Access to Abortion in New Zealand After Law Reform and COVID ‐19; A National Cohort Study

BACKGROUND: Abortion law reform (ALR) in Aotearoa New Zealand occurred in 2020 and included removing legal criteria for an abortion to be performed prior to 20 weeks' gestation, and enabling women to self-refer, abortifacients to be taken at home, and non-specialists to offer abortion care. OBJECTIVE: Assess the impact of ALR on access to abortion services and contraception provision, by ethnicity. METHODS: This is a retrospective national cohort study of all women in Aotearoa New Zealand who had an abortion, comparing the year before ALR (1 January to 31 December 2019) to after (1 July 2020 to 30 June 2021). We obtained anonymous datasets from the Ministry of Health. We used Poisson regression to analyze outcomes. We estimated relative risks and 95% confidence limits (CL) for the association between demographic and clinical variables and outcomes. We then performed multivariable analysis to adjust for age, parity, ethnicity, deprivation and domicile of residence. The primary outcome was the proportion of women who had an abortion prior to 10.0 weeks' gestation. RESULTS: Post-ALR, more women accessed abortion < 10.0 weeks' gestation (78.3% vs. 64.5% pre-ALR, adjusted relative risk 1.21 (95% CL: 1.19-1.23), p < 0.0001). Post-ALR, more Māori women accessed abortion < 10 weeks' (68.4% vs. 53.3% pre-ALR, p < 0.001). Both pre- and post-ALR, fewer Māori women accessed abortion < 10 weeks' compared to non-Māori women (53.3% vs. 67.8%, and 68.4% vs. 81.2%, respectively, both p < 0.0001). CONCLUSIONS: Following ALR in Aotearoa New Zealand, women have a 21% better chance of having an abortion procedure < 10.0 weeks' gestation compared to before ALR, after adjusting for demographic variables. Although access improved for Māori women, inequity by ethnicity remains.