Melting Clock at Moment of First Explosion - Salvador Dali, c 1954.

The Tightrope Timeline of Unplanned Pregnancy

Selina Utting, Children by Choice

About Children by Choice

• Pro-choice counselling, information, and referral service for all options with an unplanned pregnancy: abortion, adoption and parenting.

• Free Queensland-wide telephone counselling, Monday-Friday, 9-5.

• Sexuality education, website and professional development training.

•Not-for-profit with 7 part-time staff, funded by Queensland Department of Communities, donations and fundraising.

• We opened in 1972.

About Queensland: some numbers

• 1.3 million women in Queensland aged 10 – 54 years

• 61 000 births each year

• Estimated Termination Of Pregnancy (TOP): 14 000 annually

• Every year Children by Choice has 2,500 client contacts and our website has 35,000 visits of over two minutes duration

One half of all pregnancies are “unplanned”:

half continue and half choose abortion.

How do women experience this time?

What are women’s experiences of unplanned pregnancy in Queensland?

Steps to resolve an unplanned pregnancy

1. Identify that you are pregnant

2. Confirm the pregnancy and gestation

3. Make a decision

• Talk to those you trust

• Gather information

4. Present for care

Doesn’t that sound easy?

Step 1 : Pregnant???Myths and barriers… • Every woman knows that she had sex

– 15% of our clients speak about sexual violence• Pregnancy has obvious physical symptoms

– 25% of women have no morning sickness• Every woman knows when her period is due

– teenagers recognise pregnancy on average one week later than older women

– implantation bleed mistaken for a period, 25% of women experience an implantation bleed

• Contraception is foolproof and readily available– more than half of all women who present for TOP were

using a contraceptive

Step 2 : Confirm the pregnancy and gestation

Myths and barriers…• Just go to the chemist/GP

• Urban/rural divide

• Young women

• Perfect and readily available ultrasound

• Understand how gestation is calculated (from LMP, not from the date of the sex)

<=6 <=12 <=16 <=20 >20 UNSURE0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Pregnancy gestation of Children by Choice clients

Gestation statistics for our disadvantaged clients

Women’s Access Fund: • Average gestation at first contact with us: 8.7 weeks

Rural & Remote Women’s Access Fund:• Average gestation at first contact with us: 11.1 weeks• They are also younger (mode 17 vs. 22 years old) –

parallel result to the Global Turnaway Study (underway in USA)

Step 3 : Make a decision

• Value: The woman is the central decision maker

• vs. stereotype women are “ignorant” and need counselling

• Talk to someone you trust

• Telling a parent/auntie/friend

• Telling the man involved

• Gather reliable information

• Negotiating anti-choice propaganda

• Speaking to a health professional (very common for clients to tell us about unsupportive health worker)

Step 4 : Present for care

Abortion or ante-natal?

• Legislation: Criminal Code 1899 (Qld)

• One Public Provider: Cairns Sexual Health Service – Medical TOP

• Provision is 99% provided through private clinics, mostly around Brisbane

o $450- $860 for a procedure for under 11 weeks

Abortion in Queensland

Brisbane to Cape York = 2600km

Torres Strait Islands

Logistics of abortion in Qld:The CbyC Travel Agency

• Average distance travelled to access abortion by our RRR financial assistance clients = 857km each way

• 1 in 5 clients reports their location as a barrier

• Advocating for access to the Patient Travel Subsidy Scheme – different for every health district

Logistics of abortion in Qld :The CbyC Bank and

Emergency Relief (ER) Agency• In 2011-12, 381 women contacted us for financial assistance

to access a TOP (15% of our clients)

• We donated $49823

• Between 1 July 2012 and April 2013, we assisted 265 women and exhausted all of our donated funds - $20185 - to provide financial assistance

• We provide No Interest Loans repaid via Centrepay

• Number of ER agencies in Queensland prepared to financially support abortion = hardly any!

• Trying to facilitate public provision of TOP

Abortion one of many life experiences

• Research: more than half of all women seeking abortion have experienced a recent disruptive life event, such as unemployment, separation, relocating.

• CbyC’s financial assistance clients: all reliant on Centrelink payments, most are single parents, 21% experience violence.

Continuing an unplanned pregnancy• Maternity Information

o Start reading pregnancy books at page 135o Ignore pre conception TV ads, website and workshops

• Ante-natal care avoid and evadeo Unsupportive health worker eg. “why haven’t you been

in earlier?” “Is your baby an accident?” “You’re a bit old/young aren’t you?”

o It’s not “too late” for healthy choices (quitting or cutting back smoking makes a difference within 24 hours)

o Birthing options greatly reduced if not booked by 12 weeks

• Ante and post-natal depression risk• Child Safety notification

Reproductive champions

• A boss in Central Queensland gave his worker the day off and hired a car on the company account so the man could drive his partner into Rockhampton for a termination

• Queensland School Based Youth Health Nurses – pushed for their program to offer free pregnancy tests

• Therapeutic Goods Administration – on April 26, RU486 (mifepristone) was recommended for listing on the PBS (but only for use up to 7 weeks gestation!)

Be a reproductive champion

• Be a mythbuster and help throughout the woman’s journey

• Keep all the pathways open for second trimester presentations (never “late”)

• Join Children by Choice (member, facebook, twitter, buy our merchandise) at www.childrenbychoice.org.au.

Questions?

Some feedback from our clients 2011-12

References

• W Abigail, C Power, I Belan ‘Changing patterns in women seeking terminations of pregnancy: A trend analysis of data from one service provider 1996-2006’ Australia and New Zealand Journal of Public Health Volume 32, Number 3, June 2008 , pp. 230-237(8)

• Drey, EA et al “Risk factors associated with presenting for abortion in the second trimester” Obstet Gynecol 2006 Jan 107(1):128-35

• Duvnjak, A. and Buttfield, B. “Ignorant Fools: the construction of women’s decision-making in recent abortion debates in Australia” Women against Violence, 19 pp20-26, 2007.

• Finer et al, “Timing of steps and reasons for delay in obtaining abortions in the United States” Contraception 2006 Oct; 74(4):334-44

• Foster, D., Dobkin, L. & Upadhyay, U. “Denial of abortion care due to gestational age limits” Contraception 87 (2013) 3-5

• Jones, D., Frohwirth, Moore, A. “More than poverty: disruptive events among women having abortions in the USA” J Fam Plann Reprod Health Care 10.1136 on-line Aug 2012

• Marie Stopes International “What women want when faced with an Unplanned Pregnancy” 2006

• F Amin Shokravi, P Howden Chapman, N Peyman ‘A Comparison Study: Risk Factors of Unplanned Pregnancies in a Group of Iranian and New Zealand Women’ European Journal of Scientific Research Vol.26 No.1 (2009), pp.108-121