'Just get a clearer idea of who I am': LGBTQIA+ people's experiences of abortion care in Aotearoa New Zealand following law reform.

Sexual and reproductive healthcare (SRH) is recognised internationally as a human right, but inequities exist in both access to, and outcomes from, SRH in some populations. LGBTQIA+ people accessing abortion services can have harmful experiences related to embedded norms that construct abortion care as being for cisgender heterosexual women. In Aotearoa New Zealand, legislative reform has decriminalised and liberalised abortion care to improve access and reduce outcome inequities. We conducted semi-structured interviews with ten LGBTQIA+ abortion service users, aiming to understand from them what constitutes safe and accessible abortion care, and to examine how well newly reformed abortion services are serving this community. Our reflexive thematic analysis informed by the transformative paradigm identified three themes: navigating a double stigma to access abortion; invisibility as epistemic harm in abortion care; self-determining the abortion pathway as antidote. Findings demonstrated aspects of abortion services that were working well for LGBTQIA+ people, as well as harms resulting from gender and sexuality norms embedded in services that erase LGBTQIA+ people as service users. To meet LGBTQIA+ people's needs, abortion services should continue to offer flexible and multiple pathways into and through care but also need to develop strategies to address cis-heteronormativities across all service levels.