Rural women face barriers to abortion, contraceptive care, Ministry of Health review says

The Ministry of Health's review highlights improved access, but notes rural barriers persisted. Photo / 123rf

Monique Steele of RNZ

Access to abortion and contraceptive healthcare has improved in New Zealand in recent years, but there are concerns that women who live in remote or rural areas face greater challenges to accessing this care than their urban-dwelling counterparts.

Earlier this month, the Ministry of Health reviewed certain matters under the Contraception, Sterilisation and Abortion Act (1977) and how the law was working in the years following a legislative change in 2020 that decriminalised abortion and integrated other health services into it.

It found there were abortion service providers now in more locations across the motu (nation), more early abortion services were available and it saw benefits from more pre- and post-op counselling on offer for women who wanted it.

“This is a positive sign that those seeking care are experiencing fewer barriers and that the initiatives to improve access, like self-referral and telehealth, are making an impact,” the review said.

But it said there was more work to do to improve access for women living in rural communities to surgical or follow-up healthcare and to address the often lengthy and costly waits for public health-provided sterilisations like vasectomies or hysterectomies.

“Additionally, for those living most rurally, average drive-time increased as socio-economic deprivation increased.”

Jackie Edmond, the chief executive of Sexual Wellbeing Aotearoa (formerly Family Planning), agreed there had been good progress made generally, but said more should be done for rural women in particular.

“[The report is] showing that there has been progress, which is really good and we can definitely see that, but there’s still a bit more work to do in terms of ensuring access that’s equitable, particularly for rural women,” Edmond said.

“The new law is really working well generally, but we know we could do better.”

Edmond said its free tele-health service, 0800 DECIDE, helped make pre- or post-abortion counselling services more available for rural women if they choose it – but it would always offer in-person services too.

Though she said the costs associated with travel and time for appointments were barriers for some, while counselling services varied region by region.

“The challenge for rural women is, and rightly or wrongly, because abortion has a lot of stigma, and they’ve probably got very good primary care providers, but some people do not feel comfortable going to their primary care provider for an abortion.”

The ministry referred to this as “conscientious objection”, which it said was a further barrier to timely and equitable abortion services.

Edmond said rural women then had even fewer options of where to go, particularly if they chose a surgical abortion.

“So there are definitely some equity issues around access for rural women, and some regions are worse than others.

“Obviously, the more geographically isolated you are, the tougher it is.”

Most abortions at later than 9 weeks’ gestation were performed surgically, which the ministry said presented an additional burden for women who may not live near a hospital or community specialist that offered the surgical option.

“Women with cognitive or physical disabilities may be disadvantaged in accessing timely and affordable transport, particularly if they live rurally or depend on caregivers’ support for arranging travel.”

It said in 2024, 43% of women accessing a surgical abortion had to travel out of their home district for it.

The ministry recommended that Health New Zealand Te Whatu Ora address the gaps in availability nationwide, refresh abortion clinical guidelines, address training and recruitment and continue to ensure safe and timely access to abortion is available in Aotearoa.

– RNZ