Service users’ experiences of tele-health abortion services in Aotearoa (New Zealand) : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Te Kunenga ki Pūrehuroa Manawatū, Aotearoa (New Zealand)

Abstract

The Aotearoa (New Zealand) national abortion tele-health service, Decide, was launched in 2022, following legal abortion decriminalisation in 2020. The safety, effectiveness, and user satisfaction of tele-health abortion have been reported in a large body of global research. However, service user voices are often overlooked, and little is known about service delivery, especially the extent to which principles of person- and relational centred care are upheld. This study aims to address this oversight using a qualitative case study design focused on the Decide service. An online qualitative survey gathered data from 21 service users, which was analysed thematically alongside relevant textual data (seven national policy, guidance, and training documents on abortion care in Aotearoa, the Decide website content and researcher fieldnotes). A reflexive thematic analysis, guided by feminist standpoint, in conjunction with person- and relational-centred care frameworks, generated five themes: (1) the “Everything could be in done in my lunchbreak”; (2) Feeling seen, heard, and supported: Care is relational, supportive, and attentive to emotional wellbeing; (3) Care acknowledges interdependence and honours diverse support needs; (4) Care affirms autonomy and de-medicalises abortion decision-making; and (5) When person- and relational-centred care falls short: Structural strain and cultural stigma. The findings suggest that Decide services met the intended aims of being inclusive and emotionally responsive. However, pervasive stigma and structural inequalities undermine service delivery, resulting in fragmented care, erosion of trust in the service, emotional vulnerability, and suppressed autonomy. The findings highlight the importance of centring lived experience in service design and delivery, providing valuable insights for addressing service delivery issues and working toward reproductive justice.