15 Dec 2020

Abortion access improves with new law, but inequity still significant - Ministry

3:24 pm on 15 December 2020

The Associate Health Minister says she's watching district health boards "very closely" after a survey found variations in abortion services offered across the country.

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Photo: RNZ

It's been more than eight months since abortion law reform came into force, yet the Ministry of Health survey found in some parts of New Zealand early medical abortions - where two pills are taken to induce a miscarriage within the first nine weeks of pregnancy - are not locally available at all.

It also found significant differences in later gestation abortion services offered across DHBs, meaning it's harder form some people to access the procedure because of where they live.

Associate Health Minister Dr Ayesha Verrall said abortion services are an essential part of women having control over their fertility. She told RNZ she expects to see continuous improvements in the way those services are provided by DHBs across the country.

DHBs need to take responsibility for providing equitable services for people within their catchments, Dr Verrall said, but they should know she is watching their progress closely, as is the Ministry.

Dr Verrall said it's "fantastic" that since the Abortion Legislation Act came in to force in March, some DHBs have reported reduced delays and more equitable services.

Dr Ayesha Verrall

Dr Ayesha Verrall Photo: supplied

In March this year, the Abortion Legislation Act was given royal assent, replacing legislation that was more than 40 years old and treated the medical procedure as a crime.

The law change meant a health practitioner could provide abortion services when prior to this, two specially licenced doctors were required to approve the procedure first, based on strict criteria stipulated in the Crimes Act. People can also now self-refer to abortion services, where previously referrals were made by a GP.

The law change also means early medical abortion pills - which are usually taken between 24 and 48 hours apart - no longer need to be taken on the premises of a licenced abortion clinic.

Under the previous law, the need to visit a clinic at least twice to take the pills could mean a woman had to take more time off work or school, and incur additional travel and costs for things like accommodation and childcare, Parliament's Abortion Legislation Committee found.

In 2018, Auckland's National Women's Health service raised concerns about the inequitable uptake of early medical abortions in its annual clinical report: "Young Māori and Pacific women were less likely to access medical abortions, which is of concern because these women are already at increased risk of preterm birth for which surgical abortion is a risk factor."

But since the law change, some DHBs have seen an increased uptake of early medical abortions among Māori, Pacific and young people the ministry's survey found. Dr Verrall said early medical abortions were more desirable in many cases, both for women and from a clinical perspective.

Law reform has also meant that in some cases medication can be couriered to a person after an in-depth telephone consultation with a healthcare provider, removing the need for travel at all.

Currently, four of New Zealand's 20 DHBs provide the service, and three say they are looking into, or working on providing it.

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Dr Helen Paterson Photo: infogram

The Ministry of Health survey viewed by RNZ is the first of its kind since law reform decriminalised the procedure. Prior to this, the Ministry of Justice oversaw the administration of abortion services.

Dr Verrall said the law change allowed abortion to be treated as a health issue, meaning the Health Ministry could focus on systematic improvements to access across the country, could monitor DHBs, and could take an active role in solving any problems they encountered.

But the ministry survey also noted concerns within some DHBs about a lack of staff trained to provide abortion services.

Dr Helen Paterson, an obstetrician and gynaecologist who chairs the Abortion Providers Group Aotearoa, shares those concerns.

"There has been no training at formal abortion training in New Zealand [in the past], it's all been through an apprenticeship model."

Dr Paterson said the New Zealand College of Sexual Reproductive Health was soon to release an early medical abortion online training module for practitioners. But more funding needed to come with the law change so DHBs could get staff trained to do the procedures.

Otherwise, gaps in areas where services weren't available would remain, she said.

"We don't want to end up with a two-tiered system where if you're rich and well off, you can get your abortion closer to home or through telemedicine, but if you're not, you have to go with what the funded option is."

Dr Helen Paterson

Dr Helen Paterson Photo: Supplied

Three DHBs still do not offer some, or any abortion services locally - Waitematā and Counties Manukau in the Auckland Region and West Coast DHB in the South Island. This means people living in those areas who require an abortion need to travel to another DHB catchment.

None of those three DHBs offer early medical abortions via telemedicine - though the Canterbury DHB, which provides abortion services for the West Coast, says it "is a method of delivering medical abortions that we are exploring."

The cost of accessing abortion by telemedicine privately can be close to $1000.

Dr Verrall told RNZ that the Health Ministry was engaged with various professional groups who could offer training to their members at a national level, so that workforce issues faced by DHBs could be resolved.

Regarding variations in later gestation abortion services offered across DHBs, Dr Verrall said planning around surgery was not done by the Ministry. But she said the government was looking to set national standards regarding where services should be provided as part of its Health and Disability System review.

At present, the cut-off point for local abortion services varies from nine to 18 weeks' gestation, after which people may need to travel to another DHB catchment for the procedure.

By law, a qualified health practitioner can provide an abortion to anyone who is up to 20 weeks pregnant. After 20 weeks, the health practitioner must consult with another qualified health professional to decide whether it is clinically appropriate.


Abortion services - DHB quarterly survey key points:

  • Some DHBs noted greater access to early medical abortions since the Abortion Legislation Act passed.
  • Some DHBs noted the Act improved equitable access or outcomes for young people and Maori and Pacific people, who previously had a low uptake of early medical abortion compared to surgical abortions.
  • Since the law change, surgical abortions are available at earlier gestations in some DHBs, as there are fewer delays.
  • DHBs that use telehealth services have reduced the number of visits required.
  • Most DHBs have implemented or are implementing self-referral processes.
  • Some DHBs don't offer any, or offer only limited abortion services within their catchments.
  • There is significant variation between DHBs in terms of what services are provided within their region.
  • Many DHBs raised issues related to the availability of appropriate staff.
  • Some DHBs raised the need to train and upskill staff, especially in locations where abortion services were not previously provided.
  • Some DHBs want Ministry of Health support for staff training and employment.

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