Willing but not able: A survey of New Zealand health practitioners' interests in providing second trimester abortion care and the obstacles they face

Background: In 2020, abortion was removed from the Crimes Act. Abortions under 20 weeks gestation no longer require an indication and criteria for abortion above 20 weeks gestation has broadened. Prior to law reform, all abortions were provided on licensed premises and the responsible health practitioner was a doctor. Subsequently, any health practitioner with abortion in their scope of practice can provide abortion care. Aims: To describe the characteristics of health practitioners who expressed an interest in participating in second trimester abortion care, and to identify and describe the barriers to providing an optimal second trimester abortion service. Materials and Methods: This was an exponential non-discriminating snowball email survey using tick boxes and open comments. Quantitative data were analysed using descriptive statistics and free-text components were analysed using a general inductive approach. Results: The 113 respondents included: 38 hospital-based obstetrics and gynaecology doctors, 22 primary care doctors, 13 midwives and 14 nurses/nurse practitioners. Thirty-three (29.2%) and 62 (54.9%) respondents reported interest in providing second trimester surgical and medical abortion care respectively. The most commonly identified barrier to both surgical and medical second trimester abortion provision was lack of trained staff, followed by an unsupportive work environment. Thematic analysis aligned with these findings and commonly featured difficulty in accessing feticide. Conclusions: We need to actively recruit and train all health practitioners interested in providing second trimester abortion care to strengthen the workforce. This requires an organisation to oversee an inclusive national framework for abortion training, including feticide, and provide professional supervision.