Nurses and midwives would be able to prescribe abortion medications, and doctors with a conscientious objection would be compelled to refer patients to abortion providers under a new bill aimed at redressing discriminatory barriers preventing women from accessing abortions.
The private member’s bill tabled this week by Greens health spokesperson Amanda Cohn aims to legislate key recommendations from NSW Health’s review of the Abortion Law Reform Act, which found terminations are beyond the reach of many vulnerable women who cannot afford private clinics or live outside metropolitan areas.
The bill could mean an additional 885 MS-2 Step prescribers to help women out of the maze of abrortion access in NSW. Credit: Marija Ercegovac, Adobe Stock
“This review confirms what we already know,” Cohn said. “Abortion is hard to access in NSW, and this needs urgent reform.”
In the six years since abortion was decriminalised in NSW, disadvantaged women have had to search for providers into their second trimester, and underresourced public hospitals have refused to treat women seeking pregnancy terminations.
Enabling nurse practitioners and endorsed midwives to prescribe mifepristone and misoprostol (MS-2 Step) to women up to nine weeks gestation would result in the state gaining up to 885 abortion providers and bring NSW in line with Queensland, WA and the ACT.
Almost one in three NSW local government areas do not have a doctor trained to provide medical abortions, Family Planning Australia data shows.
The move is supported by doctors represented by the Australian Medical Association (AMA) NSW and Family Planning Australia, NSW’s leading provider of reproductive and sexual health services.
“[T]his is medically straightforward health care, but people are still blocked by cost, stigma, and geography,” Cohn said.
“With reproductive rights rapidly being eroded in the US, it’s never been more important to enshrine access to abortion in our public health system here in NSW.”
Health Minister Ryan Park said the government would consider the bill and the review recommendations.
Nurse practitioners and endorsed midwives have additional qualifications and authority to prescribe some medications.
The NSW Nurses and Midwives Association has advocated for nurse practitioners and endorsed midwives to become medical abortion providers for years.
Associate Professor Zoe Bradfield, president of the Australian College of Midwifery, said the bill would ensure greater access to medical abortion, particularly for disadvantaged women in rural and remote areas where endorsed midwives are often employed.
“In many countries around the world (for example, Sweden), midwives are the primary providers of early medical abortion,” Bradfield said.
The bill also seeks to strengthen the law that requires conscientious objectors to refer patients to abortion providers after the review found some were failing to do so.
AMA NSW president Kathryn Austin said the greater barrier to universal abortion access in NSW was under-resourced public services and a lack of clear pathways that meant women didn’t know where to go.
AMA NSW and Family Planning Australia developed a model to embed abortion within existing pregnancy services and link public hospitals with GPs, private clinics and other community-based providers. They want the NSW government to fully fund and integrate the model statewide.
“Only one in 10 GPs are medical abortion providers, and we really need support from public healthcare systems for patients at all gestations – particularly when there are heightened medical risks,” Family Planning Australia chief executive Sue Shilbury said.
Austin said: “This is about women having a transparent process to find the type of abortion care that suits them.
“Women who choose community services like Family Planning know that they will have a hospital as a backup, no matter how complex their needs may be.”
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