The journey of people accessing first trimester abortion in Aotearoa New Zealand: health consumers' perspectives.

Abstract

Introduction: Aotearoa New Zealand (NZ) achieved abortion law reform in 2020, allowing people to choose abortion without legal restriction up to 20 weeks gestation. Abortion can now be provided by a range of health practitioners in a variety of settings. While some progress has been made, we are yet to see abortion care being provided within the full extent of the law.

Aim: To describe the journey of people accessing first-trimester abortion care in NZ to identify how abortion services can be developed to deliver optimal first-trimester abortion care.

Methods: This was a qualitative study informed by phenomenology. Participants were recruited via a separate national survey to participate in in-depth interviews. Analysis was undertaken using a reflexive inductive approach to identify themes.

Results: Seven people were recruited. Analysis revealed four themes: (1) decision making (to have an abortion, choice of method, and coercive contraceptive decision making); (2) barriers to access (abortion service navigation, lack of access in rural areas including requirement to travel, abortion requirements); (3) abortion as a societal issue (abortion is isolating, 'slut-shaming', abortion is the taking of a life); and (4) empathy and advocacy.

Discussion: Despite decriminalisation of abortion in NZ, barriers remain. Work is required to improve access to accurate and non-judgemental information to inform decision-making. People value kind, non-judgemental clinicians and supportive whanau/friends play a major role in optimising the experience. Abortion stigma persists and has a negative impact on the abortion experience. Abortion services need support to ensure they are responsive to the needs of health consumers and reduce barriers to care.