As at 30 June 2006 there were 200 certifying consultants (of whom 128 met the Act’s specialist category requirements) on the Supervisory Committee’s list.
Fees payable to certifying consultants for consultations with women considering termination of pregnancy totalled $5,459,273 (GST inclusive) in the year ended 30 June 2006. The total for this year reflects an increase in the fee payable to certifying consultants. The fee increased from $87.50 to $135 with effect from 1 July 2005.
COMMENT
Decrease in abortion numbers
For the first time since the Supervisory Committee has been keeping records there has been a decrease in the annual numbers and rate of abortions performed in sequential years.
There has been much media debate about the possible cause or causes for this. Opinions range from the reduction in the numbers of overseas students, to the effects of school sex education programs, to the increased availability of Emergency Contraception. Notification data indicates that the decrease is across all age ranges and main centres, although regional differences remain.
The Supervisory Committee is very pleased with this trend but neither expects that it will continue, or proposes a single cause for the decrease.
Appointments
The Supervisory Committee continues to operate with only two members, placing an untenable load on those members. In September 2005, the Supervisory Committee advised the Speaker of the House that it had suspended its schedule of regular visits to institutions. Until the Supervisory Committee has its full complement of members, the suspension of visits remains in place. Unfortunately, this means the Supervisory Committee risks losing touch with service providers and the area of service provision.
5 E.28
ADMINISTRATION
The Ministry of Justice provides administrative support for the Supervisory Committee. During this year, the Supervisory Committee has been challenged by the support structure provided. The Supervisory Committee is firm in its belief that it has been under resourced, both in the amount of time allocated and the level of seniority of its staff. Discussions with the Ministry of Justice are proving productive and have gone some way towards resolving this problem during 2006.
The Supervisory Committee would like to thank its dedicated administrative staff for their efforts on its behalf this year.
QUALITY DEVELOPMENT
There have been ongoing quality developments in the area of health service provision during this year. Service providers are now required to have in place quality measures, which go to set Best Practice Standards for both health services and professional competence. To address these developments, the Supervisory Committee has established a Quality Committee Chaired by Professor Peter Stone Head of Department and Professor of Maternal Fetal Medicine, Obstetrics and Gynaecology Department University of Auckland. Professor Stone is a maternal fetal medicine specialist. The Supervisory Committee has also appointed a Nursing/Midwife Advisor, Ann Simmons. Ms Simmons has worked extensively in nursing and midwifery in abortion services. She will work with both the Quality Committee and for the Supervisory Committee in parallel to the work done by our Counselling Advisors.
The Supervisory Committee developed Quality Standards for Medical Abortion two years ago. In the coming year, we aim to facilitate the development of Quality Standards for certifying consultants, surgical abortion, and nursing and midwifery in abortion services. Once implemented, these Quality Standards will also inform the decision-making process of the Committee in respect of the licensing of institutions. The Supervisory Committee will work with those practising in the field of abortion services and in partnership with registered bodies in obstetrics and gynaecology, nursing and midwifery, and social work and counselling to develop the Standards.
Work is also under way to update the booklet Standards of Practice for the Provision of Counselling. This booklet was last updated in 1998.
