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ABSTRACT
New Zealand achieved a major sexual reproductive health and rights milestone when abortion ceased to be a crime. Introduction of the Abortion Legislation Act 2020 has significantly changed the way abortion care can be provided in New Zealand, with the potential to improve access, reduce inequities and transform the abortion experience for those people who choose to end their pregnancy. The primary care sector stands to be a key player in the provision of first-trimester abortion care. However, with issues relating to funding, training and access to medications yet to be resolved, the health sector is not yet ready to provide best-practice abortion care within the new legislative framework.
On 23 March 2020 the Abortion Legislation Act (AL) 2020 was passed into law with the result that abortion in New Zealand is no longer a crime.1 There is now scope for qualified health practitioners to provide abortion care that is evidence based, aimed at reducing inequities in access and more acceptable to pregnant people and their whanau. However, in almost 12 months since the law reform, little has changed in the way that abortion services are configured, and we are yet to realise the full extent of abortion care within a decriminalised environment.
A review of the literature was undertaken using the databases Medline and Google Scholar. The following key words were used: abortion, abortion law reform, primary care, mid-level health providers. Any references of papers identified through the literature review that seemed relevant were located and considered for inclusion in the review. This review includes relevant New Zealand legislation and standards and international recommendations on provision of abortion in primary care. The aim of this paper is to review the international literature to inform how optimal, first-trimester abortion care can be provided in the primary care setting post abortion law reform in Aotearoa New Zealand.
Background
Abortion is one of the most common gynaecological procedures, and one in four women internationally will have an abortion in their lifetime.2 For the year ending 2019 the general abortion rate in New Zealand was 13.5 abortions per 1,000 women (pregnant people) aged 15-44, and 19% of all known pregnancies ended in abortion.3 The term 'woman' is used by the AL Act. We consider this to...