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Access to abortion after decriminalization in Aotearoa New Zealand: A mixed-methods study of women's experiences and
Melanie Gibson1, Ngaire Sparkes1, E Jane MacDonald1
1Te Tātai Hauora o Hine - National Centre for Women's Health Research Aotearoa, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand.
Objective:
To explore how people are experiencing abortion care in Aotearoa New Zealand (Aotearoa) following decriminalization in 2020 and to identify aspects of equitable and accessible abortion care.
Study Design:
An observational, mixed-methods study advertised at abortion services in Aotearoa (January-November 2023). All people aged ≥ 14 years attending abortion services were eligible for an anonymous survey. Wāhine Māori (Māori women) and Pacific women accessing abortion services since the law reform, and their families, also took part in qualitative interviews to privilege their voices. Māori and Pacific researchers undertook the interviews, underpinned by Kaupapa Māori and Pacific research methodologies. Main outcome measures were aspects of equitable and accessible abortion care identified by participants.
Results:
126 surveys and seven interviews were conducted. Among surveyed participants, 52/126 (41.3%) self-referred to an abortion service and this best suited 23/40 (57.5%). The abortion occurred within a week of the first appointment with the abortion service for 103/123 (83.7%) and no participant wanted more time. Interviewees not knowing about self-referral or encountering delays expressed frustration and distress. Almost all participants (124/126, 98.4%) had private and safe access to a mobile phone, but fewer to the internet (107/126, 84.9%) or space for telehealth appointments (77/126, 61.1%). Interviewees considered a private space for early medication abortion (EMA) essential.
Conclusions:
People highly value self-referral, timeliness and choice between in-clinic abortion care or EMA at home, which reduce barriers to accessing abortion services. Protecting and further implementing these strategies are likely to contribute to achieving equitable and accessible abortion care.
Implications:
We aimed to identify aspects of equitable, timely, safe, and accessible abortion services in Aotearoa. The findings suggest that many steps have been taken towards achieving accessible and equitable abortion care in Aotearoa. However, strategies and activities to protect and further implement high-quality abortion care are needed.
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