The Supervisory Committee is also developing closer ties to The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the College responsible for all issues pertaining to the field of Obstetrics and Gynaecology, and the practice of those working in this field. This will assist the Supervisory Committee with quality and licensing issues. E.28 6
STATISTICS
TABLE 1 Induced abortion statistics (1980-2005)
TABLE 2 Number of induced abortions by institution (2005)
TABLE 3 Abortion rates by age (1995-2005)
TABLE 4 Abortion rates, New Zealand and other low fertility countries
TABLE 5 Abortion by age of women (2004-2005)
TABLE 6 Abortion by ethnic origin of women (2005)
TABLE 7 Abortion by number of previous live-births (2002)-2005)
TABLE 8 Abortion by age and previous live births (2005)
TABLE 9 Abortion by number of previous induced abortions (2002-2005)
TABLE 10 Abortions by age and number of women by number of previous induced abortions (2005)
TABLE 11 Abortions by estimated gestation (weeks) (2002-2005)
TABLE 12 Abortion by age and estimated duration of gestation (2005)
TABLE 13 Abortion by grounds of authorisation (2005)
TABLE 14 Abortions by procedure used (2005)
TABLE 15 Contraceptive method (2004-2005)
7 E.28
TABLE 1
INDUCED ABORTION STATISTICS (1980 – 2005)
December Induced Crude General Crude Year Abortions(1) Abortion Rate(2) Abortion Rate(3) Abortion Ratio(4)(5)
1980 5,945 1.9 8.5 105 1985 7,130 2.2 9.3 120 1990 11,173 3.3 14.0 156 1991 11,613 3.3 14.0 162 1992 11,595 3.3 13.9 163 1993 12,893 3.3 14.3 168 1994 12,835 3.5 15.3 182 1995 13,652 3.7 16.1 191 1996 14,805 4.0 17.3 204 1997 15,208 4.0 17.6 208 1998 15,029 3.9 17.4 207 1999 15,501 4.0 18.0 213 2000 16,103 4.2 18.7 220 2001 16,410 4.2 19.1 226 2002 17,380 4.4 20.0 242 2003 18,511 4.6 21.0 247 2004 18,211 4.5 20.5 237 2005 17,531 4.3 19.7 232
(1) Induced abortions registered in New Zealand. (Obtained from the Abortion Supervisory Committee.) (2) Per 1,000 mean estimated population. (3) Per 1,000 mean estimated number of women aged 15-44 years. (4) Per 1,000 live births, stillbirths and abortions. (5) The crude abortion rate for 1998 is based on the total number of birth notifications received by the Department of Internal Affairs. The abortion ratio for all other years is based on the number of births registered.
Note: Abortion rates from 1991 onwards are based on the mean estimated resident population. Before 1991, abortion rates are based on the mean estimated de facto population.
Source: Statistics New Zealand Hot Off The Press 2005.
E.28 8
TABLE 2
NUMBER OF INDUCED ABORTIONS BY INSTITUTION (2005)
Hospital Total % Whangarei Area Hospital 461 2.6 National Women’s Health 105 0.6 Clinical Centre Short Stay Unit 469 2.7 Epsom Day Unit 5,543 31.6 Auckland Medical-aid Trust 1,462 8.3 North Shore 20 0.1 Middlemore 21 0.1 Rotorua 11 0.1 Thames 511 2.9 Tokoroa 542 3.1 Waikato 967 5.5 Hawke’s Bay Hospital 559 3.2 Taranaki Base 294 1.7 Masterton 131 0.7 Wellington 2,882 16.4 Nelson 344 2.0 Wairau 139 0.8 Christchurch Women’s 202 1.2 Lyndhurst 2,242 12.8 Dunedin 601 3.4 5 other hospitals 25 0.1
TOTAL 17,531 100%
9 E.28
TABLE 3
ABORTION RATES BY AGE (1995 – 2005)
Abortion Rates (1)
Age 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Under 15 0.4 0.6 0.5 0.6 0.5 0.7 0.6 0.6 0.7 0.7 0.8 15-19 19.7 22.0 21.9 21.3 21.4 23.1 23.8 25.7 26.1 25.6 24.9 20-24 28.9 31.3 32.8 32.8 34.6 35.7 36.9 38.9 41.3 39.4 36.7 25-29 20.9 22.2 22.9 23.1 24.1 24.5 25.9 26.6 28.2 27.3 27.1 30-34 14.0 15.0 15.4 15.5 16.0 16.4 16.8 17.5 18.2 17.3 16.8 35-39 8.9 9.4 9.7 9.8 10.2 11.5 10.9 10.9 11.8 12.2 11.3 40-44 3.0 3.2 3.6 3.1 3.9 4.1 3.9 4.4 4.3 4.4 4.2 45 and over (2) 0.3 0.3 0.2 0.2 0.3 0.3 0.4 0.4 0.3 0.4 0.3
Total abortion Rate (3) 479.2 519.3 534.2 531.6 554.1 580.4 595.5 624.0 653.8 636.7 610.5
(1) Per 1,000 estimated mean female population in each age group (2) Per 1,000 estimated mean female population aged 45-49 years (3) The average number of abortions that 1,000 women would have had during their reproductive life if they experienced the age-specific abortion rates of a given period (usually a year). It excludes the effect of mortality.
