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LISA FERNANDEZ

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Have you ever considered what you would do if you came across a parent who didn’t share your views on immunisation? Beth Johnston explores the social minefield of immunisation.

Picture this: eight new mothers, sitting around chatting in a newly formed mothers group at a house in Perth’s northern suburbs. One mum, let’s call her Robin, takes a sip of tea and with the group now quiet, says, “So what’s everyone doing about immunisation?”

I’m shocked. What are we doing about immunisation? It’s 2011 and I’m new to this parenting game, blissfully unaware that any kind of debate around vaccination even exists. I thought it was something we all just did because it protected our children. I decide to sit back and let others speak first, to see if I’m the odd one out.

Robin continues, “I was doing some research on the internet on whether or not vaccination can cause autism, I found some pretty scary stuff so I think I’m going to go with natural immunisation instead.”

‘Natural’ immunisation is something I had never heard of before. It turns out I wasn’t alone in being concerned by these comments, as the other six mothers in the group also had a raised eyebrow. The ‘natural’ immunisation Robin was referring to was a homeopathic alternative, which is meant to stimulate the body’s natural healing response. It’s her choice and she’s entitled to that, but my instincts are to protect my own child and I wonder if I should associate with Robin and her baby.

Nationally, Australia’s child immunisation rate sits at around 92 percent, with almost 77,000 children not fully immunised

On the other side of Perth, in Fremantle, Katie Attwell found herself facing an even trickier social situation – she was the odd one out in a group of mothers who had decided not to immunise their children. Katie had always been pro-vaccination and contracting adult mumps solidified that decision for her. Having a homebirth for her second child, using cloth nappies and baby wearing drew Katie into a community of parents who shared similar values. Some may call them alternative. Regardless of titles, it soon became clear to Katie that her views on vaccination were something she did not share with her new friends.

Katie attended a coffee morning run by a local community not-for-profit group shortly after the airing of the SBS documentary The Vaccine Wars. It soon became the topic of discussion and Katie began feeling very isolated. “I was really upset because pretty much everyone in the room was saying they wouldn’t vaccinate their babies and hadn’t vaccinated their older children either,” she recalls. “Then there were others who didn’t know what decision to make, but it felt like it was just the norm in that community that you don’t vaccinate your children. I felt very isolated and frightened.”

Katie was astounded that a community so passionate about living ethically shared a view which she believed simply did not fit with the rest of their values. It became an area of great interest for Katie and she ended up joining the Immunisation Alliance WA, at first as a volunteer then as a project officer. Her experiences in her community gave her the idea for the Alliance’s current campaign, “I Immunise”, which features Katie and five other like-minded parents who are also pro-vaccination. Massive billboards featuring photos of these parents sharing what Katie describes as stories of social responsibility are scattered around the Fremantle area, branded with statements such as “I homebirth, I use cloth nappies and I immunise.”

“We’re trying to bust open the stereotype and say, if we’re positing ourselves as these people who are living ethical lifestyles, then immunisation is an essential part of that.” – Katie Attwell

The Alliance team is quick to point out that this campaign is not aimed at those who are staunch anti-vaccinators, but rather those who are undecided. Katie says there is little chance of changing someone’s mind when they are set against immunising, but she doesn’t want people who are yet to decide to think that’s the norm.

“I want to make sure that when a conversation is happening in the community, there is a robust debate and remove what I see as the dominance of the anti-vax decision,” Katie says. “We’re trying to bust open the stereotype and say, if we’re positing ourselves as these people who are living ethical lifestyles, then immunisation is an essential part of that.”

Immunisation is an incredibly emotive issue. Nationally, Australia’s child immunisation rate sits at around 92 per cent, but there are still almost 77,000 children who are not fully immunised, according to the National Health Performance Authority (2011-2012 Healthy Communities report). The current immunisation schedule sees a baby born in Australia receive approximately 14 vaccinations from birth until the age of four to potentially protect them against 12 serious illnesses (which can vary from state to state).

Julie Leask is an Associate Professor in the School of Public Health, University of Sydney and a Senior Research Fellow at the National Centre for Immunisation Research and Surveillance. Julie says immunisation is such a sensitive issue because ultimately the decision that we make for our child will influence the health of others.

Julie is quick to point out that Australia does not have declining immunisation rates, but says public confidence is an issue that needs closer monitoring. However, she says most parents with concern about vaccination will still go on to immunise their children. Through their research they have developed different positions people might take on immunisation, from unquestioning acceptance right through to total rejection of vaccines. She says the latter only accounts for 2 per cent or less of unvaccinated children, but non-vaccinators tend to cluster in certain regions.

“On either side it taps into very strong feelings that people have around their children and I think if you could reduce it down to a common denominator, it’s about people passionately and sincerely wanting to protect their children.”

