Medical abortion pill access expanded in landmark move

Access to medical abortions will be dramatically expanded in Australia under major changes that will allow all doctors and nurse practitioners to prescribe the pregnancy termination pill, and all pharmacies to stock it.

The landmark move to slash red tape around who can prescribe and dispense the drug should enable medical abortions to become a first-line option for women who want them, by encouraging thousands more health professionals to provide access to the two-part medication.

The abortion pill will this year be available to be prescribed by every doctor. Credit: James Alcock

Only about 10 per cent of doctors and 30 per cent of pharmacists are currently certified to deal with the pill – known as MS-2 Step in Australia, or RU486 overseas – which provides major obstacles for Australian women who need timely care.

Restrictions will be removed from August so health practitioners don’t have to undergo special certification and registration through the drug’s importer, the non-profit MS Health. All pharmacies will be able to dispense MS-2 Step like they would any other medication, while nurse practitioners will be able to prescribe it for the first time once the measure is enacted by states and territories.

Nurse practitioners represent about 1 per cent of nurses – they are endorsed by the Australian nursing board and have a master’s degree – and can work in settings as varied as sexual health clinics, community centres, Aboriginal community-controlled health organisations, small regional hospitals and mobile services for homeless people. They also often bulk-bill patients.

The abortion pill was first approved for use in Australia in 2006 after a fierce political debate that required a conscience vote in parliament to strip then-health minister Tony Abbott of his veto power over the drug. But it wasn’t until 2012 that MS Health started importing it and medical abortions became more widely available.

Assistant Health Minister Ged Kearney.Credit: Alex Ellinghausen

Tuesday’s announcement of loosened restrictions represents the first major regulatory change since the pill was registered by the Therapeutic Goods Administration (TGA) a decade ago and is a significant step towards the Albanese government’s election promise to deliver equitable abortion access after it dropped its 2019 policy to force public hospitals to perform surgical terminations.

Assistant Health Minister Ged Kearney said women in Australia experienced structural barriers trying to access the care they need, particularly in regional and rural areas.

“We welcome these changes that remove red tape and improve equitable access to healthcare for all Australians,” she said.

The new rules – which will be approved by the federal government following recommendations from the TGA and the Pharmaceutical Benefits Advisory Committee – were also praised by the doctors’ and nurses’ professions, who said they would be a game-changer for women.

Australian College of Nursing Practitioners president Leanne Boase said it “will make a huge difference in access”.

“It’s been so difficult for so many women to access this treatment in the past because it is something that needs to happen very early in pregnancy. It’s going to have the greatest impact in regional and remote areas, but will have an impact everywhere,” she said.

Medical abortions are caused by a two-tablet course of misoprostol and mifepristone and can be taken up to nine weeks into a pregnancy.

Uptake has steadily increased since the medication was added to the Pharmaceutical Benefits Scheme in 2013, but surgical terminations – which can be performed up to 24 weeks’ gestation, depending on the state and territory – have remained more common, according to available data.

However, surgical abortions are more expensive, are not offered at many public hospitals, and rules vary depending on the jurisdiction, meaning women can have to travel hundreds of kilometres to access one.

A 2021 study found Australia trailed comparable nations in terms of both registered prescribers and medical abortion rates; about 23 per cent of Australian abortions were medical terminations, compared with 39 per cent in the United States and 73 per cent in Britain.

Boase said it would be “so much safer” for women if medical abortions became the first-line option instead.

“It’s important to acknowledge they’ve addressed a number of barriers with these measures. Not only will [patients] be able to access it, they’ll be able to afford it. [Until now] there were really hard barriers – it was black and white, only medical practitioners and only pharmacists with certain training,” Boase said.

“One nurse practitioner told me there are only two pharmacists in their whole region they can send people to; it’s not just about finding the prescriber, it’s about finding the pharmacy.”

The Royal College of Australian General Practitioners also welcomed the move, including the expanded scope of nurse practitioners. “This will improve access, especially in rural and regional areas,” president Nicole Higgins said.

Philip Goldstone, the medical director of MS Health which made the application, said previous restrictions controlling who was certified had created “huge logistical barriers for patients wanting to access medical abortion services”.

“We’re hoping this will broaden access for patients in Australia. More GPs will immediately be able to prescribe medical abortion, rather than the current limited one in 10. When a patient is prescribed, they’ll be able to take it to any pharmacist, like any other medicine that’s registered in Australia,” he said.

“We know that the pharmacy requirement has been a particular barrier – patients would have to go from pharmacist to pharmacist, or GPs would have to have a relationship with a particular pharmacist.”

He said MS-2 Step was unfamiliar to medical practitioners when it was first introduced in Australia. “We’ve now had a decade of experience with this medicine, we know that it’s safe and effective, and we know most health practitioners have some knowledge and awareness of the process and how to provide care for patients,” he said.

However, Goldstone said the certification process was not the only problem with access. “We also know that there still exists a lot of stigma around abortion provision and abortion care, which contributes to GPs not taking up provision of medical abortion. We just hope to remove as many barriers as we are able to, this being one of them,” he said.

A Senate inquiry into reproductive healthcare, which handed down its report in May, also called for the medical abortion pill to be made easier to prescribe. The government is yet to formally respond to the report.

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