Note: Abortion rates from 1991 onwards are based on induced abortions registered in New Zealand and the mean estimated resident population. Before 1991, abortion rates are based on induced abortions registered in New Zealand and the mean estimated de facto population. E.28 10
TABLE 4
ABORTION RATES, NEW ZEALAND AND OTHER LOW FERTILITY COUNTRIES
Country Year Crude General Abortion Rate (1) Abortion Rate (2)
New Zealand (3)
1990 3.3 14.0 1995 3.7 16.1 2000 4.2 18.7 2001 4.2 19.1 2002 4.4 20.0 2003 4.6 21.0 2004 4.5 20.5 2005 4.3 19.7 Australia (4) 2003 - 19.7 Canada (5) 2003 - 14.7 Denmark 2005 2.8 14.3 England and Wales (6) 2004 3.5 16.9 Finland 2003 2.1 10.7 France (7) 1997 - 13.1 Germany 2004 - 7.7 Japan (7) 2001 2.7 13.8 Netherlands (6) 2003 1.8 8.6 Norway 2005 3.0 15.2 Scotland (6) 2004 2.5 11.8 Sweden 2005 3.9 20.2 United States 2002 - 20.9 P
(1) Per 1,000 estimated mean population (2) Per 1,000 estimated mean number of women aged 15-44 years (3) Rates from 1991 onwards are based on induced abortions registered in New Zealand and the mean estimated resident population. Before 1991, rates are based on induced abortions registered in New Zealand and the mean estimated de facto population (4) Abortions are estimated based on Medicare and hospital morbidity statistics (5) Per 1,000 women aged 14-44. Excludes abortions performed on non-Canadian residents. Due to changes in data collection methods in Ontario, caution should be taken when comparing data from 1999 onwards with earlier years. (6) Residents only (in the case of the Netherlands, includes abortions to foreign women residing in the Netherlands) (7) Abortion reporting is incomplete and the rates are at least 20 percent higher than those given above (P) Provisional - Figures not available
Sources for other than New Zealand statistics: (a) Canadian Statistics, www.statcan.ca (29 March 2005) (b) Chan A and Sage LC (2005). “Estimating Australia’s abortion rates”, MJA (Medical Journal of Australia), 182:9, 447-452. (c) Finer L B and Henshaw SK (2005). “Estimates of U. S. Abortion Incidence in 2001 and 2002”, Alan Guttmacher Institute, www.agi-usa.org [6 June 2005]. (d) Henshaw S (2004). Alan Guttmacher Institute (New York). (e) INSEE (Institut National de le Statistique). www.insee.fr/en/home/home_page.asp [30 May 2005]. (f) Office for National Statistics (2005). Annual Abstract of Statistics, 2005 Edition, No. 141, ed David Penny, Palgrave MacMillan, London. (g) Statistics Bureau (2005). http://www.stat.go.jp/english/index.htm [30 May 2005]. (h) Statistics Denmark (2005). “StatBank Denmark”. www.sst.dk [30 May 2005]. (i) Statistics Finland (2004). Statistical Yearbook of Finland 2004, Helsinki. (j) Statistics Netherlands (2005). “StatLine”. www.cbs.nl/en/ [31 May 2005]. (k) Statistics Norway (2005). “StatBank Norway”. www.ssb.no/www-open/english/ [2 June 2005]. (l) Statistics Sweden (2005). “Statistical Database”. www.ssd.scb.se/databaser/makro/start/asp?lang=2 [31 May 2005].
