News

---

Call to get ‘ducks in a row’ for MS-2 Step changes

---

From 1 August, all healthcare practitioners with appropriate qualifications and training, including nurse practitioners, will be able to prescribe mifepristone and misoprostol (sold as MS-2 Step) for medical abortions.
 
The change, enacted 11 years after the medication was approved for use in Australia, stems from a Therapeutic Goods Administration (TGA) decision to drop longstanding regulatory requirements that have limited prescribing and dispensing of the drug.
 
While welcomed by many as an overdue move to improve access to reproductive healthcare, recent media coverage has shifted to focus on non-doctor prescribing of MS-2 Step, including further easing of restrictions to include pharmacists.
 
For Associate Professor Gino Pecoraro, President of the National Association of Specialist Obstetricians and Gynaecologists, the debate surrounding who should be writing the script is counterproductive and distracting from critical safety issues that need addressing, especially in rural and remote areas.
 
‘You can’t make this about a “turf war” between doctors and nurses and pharmacists, because that takes the attention away from where it should be,’ he told newsGP.
 
‘The Government [first] needs to sort out all the infrastructure to make it safe.’
 
It is estimated that between 1–4% of medical terminations will be incomplete and may require surgical intervention, while excessive bleeding and infection are other possible complications that require access to timely medical care.
 
‘Everybody agrees that it’s not acceptable that women can’t access the full range of medical services in the regions – I don’t think anybody would argue with that,’ Associate Professor Pecoraro said.
 
‘[But] there are a number of safety, indemnity, administrative and legislative issues [that need resolving] before we open prescribing of this medication to non-doctors.
 
‘We should have the appropriate pathways in place to deal with complications that might arise in resource-poor environments where there may not even be a doctor available around the clock.’
 
Dr Wendy Burton, Chair of RACGP Specific Interests Antenatal and Postnatal Care, has welcomed the TGA announcement but is not in favour of pharmacy prescribing, noting the importance of patient consultations prior to going ahead with a medical termination.
 
‘It takes time to have these conversations, [receive] consent for this intervention, confirm understanding of the process and side effects, to discuss contraceptive options going forward and to safety net women,’ she told newsGP.
 
‘Prescribing analgesia is [also] likely to be required … [and] in my experience these appointments are a mix of mental and physical health as well as pharmacological effects of the medication.
 
‘Improving access is a good thing, but these are nuanced conversations.’
 
Associate Professor Pecoraro agrees, highlighting the various aspects of care required for medical terminations.
 
‘Who is responsible for the post-abortion care including counselling, contraception, treatment of any STI which may been detected, etcetera?’ he queried.
 
‘Abortion is more than just prescribing and dispensing of a tablet, it should involve a complete history and examination and dealing with concomitant issues.
 
‘You need to get all your ducks in a row before you make sweeping changes, the first rule needs to be “do no harm”.’
 
As it stands, uptake of the training currently required for GPs to prescribe MS-2 Step remains low, with only one in 10 GPs certified to prescribe.
 
While removing the regulatory requirements is expected to increase the number of GPs who provide medical terminations in the community, it is unclear to what extent.
 
Research suggests that there are various reasons for low uptake of MS-2 Step training by GPs, including:

• the feeling that abortion is outside of their scope of practice
• the complexity and difficulty of managing the procedure
• perceived stigma
• religious and moral objections
• difficulties referring patients to local public hospitals if complications occur or surgical abortion is required.

Associate Professor Pecoraro says the reasons for previously low uptake should be better understood before any further expansion of prescribing powers.
 
‘Why have so few GPs taken up the potential prescribing of this medication? It might be that with the removal of the need for added training, more do take it up – or it might not. If the latter proves true, then perhaps we need to explore why that is,’ he said.
 
‘It might be because they find it too difficult to safely provide the service, particularly in small centres, and bypassing the GP and getting nurse practitioners and pharmacists to prescribe [the medication] may not solve the problem.
 
‘There are many other medical procedures which can only be provided in centres of a certain size for safety reasons and in these situations, government-funded transport and accommodation is provided for people needing them.’
 
Log in below to join the conversation.

---

---

GP training medical abortion MS-2 Step women’s health

---