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Push to make abortion more accessible


Anastasia Tsirtsakis


19/01/2023 4:49:22 PM

Recertification for GP providers is one of the barriers experts are calling to be lifted to ensure accessibility across Australia.

A pregnant woman undergoing an ultrasound.
Just under 10% of GPs were registered to provide a medical abortion in December 2020.

Abortion is legal across Australia, with South Australia the last state to decriminalise it in 2021. But many patients are still facing challenges in accessing the service.
 
As it stands, medical abortion – using mifepristone and misoprostol (M2-Step) – is only available up to nine week’s gestation, while publicly funded surgical abortion is limited, with a considerable proportion carried out by private providers.

A recent paper, published in the Australian Journal of Primary Health, has helped to highlight the extent of the issue. Researchers reviewed 17 Australian HealthPathways – an online system used in primary care on referral pathways to local services – and found 35% had no public services listed for medical abortion and almost half (47%) had no public services listed for surgical abortion.
 
The majority emphasised that public services should be considered ‘only as a last resort’.
 
Study co-author Professor Danielle Mazza is the Chair of General Practice at Monash, Chief Investigator and Director of SPHERE, and Special Adviser on the Australian National Women’s Health Advisory Council.
 
She has been a vocal advocate for regulatory change and says the challenges women face to access timely and free medical and surgical abortion are numerous, particularly for those in rural and remote areas.
 
‘First of all, they may not even be aware that you can get a medical abortion, they may still think that the only means is surgical,’ she told newsGP.
 
‘Then it’s navigating to a provider. They may not be aware that GPs can offer this service, [or] it might not be advertised by the GP because of fear of retaliation or because of the stigma associated.
 
‘We also know that sometimes getting an ultrasound in a timely way can be very difficult, particularly for rural women.’
 
Then there is the cost.
 
Medical abortion can involve several consultations, including an ultrasound and prescription, which despite being listed under the PBS, can all amount to several hundreds of dollars out of pocket.
 
Meanwhile, access to a provider is another issue.
 
In December 2020, only 2841 of 29,017 registered GPs were active prescribers of medical abortion, and 5347 of 32,393 registered pharmacists were active dispensers.
 
With numbers this low, Professor Mazza says there is evidence to show that there are ‘abortion deserts’ throughout Australia, where there is not even one GP provider or a pharmacy dispenser in the region.
 
In a move to cut barriers to medical abortion, MS Health, the private sponsor behind MS-2 Step in Australia, made a submission to the Therapeutic Goods Administration (TGA) with a number of propositions. Some of these include:

  • expanding the number of health practitioners eligible to prescribe
  • removal of the requirement for GP recertification
  • lifting the requirement for pharmacist registration to dispense.
The pharmaceutical company has also lodged a request with the Pharmaceutical Benefits Advisory Committee for authority scripting to be automated.
 
Though Professor Mazza supports MS Health’s submission, she says they are only ‘baby steps’ and that further deregulation is needed. These include lifting the gestational limit for medical abortion from nine weeks, to scrapping the requirement for GPs to register as providers.
 
‘There should never have been a recertification requirement in the first place – and I don’t believe that GPs should be required to register to become a medical abortion provider,’ Professor Mazza said.
 
‘MS-2 Step and medical abortion care is just like any other medication and any other consultation that a GP undertakes – it’s no different from any other prescription. You don’t have to register to prescribe blood thinners.’
 
The evidence appears to support Professor Mazza’s calls, with international examples such as Canada showing medical abortion can be deregulated while maintaining safety and increasing access.
 
Dr Ronli Sifris, a Senior Lecturer and Deputy Director of the Castan Centre for Human Rights Law in the Faculty of Law at Monash University, supports the move to remove barriers, and agrees the burdens placed on health professionals wishing to prescribe MS-2 Step has a ‘deterrent effect’.
 
‘Removing some of the burdens that health professionals face and making medical abortion easier to access would hopefully resolve some of the existing access issues by, for example, lowering the cost of a medical abortion and making it easier to obtain outside of urban areas,’ he said.

In addition to making medical abortions more accessible, Professor Mazza says there needs to be more accountability when it comes to ensuring that surgical abortion is available to women who require the service, regardless of their postcode.
 
‘Abortion is an essential women’s healthcare service and women need to have a choice of either medical or surgical abortion – and there needs to be regional level accountability for services,’ she said.
 
‘Just like the government is concerned where there are no mental health service providers and they commission those services, we believe that at a regional level, similar commissioning could occur to ensure that every woman in Australia has access to these services when they’re needed.
 
‘It’s very easy for hospitals to make excuses and say, “Oh we just don’t provide that service” if the local gynaecologist doesn’t want to do it, rather than say, “Well, this is a necessary service that we need to provide and if you refuse to do it, we will just need to employ somebody else”.’
 
The TGA is expected to hand down a decision on MS Health’s submission by May.
 
Given the increased evidence base around the safety and efficacy of medical abortion since its introduction to Australia, Professor Mazza is hopeful the advisory board will make changes.
 
‘The TGA is very reasonable and there’s a lot more evidence,’ she said.
 
‘The world has changed, the guidelines are there; there are NICE guidelines, there are World Health Organization guidelines, there are [Royal Australian and New Zealand] College of Obstetrics and Gynaecology guidelines – they’re very clear and evidence-based.
 
‘So we’re drowning in guidelines about it and the regulation has to keep up with what the current guidelines are. We don’t need all of this registration and palaver when we’ve got guidelines that any GP can look up and follow.
 
‘It’s a time when women are very vulnerable and it’s a very difficult process to go through as it is, let alone putting all these healthcare barriers in front of them.’
 
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