Barriers for patients and GPs to MS-2 Step

Access to medical abortion remains a challenge to people facing geographical and economic barriers. Yet, according to a new study, financial disincentives for GPs providing such care is also fuelling access issues.
 
Published in the Medical Journal of Australia and undertaken by researchers from the University of Melbourne, the paper reviews 23 studies on the provision of medical abortion in Australia from January 2013 to January 2025, by GPs, nurses, midwives, and pharmacists.
 
In August 2023, landmark regulation changes came into effect, lifting several restrictions around prescribing mifepristone and misoprostol (MS-2 Step) for medical terminations.
 
The study authors write that, prior to this reform, only 7% of GPs and 22% of pharmacists were active providers of MS-2 Step, and most were in major cities.
 
Yet medical abortion rates are almost twice as high in regional and remote areas as in major cities, which speaks to the importance of overcoming access barriers related to geographic location.
 
‘General practitioner providers are motivated by the belief that abortion care is integral to women’s health care and should be financially, geographically, and socially accessible,’ the authors said.
 
‘This sense is greater among clinicians who provide care to socially marginalised, disadvantaged, or rural women for whom access to services may not be straightforward.’
 
Since 2013, MS-2 Step has been subsidised by the Pharmaceutical Benefits Scheme for early medical abortion (up to 63 days’ gestation) in primary care.
 
Increasing numbers of prescriptions of MS-2 Step indicate its use is growing.
 
Women’s health expert Associate Professor Magda Simonis told newsGP that GPs need to be better supported to provide medical abortions, not just financially, but with more training to manage what are complex and time-intensive consultations.
 
‘There’s the initial consultation where an unplanned or unwanted pregnancy is disclosed, but sometimes there’s ambivalence, or there’s other predicating circumstances, such as sexual coercion,’ she said.
 
‘Exploring the circumstances around that and the reasons for seeking termination may also suggest other concerns, and they need to be also addressed and talked through.
 
‘They’re not simple 20-minute consultations, and it usually takes more than two [consultations] to provide the kind of care and follow-up that women require.’
 
Associate Professor Simonis said this continuity of care is something general practice is ‘really well placed to provide’.
 
The researchers also found most medical abortion providers are women, but there is little financial incentive for GPs to engage in sexual and reproductive health work.
 
‘Recent scrutiny of the Medicare Benefits Scheme (MBS) affirms the existence of gender-related biases in federal funding structures; for example, the MBS rebates for women’s health procedures are smaller than for men’s health procedures,’ they wrote.
 
Associate Professor Simonis said this is indicative of the gender pay gap ‘that spans across almost every sector’.
 
‘We [female doctors] spend more time with our patients, on average,’ she said. ‘We do more complex consultations, we deal with more than one issue.
 
‘We rarely keep to the 10-minute consult, and we don’t consider the financial implications of the time-intensive care that we’re providing as compared to our non-female counterparts.
 
‘Women tend to be working part time and have other carer responsibilities, so their office hours and availability is limited, so then they become really overloaded with the complex cases, and burnout is a significant issue which I think needs to be looked at.
 
‘Women usually bear the brunt of being the carers of children and older people, have responsibilities that keep them from fulfilling their full professional potential, and therefore earn less over a lifetime.’
 
Associate Professor Simonis said it is a bias that extends to female healthcare.
 
‘It’s not just the doctors who are earning less for doing the hard work,’ she said.
 
‘It’s also the women who, throughout their lives, have to fork out a lot more money than men do to maintain their relative health and to meet their needs.’
 
Moving forward, the authors said financial and structural support is urgently needed for the geographic decentralisation of medical abortion training and services.
 
‘Regulatory, governance, funding, and service coordination barriers need to be overcome to improve early medical abortion delivery in Australian primary care,’ they concluded.
 
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