An MS-2 step in the right direction

This month, we welcomed important news from the Therapeutic Goods Administration (TGA) which will improve access to abortion for women and pregnant people across Australia. The TGA has removed a number of restrictions on health professionals who prescribe and dispense early medical abortion medication. These medicines, known as MS-2 Step (Mifepristone and Misoprostol), are taken as two tablets up to nine weeks gestation to induce an early abortion.

Many pregnant people do not realise they are pregnant until four to six weeks gestation, leaving them with a tight window for an early medical abortion. Until this month’s announcement, only registered and certified doctors who had undertaken specific training could prescribe MS-2 Step. Similarly, only pharmacists who were registered as providers could dispense the medication. As a result, only about 10 per cent of GPs in Australia were registered to provide MS-2 Step.

We know that racialised and geographically marginalised groups of women and pregnant individuals face multiple barriers to abortion and antenatal services. These groups include migrant and refugee people, temporary visa-holders excluded from Medicare or abortion- and pregnancy-care under their private health insurance, and people living in regional areas. They are at higher risk of missing the nine-week window for care, especially if their usual GP cannot prescribe MS-2 Step, requiring multiple health providers referrals, which can be a time-consuming process.

After nine weeks gestation, women and pregnant people must undergo a surgical abortion. While both procedures are safe, the medications for early medical abortion can generally be taken at home and carry a lower risk of health complications. Surgical abortions tend to be costlier and can entail hospital admission and a longer recovery period.

From August this year, all doctors and nurse practitioners with appropriate qualifications will be able to prescribe the medication, and restrictions on pharmacists will be lifted. This means women and pregnant people will be able to access medical abortion in a timelier manner, which is a significant win for reproductive autonomy and rights.

At MCWH, we welcome and celebrate the ongoing removal of medical and legal barriers to abortion access. At the same time, we continue to advocate for the removal of multiple non-legal barriers, including cost, visa restrictions, geographic location and practitioner attitudes and training. Many of these barriers were amplified by the restrictions associated with COVID-19, intersecting with structural racism and sexism to disproportionately impact First Nations, migrant and refugee, rural, and socioeconomically disadvantaged women and pregnant people, as well as those with a disability.

To make abortion more accessible to migrant and refugee women and pregnant people, we call on federal and state governments to implement the recommendations of the Senate Inquiry into Universal Access to Reproductive Healthcare. Providing sexual and reproductive health services nationally, irrespective of visa status, would build a truly equitable healthcare system, one which empowers all people living in Australia, and upholds and strengthens our reproductive autonomy, rights and health.

First published in edition #123 of The WRAP on 28 July 2023.