Abortion - by Alastair MacFarlane

This address was given to a Family Planning Seminar held at the Postgraduate School of Obstetrics and Gynaecology, University of Auckland, Nov. 1971.
Dr A. Macfarlane MB, ChB, FRACS, FRCOG, was NZ President of the Royal College of Obstetricians and Gynaecologists. He was not a member of any society supporting or opposing change in the law on abortion.


The subject of abortion, charged as it is with sentimentalism, bigotry and emotion, is one which could occupy many hours of inconclusive argument and discussion but within the context of family planning, the role which it should have to play is limited.

The whole emphasis of this course and indeed the purpose of the course itself has been to accentuate the value of preventive measures in pregnancy control, not only to allow people to space their families as they would wish, but in the hope of preventing clamour for induced abortion, purely as a delayed form of contraception.

It has been claimed that a woman should be the master - or possibly the mistress - of her own destiny and should have the right to decide the fate of her own pregnancy.
It has been claimed that a woman should be the master - or possibly the mistress - of her own destiny and should have the right to decide the fate of her own pregnancy. Many of the claims in favour of this are compelling and difficult to refute but correspondingly valid arguments may be offered in opposition.

In the past the medical profession has often been cited as one of the chief opponents of liberalising abortion and it might be interesting to pause for a moment and contemplate why this has been so.

Traditionally and throughout his teaching, a doctor has been trained to realise that his vocation in life is preservation of the life and health of his patient.

More especially if he is a gynaecologist he is intimately concerned with the investigation and treatment of infertility, the promotion of the wellbeing of both mother and foetus throughout the early and later stages of pregnancy and labour until he achieves the healthy mother and newborn baby.

It is hardly surprising that he views the destruction of the foetus, no matter how early, with distaste. He is also acutely aware that the termination of any pregnancy is not without risk and that depending on circumstances, particularly on the duration of a pregnancy, its termination may not only be hazardous to the mother but lethal.

It is up to each individual doctor to face his responsibilities when they arise and act accordingly.
Notwithstanding there are unquestionably many pregnancies which for a variety of reasons do warrant termination in the overall interest of the patient and to deny the fact would be callous and unrealistic. So it is up to each individual doctor to face his responsibilities when they arise and act accordingly.

What then are some of the situations that may merit termination?
I think most people would accept the fact that where a woman wishes her pregnancy to continue there are very few remaining purely medical conditions which demand its termination in the interests of her health.

Furthermore, we are increasingly led to believe by the psychiatrists that, very few women will suffer permanent or irreparable mental disorder by allowing a pregnancy to continue where the mother wants it to do so. The operative question therefore would seem to be "does the patient want the pregnancy or not, and if not can valid reasons be found for its termination?"

Any woman be she married or single, through ignorance, irresponsibility, failure in contraceptive technique, through a momentary lapse or as a result of sexual assault may find herself the victim of unexpected or unwanted pregnancy. The question then arises.

What if anything should be done? Should abortion be permitted? Is it desirable?

Even the most responsible citizens with the highest sense of right and wrong will vary in their opinions in a spectrum of permissiveness from abortion on demand at one end to rigid denial at the other.

"...the fact remains we are dealing with a worried, anxious, distressed and often distraught woman seeking relief from an overwhelming problem..."
You can moralise to your heart's content on the sanctity of life, the rights of the foetus, on religious attitudes or what you will, but the fact remains we are dealing with a worried, anxious, distressed and often distraught woman seeking relief from an overwhelming problem - perhaps a woman already burdened by an impossible socio-economic situation - perhaps a single girl terrified to face her parents, afraid to confront her employers with the problem, or threatened by a merciless society, permissive in so many other respects but unwilling to accept her in the state of unmarried pregnancy.

Any doctor would be callous in the extreme were he not to receive her with sympathy and understanding. But is he entitled to interfere?

Socio-economic factors of themselves are no grounds for abortion but it is virtually impossible to ignore them in assessing the physical and mental welfare of any patient - and I am absolutely convinced that they must be taken into consideration.

Imagine a moment, a woman with five or six children in poor economic circumstances, with a dissolute, irresponsible, possibly violent drunken husband, unemployed and possibly unemployable, where she herself has to go out to work to support the meagre existance of her already neglected family - and she suddenly finds herself pregnant.

She has to make provision for her existing family at the time of her confinement and she must provide for the new baby while she herself returns to work all too soon after the delivery, with an extra mouth to feed.

There are some starry eyed enough to consider this a blessing. Personally I would label it a disaster.

"Possibly the foetus has rights but are these absolute or relative? Should they outweigh the rights of the mother or her existing children?"
I have referred to the rights of the foetus. Possibly the foetus has rights but are these absolute or relative? Should they outweigh the rights of the mother or her existing children? Furthermore it is interesting to contemplate - should the fertilised ovum have rights greater than its unfertilised counterpart? I don't know. Perhaps you do.

