A major report proposing simplifying and decriminalising abortion law is also backing a call that nurses could safely carry out early abortions.
The Law Commission presented its 300 page briefing to the Justice Minister Andrew Little late last week that outlines three legal model proposals (see details below) for decriminalising abortion and repealing the requirement for two doctors to certify that a woman met the criteria for an abortion.
The report has been applauded by both the New Zealand Nurses Organisation and Family Planning with both supporting Model A (see below) because it places the decision-making process in the hands of the pregnant woman in consultation with her health professional.
“This would remove red tape and harmful delays and better equip women to take charge of their own health,” says NZNO professional nursing advisor Kate Weston.She added that NZNO was pleased that nurses’ voices had been heard as nurses play “a huge role in women’s reproductive health and are much more likely to have ongoing relationships with patients than the consultants currently required to approve abortions”.
Likewise Family Planning chief executive Jackie Edmond said the model would “promote earlier, more equitable access to both medical and surgical abortion, remove stigma and recognise pregnant people’s autonomy in reproductive health decisions”.
The Commission has also suggested other law reforms including removing the requirement for only doctors to carry out abortions, with many submissions pointing out that the development of medical abortion in particular meant doctors were no longer necessary to ensure patient safety.
An early medical abortion (EMA) is an option available up to nine weeks into a pregnancy and currently involves a woman attending an abortion facility to take two medications to induce a miscarriage, then returning home to miscarry. EMA has replaced surgical abortion as the preferred option for women presenting early in pregnancy.
The Commission heard advice in Great Britain and France that nurses are largely responsible for administering EMA, in Sweden it is mostly administered by midwives, and that totally home-administered EMA is available in most Australian states with midwives, nurses and pharmacists able to supply or administer EMA under the direction of a medical practitioner. It noted that abortion care was within the scope of practice of midwives in some other countries and that in the United States suitably trained nurse practitioners, physician assistants and nurse-midwives carry out first trimester surgical abortions in some states. The report also noted that NZNO submitted that appropriately trained nurses could safely prescribe and dispense EMA and some perform early surgical abortions with appropriate supervision.
The Commission says abortion service providers and health professional organisations agreed that the health practitioner regulatory bodies, like the Nursing Council and the Midwifery Council, were best placed to determine which practitioners could safely carry out abortion procedures, as they did for other procedures. “Removing legislative restrictions would better enable scopes of practice to change as medical technology, training and best practice advance,” says the Commission.
Conscientious Objection options
Currently New Zealand law says no doctor, nurse or other person is obliged to perform or assist an abortion if they object to doing so on the grounds of conscience.
But the Health Practitioners Competence Assurance Act does require a conscientiously objecting health professional to inform the woman that they can obtain an abortion from another health practitioner of Family Planning Clinic.
The Commission said that the New Zealand College of Midwives and NZNO both had submitted that they considered it a responsibility of nurses and midwives to give accurately and timely information about abortion services and referrals. But others, including the New Zealand Medical Association and Nurse Practitioners New Zealand supported the retention of current conscientious objection provisions.
In response the commission suggested two options – the first being to maintain the current conscientious objection legal provisions and the second to require health practitioners to promptly disclose their objection and refer women to another health practitioner or abortion service provider.
Last week Justice Minister Andrew Little said that the issue of abortion was personal for each MP and he would be talking to colleagues across all parties before progressing further with the Commission’s report and proposals.
Law Commission Proposals
- No statutory test required for abortion at any gestation level.
- The decision whether to have an abortion would be made by a woman in consultation with her health practitioner.
- A new statutory test would be introduced under health legislation to replace the current one under the Crimes Act.
- The health practitioner who intends to perform the abortion would need to “reasonably believe the abortion is appropriate in the circumstances, having regard to the woman’s physical and mental health and wellbeing”.
- No statutory test for pregnancies of not more than 22 weeks gestation (same as Model A).
- A health practitioner would need to carry out statutory test (as in Model B) for pregnancies of more than 22 weeks gestation.
Other related proposals
- Change legalisation so women can access abortion services directly, or be referred by any health practitioner they choose to consult (for example, a GP, nurse, midwife or counsellor).
- Remove the legal requirement for abortions to be performed by a doctor to allow them to be performed (or administered in case of EMA) by health practitioners with appropriate qualifications and experience for the method of abortion. This could include registered nurses and midwives.
- Repeal the requirement for abortions to be performed at a facility licensed by the Abortion Supervisory Committee (particularly EMA) and instead require facilities providing surgical abortions to be governed the same way as similar level health services.
- Service standards should require abortion service providers have counselling available to women considering abortion or who have had an abortion.
- Repeal the criminal offences for abortion or amend them so that they only apply to unqualified people who perform abortions.
At present, under the Contraception, Sterilisation, and Abortion Act 1977, it is unlawful for an abortion to be carried out unless it is authorised by two ‘certifying consultant’ doctors. To authorise an abortion, these consultants must believe the situation meets one of the criteria under Section 187A of the Crimes Act 1961, which include that continuing the pregnancy would result in serious danger to the physical or mental health of the woman or there would be a substantial risk that the child would be ‘seriously handicapped’.
- The latest abortion statistics show that that 13,285 abortions were performed in 2017 – down from a peak of 18,511 in 2003.
- The general abortion rate (abortions per 1,000 women aged 15–44 years) was 13.7 per 1,000 women in 2017, slightly up on 2016’s 13.5 rate which was the lowest in over 25 years.
- The statistics, released by Stats NZ in June 2018, also showed that most abortions (64 per cent) were a woman’s first abortion and 59 per cent were performed before the 10th week of the pregnancy – up on 57 per cent last year.