Eileen Joy and Liz Beddoe

We knew that it was coming, the leaked  US Supreme Court draft opinion strongly suggested Roe would fall, yet when it did our geographical distance and that advance knowledge did not make it less painful.

Roe versus Wade has fallen, and with it the constitutional right to an abortion in the United States is gone. Abortion laws remain, but the right is gone. Now access to abortion depends on the whims of individual states, many of which had ‘trigger’ laws ready to be enacted once Roe fell.

Plenty of commentators have talked about what this means in the United States (see here). About the ramifications for other rights thought attained (see here and here). Others  have talked about the intersectional oppressions made deeper by this decision, that for BIPOC and/or poor people this makes already tenuous access to reproductive justice that much harder (see here). Here we wish to talk about the ripple effects of this decision and how despite the recent abortion law reform we have much to still be vigilant about. It is these issues that we wish to draw social workers, indeed everyone’s attention to.

Reproductive justice is a social work issue and is essential in the fight against health inequalities (Gomez et al., 2020). We also have a very poor record on maternal mental health in Aotearoa. This is also a reproductive justice issue and it is disproportionately unjust for Māori and Pasifika women. In a Ministry of Health (2021) stocktake of services, “only around half of the 20 DHBs reported that wāhine Māori in their region could receive mental health care through a kaupapa Māori service or provider, and very few DHBs reported having a specific focus on Pacific or Asian women”. There is a lot to be done.

We also wish to make it very clear that reproductive justice means including all genders. No gender is free until all genders are free from reproductive injustice. Abortion activism and access to abortion must include all people who can get pregnant.

The situation in Aotearoa

Over the weekend Christopher Luxon made several statements claiming that he would not make any changes to the existing law – a claim that four of the forced birther Supreme Court judges also made  before lying changing their minds. In the most recent statement Luxon claims that “these laws will not be relitigated or revisited under a future National government.” Does he really mean any future National government — certainly not something he can or should guarantee. Further he states that “these health services will remain fully funded”. Aside from the fact that we do not trust him, we need to examine what he could do because there are ways to make abortion harder that do not involve changing the law. Shane Reti (National, spokesperson for health) said that he would be interested to see how Roe v Wade would influence the situation in NZ, and wouldn’t rule out any restrictions on abortion access because that would be “a matter for caucus.” Well, we know who is in that caucus – a bunch of people who oppose abortion.

Lets look at what reducing funding could look like — i.e. if Luxon reneges on that promise:

• Under the new system, abortion services will be primarily funded by Health NZ (the new overall agency that is replacing the DHB system). This will give the govt greater control over which services are funded, compared to the devolved DHB system. For example, abortion services could be removed from the Service Coverage Schedule, which would remove the requirement/expectation for funding. Then subsequent budget bids for abortion services could not be approved, or could be approved at an inadequately low level.
• Under the DHB system, DHBs were required to *fund* services rather than provide them. This meant several DHBs contracted out service provision to Family Planning NZ or The Women’s Health Clinic. These contracts will be transfered to Health NZ in the new system. As external contracts they are especially vulnerable to simply not being renewed. This would leave regions including Tauranga (Family Planning), Mid-Central DHB, Whanganui DHB, Wairarapa DHB and Southern DHB (The Women’s Clinic) without local services.
• The Ministry of Health has also contracted the New Zealand College of Sexual and Reproductive Health (NZCSRH) to develop new training packages for new and current abortion providers (cost of undertaking the course was included). Funding of this training could be discontinued.
• Travel and accommodation costs for pregnant people who need to travel to have an abortion are currently supposed to be reimbursed. While this situation is not good enough, it could be made even more difficult if these costs weren’t reimbursed at all.
• The national abortion telehealth service, DECIDE, is centrally funded by MoH until 2024. This service could be scrapped or the contract not renewed.

There are also other funding issues:

• A mechanism to pay GPs and other primary care health practitioners hasn’t been established yet in the new health system. This is one of those long-standing issues that we would expect to simply to continue to be unresolved under an anti-abortion Government.
• Training of new providers is an ongoing issue, especially for surgical abortions, later gestation abortions and feticide (we currently have two health practitioners who provide feticide nationwide – this is the injection to stop the fetal heart before an abortion at 22 weeks gestation or more). Increasing the number of feticide providers will likely require special recruitment efforts from overseas or special funding to train someone here in NZ.
• ‘Crisis Pregnancy Centres’ and other organisations which actively seek to disrupt the provision of abortion services could receive more funding. This could potentially include anti-abortion ‘counselling’. The requirement in the legislation is that counselling must be offered but cannot be mandatory. However, there isn’t a requirement that it needs to be unbiased.

