Reproductive justice: Improving access to abortion services in Aotearoa New Zealand

<p>With the recently introduced Abortion Legislation Bill 2019, 2020 could be the year that Aotearoa decriminalises abortion. The Bill, if passed, would remove abortion from the Crimes Act 1961 and treat it, instead, as a health issue. Current legislation has been heavily critiqued for undermining patients’ human rights to healthcare and bodily autonomy, causing lengthy delays in treatment, and contributing to stress. Access to abortion is unequal for different members of society, particularly for those who face socioeconomic disadvantages, are marginalised, rural, Māori, religious, migrant, or a combination thereof. Factors that obstruct access may be legal, geographical, socioeconomic, cultural and societal. Additionally, stigma, the lack of availability of willing abortion practitioners, and conscientious objection represent significant barriers. Improving access to abortion would assist in the achievement of reproductive justice and Aotearoa’s national and international agreements, such as Te Tiriti o Waitangi and the United Nation’s Sustainable Development Goals. This study explores how access to abortion can be improved, particularly for the most disadvantaged, whether or not the law changes. It aims to contribute to improved and more equitable access to abortion services. Undertaken from a social constructivist and transformative epistemology, semi-structured interviews were conducted with 13 abortion providers, academics and advocates, as they are the knowledge-holders of abortion access. The research is guided by the framework of reproductive justice, which recognises every aspect which may hinder or empower a person’s right to control their fertility. The study found that decriminalisation and telemedicine have the greatest potential to improve access to abortion in Aotearoa, particularly for the most disadvantaged. Other ways to improve access, regardless of law change, include improved cultural competency, efforts to reduce stigma, changes to conscientious objection, and integrated services. Decriminalisation would assist in improving access to abortion and making advancements towards reproductive justice and human rights. However, questions remain over the future of funding, training and access.</p>

Reproductive justice: Improving access to abortion services in Aotearoa New Zealand

<p>With the recently introduced Abortion Legislation Bill 2019, 2020 could be the year that Aotearoa decriminalises abortion. The Bill, if passed, would remove abortion from the Crimes Act 1961 and treat it, instead, as a health issue. Current legislation has been heavily critiqued for undermining patients’ human rights to healthcare and bodily autonomy, causing lengthy delays in treatment, and contributing to stress. Access to abortion is unequal for different members of society, particularly for those who face socioeconomic disadvantages, are marginalised, rural, Māori, religious, migrant, or a combination thereof. Factors that obstruct access may be legal, geographical, socioeconomic, cultural and societal. Additionally, stigma, the lack of availability of willing abortion practitioners, and conscientious objection represent significant barriers. Improving access to abortion would assist in the achievement of reproductive justice and Aotearoa’s national and international agreements, such as Te Tiriti o Waitangi and the United Nation’s Sustainable Development Goals. This study explores how access to abortion can be improved, particularly for the most disadvantaged, whether or not the law changes. It aims to contribute to improved and more equitable access to abortion services. Undertaken from a social constructivist and transformative epistemology, semi-structured interviews were conducted with 13 abortion providers, academics and advocates, as they are the knowledge-holders of abortion access. The research is guided by the framework of reproductive justice, which recognises every aspect which may hinder or empower a person’s right to control their fertility. The study found that decriminalisation and telemedicine have the greatest potential to improve access to abortion in Aotearoa, particularly for the most disadvantaged. Other ways to improve access, regardless of law change, include improved cultural competency, efforts to reduce stigma, changes to conscientious objection, and integrated services. Decriminalisation would assist in improving access to abortion and making advancements towards reproductive justice and human rights. However, questions remain over the future of funding, training and access.</p>

Barriers to Abortion in the Autonomy-Based Danish Legal Model

In 2016, the Committee on Economic, Social and Cultural Rights adopted General Comment 22 on the right to sexual and reproductive health, which affirmed that states are obliged to adopt “appropriate legislative measures” to achieve the full realization of sexual and reproductive health and rights. It affirmed that the right to sexual and reproductive health is an integral part of the right to health and recognizes abortion services as a component part of the right to health. While a liberal legislation is in itself a step towards the realization of this obligation, in this article we explore a number of potential barriers to abortion access in an autonomy-based legal model using the Danish legal model as the case study.

The Potential of Self-Managed Abortion to Expand Abortion Access in Humanitarian Contexts

Refugees and displaced people face uniquely challenging barriers to abortion access, including the collapse of health systems, statelessness, and a lack of prioritization of sexual and reproductive health services by humanitarian agencies. This article summarizes the evidence around abortion access in humanitarian contexts, and highlights the opportunities for interventions that could increase knowledge and support around self-managed abortion. We explore how lessons learned from other contexts can be applied to the development of effective interventions to reduce abortion-related morbidity and mortality, and may improve access to information about safe methods of abortion, including self-management, in humanitarian settings. We conclude by laying out a forward-thinking research agenda that addresses gaps in our knowledge around abortion access and experiences in humanitarian contexts.