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Liz Beddoe and Eileen Joy look at the potential consequences for New Zealand of the US Supreme Court’s decision on abortion, and find numerous ways in which even so-called ‘established law’ can be undermined by funding and barriers to entry.
Roe vs. Wade failed and while abortion laws exist at the state level, 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 reform of the abortion law, we still have a lot to be vigilant about, especially from a social work perspective.
Reproductive justice is essential in the fight against health inequalities.
National leader Christopher Luxon has repeatedly said he will not make any changes to the existing law, something four of the Supreme Court justices also said before changing their minds.
In a more recent statement, Luxon stated, “These laws will not be reconsidered or revisited under a future national government.” Does he really mean any future National Government? This is definitely not something he can or should guarantee. He added that “these health services will remain fully funded”.
There are ways to make abortion more difficult that do not involve changing the law. National’s health spokeswoman Shane Reti said he would be interested to see how Roe vs. Wade will affect the situation in New Zealand; he will not rule out any restrictions on access to abortion, as it will be “a matter for caucus”. Well, we know who’s in that caucus – a bunch of people who oppose abortion.
Let’s see what the reduction in funding might look like, that is, if Luxon were to relinquish that promise. Under our new healthcare system, abortion services will be funded primarily by Health NZ, the new overall agency that replaces DHBs.
This will give the government greater control over what services are funded, compared to the returned DHB system. For example, abortion services can be removed from the Service Coverage Schedule, which will remove the requirement / expectation for funding. Subsequent budget offers for abortion services may be rejected or approved at an insufficiently low level.
Under the DHB system, DHBs were required to fund services rather than provide them. This meant that several of them outsourced service delivery 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 particularly vulnerable to simply not being renewed. This will 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, including the cost of the course. Funding for this training may be discontinued.
Travel and subsistence expenses for those who have to travel to undergo an abortion are currently supposed to be reimbursed. Although this situation is not good enough, it can be made even more difficult if these costs are not reimbursed at all.
The national abortion telecom health service, DECIDE, is centrally funded by the Ministry of Health until 2024. This service can be scrapped or the contract not renewed.
Also, a mechanism to pay general practitioners and other primary care health practitioners has not yet been introduced in the new health system. This is one of those long-standing issues that we would expect to remain simply unresolved under an anti-abortion government.
In addition, Crisis Pregnancy Centers and other organizations actively seeking to disrupt the provision of abortion services may receive more funding. This could possibly include ‘counseling’ against abortion. The current requirement is that counseling be offered, but it may not be mandatory. However, there is no requirement that it be unbiased.
Apart from funding, there are also regulatory issues; for example, requires all abortion providers to comply with the standards for abortion in the Ngā Paerewa Health and Disability Services Standard NZS 8134: 2021.
This was a major issue for providers during consultation on the new standards, as it would essentially function as a series of ‘targeted regulation of abortion providers’ laws if applied to all providers.
These laws make it much more difficult to operate clinics due to increasingly burdensome and time-consuming patient ” safety requirements. It currently only applies to abortion services that meet the definition of hospital-level care, that is, with the intention of providing 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 may 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 fishing hook could be safe area applications for abortion clinics that are not approved by the Ministry of Health. The ministry can also impose cumbersome and time-consuming reporting requirements for clinics, meaning they can see fewer patients. The requirements may also change via the New Zealand Aotearoa Abortion Clinical Guidelines.
For example, currently, pregnancy must be confirmed by urine or serum hCG or ultrasound. Ultrasound can be made mandatory, which will increase travel requirements in rural areas and make abortion through telecom health (pills) provision more difficult.
There may also be changes to medication regulation. In 2021, it became possible for medicines to be provided outside hospitals, but there is the potential for this to be reversed when the Therapeutic Products Bill is introduced.
And further non-legislative guidance or oversight of sex-selective abortions can be instituted. 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 must be before 2025) and make any recommendations necessary to do so. to prevent.
We call on social workers to take a strong stand on reproductive justice, as it is essential in the fight to remove health inequalities. We also want to make it very clear that reproductive justice means that all generations are included. Abortion activism and access to abortion should include all people who may become pregnant.
The anti-choice movement has advanced its agenda by spreading misinformation about abortion. It is essential that the facts are broadcast everywhere.
There are numerous ways in which even so-called ‘established law’ can be undermined by funding and access barriers.