Leaps ahead in law but not in practice: Why we need to train in second trimester abortion care.

Abstract

Abortion care has always been controversial, with health professionals worldwide continually working to offer well-rounded safe services. Key improvements in New Zealand since abortion law reform include the ability to self-refer, no formal certification under 20weeks gestation, and change to the indications for abortion after 20weeks. Nationally, we know that the second trimester abortion incidence is stable, and will therefore require an ongoing workforce to sustain the service. To document the current second trimester workforce for medical and surgical abortion in New Zealand, and examine their training and practice. Anonymous non-discriminatory snowball survey covering the domains of demographics, barriers to abortion care, abortion training, abortion provision and procedure specifics using Qualtrics software. Eleven practitioners currently perform dilation and evacuation, and 33 wish to. Current providers have between zero and three other colleagues to assist them in service provision. Most learned by an informal apprenticeship model and operate relatively infrequently. There is variance in the cervical preparation and evacuation procedure as well as skillset and/or willingness for later gestations. Fifty-nine practitioners' units currently provide medical abortion, and 62 wish to. There is more coherence in the regime of medical abortion, although the availability of this is affected by gestation and location. For most women requesting second trimester abortions, additional time, cost and stress is still very much the status quo. District Health Boards need to prioritise training and workforce planning to ensure the availability of this essential service.