This week's announcement by the federal Assistant Minister for Health and Aged Care, Ged Kearney, deregulating the prescribing and dispensing of the medical abortion pill, mifepristone, by the Therapeutics Goods Administration is both welcome and, quite frankly, about time.
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A key step in ensuring increased abortion access, it brings us into line with other countries such as Canada where both doctors and nurses have been able to prescribe the abortion pill like any other prescription medicine since 2017 without safety being compromised.
The restrictive arrangements put in place when medical abortion first became available in Australia more than a decade ago brought about problematic consequences, reducing access to abortions largely in women from lower socio-economic groups or among those living in rural and regional areas.
For the past 10 years GPs who wanted to provide the abortion pill to their patients had to undergo mandatory training, registration and re-registration every three years.
These unusual requirements engendered suspicion and confusion amongst GPs and put up barriers to service provision. Currently only about 10 per cent of GPs are registered to prescribe and 27 per cent of community pharmacists registered to dispense, medical abortion medication.
Now, with these constraints removed, it seems likely that more GPs will integrate medical abortion service provision into their practice offering women a safe abortion option that can be undertaken in the comfort of the woman's home.
Importantly, the TGA's deregulation opens the door to other medical providers, such as midwives and nurses, also being given the authority to prescribe the abortion pill.
While nurse practitioners will be the first ones able to do so, this is a clear message that the Australian health system recognizes nurses and midwives as crucial in the provision of family planning.
It will also make abortion more readily available in places where there is no GP. In 2019 one third of Australian women lived in areas where not even one GP provided a medical abortion. In remote Australia this figure is as high as 50 per cent.
The deregulation message from the Minister also aims to destigmatize abortion - a procedure undertaken at least once by one in five of all Australian women.
The past decade has seen surgical abortions decline while the proportion of medical abortions has increased, to around 30 per cent - so there is clearly a want and need for this approach which involves taking two lots of tablets to bring about what is essentially a medically-induced miscarriage.
Much has changed since Australian women first gained access to medical abortion medication back in 2012. International guidelines from the World Health Organization and others endorse nurse-led provision.
There is also significantly more support and training available for providers with national guidelines and resources for practitioners and an online Community of Practice (AusCAPPS) which supports primary care practitioners to deliver medical abortions.
Women also have ready access to written patient information and videos from a range of reputable sources online like family planning clinics and the government's Healthdirect website.
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Medicare now also supports the remote delivery of medical abortion via telehealth. This has been enormously beneficial in increasing access for women across Australia to medical abortions.
Unlike other GP telehealth arrangements, there is not a requirement to have been a pre-existing patient of the doctor or practice and women in South Australia for example could be provided a medical abortion from a GP via telehealth in Queensland.
In 2017 Canada did what Australia has just done - removed the need for a pharmacist or doctor to register and undergo mandatory training, extending those eligible to prescribe from a physician to an "authorised health professional".
Since these changes were introduced there has been no increase in the number of abortions. But there has been a large increase the number of providers and greater access to services more quickly, enabling women to have their abortions earlier and easier.
Assistant Minister Kearney should be lauded for her commitment to ensuring that all Australian women can access abortion when they need it. The message is clear: women, regardless of where they live, have the right to a safe and easy abortion and any barriers to this should be removed.
- Professor Danielle Mazza AM is head of the department of general practice at Monash University and director of the SPHERE NHMRC Centre of Research Excellence in Women's Sexual and Reproductive Health in Primary Care.
