Abortion pill Qld: Nurses, midwives to gain prescription powers

One of the state’s leading obstetricians says the Queensland Government needs to understand the “risks” of allowing nurses and midwives to prescribe the medical abortion drug.

• Broken system: Women’s horror stories

A group of specialist obstetricians is warning the Queensland Government to understand the “risks” of allowing nurses and midwives the ability to prescribe the medical abortion drug.

The Courier-Mail revealed on Wednesday that Queensland could become the first state in Australia to allow nurses and midwives to write prescriptions for the abortion pill when the TGA signs off on changes to restrictions surrounding the drug.

However, National Association of Specialist Obstetricians and Gynaecologists president Associate Professor Gino Pecoraro said he believed only doctors “have the required skill and expertise” to manage unwanted pregnancy and termination and any potential complications the treatment can cause.

“While this may superficially appear a great initiative in providing better access for women seeking what should be a straightforward termination, there are significant risks associated with the treatment,” he said.

“Women absolutely need affordable and timely access to the full range of reproductive health care services, however, before committing to this course of action, the Queensland Health Minister needs to fully understand those risks.”

National Association of Specialist Obstetricians and Gynaecologists president Associate Professor Gino Pecoraro. Picture: Tara Croser.

But Griffith University Senior Lecturer in Midwifery Dr Roslyn Donnellan-Fernandez said nurses and midwives were well trained to provide the service and it would “most certainly” improve access.

“Early medical termination of services already nurses and midwives are prepared educationally and clinically and provide support and care for women … when they are making these decisions,” she said.

“If we are talking about early access to safe medical termination, particularly in rural and regional areas, yes midwives and nurses do have a role to play.”

The TGA revealed it would remove arduous restrictions on doctors and pharmacists and allow nurses and midwives to prescribe, at the Senate inquiry into universal access to reproductive healthcare.

MS-2 Step – the only available medical abortion pill in Australia – can currently only be prescribed by doctors who have completed special training and are registered to prescribe it.

Pharmacists also need to be registered to dispense the drug.

The Courier-Mail understands that once the TGA lifts the restrictions the government will move to make legislative changes to give nurses and midwives the ability to prescribe.

Termination of pregnancy can result in haemorrhage and around one per cent of women who have a medical abortion will experience an infection.

Associate Professor Pecoraro said that instead of funding nurses and midwives to deliver the service, the state should continue to lobby the Federal Government to reverse decades of under investment in women’s health and make sure that Medicare rebates actually cover the cost of providing the services needed by women.

Nurses, midwives to prescribe abortion pill in ‘game changer’

Queensland is set to become the first state in Australia to allow nurses and midwives to write prescriptions for the abortion pill, in a bid to help bridge the severe lack of termination services across the state.

The medicines watchdog revealed it would remove arduous restrictions on doctors and pharmacists and allow nurses and midwives to prescribe, after a Senate inquiry into universal access to reproductive healthcare.

MS-2 Step – the only available medical abortion pill in Australia – can currently only be prescribed by doctors who have completed special training and are registered to prescribe it.

Pharmacists also need to be registered to dispense the drug.

The Courier-Mail understands that once the TGA lifts the restrictions the government will move to make legislative changes to give nurses and midwives the ability to prescribe.

A statement from Queensland Health Minister Yvette D’Ath said: “I look forward to the TGA making a decision that would allow more healthcare practitioners to prescribe and dispense MS-2 Step, especially throughout regional and rural areas.”

Therapeutic Goods Association chief medical adviser Robyn Langham told the recent inquiry the TGA would approve the changes in a matter of weeks.

Children by Choice CEO Daile Kelleher. Picture: David Clark

Dr Langham said the evidence provided by drug manufacturer MS Health showed there were very low numbers of general practitioners registered to prescribe and low number of pharmacists registered to dispense.

“It was universally agreed that what was put in place 10 years ago was no longer relevant,” she said.

“It was really out of step with current international guidelines, and it certainly was not meeting the needs of the Australian community in what it did.”

Children by Choice CEO Daile Kelleher said while the Australian first was a huge win for Queensland women, particularly in the regions, it was not the only change needed to fix the state’s dire abortion access issues.

The Sunday Mail previously reported that women seeking a termination across the state were being turned away from major metropolitan hospitals, travelling hundreds or thousands of kilometres and being forced to plead with not for profits for financial assistance to access the time-sensitive health service.

“It is a bit of a game changer because that does mean there are less barriers,” she said.

“We’d love to see more sexual health clinics across Queensland to be prescribing things like early medical abortion that would certainly make a difference in the gap that exists for people.”

Health Minister Yvette D’Ath

Queensland Nurses and Midwives’ Union secretary Beth Mohle said her members were supportive of being able to work to their full scope of practice and provide access to “equitable reproductive healthcare”, but more investment would be needed in training the workforce.

“Nurses and midwives play key roles in providing respectful sexual, reproductive and maternal health services statewide,” she said.

“In addition, as nursing and midwifery are female-dominated professions, the vast majority of our 70,000 members are also personally impacted by the provision of these services.”

Ms D’Ath said her government would continue to improve access to abortion services and she supported a woman’s right to choose.

“The greatest danger to termination services in Queensland is the Leader of the Opposition (David Crisafulli), who voted against decriminalising termination of pregnancy in 2018,” she said.

But a spokesman for the LNP said the party granted MPs a conscience vote during the last debate, and has repeatedly stated it has no plans to re-criminalise abortion.

“The priorities of the LNP in government would be properly resourcing the health department and healing the Queensland Health Crisis created by a decade of the chaotic Palaszczuk Labor Government,” he said.

The Senate inquiry is due to report back to Parliament later this month.

TOP 10 BARRIERS TO ABORTION IN QLD

1. Interpersonal violence including family, intimate partner and sexual violence, reproductive coercion and new relationships: 1368

2. Affordability: 1077

3. Internalised stigma and knowledge: 700

4. Demographics (what does this mean): 545

5. Mental health: 530

6. Social stigma: 306

7. Health status: 295

8. Primary healthcare attitudes and service: 225

9. Infrastructure and logistics: 206

10. Health information: 123

— Data taken from CSIRO report that examined Termination of pregnancy in Queensland post decriminalisation between December 2018 and June 2020. The only available data was held by Children by Choice who see around 20 per cent of the estimated 14,000 abortions performed in Queensland every year.

UNINTENDED PREGNANCIES IN AUSTRALIA

* Women living in rural areas are 1.4 times more likely to experience either a mistimed or unwanted pregnancy than women living in metro areas. This is mostly because their access to contraception and abortion services are much worse than their city-living counterparts.

* Around 40 per cent of all pregnancies in Australia are unintended – with 197,234 recorded in 2020 alone.

* Of the unintended pregnancies experienced in 2020; one per cent were stillbirths, 15 per were miscarriages, 31 per cent of pregnancies were terminated and 53 per cent resulted in live births.

* About 73 per cent of women who experience an unplanned pregnancy were using contraception, most commonly the pill (39 per cent).

— Information taken from pharmaceutical company Organon’s report: Impact of unintended pregnancy, June 2022. The report was prepared by an analytics company using high quality, publicly available data.