by Melanie Gibson, Ngaire Sparkes, EJane MacDonald, Michelle Wise, Emma MacFarlane, Helen Paterson, Wendy Dallas-Katoa, Bev Lawton, Tania Slater
Contraception Volume 156, April 2026, https://doi.org/10.1016/j.contraception.2025.111314
Open access
Abstract
Objective: To explore how people are experiencing abortion care in Aotearoa New Zealand (Aotearoa) following decriminalization in 2020 and to identify aspects of equitable and accessible abortion care.
Study Design: An observational, mixed-methods study advertised at abortion services in Aotearoa (January-November 2023). All people aged ≥ 14 years attending abortion services were eligible for an anonymous survey. Wāhine Māori (Māori women) and Pacific women accessing abortion services since the law reform, and their families, also took part in qualitative interviews to privilege their voices. Māori and Pacific researchers undertook the interviews, underpinned by Kaupapa Māori and Pacific research methodologies. Main outcome measures were aspects of equitable and accessible abortion care identified by participants.
Results: 126 surveys and seven interviews were conducted. Among surveyed participants, 52/126 (41.3%) self-referred to an abortion service and this best suited 23/40 (57.5%). The abortion occurred within a week of the first appointment with the abortion service for 103/123 (83.7%) and no participant wanted more time. Interviewees not knowing about self-referral or encountering delays expressed frustration and distress. Almost all participants (124/126, 98.4%) had private and safe access to a mobile phone, but fewer to the internet (107/126, 84.9%) or space for telehealth appointments (77/126, 61.1%). Interviewees considered a private space for early medication abortion (EMA) essential.
Conclusions: People highly value self-referral, timeliness and choice between in-clinic abortion care or EMA at home, which reduce barriers to accessing abortion services. Protecting and further implementing these strategies are likely to contribute to achieving equitable and accessible abortion care.
Implications
We aimed to identify aspects of equitable, timely, safe, and accessible abortion services in Aotearoa. The findings suggest that many steps have been taken towards achieving accessible and equitable abortion care in Aotearoa. However, strategies and activities to protect and further implement high-quality abortion care are needed.
From the Introduction
Aotearoa New Zealand (Aotearoa) decriminalized abortion in March 2020. The law governing abortion provision was removed from the Crimes Act and introduced to the Health Act. The intent of the law change was to reduce barriers to accessing abortion services. Prior to the law reform, women identified inequitable geographical access to abortion care, obstruction from practitioners with conscientious objections, and a lack of timely care as major barriers. Key law changes introduced the freedom to self-refer to an abortion service, removed clinical and statutory criteria before 20 weeks’ gestation, allowed a greater range of health practitioners (such as general practitioners (GPs), nurses, and midwives) to provide abortions, and no longer restricted abortion provision to licensed premises, enabling settings such as primary care and telehealth. Statutory clinical criteria must be met for abortions after 20 weeks’ gestation. Practitioners with conscientious objections must tell the person of their objection at the earliest opportunity, and how to access the closest abortion provider. The vision of the Ministry of Health is for abortion services in Aotearoa to be accessible, equitable, person-centered and high-quality. This aligns with the World Health Organization healthcare quality dimensions: effective, safe, person-centered, timely, equitable, integrated and efficient.
Keywords: abortion, adolescent health, health equity, indigenous peoples, Māori, rural health