October 2018 Wellington, New Zealand Alternative approaches to abortion law Ministerial briefing paper ALTERNATIVE APPROACHES TO ABORTION LAW MINISTERIAL BRIEFING PAPER ADDENDUM The Commission notes that the Termination of Pregnancy Bill 2018 (Qld) was passed by the Queensland Parliament on 17 October 2018, shortly after this ministerial briefing paper was finalised for printing. The Law Commission | Te Aka Matua o te Ture is an independent, publicly funded, central advisory body established by statute to undertake the systematic review, reform and development of the law of New Zealand. Its purpose is to help achieve law that is just, principled, and accessible, and that reflects the heritage and aspirations of the people of New Zealand. The Commissioners are: The Hon Sir Douglas White — President Donna Buckingham Belinda Clark QSO Helen McQueen The office of the Law Commission is at: Level 9, Solnet House, 70 The Terrace, Wellington 6011 Postal address: PO Box 2590, Wellington 6140, New Zealand Document Exchange Number: SP 23534 Telephone: 04 473 3453 Email: [email protected] Internet: www.lawcom.govt.nz A catalogue record for this title is available from the National Library of New Zealand. Kei te pātengi raraunga o Te Puna Mātauranga o Aotearoa te whakarārangi o tēnei pukapuka. ISBN: 978-1-877569-87-6 (Online) This title may be cited as NZLC MB4. This title is available on the internet at the Law Commission's website www.lawcom.govt.nz Copyright © 2018 New Zealand Law Commission. This work is licensed under the Creative Commons Attribution 4.0 International licence. In essence, you are free to copy, distribute and adapt the work, as long as you attribute the work to the Law Commission and abide by other licence terms. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/ Foreword This ministerial briefing paper has been prepared as a matter of priority under section 7(3) of the Law Commission Act 1985, at the request of Hon Andrew Little, the Minister of Justice. It provides advice on what alternative approaches could be taken in New Zealand’s legal framework if the Government decides to propose a policy shift to treat abortion as a health issue. The Commission has not conducted a full review of all aspects of abortion law and does not express a view on the appropriate policy approach. The Commission received input from the health sector and submissions from members of the public in developing its advice. I would like to express our gratitude to all who shared their expertise and views. I would also like to acknowledge in particular the advice and assistance provided by the Ministry of Health in facilitating the Commission’s consultation with health sector representatives. This briefing paper has been prepared by Belinda Clark and a team of the Commission’s legal and policy advisors. I thank them for their hard work. The Hon Sir Douglas White President 1 CONTENTS LAW COMMISSION Contents Abbreviations and terms ................................................................................................................ 5 Introduction ..................................................................................................................................... 7 The Minister of Justice’s request for advice .............................................................................................. 7 The Commission’s approach .............................................................................................................................8 Input from health professionals and the public ..........................................................................................8 Executive summary ....................................................................................................................... 11 1. Abortion law in New Zealand .............................................................................................. 15 Overview ......................................................................................................................................................... 15 Performing an abortion is a crime except in certain circumstances............................................ 16 It is an offence for a woman to procure her own miscarriage ...................................................... 18 It is an offence to perform an abortion without certification or outside a licensed institution ......................................................................................................................................................... 19 Abortion services are regulated under the Contraception, Sterilisation, and Abortion Act .................................................................................................................................................................... 20 2. Abortion in practice ............................................................................................................. 31 Introduction..................................................................................................................................................... 31 Key statistics .................................................................................................................................................. 31 Standards of care for women requesting abortion ......................................................................... 35 The abortion process ................................................................................................................................. 36 Culturally appropriate services ............................................................................................................... 44 Cost of abortion services .......................................................................................................................... 45 Methods of abortion ................................................................................................................................... 46 3. Wider legal context.............................................................................................................. 51 Introduction..................................................................................................................................................... 51 Human rights laws ........................................................................................................................................ 51 The Treaty of Waitangi and tikanga Māori ......................................................................................... 60 General health regulation .......................................................................................................................... 64 2 ALTERNATIVE APPROACHES TO ABORTION LAW: MINISTERIAL BRIEFING PAPER LAW COMMISSION PART ONE: ALTERNATIVE LEGAL MODELS FOR TREATING ABORTION AS A HEALTH ISSUE 4. Three models for when abortion would be lawful .............................................................. 75 Introduction ...................................................................................................................................................... 75 Model A .............................................................................................................................................................. 77 Model B ............................................................................................................................................................... 81 Model C .............................................................................................................................................................. 87 5. Law changes required for all three models ......................................................................... 93 Introduction ...................................................................................................................................................... 93 The grounds for abortion in the Crimes Act 1961 would be repealed .......................................... 93 The requirement for authorisation by two certifying consultants would be repealed ........... 95 PART TWO: OTHER ASPECTS OF ABORTION LAW 6. Criminal aspects of abortion law.......................................................................................... 99 Introduction ...................................................................................................................................................... 99 Abortion laws and professional standards can be enforced in a variety of ways ................. 100 General laws protect against unsafe medical practice .................................................................... 104 Reforming the criminal offences for abortion ..................................................................................... 108 Repealing the regulatory offences for breaching the current licensing and certification requirements ....................................................................................................................................................114 Ensuring compliance with the statutory test for abortion if Model B or C is adopted .......... 115 Ensuring abortions are only performed by qualified people ........................................................... 118 7. Access to abortion services ................................................................................................. 121 Introduction .....................................................................................................................................................