Jenna Price | Abortion and contraception access in Australia still lagging

And this week, those of us who believe women in Australia should have the right to access abortion (just about all of us), gave a cheer to the Therapeutic Goods Administration, the government authority which evaluates and regulates medicines, which this week made it easier for women to get access to abortion drugs.

From August 1, changes to current restrictions mean any appropriately qualified healthcare practitioner (GPs, nurse-practitioners) can prescribe what's called MS-2 Step and any pharmacy can stock and dispense these drugs for medical abortion. The combination of mifepristone and misoprostol is used for medical abortions up to nine weeks gestation.

Great move - but the battle to have accessible abortion for all women in Australia is far from over. According to the University of Melbourne's Louise Keogh, one of the few researchers in Australia who tracks the data, around 80,000 women a year have abortions. It's hard to get an exact figure because the data is a bit useless (that's me paraphrasing Keogh, a professor of health sociology).

The problem is this. Yes, abortion is legal but it is also very, very expensive. Keogh says that the number of women who can access abortion at public hospitals is tiny. And in 2019, then deputy Labor leader Tanya Plibersek said a Shorten Labor government would force public hospitals to provide abortion care.

The Prime Minister Anthony Albanese knocked that on the head last year because, he said, provision of those services is a "state matter". Sure, but public hospitals get Commonwealth funding, right? Plibersek even said at the time: "Commonwealth-state hospital funding agreements will expect termination services to be provided consistently in public hospitals."

Keogh analyses that shift from 2019 to now as a response to lobbying. It's the history of the procedure's illegality over time and the constant religious opposition.

"It's the size and power of a strong lobby group which runs a daily consistent campaign. They don't think it should be legal."

Keogh says that other countries do it much better than we do, even the UK which seems to be entirely in health access mayhem. Yes, even the UK does it better than us, she says: "It is impossible to get a free abortion in Australia."

And what's terrifying is this. Sure, Catholic hospitals may choose not to provide abortion care for religious reasons. But according to surgeon Neela Janakiramanan: "I've interviewed doctors in regional towns who told me that they aren't allowed to provide abortion at the public (non-Catholic) hospital if they want to continue also working at the local private (Catholic) hospital. The overreach of religious health care providers is shocking."

And even worse for women who live in rural and regional Australia. Anna Noonan's PhD research is on rural access to abortion. It's no theoretical concept for her - she lives in the Central West of NSW and access to abortion in non-metro areas is tough.

Is there an organisation women can approach for help or do they all routinely travel to the big towns and cities?

"There is definitely a community of rural people who help each other out to locate services and that comes through small town networks and community ties, about where services might be available. That knowledge gets passed on," says Noonan.

She is elated by the TGA's move but says there is such a long way to go: "Still, I feel like every single step towards normalising abortion as part of healthcare is a win."

And the changes signal to the health provision community that this procedure is safe, it's legal and it's very common. It reassures rural GPs that you don't need more specialist training to support women seeking abortions.

What else do we need to do? Noonan says we need to develop a sense of collective responsibility in both primary care and the hospital system - and we need to undermine the stigma around abortion provision. That's true everywhere but especially true for rural GPs who are already entirely overburdened.

"This is not the responsibility of GPs in private practice. It should be shared by primary care and the public health system and be funded by the government."

So while it's excellent the TGA has changed the rules, Deborah Bateson, now a professor of practice in the medical school at the University of Sydney, said this decision about abortion drugs won't be the end of the access problem.

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Some women seeking abortion need surgical abortions and those, of course, are only available in surgical settings. Ensuring that hospitals across our nation provide free abortion will make access equitable for everyone.

Bateman, who has worked in reproductive rights forever (OK, for over 30 years), says we can go further, we can copy what happens in other countries. Cut the cost of contraception entirely. Provide free IUDs. All excellent initiatives. And make sure our medical workforce is appropriately trained across both contraceptive provision and abortion provision.

For years, our medical schools didn't even teach abortion procedures to medical students. The work of Kirsten Black and others made that change. Caroline de Costa, a professor at the Cairns Institute attached to James Cook University, has seen a massive change in her 46 years of practice. Her 2021 research with colleague Hon Chuen Cheng shows medical student training in the area is still lacking and students lack confidence. But the fact that the majority of students in her survey have had exposure gives her hope.

"I'm optimistic about the future," she says.