Establishing abortion services in primary care and community settings

Te Whatu Ora and Manatū Hauora are committed to ensuring that quality abortion services are equitable and accessible to all people who wish to access them. A key part of this is supporting primary care and community settings to start providing first trimester abortion services. This means fewer people will need to travel to access abortion services.

The changes to the abortion legislation in 2020 mean a wider range of health practitioners can now provide abortions (subject to scopes of practice and training). This means that abortions can be more easily provided through a range of primary care and community settings by doctors, midwives, nurse practitioners and registered nurses.

DECIDE, the national abortion telehealth service, supports primary and community providers to start offering abortion services. DECIDE offer 24/7 clinical support for people after they have had an early medical abortion as well as virtual abortion-related counselling services.

Providers offering abortion services in primary and community settings are able to draw on the telehealth service to support their provision of services. For example, general practices do not need to have an on-site counsellor, as a person wanting abortion-related counselling can be referred to DECIDE for counselling via telehealth.

There are several considerations for health practitioners and service providers who are planning to start offering abortion services within primary care and community settings. Some of these are outlined below.

Training and guidance

Health practitioners will need to ensure that providing abortion services is within the scope of their practice and that they have the appropriate training, guidance, and support. This may include:

• reviewing the New Zealand Aotearoa Abortion Clinical Guideline for best practice care
• completing nationally available online training provided through the New Zealand College of Sexual and Reproductive Health (NZCSRH) via the BPAC website (available from November 2022 onwards)
• engaging with information and resources provided by your professional college
• joining relevant practitioner peer networks or professional organisations.

Access to funding

Please note that currently there is only limited direct funding for primary care-based GPs and midwives via the Primary Maternity Services Notice section 88 funding (single-service payments).

Te Whatu Ora are currently considering primary care funding for EMA at a national level, but no decision has been made.

Connections to local services

Providers may find it helpful to make key stakeholders aware of their new service and ensure they have principal points of contact within their local area. This may include:

• local hospital (abortion service or women’s health/gynaecology service)
• pharmacy (note health point hold a list of pharmacists supplying EMA medications)
• other sexual health services
• kaupapa Māori or iwi-based health services.

Additional support

There may be some aspects of abortion services that providers are not able to provide or need support to provide. Providers should consider which organisations they may work with to ensure that people under their care receive quality and equitable abortion services.

For example, you will need to establish:

• local care pathways to manage complications
• links to the DECIDE national telehealth service to support urgent out of hours clinical care and provide abortion counselling services
• local care pathways to long-acting reversible contraception and other contraceptive options if you don’t provide these services.

Reporting requirements

Health practitioners providing abortion services must be included on a list held by Manatū Hauora and are obliged to report on the services they provide. This includes a notification report for each abortion performed and an annual report. Further information is available at Abortion reporting or by emailing csaact@health.govt.nz for links to the online notification form and annual report template.

Providers should factor this reporting into their planning, including resource to complete the abortion notifications and annual report.

Internal processes

Abortion services are another health service and most internal processes will apply in the same way. There are some additional factors to consider, including:

• reserving more time for appointments for abortion services. EMA consultations generally take between 30–60 minutes
• cover for when staff are not available
• any non-clinical staff training that is required
• internal processes for any staff within the organisation who have a conscientious objection to being involved in providing abortion services.

Awareness of service

Providers should consider how people will know that they are now providing abortion services. This may include updating website information and other communications.

The DECIDE website publishes provider information. Providers can choose not to have their name and contact details published on this list by advising Manatū Hauora.

Wellbeing and safety

Abortion is a sensitive topic for some people and there are a variety of views about abortion services in Aotearoa New Zealand. Providers may wish to consider how they will ensure the wellbeing and safety of their staff and people accessing services through their facility. This may include:

• protecting the privacy of individual staff or health practitioners
• internal policies or procedures to handle protest activities, or any disruption or disagreement over provision of abortion services
• considering whether it is necessary to apply for a Safe Area around the provider premises.

The Abortion Providers Group Aotearoa New Zealand (APGANZ) and NZ College of Sexual and Reproductive Health (NZCSRH) offer peer support and professional development for abortion providers and so you may wish to join one or both of these organisations.