Australia’s abortion laws need a national consensus on reforms

State and territory ministers for women and the federal minister, Katy Gallagher, will meet this week to discuss safeguarding Australia’s abortion laws and draft a national agreement on standards.

A national approach has been a possibility since 2020 when the Women’s Health Strategy was implemented, aiming to make abortions universally accessible by 2030. This would mean making abortions available in public hospitals. 

Along with amendments to state and territory abortion laws, much-needed changes to Medicare and the Therapeutic Goods Administration (TGA) guidelines are on the cards. TGA guidelines regarding abortion pills haven’t been updated since they were first approved in 2012.

Here are some changes that could be implemented. 

Medicare line item

The cost of abortions differs wildly across Australia. Private clinics charge upwards of $400 for medical abortions and $600 for surgical — much of the costs are down to the GP counselling that goes with abortion. GPs can charge for a standard consult through Medicare which sits at a pithy 10 minutes, but will often have to charge patients out-of-pocket fees for additional counselling time. 

Adding a Medicare line item for medical abortions would give more GPs an incentive to offer the service, and make it cheaper –although there are concerns this would lock them into a set timing and fee structure rather than allowing as much time as a patient needs.

Registration

Abortion pills MS-2 Step, consisting of mifepristone and misoprostol, are the only medical abortion drugs available in Australia. They’re sold by MS Health, a subsidiary of MSI International, the largest abortion provider in Australia. 

The drugs have been widely used around the world since the ’90s, with trial after trial showing them safe and effective. But in Australia they’re more heavily regulated than almost any other drug. 

Doctors and pharmacists must undergo an online training course to prescribe and dispense the drug. Although training takes just a few hours and is free, it’s been described as a “tick the box” exercise that hinders availability. As of June 30 2022, there were just 3441 medical practitioners actively registered to prescribe abortion pills, and 4896 pharmacists certified to dispense them. In some remote regions there are no registered dispensers or prescribers. 

Changes to the TGA could do away with mandatory registration and, as with other drugs, allow professionals to prescribe and dispense them as they see fit. 

Nurse-led care

As well as those changes, the TGA could also change guidelines to allow nurses to provide early medical abortion in general practice. 

Putting nurses in charge would make abortions more affordable and timely — but also allow Aboriginal and Torres Strait Islander health workers to provide culturally appropriate care. 

Increased training needs to be a priority for nurses and GPs; The Royal Australian College of General Practitioners wants to integrate abortion studies into the national curriculum to make it part of regular healthcare. 

Extending availability

Under the TGA, mifepristone is available only up until nine weeks’ gestation, but the World Health Organization recommends pregnancies under 12 weeks be self-managed at home using abortion pills. Making the pills available later would require updated counselling and medical advice, but changing the guidelines would make abortions more accessible in remote and regional areas. 

National standards

As well as Medicare and TGA changes, Australia could implement national legislation on abortion. Abortion has been decriminalised in every jurisdiction except Western Australia, but access by gestation period differs in each state and territory. For example, the Northern Territory allows abortion later than any other state at 24 weeks.

State ministers have said they would support the national laws only if it meant access was maintained or improved.