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