“The people who oppose immunisation, their feelings are tied up in disquiet about conventional medicine and medicine’s occasion but spectacular failures such as thalidomide and resulting mistrust that can engender in some people,” Julie explains. “Unfortunately that can spill over into vaccination. Then there are heightened levels of frustration about the public discussion around non-vaccinating parents where they are made to feel like they are being actively negligent or irresponsible and there have been punitive measures proposed such as removing their family tax benefits.

“On either side it taps into very strong feelings that people have around their children and I think if you could reduce it down to a common denominator, it’s about people passionately and sincerely wanting to protect their children.”

Catherine Ranford is a midwife and mother of two who chose not to fully immunise her second child, now eight years old. When her daughter Bethany was born, Catherine recalls as a new mother she simply went along with the status quo and “did as she was told”, fully vaccinating. When she had her second child, Peter, she decided to do some research into vaccination and wasn’t comfortable with what she found.

“I decided still to vaccinate Peter, but to delay until he was six months old and then just do them one at a time,” Catherine says. “My husband agreed and we found a very supportive GP. We just wanted to give his immune system time to mature and introduce them gradually so it wouldn’t potentially knock his system around.

“…it’s a really personal decision that should be made between a child’s parents and their GP.” – Catherine Ranford

“But then Peter had a severe reaction to his second vaccination, with vomiting and extremely high temperatures and after that we decided not to go ahead with any other vaccinations.”

Peter has been a healthy child and Catherine says she has never had any issues at school or day care, something she believes breastfeeding played a large part in. If she had her time again, Catherine says she would most likely have practiced delayed vaccination with Bethany too, but she does not preach on the topic. “If someone knows Peter isn’t vaccinated and asks me about it, I will talk about it but it’s certainly not something I go around debating,” she says. “I won’t give advice because it’s a really personal decision that should be made between a child’s parents and their GP.”

One of the main advocates for families who choose not to vaccinate is the Australian Vaccination Network (currently in the midst of a name change due to ruling by the Administrative Decisions Tribunal). AVN public officer, Meryl Dorey, says they believe vaccination should always be a matter of personal, informed choice. She says their members vary in their opinions on vaccination, with some still choosing to vaccinate, some vaccinating selectively and some not vaccinating at all.

According to Meryl, those families choosing not to vaccinate do so for a few reasons; it could be as the result of having a child or knowing of someone who had a reaction to a previous dose of vaccine, prompting them to research the topic further.

“Another reason is that they don’t necessary believe the vaccines are going to be protective,” Meryl says. “They are questioning the effectiveness and the safety, from the perspective of the ingredients of vaccinations and contaminations as well as the long term and autoimmune problems that have been associated with vaccinations.

“They are not simply saying, ‘I don’t care about vaccinations, I’m not giving them to my child,’ they are doing lots of research, reading medical journals, consulting with health practitioners on both sides of the fence and after that, making the decision that for their child, they feel that the risks of vaccination outweigh the benefits.”

Meryl speaks of families being vilified for their decision. While there is no doubt that the issue can cause immense friction, Julie Leask says that there is actually no massive debate surrounding immunisation.

“It can be terribly awkward in those situations where everybody is immunising and someone says they’re not,” she says. “Then the other mums will worry that represents a risk to their children and it can create a lot of tension and can be quite a divisive topic.

“But it isn’t a massive debate. It’s made to look like that because the opponents of immunisation are a small group but they are incredible vocal, very committed and active.

“There is such a strong reaction to them that it looks like there is a hot debate where there is 50-50, but those national figures show it’s only around 2 per cent not wanting to vaccinate. The other issue is when poverty or social exclusion creates a set of circumstances so that children are inadvertently late for their vaccines.

“In medicine, there is overwhelming commitment to vaccines because they are largely safe and effective. Of course, like any medicine, vaccines bring some risk and some vaccines are not as effective as others. I think in medicine we’ve got a real role to communicate honestly and frankly with parents about the importance of vaccination and also some of their minor limitations, so parents go in with realistic expectations.”

For one in six couples, trying to conceive a child can be nothing short of an uphill battle. With so many varied reasons for couples struggling to fall pregnant.

According to Roger Hart, Professor of Reproductive Medicine and Medical Director Fertility Specialists of WA, School of Women’s and Infants Health, The University of Western Australia and King Edward Memorial Hospital, a healthy lifestyle is the number one priority and is the first thing he asks his clients to address.

“The woman needs to make sure her pap smear is up to date and any medication she is taking is optimised and looked at whether it is suitable for conception,” says Professor Hart.

