Bodily autonomy: Australian women still face obstacles when seeking abortion services

In July last year, following a Senate inquiry into universal access to reproductive healthcare, the Therapeutic Goods Administration (TGA) removed restrictions on prescribing and dispensing the medical abortion pill MS-2 Step (mifepristone and misoprostol).

As a result, medical practitioners are no longer required to complete mandatory training and registration to provide this service.

The lifting of restrictions means “MS-2 Step can now be prescribed by any healthcare practitioner with appropriate qualifications and training, without the need for certification”.

The prescribing of medical abortion now mirrors that of any standard prescription in general practice, such as antibiotics or blood pressure medicine.

The TGA's decision brought Australia closer to comparable settings in countries such as Canada, where the lifting of restrictions resulted in an immediate increase in the number of health professionals providing medical abortion.

Australia heading in the right direction

Australia following suit is a comforting sign that we’re heading in the right direction. This is especially reassuring in light of the continued aftermath of the 2022 United States overturning of Roe v Wade, which removed American women’s constitutional right to abortion, leaving them at the behest of state legislatures, as is the situation in Australia.

The completion of decriminalising legislation around Australia this year is an important signal that the Australian community regards abortion care as healthcare, and expects our legislative frameworks to inch closer to reflecting that.

Antiquated laws still exist across the globe, such as in Honduras and Nicaragua, where abortion is illegal in all circumstances.

At the other end, countries including Canada and the United Kingdom are leading the way, with abortion available at zero cost. These inconsistencies highlight the progress needed to ensure all women have equal access to such vital services, and echo the inequities evident within our own borders.

In a divided global landscape where reproductive freedom and bodily autonomy aren’t guaranteed, Australia must persist in eliminating the barriers women face when seeking an abortion.

Have the TGA amendments worked?

Close to a year on since the TGA made its announcement, have the amendments achieved the desired outcome? The verdict is unclear.

Speaking to members from the SPHERE Women’s Sexual and Reproductive Health Coalition, anecdotal evidence suggests practitioner participation remains challenging.

In South Australia, reports are that the situation is very much the same, with endorsed midwives and nurse practitioners waiting on legislative and guidelines updates before they can prescribe. Moreover, significant service disparities are persisting in the northern metropolitan regions, and throughout regional and remote areas.

Read more: Women’s Health Week: Breaking down the barriers to abortion access in Australia

Brigid Coombe, from the South Australian Abortion Action Coalition, says there are a limited number of GP providers outside metropolitan Adelaide.

“There’s very slow uptake by country GPs and pharmacies. While some patients may prefer travelling to Adelaide rather than attending a local GP service where clinic staff are known to them, for many this is very costly and arduous,” she said.

Inconsistent legislation a factor

The 2022 South Australia Abortion Report revealed that within the previous five years, 95% of pregnancy terminations were conducted in metropolitan Adelaide. Not only that, of the women accessing abortion in rural South Australia, just 9.8% access termination-of-pregnancy services in their local region.

It’s also understood that for women who could otherwise access early medical abortion (EMA) in their local area, access to ultrasounds adds another hurdle.

Inconsistent legislation across Australian states and territories may be hindering the implementation of this regulatory change. For example, in New South Wales, state legislation restricts the prescribing of MS-2 Step to medical practitioners only.

Read more: Addressing the inequity of abortion access

While opening prescribing is a powerful step in the right direction, truly improving access to abortion care is contingent on addressing systemic barriers regarding patient fees and practitioner training opportunities and remuneration.

Abortion care can be expensive, and out-of-pocket costs greatly impact women’s ability to access sexual and reproductive health services.

Economic barriers can exacerbate health inequities in disadvantaged populations, including Aboriginal and Torres Strait Islander women, and those living in regional and remote areas. Making abortion free is therefore an essential step if we want to achieve universal access to reproductive healthcare as per the National Women’s Health Strategy 2020-2030 (2018).

In addition, the current Medicare Benefits Schedule doesn’t have item numbers for specific practitioners to provide EMA. Without appropriate remuneration, there’s little incentive for primary care practitioners other than GPs to offer these services.

Further, ensuring they have the time and resources to participate in training is essential. Significant costs can accrue through loss of income, travel time, accommodation, and course fees. Even when practitioners are adequately trained, remuneration remains low, acting as a disincentive.

More funding and training needed

Considering these factors, it's clear the TGA changes cannot be fully exploited without improvements to funding and training. However, signs suggest we’re heading in the right direction, with many states making significant strides towards improving women’s access to EMA in the past year.

In Western Australia, abortion was fully decriminalised this March. Additional legislative changes mean women don’t need a doctor’s referral to get an abortion, nor do they need to complete counselling, and endorsed midwives and nurse practitioners can now prescribe MS-2 Step.

Read more: Call the doctor: Telehealth and the case for making contraception, abortion, and pregnancy care permanent

In Victoria, Premier Jacinta Allen has announced the first five of 20 women’s health clinics to open in Melbourne hospitals from June. Clinics will provide free, comprehensive care, spanning abortion, endometriosis, pelvic pain, polycystic ovary syndrome (PCOS).

In March 2024, Queensland released its Termination of Pregnancy 2032 Action Plan. This included amendments to the Termination of Pregnancy Act 2018 and Criminal Code Act 1989, announcing pivotal legislative reform that enables health practitioners including nurses and midwives with appropriate qualifications and training to prescribe MS-2 Step.

Expanding the range of practitioners will ensure more Queenslanders can access abortion, particularly for those living in regional and remote areas where GPs are in limited supply.

SPHERE recommendations to the Senate review

Alongside recent legislative changes, the Senate launched its Unleashing the Potential of our Health Workforce Scope of Practice Review. Currently in phase three, with a final report and implementation plan due this October, the review is assessing the best available evidence on the benefits, outcomes and potential risks of health professionals working to their full scope of practice in primary care.

To date, Monash University’s SPHERE Centre for Research Excellence has made two submissions recommending no-cost EMA, increased training opportunities and remuneration, including specific Medicare Benefits Schedule (MBS) item numbers for non-medical health practitioners.

This review serves as another building block in achieving critical improvements to sexual and reproductive healthcare in Australia.

Even more pressing is the 14 May federal Budget announcement. It’s unclear what changes this may bring to abortion and contraceptive care, but the Mid-year Economic and Fiscal Outlook offered promising signs, with $1.1 million in continued funding for the Australian Contraception and Abortion Primary Care Practitioner Support Network, to support training to deliver essential women’s healthcare.

While the TGA changes may not have yielded fruit immediately, such achievements show women’s health, including access to abortion, is rising in priority, and with Budget night around the corner, fingers are crossed the trend continues.