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Improving Access to Abortion Services in Aotearoa New Zealand

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Improving Access to Abortion Services in Aotearoa New Zealand REPRODUCTIVE JUSTICE: IMPROVING ACCESS TO ABORTION SERVICES IN AOTEAROA NEW ZEALAND Penelope Downing A thesis submitted to Victoria University of Wellington in partial fulfilment of requirements for the degree of Master of Development StuDies School of Geography, Environment and Earth Sciences Victoria University of Wellington March 2020 Abstract 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. Keywords: abortion, access, Aotearoa, law change, reproductive justice. Trigger warning: This thesis mentions violence, rape, and coercion. i Acknowledgements I expected to spend a year writing a thesis. Instead, I found more time than I could possibly imagine for friendships, personal development, love, adventures and breakdowns. It sure was a year, the hardest of my 25 years to date. To my participants, for your expertise, support, encouragement, honesty, excitement and invitations. I am immensely grateful, and I hope this thesis serves you in some way on the path to equitable access. To Polly Stupples and John Overton, for your support over the years, from study, to job and scholarship support, to being supportive and flexible around the hard times. For staying ever encouraging, optimistic, focused and realistic, even when I struggled to be. To my wonderful, fun, loving supportive community. For the soul chats, walks, activism, beers, dinners, surprises, rock climbs, quizzes, runs, swims, events, dances, calls, camps, and clothing swaps. Most of all, for the conversations over cups of coffee. I would not be where I am without your support and encouragement. Special shout out to Catherine, Emma and Nick, my friends in Development and Environmental Studies, Cook Watch 655, Something Woke, flatties, and my international pals, especially those who came to visit Aotearoa! And I would love to give a particular shout out also to Lucy, Bridget and Lauren, Mel, Isabella, Payal, Carlie and Chantelle, for the times you went over and above for me, which were often and unforgettable. Thank you sincerely. To my family, for the love, support, banter and the constant “mhmm-ing” when I went on my rants about inequality and justice. Especially to my Dad, for taking phone-calls when I didn’t know how to adult, proof-reading, visiting Wellington, and acting as a personal life coach. To Lucy Croft, for your endless patience, love and support. For being one of my favourite humans. For being a cousin, a best friend, and a soul-sister all in one. For looking after me when I struggled to look after myself during 2019. For your advice, your puns and your fun. And for voluntarily proof-reading a thesis on abortion. For your washing machine when I lived in the van, your cuddles and ii sofa when it broke down (often), your flat’s kindness and furnishing of my room when I decided to find a home. Legendary. To my workplaces over the last 2 years: UNICEF, the Sustainability Trust, the Wellington Women’s Health Collective, and Etta, for giving me the opportunities to grow in NGO and community roles which I have loved and cherished. It’s been a blast. To Graduate Women Wellington, thank you for your generous scholarship to help complete this thesis. I am very grateful. To the various organisations that supported me through the storms. I am eternally grateful. Finally, to Outward Bound, for generously providing me with a scholarship to attend when I should have been writing a thesis. It was life changing. With gratitude, Penny iii Table of Contents Abstract .......................................................................................................... i Table of Contents ......................................................................................... iv List of Tables ............................................................................................... vii List of Figures .............................................................................................. vii Chapter 1: Introduction to research ............................................................... 1 1.1 Introduction ...................................................................................... 1 1.2 Abortion as a development concern in Aotearoa ............................. 6 1.3 Research aims ................................................................................. 7 1.4 Research methodology .................................................................... 7 1.5 Research questions ......................................................................... 9 1.6 Chapter summary ............................................................................. 9 Chapter 2: Abortion in development ............................................................ 11 2.1 Chapter introduction ....................................................................... 11 2.2 Development: safe and legal abortion in ‘developed’ countries? ... 12 2.2.1 Barriers to, and inequalities in, abortion access ......................... 12 2.2.2 Global abortion statistics ............................................................. 15 2.2.3 Gender and development ........................................................... 16 2.2.4 United Nations international development agreements .............. 18 2.2.5 Abortion access: the links between human rights, healthcare, bodily autonomy and decriminalisation ................................................. 23 2.2.6 Reproductive justice ................................................................... 25 2.3 Chapter summary ........................................................................... 27 Chapter 3: Decriminalisation, potential futures and improving access ........ 28 3.1 Chapter introduction ....................................................................... 28 3.2 Improving access with decriminalisation: the examples of Australia and Canada ............................................................................................. 28 3.3 Improving access with primary-care ............................................... 32 3.4 Improving access with telemedicine ............................................... 33 3.5 Improving access via cultural competency .................................... 34 3.6 Chapter summary ........................................................................... 35 Chapter 4: The Aotearoa abortion context: history, legislation, access and proposed changes ....................................................................................... 36 4.1 Chapter introduction ....................................................................... 36 4.2 Aotearoa abortion statistics ............................................................ 36 4.3 Proposed changes to abortion legislation 2020 ............................. 37 4.4 History of abortion in Aotearoa ...................................................... 40 4.5 Current abortion legislation ............................................................ 43 4.6 Critiques of Aotearoa’s abortion laws ............................................ 44 4.7 Delays to accessing services ......................................................... 48 4.8 Barriers to abortion access in Aotearoa ......................................... 49 4.9 Public opinion on abortion .............................................................. 50 4.10 Abortion providers .........................................................................
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