Location a key barrier to medical abortion: Study

Geographic location remains a key determinant of access to early medication abortion in Australia, despite the service now being offered by more GPs, according to the findings of a study led by Flinders University.
 
While many GPs choose not to provide abortion care, the study has prompted researchers to call for greater support for GPs who do offer the service, improved training, and expanded telehealth to improve access.
 
The study’s lead author, Associate Professor Luke Grzeskowiak, said the findings reveal medical abortion access ‘still depends heavily on your location’.
 
‘Where you live continues to play a major role in whether you can access care through a local GP and for some people, that can mean travelling long distances or navigating unfamiliar services,’ he said.
 
‘There is still more work to do to make care consistent and accessible across Australia.’
 
Published in BMJ Sexual & Reproductive Health, the ‘Longitudinal trends and characteristics of medication abortion in Australian general practice’ study analysed data from more than one million women across 400 general practices nationwide between 2014 and 2021.
 
During that time, the number of women receiving medical abortion through GPs rose from about one in 10,000 to just over one in 500, while practices offering the service increased from around one in 25 to about one in five.
 
Despite these increases, the availability of medical abortion in Australia is significantly less than that in comparable nations.
 
While early medication abortion represents up to 90% of abortions in many high-income countries, it accounts for only around half of those in Australia, highlighting what researchers say is ‘a gap between policy progress and real-world access’.
 
‘Medical abortion is widely used internationally and offers a safe, effective option for early pregnancy care, but in Australia we are not yet seeing the same level of access,’ said Associate Professor Grzeskowiak, adding that at any point during the study period, only about one-third of practices provided early medication abortion.
 
He said the findings also reveal that more than half of patients were new to the practice where they received care, ‘suggesting many had to seek out a new provider.’
 
‘That tells us people are often having to go to considerable effort to find a GP who offers this service,’ he said.
 
Study co-author, Head of Monash University’s Department of General Practice Professor Danielle Mazza, said while progress has been made in the five years since the study data was collected, there is ‘still a long way to go’.
 
‘The finding of 57% of women attending a new practice to do so is quite concerning,’ she told newsGP.
 
‘In an environment where care is becoming more fragmented, that means they don’t have an established relationship with a general practice, and they have to seek it elsewhere, and that means delay.
 
‘When it’s time sensitive, and women have to get the service before nine weeks, that’s really problematic.’
 
Professor Mazza said changes introduced since 2023, such as the TGA’s deregulation of mifepristone and misoprostol (MS-2 Step), and the introduction of MBS telehealth item numbers for sexual and reproductive telehealth, are ‘really important’, but she does not believe enough has been done to make women with access barriers aware of the availability of the MBS items.
 
Similarly, she would also like to see greater awareness among GPs of resources available to them for support in providing early medical abortion education and LARC, such as the AusCAPPS Network and a recently added module on the RACGP’s Check program.
 
‘We’d encourage GPs and especially GP registrars to sign up to AusCAPP,’ she said.
 
‘It’s open to all AHPRA-registered practitioners now, so we’re trying to spread the knowledge and information and help providers to get confidence and skills to provide the service.’
 
The researchers hope to conduct follow-up studies to see whether inequities continue to ease in Australia.
 
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abortion access early medication abortion health inequity medical abortion reproductive health sexual health telehealth