Abortion access could be better
Experts say medical abortions in Australia are still being affected by a restrictive history.
A new paper published by the Australian Medical Association (AMA) says the time has come to lift restrictions on abortion to enable equitable access for all Australian women.
The paper is focused on the drugs mifepristone (popularly known as RU486) and misoprostol, which are taken for early medical abortion (up to 9 weeks’ gestation) and later medical abortion in hospital.
The use of these drugs is considered part of the “gold standard” for medical abortion, according to Professor Caroline de Costa, professor of Obstetrics and Gynaecology at James Cook University.
The drugs have had a chequered history in Australia since their introduction in the early 1990’s.
Availability of mifepristone was blocked from 1996 to 2006, and only became accessible after Senator Brian Harradine’s traded support for amendments to the Therapeutic Goods Act of 1989 with then Prime Minister John Howard, in exchange for Harradine backing the privatisation of Telstra.
“This amendment meant that, for 10 years, Australian women were not only unable to access the drug but they also knew very little about its increasingly wide and safe use overseas,” wrote Dr de Costa.
Even after the Harradine amendment, the controversy surrounding the drug in Australia deterred all pharmaceutical companies from manufacturing or promoting mifepristone here.
For several years after this, it was only provided by doctors in private practice.
Even now, the drugs are put into a ‘special’ category by the Therapeutic Goods Administration.
“The approval for the drug [by the Therapeutic Goods Administration] was finally granted in 2012; however, its registration was accompanied by an onerous risk management plan that placed conditions and restrictions on how the drug would be prescribed and dispensed for medical abortion,” wrote Dr de Costa and colleagues.
“There may have been some justification for all these requirements in 2012, when the drug was (fairly) new in Australian practice. It has now been licensed for more than 6 years and over 100 000 medical abortions have been performed using it.
“There is no good reason why mifepristone, which has minimal side effects and is supplied uniquely as a single tablet, needs to remain indefinitely as a special drug — a status that contributes to the stigmatisation of abortion itself and of the many women who make the decision to terminate a pregnancy.
“The procedure of medical abortion can be easily managed by any medical practitioner, including in rural practice, who routinely cares for women presenting with spontaneous miscarriage. No extra procedural skills are required, provided the practitioner can refer those women needing surgical evacuation of incomplete abortion to an appropriate hospital.
“Medical abortion is now available to women in many parts of Australia, but not all,” they concluded.
“Despite the introduction of telemedicine abortion services, these are not available to all women, especially in rural and remote areas, and in particular to Indigenous women, who often present later and have to travel further to access abortion care.
“It is time to make mifepristone and early medical abortion accessible to all Australian women.”