And furthermore, once the baby has been born, what of its future? We read all to frequently of the battered baby syndrome - of cruelty, violence and neglect - features all too frequent in some of the lower echelons of society. Is this what we mean by the right to live?

I suppose opinions on all these points are based largely on moral or religious principles but it is encouraging to read the tolerant and broadminded statement of the general assembly of the Presbyterian Church published in last week's papers.

In May of this year I attended the 19th British Congress of Obstetricians and Gynaecology in Dublin. Both there and in England I took the opportunity of seeing at first hand the results of the relaxation of the abortion laws in Britain [in 1967] and of discussing the subject with a number of leading British Gynaecologists.

I visited units in various parts of the country, units often diametrically opposite in their views on abortion. I viewed abortion clinics first hand and I heard details of the commercial rackets with their paid taxi drivers and airport touts vying for the custom of overseas clients who, being unable to obtain abortions in National Health Hospitals, were willing to pay vast sums of money to have the operation performed in private.

But leaving aside for the moment these less attractive aspects of the problem, it would appear that the large majority of gynaecologists are endeavouring to interpret the law as it was originally intended.

"...the new law 
has undoubtedly resulted in a liberality of thought not only in the climate of 
public opinion but in the run of the mill gynaecologist..."
While it has perhaps hardened the attitudes of those who had been strenuously opposed to abortion and has confirmed the liberal in their beliefs, the new law has undoubtedly resulted in a liberality of thought not only in the climate of public opinion but in the run of the mill gynaecologist who had come to view termination of pregnancy on psychiatric grounds, if not with approval, at least as being justified in many cases.

Although I could obviously find no complete unanimity of opinion, the view of most gynaecologists was that although the [British Abortion] Act had in fact possibly resulted in over-permissiveness, it had relieved much misery, anguish and despair and had saved the mental and physical health of innumerable women. And this I think is probably true.

New Zealand statute law, as you know, allows termination of pregnancy only to save the life of the mother. And there it stops. However, by a number of judgments and subsequent cases, law can now be interpreted to encompass the health of the mother, both physical and mental. In other words, termination can be condoned if the pregnancy is likely to interfere with the mother's health and leave her a physical and mental wreak.

There is absolutely no doubt that in New Zealand in probably a large majority of cases where abortions are performed on the grounds of mental health, the so-called "psychiatry reasons" invoked fall far short of those which would leave her a mental wreck, and although they may be legal and fully justified in relieving the patient of anguish and mental trauma, in relation to existing law they are virtually hypocrisy. This is a thoroughly unsatisfactory situation.

The question has been asked, should all law on the subject be abolished and the decision be left entirely to the gynaecologist?

Unless the law provides for the extreme of either complete prohibition or abortion on demand, it is liable to considerable variation in interpretation by the individual doctor and no matter how compassionate and understanding he may be, I sometimes wonder to what extent his decision may be influenced by the thought of the General Medical Council breathing down his neck, ready to strike his name from the register if the abortion he performs is considered illegal.

My enquiries in Britain have
shown that even in early pregnancy and even in the most efficiently conducted
units the morbidity rate is not inconsiderable.
On the other hand, abortion is a clinical problem. It is not without risk. Its dangers are not measured by mortality rates alone. My enquiries in Britain have shown that even in early pregnancy and even in the most efficiently conducted units the morbidity rate is not inconsiderable. This being so it is obvious that the situation cannot be governed by law alone and that the doctor must at least share the responsibility in a decision to abort.

But we have not met to discuss whether or not New Zealand abortion law should be modified. Laws are usually a reflection of the moral code of a society and these vary from community to community and from generation to generation according to the needs of both.

There are many who will consider that New Zealand laws might be relaxed for the benefit of the majority and personally I would not oppose this view but it must be made more specific. It would also have to include laws safeguarding the interest of New Zealand women and preventing the commercialisation of abortion which has occurred in Britian.

Although I support private enterprise it might be prudent to suggest that all terminations of pregnancy should be carried out in public hospitals. But before this were done it would be essential that the Government should provide the accomodation and the trained medical personnel to cope with the increased demand which would inevitably occur.

If [abortion is]
used to excess it might well make women more careless and less likely to use
contraceptive methods as has happened in Czechoslovakia.
But from the point of view of family planning which is really the subject under consideration, whether the law is changed or not, abortion should have little to contribute. It is a dismal and unsatisfactory method of population control. If used to excess it might well make women more careless and less likely to use contraceptive methods as has happened in Czechoslovakia.

If it is to be used at all it should only be in the role of a last resort and indeed is a confession of failure of family planning itself. The emphasis must be placed on prevention.

Family planning services and contraceptive clinics should be established. Courses of instruction should be organised to educate doctors and nurses and the general public in contraceptive techniques.

And finally, public crusades might well be mounted to make the community aware of their collective and individual responsibility in the prevention themselves of the unwanted pregnancy.