Abstract
Background
The introduction of the Abortion Legislation Act 2020 in Aotearoa, New Zealand, removed legal restrictions to abortion up to 20 weeks’ gestation. However, barriers to abortion remain, especially for those living rurally, Māori, Pacific, LGBTQI+ people, and people living with disabilities.
Aim
To determine how optimal first-trimester abortion care can be provided in Aotearoa New Zealand post-law reform.
Methods
This thesis comprises four studies, each informing the next. The first study involved an electronic survey to determine what skills health practitioners have to provide first-trimester abortion care in Aotearoa and whether they were willing. This was followed by a second study using qualitative interviews with health practitioners to understand the nature of the journey for people accessing first-trimester abortion. This led to interviews with women/pregnant people who had recently accessed first-trimester abortion care to appreciate their experience. The final study was a case study which explored nurse provision of early medical abortion (EMA) in a rural primary care practice.
Results
Health practitioners in Aotearoa possess a range of clinical skills and the willingness to provide first-trimester abortion care. Analysis of interview data from health practitioners identified barriers to abortion care in Aotearoa and suggested strategies to overcome these. The study with abortion consumers also identified barriers to abortion care. It provided a nuanced view into the decision-making processes for people considering abortion and the importance of having an advocate. The final component demonstrated the successful provision of nurse-led EMA in primary care to facilitate access to first-trimester abortion.
Conclusion
Integration of EMA into the primary care sector, provided by a range of suitably trained and supported health practitioners, is a solution to increasing access to first-trimester abortion. For this to happen, the primary care sector requires support from secondary services and appropriate resourcing. Increasing abortion access at the primary care level may go some way to reducing abortion stigma, which is a significant barrier to optimal abortion care and needs to be addressed at multiple levels of society.