ASMS

Working for better health care in New Zealand

The Association of Salaried Medical Specialists (ASMS) is the professional association and union uniting doctors and dentists in New Zealand.

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Abortion law reform: what it means for us

18 June 2020 Dr Beth Messenger - National Medical Advisor, Family Planning

After more than 40 years of an abortion law that put unnecessary legal barriers between women and their health providers, New Zealand has finally righted a wrong and introduced a new legal framework so abortion can be treated as a health issue, not a criminal one. So, what does this mean in practice? What does it mean for the thousands of women and pregnant people who seek abortions each year due to an unintended pregnancy? What does it mean for health care providers?

It means a lot.

It means that for women seeking an abortion, they can now ring the Ministry of Health’s Abortion Information line on 0800 499 500 or visit their website and find out where the nearest provider is to them. They can call that provider directly to ask for an appointment. They won’t have to first try to get a referral from a doctor who may or may not have a conscientious objection to abortion.

It means that when a woman sees a health practitioner to have an abortion before 20 weeks, she won’t need to prove that she is mentally fragile. She won’t feel terrified that she might not be granted one. There are no legal tests to pass. The law now reflects that people have abortions for a broad range of personal reasons, and their ability to make the decision for themselves should be respected.

It means that women will have fewer appointments, so they will be able to have abortions earlier, which is safer for them. With proper funding and regulation, New Zealand should become more like other similar countries where the vast majority of abortions happen before the 10th week of a pregnancy.

These positive changes aside, some of the promise of the new law will only be realised if the Ministry of Health ensures funding to integrate abortion into other primary care, specifically sexual and reproductive health care. Under the new law, a range of providers, like Family Planning nurses and doctors can be trained to provide abortions, particularly early medication abortion (EMA), but they need to be funded to provide this service in order to be able to expand where we provide abortions. Right now, we only provide them in our Tauranga clinic because that is the only place where a DHB would contract us so we could obtain a license. While there is no longer a requirement to have a specific license for abortion care, we will only be able to expand funded abortion services to clinics outside of DHBs if we are supported by the Ministry of Health to do so. If abortion funding simply remains with current providers, then equitable access will not expand.

With abortion now regulated like other health issues, the new law applies to health practitioners, such as nurse practitioners and midwives as well as doctors. The new law should mean less fear and stigma for health practitioners who provide abortions. They will be expected to adhere to good practice guidelines and ethical standards as they do for any health issue, but difficulties around interpreting antiquated legal criteria have been removed. Hopefully more health practitioners will access training, so they are able to provide this essential reproductive health care.

Our expectation is that access to abortion should further expand under the new law. PHARMAC has already consulted on a proposal to expand funded access to abortion medications misoprostol and mifepristone so early medical abortion can be provided in primary care. This is a positive step forward. The medicine should be added to prescribing lists for nurses, so that Family Planning nurses and others who are registered nurse prescribers, providing sexual and reproductive health care services could also prescribe early medication abortion medication independently.  Other countries have shown that nurses as well as midwives are well-suited to deliver high quality abortion care. Indeed, the early medical abortion service we have offered at our Tauranga clinic since 2013 is predominantly a nurse delivered service.

The new law means that when women encounter a health practitioner who has a conscientious objection to abortion instead of just being told they can get services somewhere else, they must be told how to get the contact details of another provider closest to them. While this still leaves barriers to accessing these services, it puts slightly greater emphasis on the needs of the patient.

The law makes a few other important changes. For example, this new law may help improve access to contraception. Last year, the Ministry of Health released information about contraceptive use in New Zealand based on the 2014/2015 Health Survey. The last time we had any national data on contraceptive use was in 1999 – that is 20 years ago. It is not surprising that there are significant gaps in access to contraception in New Zealand. Policy and funding decisions have been made in the absence of reliable data. This all changes under the new Law because the Ministry of Health is now required to report on equitable access to contraception, sterilisation, and abortion every five years. This will provide us with important information to improve contraceptive contracting and service provision.

The law, unfortunately, did not address one significant issue – safe zones. With at least one Member of Parliament encouraging anti-choice activists to keep fighting during the Bill’s debate, it is likely that protest activity at abortion services will continue and could possibly get worse. The first test of this oversight is likely to be soon with a series of nationwide anti-choice vigils planned for 20 June.  However, if protest activity ramps up, it is an issue which may need to be revisited. As another MP said, it isn’t an issue of free speech as anti-choice protestors could gather at Parliament or other government offices to express themselves. Gathering at abortion services is about harassing and intimidating clients and providers. This is unacceptable and curtails rather than advances people’s rights.

In addition to all the real, practical changes for people seeking abortion and the health care workers providing this service, the new law is also symbolic. Women and pregnant people did access abortions under the old legal framework and health care workers provided them. But removing abortion from the Crimes Act and treating it as a health issue acknowledges the right of women and pregnant people to make decisions about a pregnancy, and consequently, about their lives and future. Reproductive decisions are human rights and fundamental to good health and wellbeing.