Annette Milligan
Public health campaigner
Abortion law hasn’t shifted since Annette Milligan was a teenager and, in her opinion, change is long overdue. Recent proposed law changes, taking the procedure out of the Crimes Act and making it easier for women to access, is music to her ears. ‘‘The current situation is inhumane,’’ she says. ‘‘It puts women through many unnecessary barriers at what can be a very difficult time.’’
Throughout her 30-year career as a nurse, she has seen it all. ‘‘I have heard a lot of stories in those 30 years and I’m not going to sit in judgment on any woman’s life. With the best intentions in the world, sometimes things happen. For a long time, I have worked really hard to see that every child that comes into this world is a wanted child and comes into a situation where a parent or parents are able to support that child. In my experience all women give this an enormous amount of thought. Women are very capable of making those decisions.’’
Milligan’s mother was a nurse, and during her childhood Annette alternated between nursing or teaching as potential career paths. She eventually picked teaching and worked in the United Kingdom, but when she returned to New Zealand in 1979 she couldn’t find a job.
She was walking across Trafalgar St in Nelson one day when the thought suddenly struck her that she was going to be a nurse. Although it was too late for the intake at Nelson’s nursing school, she begged them to take her as a late applicant. At 29, she was an older student, but immediately loved it. The combination of nursing and education worked well when it came to public health education.
When she opened the doors of her Independent Nursing Practice on February 13, 1989, the world was quite different. The HIV/ Aids epidemic was in full swing. Young Eve van Grafhorst had moved to New Zealand, and public health campaigns were in full swing. Yet it was a time of fear, misunderstanding, and prejudice.
New Zealand started a needle exchange programme to reduce the incidence of HIV. But the argument against it was that, if clean needles were available, young people would go out in droves and start using. ‘‘It never happened and it wasn’t going to,’’ Milligan says. ‘‘It was an amazingly successful intervention. I remember talking to an American woman in the early 1990s and her eyes filled with tears when she heard about it; she said, ‘You have no idea how lucky you are’.’’
Milligan has recently sold her practice, and is retiring from nursing (though not from community support). It has given her the time and perspective to look back at changes in public health in the past 30 years.
Access to contraception has dramatically improved for those under 22 and, while in 1989 the contraceptive pill was the mainstay, the introduction of long-acting contraceptives such as Implanon and Mirena have made a dramatic difference to many women.In 1989, unplanned pregnancies were in the order of 35 to every 1000 women; now the rate has dropped to under 20. ‘‘I think that it’s really pleasing to see women delaying pregnancy a little longer. But it took a long time to get there.’’
Anxieties and mythology about birth control still abound, with some women anxious about it affecting long-term fertility. ‘‘Any evidence for that is extremely weak, but young women are at risk because older women say things like, ‘If you stay on the pill for too long you’ll become infertile’. Actually, nothing could be further from the truth.’’
Another common anxiety is that the pill increases the risk of breast cancer. ‘‘If you want to prove that it is causative, you have really got your work cut out; some studies say it is protective, some say it puts women at risk. There is no strong evidence.’’
On the other hand, the evidence that drinking alcohol increases the risk for breast cancer is ‘‘as clear as a bell’’. ‘‘If people are worried about young women’s rate of breast cancer, can we please focus on alcohol rather than the contraceptive pill? In 1989, alcohol was less freely available and young women actually weren’t a target of the alcohol industry; we didn’t have alcopops and other drinks packaged up specifically with young women in mind.’’
Another treatment that’s changed dramatically is that for sexually transmitted diseases. In 1989, genital warts, a side-effect of the humanpapilloma virus (HPV), were common. ‘‘We didn’t have very good treatments and I remember young women coming in several times a week to have warts painted by a nurse.’’ It was an ‘‘undignified and humiliating procedure’’ that took several visits to clear up. It could also mean annual smears and/or colposcopies (a cervix examination and sometimes biopsy) – ‘‘treatments that no woman would put their hand up and say they wanted’’.
The treatment that made the biggest impact has been the Gardasil vaccine. But when it was first introduced, the same arguments against the vaccine were used as those made against providing safe needles back in the days of the HIV crisis. ‘‘Amidst all the concern about the HPV vaccine, some of it was based on an antivaccination philosophy, but more of it was based on a philosophy that young women having the HPV vaccine will then go out and become madly promiscuous and ‘lose control’. It is just ridiculous. Words fail me.
‘‘Of course no such thing happened, and I have had to sit and watch statistics from Australia about how colposcopies etc have plummeted because all girls have the vaccine in Australia.’’ In New Zealand, it has taken longer. ‘‘It is really tragic that it has taken us this long to get our heads around the HPV vaccine being an amazing opportunity to eliminate a viral-borne cancer in our society.’’
Back on abortion reform, it’s Milligan’s view that the decision should be between a woman and her health provider. ‘‘And no-one else. There is no place for it in the Crimes Act at all, and removing it and making it a less torturous process to navigate is a good thing. I’m very supportive of the move – though I’m not quite sure it will go far enough.’’
The bill is in dramatic contrast to what is happening in the United States, with legislation steadily stripping abortion rights from women. ‘‘It is just heartbreaking. All I can think is that nobody has listened to the stories of the women. I don’t understand cruelty, and I don’t understand why we feel the need to interfere in other people’s lives and other people’s decision-making.
‘‘I get very angry with the claiming of the term ‘pro-life’; I am pro-life too. I am pro 16-year-old girls having the right to have a life too. And women who are 45 and find themselves unexpectedly pregnant; I have seen situations in which not being able to access an abortion was catastrophic. How dare anybody inflict that on another human being.
‘‘Women will not be stopped from having abortions; they will be desperate and do desperate things, and will get hurt and will die.’’
As for the clinic’s future, Milligan says the time is right for it to have ‘‘a breath of fresh air’’, and is pleased it will continue as a nurseled service. Meanwhile, she plans to continue her community involvement. ‘‘I don’t want to be doing nothing. It’s been the most wonderful 30 years. You are seeing people often at the worst times in their life, and it’s been an absolute privilege to help.’’
‘‘I am pro-life too. I am pro 16-yearold girls having the right to have a life too.’’