Early medical abortion in Cairns, Queensland: July 2006 – April 2007

Practice nurse provision of early medical abortion in general practice: opportunities and limitations

Approximately one in three Australian women with an unintended pregnancy will have an abortion, yet significant barriers remain to ensure the delivery of equitable and timely medical abortion services, including lack of trained providers, high out-of-pocket costs, abortion stigma, conscientious objection and large geographical distance to services. Practice nurses can be suitably trained to provide early medical abortion in general practice; however, there remain several key limitations to the implementation of nurse-led models of care. This forum article discusses these limitations, including issues concerning legislation, funding models, lack of access to medical abortion training, practice structure and systems, and makes recommendations as to how increased access to medical abortion in Australia can be achieved.

The use of mifepristone for medical abortion

OBJECTIVES

To provide advice on the use of mifepristone for medical abortion.

TARGET AUDIENCE

All health professionals providing gynaecological care, and patients.

VALUES

The evidence was reviewed by the Women's Health Committee RANZCOG, and applied to local factors relating to Australia and New Zealand.

BACKGROUND

This statement was first developed by Women's Health Committee in November 2007 and reviewed in March 2019.

FUNDING

The development and review of this statement was funded by RANZCOG.

Medical abortion in Australia: a short history

Surgical abortion has been provided liberally in Australia since the early 1970s, mainly in privately owned specialist clinics. The introduction of medical abortion, however, was deliberately obstructed and consequently significantly delayed when compared to similar countries. Mifepristone was approved for commercial import only in 2012 and listed as a government subsidised medicine in 2013. Despite optimism from those who seek to improve women's access to abortion, the increased availability of medical abortion has not yet addressed the disadvantage experienced by poor and non-metropolitan women. After telling the story of medical abortion in Australia, this paper considers the context through which it has become available since 2013. It argues that the integration of medical abortion into primary health care, which would locate abortion provision in new settings and expand women's access, has been constrained by the stigma attached to abortion, overly cautious institutionalised frameworks, and the lack of public health responsibility for abortion services. The paper draws on documentary sources and oral history interviews conducted in 2013 and 2015.

Knowledge of abortion law and provision of abortion services amongst tertiary students in Far North Queensland

Abortion is an important health issue for Australian women, yet there are large variations across Australia in abortion service provision and in state laws regulating abortion practice. We conducted a survey of tertiary students in Far North Queensland to ascertain their knowledge of local abortion services and of abortion law in Queensland. Important gaps were demonstrated in their knowledge of the law and of the availability of abortion services.

Medication abortion in Canada: a right-to-health perspective

The right to health under the International Covenant on Economic, Social, and Cultural Rights, to which Canada is a signatory, entitles women to available, accessible, and acceptable abortion care. Abortion care in Canada currently fails this standard. Medication abortion (the use of drugs to terminate a pregnancy) could improve abortion care in Canada, but its potential remains unrealized. This is in part attributable to the unavailability of mifepristone, the safest and most effective pharmaceutical for medication abortion. Given that it could improve abortion care, we investigated why mifepristone remains unapproved in Canada, whether its unavailability is attributable to government inaction, and whether Canada is therefore failing to fulfill its obligations under the right to health.

Introducing early medical abortion in Australia: there is a need to update abortion laws

Recent changes to Federal Therapeutic Goods Administration legislation have seen the limited introduction of the drug mifepristone to Australia for the purpose of early medical abortion. At the same time it has become evident that both methotrexate and misoprostol, licenced and available for other indications, are being used safely and appropriately for early abortion by Australian medical practitioners. Early medical abortion is widely practiced overseas where its safety and effectiveness are well supported by current evidence. However, abortion law in many states is still contained within the Criminal Codes and does not reflect current evidence-based abortion practice. In other states and territories restrictions on where abortions may be performed pose potential barriers to the introduction of mifepristone for medical abortion. There is an urgent need for abortion law to be clarified and made uniform across the country so that the best possible services can be provided to Australian women.