Aotearoa must be vigilant after Roe v Wade

Roe vs. Wade has fallen and while state-level abortion laws remain, the US constitutional right to an abortion is gone.

We want to talk about the ripple effects of this decision in Aotearoa and how despite the recent abortion law reform we still have much to be vigilant about, particularly from a social work perspective.

Reproductive justice is essential in the fight against health inequalities.

National leader Christopher Luxon has said several times he wouldn’t make any changes to the existing law, something four of the Supreme Court judges also said before changing their minds.

In a more recent statement, Luxon claims, “These laws will not be relitigated or revisited under a future National government.” Does he really mean any future National government? That’s certainly not something he can or should guarantee. Further he states “these health services will remain fully funded”.

There are ways to make abortion harder that don’t involve changing the law. National’s health spokesperson, Shane Reti, said he would be interested to see how Roe vs Wade would influence the situation in New Zealand; he wouldn’t rule out any restrictions on abortion access because that would be “a matter for caucus”. Well we know who is in that caucus - a bunch of people who oppose abortion.

Let’s look at what reducing funding could look like, i.e. if Luxon were to renege on that promise. Under our new health system, abortion services will be primarily funded by Health NZ, the new overall agency replacing DHBs.

This will give the government greater control over which services are funded, compared to the devolved DHB system. For example, abortion services could be removed from the Service Coverage Schedule, which would remove the requirement/expectation for funding. Subsequent budget bids for abortion services could be turned down or approved at an inadequately low level.

Under the DHB system, DHBs were required to fund services rather than provide them. This meant several of them contracted out service provision to Family Planning NZ or The Women’s Health Clinic. These contracts will be transferred to Health NZ in the new system.

As external contracts they are especially vulnerable to simply not being renewed. This would leave regions including Tauranga (Family Planning), Mid-Central DHB, Whanganui DHB, Wairarapa DHB and Southern DHB (The Women’s Clinic) without local services.

The Ministry of Health has also contracted the New Zealand College of Sexual and Reproductive Health (NZCSRH) to develop new training packages for new and current abortion providers, with the cost of undertaking the course included. Funding of this training could be discontinued.

Travel and accommodation costs for those needing to travel to have an abortion are currently supposed to be reimbursed. While this situation is not good enough, it could be made even more difficult if these costs weren’t reimbursed at all.

The national abortion telehealth service, DECIDE, is centrally funded by the Ministry of Health until 2024. This service could be scrapped or the contract not renewed.

Also a mechanism to pay GPs and other primary care health practitioners hasn’t yet been established in the new health system. This is one of those long-standing issues that we would expect to simply continue to be unresolved under an anti-abortion government.

Further, Crisis Pregnancy Centres and other organisations that actively seek to disrupt the provision of abortion services could receive more funding. This could potentially include anti-abortion ‘counselling’. The current requirement is that counselling must be offered but can’t be mandatory. However, there isn’t a requirement that it needs to be unbiased.

Aside from funding, there are regulatory issues as well; for example, requiring all abortion providers to meet the standards for abortion in the Ngā Paerewa Health and Disability Services Standard NZS 8134:2021.

This was a big issue for providers during consultation on the new standards because it would essentially function like a series of ‘targeted regulation of abortion providers’ laws if it applied to all providers.

These laws make it much harder to run clinics due to increasingly onerous and time-consuming patient ‘safety’ requirements. It currently only applies to abortion services that meet the definition of hospital level care, i.e., intending to provide care for two or more people simultaneously for 24 hours or longer.

However, through the Health and Disability Services (Safety) Act 2001, the Minister of Health can recommend that any service be subject to these standards, many of which are not possible for small clinics or independent health practitioners to implement.

Another fish hook could be safe area applications for abortion clinics not being approved by the Ministry of Health. The ministry could also introduce burdensome and time-consuming reporting requirements for clinics, meaning they can see fewer patients. The could also change requirements via the New Zealand Aotearoa Abortion Clinical Guidelines.

For example, currently pregnancy needs to be confirmed by urine or serum hCG or ultrasound. Ultrasound could be made mandatory, which would increase travel requirements in rural areas and make abortion via telehealth (pills) provision more difficult.

There could also be changes to medicine regulation. In 2021 it became possible for medications to be provided outside of hospitals, but there’s the potential for this to be reversed when the Therapeutic Products Bill is introduced.

And further non-legislative guidance or surveillance around sex-selective abortions could be introduced. This is a difficult one because the government is required to monitor and report on sex-selective abortions in New Zealand at least every five years (next report due before 2025), and make any recommendations necessary to prevent them.

We're urging social workers to take a strong stand on reproductive justice as it’s essential in the struggle to remove health inequalities. We also want to make it very clear that reproductive justice means including all genders. Abortion activism and access to abortion must include all people who can get pregnant.

The anti-choice movement has progressed its agenda by spreading misinformation about abortion. It is imperative that the facts are broadcast everywhere.

There are numerous ways that even so-called 'settled law' can be undermined by funding and access barriers.