Aside from funding issues there are regulatory issues as well:

• Requiring all abortion providers to meet the standards for abortion in the Ngā Paerewa Health and Disability Services Standard NZS 8134:2021. This was a big issue for providers during consultation on the new standards because it would essentially function like a series of ‘Targeted Regulation of Abortion Providers’  laws if it applied to all providers. These laws make it much harder to run clinics due to increasingly onerous and time-consuming patient ‘safety’ requirements. It currently only applies to abortion services that meet the definition of hospital level care (intending to provide care for 2 or more people simultaneously for 24 hours or longer), but through the Health and Disability Services (Safety) Act 2001, the Minister of Health can recommend that any service be subject to the standards. Many of the standards are not possible for small clinics or independent health practitioners to implement.
• Not approving safe area applications for abortion clinics – these have to be approved by the Minister of Health. The statute (in the CSA Act) is:

2) The Minister of Health may recommend the making of regulations under subsection (1) if the Minister is satisfied that prescribing a safe area—

(a) is desirable to address any risk to the safety and well-being of persons doing any of the following, and to respect the privacy and dignity of those persons:

(i) accessing abortion services:

(ii) providing, or assisting with providing, abortion services:

(iii) seeking advice or information about abortion services:

(iv) providing, or assisting with providing, advice or information about abortion services; and

(b) can be demonstrably justified in a free and democratic society as a reasonable limitation on people’s rights and freedoms.

• Introducing burdensome and time-consuming reporting requirements for clinics, meaning they can see fewer patients.
• Increasing requirements via the New Zealand Aotearoa Abortion Clinical Guideline. For example, currently pregnancy needs to be confirmed by urine or serum hCG or ultrasound. Ultrasound could be made mandatory, which would increase travel requirements in rural areas and make abortion via telehealth (pills) provision more difficult.
• Medicine regulation – 2021 changes made it possible for medications to be provided outside of hospitals. There’s the potential for this to be reversed when the Therapeutic Products Bill is introduced.
• Introducing further non-legislative guidance or surveillance around sex-selective abortions. This is a difficult one because the Govt is required to monitor and report on sex-selective abortions in NZ at least every 5 years (next report due before 2025), and make any recommendations necessary to prevent sex-selective abortions – i.e. if they are happening, make recommendations to prevent them.

What can social workers do?

First of all social workers need to stop dithering and take a strong stand on reproductive justice.  “Reproductive justice is essential in the struggle to remove health inequalities. Currently escalating threats to reproductive rights are rarely discussed in contemporary social work literature. Discomfort in the profession about addressing challenges to abortion rights exposes a lack of courage to treat abortion as essential healthcare” (Beddoe, 2021). We need to support our professional association to be strong and unequivocal in its support for reproductive justice (Beddoe, Hayes & Steele, 2019).

Do not be fooled by thinking that our laws and related provisions mean we are safe. As we’ve shown above there are numerous ways that even so called “settled law” can be undermined by funding and access barriers.  Social work colleagues at the Columbia School of Social Work in the US posted a list of actions to take to take and we urge social workers to follow suit in appropriate ways. These are some possible local actions:

• Join and/or donate to ALRANZ Abortion Rights Aotearoa  http://alranz.org/
• Know (and share) the facts. Abortion is a medically necessary and safe component of comprehensive reproductive medical care, and we know from research that most people in Aotearoa New Zealand support safe legal abortions.  The anti-choice movement has progressed their agenda by spreading misinformation about abortion. It is imperative that the facts about abortion are broadcasted everywhere.
• Support organizations in need. There are many ways to support (financially and otherwise!) organizations providing services.
• Elect pro-choice candidates to office. See here for the voting record in 2020. It is vitally important pro-choice politicians are in office to vote to support our 2020 legislation and make sure that services are accessible, equitable and properly resourced. That means safety for wāhine Māori, Pasifika and all people, urban and rural, in need.

References

Beddoe, L. (2021). Reproductive justice, abortion rights and social work. Critical and Radical Social Work, 10(1), 7-22. doi:10.1332/204986021X16355170868404

Beddoe, L., Hayes, T., & Steele, J. (2019). Social justice for all!’ The relative silence of social work in abortion rights advocacy. Critical and Radical Social Work, 8(1), 7-24.

Gomez, A. M., Downey, M. M., Carpenter, E., Leedham, U., Begun, S., Craddock, J., and Ely, G. (2020).  Advancing reproductive justice to close the health gap: A call to action for social work. Social Work. doi:10.1093/sw/swaa034

Ministry of Health. 2021. Maternal Mental Health Service Provision in New Zealand: Stocktake of district health board services. Wellington: Ministry of Health. https://www.health.govt.nz/publication/maternal-mental-health-service-provision-new-zeal

Artwork by Caitlin Merriman