“We need to make sure the woman’s Rubella blood test is up to date, that she has started their folic acid and the couple need to be of optimal health with regular exercise, with no drinking for the woman, and minimum drinking for the male and no smoking. The woman’s weight also needs to be an optimal Body Mass Index (BMI) of between 20 and 25. That’s what I would recommend before they start.”

Many people assume that with a couple’s infertility the problem is mostly associated with the woman; however, in 40 per cent of couples who experience infertility, the problem rests with the male. Professor Hart recommends that a healthy lifestyle for the male is as equally as important.

It takes only 90 days to adopt a new lifestyle to improve the sperm count.

“We all tend to focus on the woman, but we need to get the males in optimal health too. He needs to be taking multivitamins that improves natural conception and all parameters of sperm count. If a male smokes he needs to stop, as a male that smokes gives his child an increased risk of cancer. Obviously the woman has to carry on with good heath for the next nine months and during breastfeeding, but he should jump on the bandwagon too. It takes only 90 days to adopt a new lifestyle to improve the sperm count.”

Professor Hart emphasises the importance of weight management as a crucial factor in the ability to conceive. “We certainly know that sexually transmitted diseases are more common now which can cause issues in fertility. Also, obesity and BMI growth have a significant impact on fertility in terms of trying to conceive spontaneously, the success of fertility treatment, the risk of miscarriage and complications in pregnancy when the woman conceives. (Obesity) is a major factor causing infertility in the population.”

Treatments

There are numerous treatments for infertility and falling pregnant can be a long road for some couples, with fertility clinics also offering counselling during this trying time. Initial consultations would include a physical examination (including medical history), blood tests (to check for levels of ovulation,) ultrasound scans and/or a laparoscopy (an examination of reproductive organs.) Some woman may also require surgery yet some may simply just require a boost in ovulation. Everyone is different.

Kerryn Ellis and her husband went through four and a half years of different fertility treatment before finally falling pregnant. Using Fertility North in Joondalup, the couple’s success came to fruition following the ICSI method (where a single sperm is injected directly into an egg.)

“I was convinced I wasn’t pregnant. They called me and said ‘Oh yes you are,’ it was fantastic!” says Kerryn.

“I was convinced I wasn’t pregnant,” says Kerryn, who asked the clinic to bring her blood test forward as she didn’t feel pregnant. They called me and said ‘Oh yes you are,’ it was fantastic!”

 

A natural approach

When Rebecca Shiel had been through virtually every available fertility treatment for four years, she took the advice of a friend and visited a naturopath who administered four courses of acupuncture and Chinese herbs. It worked. After years of invasive surgery and miscarriages, Rebecca’s body had responded positively to the treatment and she is now a mother to a three year old boy.

“I don’t believe that the acupuncturist’s success was a coincidence,” says Rebecca. “I’d definitely recommend this treatment, it raises your state of positivity.”

At the IVF Support Centre in Claremont, Director Andrash Bodonyi specialises in the administration of acupuncture for women seeking to fall pregnant and his clinic boasts an astonishing success rate. “We don’t understand how acupuncture works exactly, but we know from clinical trials that it just does,” says Andrash, who claims that acupuncture has been shown to increase the blood supply to both the ovaries and uterus.

“Acupuncture is extremely effective. Clinical experience shows that acupuncture creates hormonal balance and helps with profound relaxation which also affects the uterus. We have women with us who have tried everything and we give them a real chance. That’s the beauty of acupuncture; it is non-intrusive with a high safety standard. It has all the benefits without the risk.”

For more information visit www.ivfsupport.com.au/home.php

Surrogacy

According to Concept Fertility Centre Scientific Director Peter Burton, the biggest limiting factor in surrogacy is trying to find a suitable surrogate. “People have to be able to fulfil criteria and there are strict guidelines. Not everyone is suited to surrogacy and it can be a long and difficult process, emotionally and financially,” says Dr. Burton.

The process did work for one couple in April this year however, when they had their son delivered after the woman’s sister had carried the baby following in-vitro fertilisation, the first patrons since the legalisation of surrogacy in 2009. Since then, the Reproductive Technology Council has approved only 12 applications.

For more information on surrogacy visit www.rtc.org.au/consumer/surrogacy_wa.php

 

Costs Involved

Costs for treatment for fertility treatments will vary hugely depending on what is required. Some clinics will charge an all-inclusive fee while others will quote an out of pocket fee. For the cost of IVF, with health insurance, expect to pay an out of pocket cost between $1000 to $5,000 per treatment. This will also cover any medications used. You will also need a referral from your GP or a gynaecologist/obstetrician to be eligible for Medicare rebates for your specialist appointments.

For more information about IVF fees and the Medicare Safety Net Threshold, visit www.ivf.com.au/ivf-fees