Telemedicine abortion service to expand access to care

 Whomever you are and wherever you live in Aotearoa New Zealand, you have the right to end a pregnancy if you want or need to. One way to do so is through early medical abortion, which uses pills and allows for self-managed abortion at home. This option has been available via telehealth for some time but has become more common in recent years, especially since the start of the COVID-19 pandemic. 

 A new service called DECIDE, launched in April by the Ministry of Health, is helping to expand existing telehealth services and close overall gaps in access to abortion care. DECIDE provides consultations and medications for early medical abortions, along with related services, including consultations, information, referrals, counselling, and after-care support. This service cannot replace in-person care, which will always be necessary in certain cases, but helps to enlarge access to safe and timely abortion. This is a great step forward for equitable sexual and reproductive healthcare. 

 There is a growing evidence base on telehealth abortion services, especially due to its increased of rollout across the globe due to COVID-19 restrictions. International research shows that telehealth abortion care is extremely safe and effective. Self-managed medical abortion conducted by telehealth is just as safe and effective as when the procedure is completed in person at a doctor’s office, clinic, or hospital. This option is not associated with higher risks of complications compared with pills accessed in-office. In fact, only 2% of medication abortions result in complications, and most of those are minor. Plus, most patients report being satisfied with their experience.

The research also suggests several advantages to telehealth abortion services, namely:

  • allow more privacy and autonomy (avoid harassment, conscientious objection, disclosing choice if unsafe)
  • help ensure timely care
  • greater flexibility reduces burdens of cost, travel, and time
  • reduce pregnancy-related deaths


 Telehealth services are especially beneficial to those who may not otherwise be able to access abortion care. This may be due to low resources, disability, caregiving or work responsibilities, or geographical distances, especially if disclosing an unintended pregnancy is difficult or unsafe. Indeed, researchers report that barriers limiting abortion access most profoundly affect communities that already face health care and social inequities and can therefore widen existing socio-economic inequalities.

 It is also important to note that access to early medical abortion through telehealth ensures timely care. While abortion is among the safest medical procedures, the earlier it is done, the fewer complications there could be. Reducing wait times for abortion, which has been a major problem in the past, can also help alleviate some of the stresses associated with unintended pregnancy.

The country is already seeing higher rates of earlier access to abortion and the final rollout of the DECIDE services will hopefully maintain this trend and contribute to more equitable access to sexual and reproductive healthcare for all.

On access, privacy, & safety

I went to university in a small town in the American South – a tiny island of moderate politics in a swathe of conservative rural counties. There was a small abortion clinic a few blocks north of down town that served several neighbouring towns and counties (87% of American counties have no abortion provider. In non-metropolitan areas, that number is 97%.). In the era of increasing limitations on access to sexual and reproductive healthcare, hours had been cut back and the doctor was only on site a few hours, one day a week.

A group of anti-choice protesters, some students and some older town residents from the nearby churches, occupied the sidewalk every week, rain or shine. The tiny plot of land only had parking for a few staff cars, so patients had to park across the street at the big stationery store. The clinic, understaffed as it was, relied on volunteer escorts to accompany patients across the street and past the protesters to the clinic.

It wasn’t just about supporting patients. Fatal attacks had occurred at two other clinics in the state and at others around in the country. Although Dr George Tiller hadn’t yet been murdered while ushering at his church, he had been shot and his Kansas clinic bombed in two separate attacks. Eric Rudolph, who planted bombs at the 1996 Atlanta Olympics, two clinics, and a nightclub, had recently plead guilty after five years on the run. Arson and bomb threats occurred nationwide; dealing with threats and suspicious packages was standard training protocol for new staff.

At our clinic, escorts were briefed on buffer zone laws. The security guard kept a small, worn notebook, where he recorded details about each and every protester – arrival and departure, their behaviour, who brought their children, a record of calls to the police to report harassment. Some silently prayed well behind the line, but others frequently harassed patients.

My class schedule often conflicted, and so I didn’t spend as many afternoons at the clinic as I should have. Escorting was emotionally draining for us – I can only imagine what patients must have felt walking through a crowd of scorn and judgement, flanked only by a couple of young students. Yet many still stopped us as we led them into the reception area, turning to smile or quietly whisper ‘thank you.’ It broke my heart every time.

One of my first afternoons, I was there with two other friends. Holidays were coming up and students were heading out of town, so the protesters were down to the locals – the middle-aged man with his horrific sign and the Catholic woman with the line of children and rosary beads. We were chatting about our weekend plans when a car pulled up and stopped in the drive. We tensed – there were no appointments left that day – and glanced nervously at one another.

A thirty-something woman got out of the car carrying a little vase of carnations with a ‘Thank You!’ helium balloon tied to the vase. She walked over to us and said within earshot of the protesters, ‘Thank you. You were there for my sister when no one else was. You don’t hear it enough, but there are a lot of people who are grateful for what you do. Please pass this on to everyone inside.’ Dumbstruck, we smiled, clumsily strung together words to thank her, but she was back in her car and pulling away.

And so we cried. For her generous gesture, her sister, every patient, every doctor, every receptionist, every partner, friend, or family member who held a hand or offered a ride, every woman who suffered an unsafe abortion, for those who have felt the heartbreak of discovering a foetal anomaly, for a culture where our first reaction to an unexpected visitor was fear, and for a society where a trip to the doctor had become a political act requiring courage, security, and personal risk just to get in the door, never mind the complexity of the decision to choose abortion itself.

I know that New Zealand is not the United States and I sincerely hope the import of American anti-choice rhetoric stops with harassment, misinformation, and ribbons. But shame, stigma, and ill-informed judgement hurt even when not accompanied by pipe bombs.

Safe, private access matters, not just to patients, but to everyone. The receptionists, the nurses, the janitorial staff who clean the building, the staff and customers of neighbouring buildings – everyone who ensures that women have the ability to make private decisions about their own health. Choices about fertility, pregnancy, and abortion are complex and challenging in the best of circumstances. Women do not enter into them lightly and it is insulting to assume otherwise.

The Family Life International ‘vigil’ outside Wellington Hospital insensitively affects patients, staff, and visitors to the hospital, the majority of whom have nothing to do with abortion services and are likely facing their own challenging situations. It is difficult enough to be admitted to hospital or visit loved ones who are ill without being bombarded by chanting and stigma.

I do not contest FLI’s right to judge and disagree with the choices of others – I believe that informed discourse is the foundation of a free society – and while I personally doubt the efficacy of shaming others into supporting one’s view, I respect their decision to choose these tactics. I do, however, question their sincerity in promoting ‘a spirit of unity’ by disrupting the lives of innocent hospital patients and staff. There is a time and a place for respectful debate, and there is a time to allow individuals to seek medical services in private.

This was written by an ALRANZ member and reflects the author’s individual opinion. Please get it touch if you would like to share your own experience or thoughts on our blog.