11 E.28
TABLE 5
ABORTION BY AGE OF WOMEN (2002 – 2005)
Age Group 2002 2003 2004 2005 % (n) % (n) % (n) % (n) Under 15 0.5 78 0.4 89 0.5 85 0.5 92 15-19 20.8 3,602 20.3 3,757 20.6 3758 21.2 3718 20-24 29.4 5,124 30.6 5,670 30.4 5528 29.7 5203 25-29 19.8 3,450 19.6 3,619 19.2 3501 19.9 3491 30-34 15.4 2.676 15.1 2,800 14.5 2644 14.4 2520 35-39 9.8 1,715 10.0 1,846 10.5 1916 10.1 1773 40-44 4 686 3.7 692 4.0 721 3.9 687 45 and over 0.2 49 0.2 38 0.3 58 0.3 47
TOTALS 99.9 17,380 100.0 18,511 100.0 18,211 100.0 17,531
TABLE 6
ABORTION BY ETHNIC ORIGIN OF WOMEN (2004 - 2005)
Ethnic Group 2004 2005
European 9030 8,475 Maori 2712 2,767 Pacific Peoples 1701 1,673 Asian 3097 2,868 Other ethnic groups 204 209 European and Maori 1033 940 European and Pacific Peoples 206 202 European and Asian 41 40 European and other 4 7 Maori and Pacific Peoples 98 99 Maori and Asian 11 10 Maori and Other 5 3 Pacific Peoples and Asian 12 20 Pacific Peoples and Other - 1 Asian and other 1 50 European/Maori/Pacific Peoples 36 12 European/Maori/Asian 6 5 European/Pacific Peoples/Asian 2 1 European/Pacific Peoples and Other - - Maori/Pacific Peoples/Asian 5 Not specified 7 149
TOTALS 18,211 17,531
This information contains limitations in the methodology and the data should be used with discretion. E.28 12
TABLE 7
ABORTION BY NUMBER OF PREVIOUS LIVE-BIRTHS (2002 – 2005)
Number of 2002 2003 2004 2005 children % (n) % (n) % (n) % (n) None 49.2 8,547 51.1 9,451 50.6 9,216 50.7 8,894 1 18.5 3,223 17.9 3,312 18.5 3,366 18.5 3,245 2 18.0 3,121 17.3 3,206 17.3 3,152 17.2 3,010 3 8.7 1,516 8.2 1,526 8.1 1,473 8.0 1,395 4 3.5 602 3.4 634 3.4 626 3.3 582 5 1.3 221 1.3 233 1.4 257 1.5 258 6 0.4 76 0.5 84 0.4 74 0.5 85 7 or more 0.4 74 0.3 65 0.3 47 0.3 62
TOTAL 100.0 17,380 100.0 18,511 100.0 18,211 100.0 17,531
TABLE 8
ABORTION BY AGE AND PREVIOUS LIVE BIRTHS (2005)
Age Total 0 1 2 3 4 5 6 or more Group Under 15 92 91 1 15-19 3718 3264 398 52 3 1 20-24 5203 3262 1152 557 176 47 7 2 25-29 3491 1325 733 823 373 148 64 25 30-34 2520 607 526 739 370 171 65 42 35-39 1773 272 298 594 326 149 78 56 40-44 687 70 130 229 136 62 39 21 45 and over 47 3 7 16 11 4 5 1
TOTALS 17,531 8,894 3,245 3,010 1,395 582 258 147
TABLE 9
ABORTION BY NUMBER OF PREVIOUS INDUCED ABORTIONS (2002 – 2005)
Previous Induced 2002 2003 2004 2005 Abortions % (n) % (n) % (n) % (n) 0 65.9 11,458 65.7 12,169 64.2 11,696 63.9 11,210 1 24.0 4,164 24.2 4,473 24.7 4,490 24.8 4,345 2 7.1 1,236 7.2 1,330 7.7 1,395 8.0 1,394 3 2.2 383 2.1 380 2.4 431 2.4 427 4 0.6 101 0.6 106 0.7 127 0.7 116 5 0.2 28 0.2 38 0.3 50 0.1 23 6 0.1 10 0.1 12 0.1 19 0.1 16 7 - - 0.0 1 - - 8+ - - 0.0 2 0.0 3
TOTALS 100.0 17,380 100.0 18,511 100.0 18,211 100.0 17,531 13 E.28
TABLE 10
ABORTION BY AGE AND NUMBER OF WOMEN BY NUMBER OF PREVIOUS INDUCED ABORTIONS (2005)
Age Group Total 0 1 2 3 4 5 6 or more
Under 15 92 90 2 15-19 3,718 3,147 493 71 7 20-24 5,203 3,465 1,276 366 82 12 1 1 25-29 3,491 1,870 1,050 395 126 38 6 6 30-34 2,520 1,280 794 305 98 31 8 4 35-39 1,773 974 515 167 80 28 7 2 40-44 687 358 203 84 33 6 1 2 45 and over 47 26 12 6 1 1 - 1
TOTALS 17,531 11,210 4,345 1,394 427 116 23 16
TABLE 11
ABORTIONS BY ESTIMATED GESTATION (WEEKS) (2002 – 2005)
