"Currently early medical abortion is available in Aotearoa at home up to 10 weeks gestation. With the changes to abortion legislation allowing better access to this service, early medical abortion at home has, in recent years, become the preferred choice for eligible patients under 10 weeks in New Zealand. Abortion at home allows patient to be in their own environment, with the support people they chose, at a time that suits. The financial implications of transport, parking, time off work and childcare when required to attend for an in-hospital procedure is significant to most. This study from Scotland (which provide a similar model of abortion care to Aotearoa) shows that patients could safely utilise this method at home to 11+6 weeks allowing greater choice. Our national clinical guideline should be updated to reflect this."

"This is an observational study from Scotland reviewing 5 years of referrals for early medication abortion up to 12 weeks, comparing women who chose to take their medications at home to those who chose to remain in hospital for their procedure.

"In the abortion legislation in England and Wales, EMA is limited to EMA at home up to 10 weeks gestation. Whereas the abortion legislation in New Zealand (2020), there are no specifications whatsoever about how when or where an abortion occurs. New Zealand has appropriately taken the approach that these are clinical decisions to be made within a clinical guideline published by the Ministry of Health, and not an issue of law to sit within the Ministry of Justice as it did before 2020.

"In the clinical guidelines in Scotland, eligible women up to 12 weeks are offered EMA at home. Whereas the clinical guidelines in New Zealand (2021) offer EMA at home up to 10 weeks’ gestation, and inpatient (in hospital) after 10 weeks. I chaired the guideline development group and at the time of developing our national clinical guideline in 2020, there were no randomised controlled trials comparing inpatient to outpatient management of EMA between 10 and 12 weeks. I was an advisor to the guideline development group when RANZCOG developed a clinical guideline on abortion care in 2024 and there were still no trials on this research question, hence they also recommend outpatient management up to 10 weeks.

"In reality what ends up happening in New Zealand is that people requesting abortion after 10 weeks end up being offered surgical abortion rather than inpatient medical abortion. I would support more research into this area, for example, offering a trial where people are allocated surgical abortion (current practice), medication abortion in hospital, or medication abortion at home (using the Scotland protocol of eligibility).

"In New Zealand, according to the Ministry of Health annual report 2024

• 86% of all abortions were provided at 10 weeks or earlier
• Over 10,000 women had an EMA
• Only 2% of all abortions were provided medically between 10 and 20 weeks

"The study out of Scotland suggests that medication abortion at home between 10 and 12 weeks is similarly safe and effective to in hospital. There is so little funding in NZ for abortion research that we do not actually have data on the outcomes of people having medication abortion in NZ to compare this study result to our local population. But it is promising to have international research to support shifting some of this care out of our hospitals and out of our operating theatres for women who wish to have their abortion at home and who would be safe to offered this choice."