By Susan Strongman of RNZ
Local abortion services remain unavailable to people living in much of the sprawling South Auckland area - which has a population of close to 600,000 and encapsulates some of the most deprived suburbs of New Zealand - despite the issue being repeatedly raised for more than 12 years.
People living within the Counties Manukau District Health Board (DHB) catchment who need an abortion must travel to the affluent central Auckland suburb of Greenlane. Experts say this creates an access barrier for South Auckland women.
Financial barriers created by the lack of a local service can include the cost of travel, childcare and taking time off work. For people living in Counties Manukau, where the population is younger and more deprived than elsewhere in New Zealand, those costs can be significant.
The area is also home to a high number of Pacific peoples, of whom 64 per cent are "highly deprived", according to Health Ministry data. The Counties Manukau DHB describes Pacific peoples' engagement with and access to health services when they need them as "a challenge".
For 42 years, the Auckland District Health Board's Epsom Day Clinic, at Greenlane Clinical Centre, has been the only public hospital that provides first trimester abortion services for people living anywhere in the Counties Manukau catchment, which covers east and South Auckland from Ōtāhuhu to south of Port Waikato.
Concern about the lack of local abortion services in South Auckland was first raised in 2008 by the government-appointed Abortion Supervisory Committee during a visit to South Auckland.
In 2014, the issue was raised a second time by the committee during the licence renewal process, and a third time in its annual report.
"We are extremely concerned with the access issues of greater Auckland, particularly the burden placed on the women of South Auckland in relation to their access to local services," the report read.
In 2017, the committee described the situation in Auckland as "unacceptable and untenable with a climbing and sprawling population", and called for the establishment of a first trimester service in South Auckland.
Abortion was decriminalised in New Zealand in March. But in South Auckland, there is still no service.
For solo mum Amber*, accessing an abortion earlier this year meant an hour-long slog to Greenlane, then another hour back to her South Auckland home. The trip - which she had to make twice, for two appointments - cost her petrol and parking money, which she could barely afford.
Each time Amber took the motorway north to the clinic, she passed the East Tamaki off-ramp that leads to her local hospital, Middlemore, where she wishes abortion services were available. "It would've been much more convenient," she says.
Even before dealing with the drive out of Counties Manukau, Amber faced the challenge of arranging appointment times that coincided with her children being at school.
Once that was sorted, Amber says she wasn't supposed to drive herself home after having the procedure. But at about $40 each way, a taxi was out of her price range and she didn't have anyone to pick her up.
If she'd taken a bus or train, she wouldn't have got back to South Auckland in time to pick her children up from school. She had no choice, she says.
"I lied. I told them I had a friend to drive me back, but I didn't. I drove myself."
It's not only people living in Counties Manukau who face this issue. Waitematā DHB - which covers Auckland's North Shore to north of Wellsford, as well as parts of West Auckland - also sends people to Greenlane for first trimester abortions.
According to the DHBs, 70 per cent of women who access abortion services at Greenlane come from outside the area - 40 per cent from Counties Manukau and "approximately 30 per cent each for Waitematā and Auckland".
From parts of the Waitematā and Counties Manukau catchments, a return trip by car to Greenlane Clinical Centre can take more than two hours, with travel times varying depending on traffic.
This is in conflict with the Health Ministry's standards of care, which recommend "women should not have to travel more than two hours to access first trimester abortion services".
Dame Linda Holloway is the former chair of the Abortion Supervisory Committee, (the committee was disestablished on March 24 this year when the Abortion Legislation Act, which decriminalised the procedure, came into force). She told RNZ she was frustrated that local services are still not offered to people in South Auckland.
"We've been aware of this issue for over a decade and it is something that at the time of the disestablishment of the committee we were still concerned about."
Due to the country working under Covid-19 restrictions from the day after the act came into force, there was no "handover meeting" where Holloway and the committee's two other members were able to speak with senior Health Ministry officials about their concerns, she said.
Had such a meeting taken place, the lack of abortion services in South Auckland would have been "amongst the issues that we would have raised", Holloway said.
"It's just been an issue that has been so disappointing for so long."
In information provided to Parliament last year, the Supervisory Committee noted the reasons why a DHB might not provide abortion services could include "conscientious objection, perceived community resistance, or resistance of senior medical professionals within a women's health service".
RNZ asked the Counties Manukau DHB why local services were still not available when concerns about the lack of local abortion services available to women in South Auckland were first raised 12 years ago.
Counties Manukau DHB has not responded to that, or other questions from RNZ. Instead, questions were passed on to the Auckland DHB, which is also yet to respond.
In 2018, more than a decade after the concerns about the lack of abortion services in South Auckland were first raised, the need for a service review in the region was noted as an "emerging issue" in planning documents published by both Waitematā and Auckland DHBs.
In October this year, the region's three DHBs called for registrations of interest for the provision of first trimester abortion services within the Waitematā and Counties Manukau catchment areas.
"We want to increase equity and access to high quality first trimester abortion services for women living in Waitematā DHB, Auckland DHB and Counties Manukau," the document reads.
"This is an opportunity to improve access to high-quality first trimester abortion services for women who currently face access barriers. This service will improve women's choices in terms of where she can access a first trimester abortion, and ensure that women's choice regarding access to medical and surgical options is respected."
South Auckland-based Labour MP Louisa Wall said barriers to accessing good-quality, timely healthcare are an ongoing issue for women in South Auckland, but abortion law reform was a step in the right direction.
"I think that the passing of the Abortion Legislation Act will make it a necessity that we provide those surgical and medical services within the catchment area."
Wall said she was pleased a South Auckland abortion service is being planned, though she has no doubt it could and should have been done sooner.
Documents viewed by RNZ show the three DHBs hope to have first trimester abortion services running in South Auckland and Waitematā DHB catchments by July next year - 13 years since the issue was first brought up with the Counties Manukau DHB in June 2008.
* Name has been changed.