Weeks 2002 2003 2004 2005 % (n) % (n) % (n) % (n) 5 0.1 18 0.1 23 0.1 19 0.1 20 6 1.4 235 1.5 281 1.5 268 1.5 256 7 5.0 876 5.3 977 5.4 976 5.7 995 8 10.1 1,751 9.9 1,824 10.1 1835 10.2 1,782 9 16.0 2,773 14.6 2,710 19.2 3505 16.7 2,928 10 22.0 3,820 21.0 3,882 21.6 3933 20.6 3,620 11 17.4 3,019 18.7 3,456 16.5 3007 17.2 3,011 12 15.1 2,633 15.7 2,903 14.3 2613 15.1 2,640 13 7.5 1,300 8.1 1,494 6.4 1164 7.7 1,350 14 2.0 347 1.8 326 1.4 255 1.4 242 15 0.8 147 0.8 157 0.9 157 1.0 170 16 0.8 139 0.7 132 0.9 160 1.0 168 17 0.7 125 0.6 120 0.6 111 0.7 129 18 0.4 62 0.4 76 0.4 76 0.5 91 19 0.3 46 0.3 47 0.3 46 0.2 43 20 0.2 29 0.2 31 0.1 22 0.1 21 Over 20 wks 0.4 60 0.4 72 0.3 64 0.3 65
TOTAL 100.00 17,380 100.00 18,511 100.00 18,211 100.00 17,531 E.28 14
TABLE 12
ABORTION BY AGE AND ESTIMATED DURATION OF GESTATION (2005)
Age Group Total Under 8 8-12 13-16 17-20 Over 20 weeks weeks weeks weeks weeks
Under 20 3,810 200 3,110 429 60 11
20-24 5,203 402 4,144 581 69 7
25-29 3,491 246 2,777 397 52 19
30-34 2,520 199 1,989 274 45 13
35-39 1,773 155 1,380 187 36 15
40-44 687 64 545 57 21 -
45 and over 47 5 36 5 1 -
TOTALS 17,531 1,271 13,981 1,930 284 65
TABLE 13
ABORTION BY GROUNDS OF AUTHORISATION (2005)
Grounds Total % Serious danger to life 4 0.0 Serious danger to physical health 10 0.1 Serious danger to mental health 17,267 98.5 Serious danger to life and physical health 1 0.0 Serious danger to life and mental health 1 0.0 Combination of serious danger to physical and mental health 89 0.5 Substantial risk of physically or mentally abnormal seriously handicapped child 45 0.3 Serious danger to physical or mental health of woman plus a substantial risk of physically or mentally abnormal seriously handicapped child 114 0.7
TOTALS 17,531 100.0
15 E.28
TABLE 14
INDUCED ABORTIONS BY PROCEDURE DECEMBER YEAR 2005
Procedure (n) %
Pre-operative prostaglandin and suction evacuation 13,728 78.3 Pre-operative prostaglandin, suction evacuation and dilation and curettage 2,609 14.9 Mifegyne and prostaglandin 656 3.7 Suction evacuation 287 1.6 Pre-operative prostaglandin, suction evacuation and other surgical 91 0.5 Prostaglandin 62 0.4 Mifegyne and other medical 38 0.2 Pre-operative prostaglandin and dilation and curettage 14 0.1 Mifegyne 11 0.1 Other medical 10 0.1 Suction evacuation and other surgical 6 0.0 Mifegyne, prostaglandin and other medical 5 0.0 Pre-operative prostaglandin, suction evacuation, dilation and curettage and other surgical 5 0.0 Prostaglandin and other medical 3 0.0 Suction evacuation and dilation and curettage 3 0.0 Other surgical 1 0.0 Pre-operative prostaglandin, dilation and curettage and other surgical 1 0.0 Pre-operative prostaglandin, suction evacuation and mifegyne 1 0.0
Total 17,531 100.00
TABLE 15
CONTRACEPTIVE METHOD (2004 – 2005)
Contraception method 2004 2005 % (n) % (n) Oral contraceptives 13.8 2,505 13.4 2,357 Condoms 28.9 5,269 28.0 4,903 Diaphragm 0.2 31 0.1 20 Injection 0.7 124 0.5 91 Natural family planning 2.6 476 2.3 403 Intra-uterine device 0.9 164 1.0 176 Morning after pill 1.3 242 1.2 208 None 51.1 9,302 53.2 9,319 Other method 0.5 98 0.3 54
TOTALS 100.00 18,211 100.00 17,531
This information contains limitations in the methodology and the data should be used with discretion.