For a very long time, women have been indoctrinated to think that anything they get, no matter how small, they should be grateful for. But I’m bored of being grateful for the crumbs people with uteruses get handed.
Yes, we should absolutely welcome the news that red tape surrounding the prescribing and provision of MS-2 Step (the combination of mifepristone and misoprostol to induce abortion, also known as a “medical abortion”) will be loosened in Australia. It makes total sense.
But let’s be real: this move represents a crumb in the broader context of reproductive justice. And if it stands alone with no additional supports around it, it won’t meaningfully contribute to equal access to abortion services.
The decision was made by the Therapeutic Goods Administration, with support from the not-for-profit pharmaceutical company MS Health, part of MSI Australia, formerly known as Marie Stopes Australia. Nurse practitioners will now be able to prescribe it, pharmacies will be able to dispense it and GPs will no longer have to do special training to be permitted to prescribe it.
In the Royal Australian College of General Practitioners submission to the Senate community affairs references committee’s inquiry into universal access to reproductive healthcare, it requested more training for GPs who wish to provide medical abortion to their patients. Only about 10% of GPs can now provide medical abortion, despite it being a largely reliable and safe medication. There are reasons for that, and it’s not because the training is onerous; it’s a free, two-hour training module conducted online.
So what are the “real” barriers to provision of medical abortion?
“Current rebates are not adequate to cover the cost of providing medical abortions, which includes highly skilled person-centred care accounting for factors such as education about all options in unplanned pregnancy, contraceptive needs, interaction with co-morbid health conditions, cultural diversity, trauma, domestic violence, and abortion stigma itself,” the RACGP said in its Senate inquiry submission.
Put bluntly, what’s missing is time. The time needed to provide patient-centric, considered care to those who are undergoing medical abortion is not available because our medical system is, to use the technical term, totally and utterly borked.
Simply put, we can’t broaden the scope for people to prescribe these drugs if we can’t provide the care they need to use them; the two are inextricably linked and must be approached in tandem. This is where the government should step in.
It keeps being said but it bears repeating: our medical system is underfunded and under-resourced. Medicare rebates are in desperate need of wholesale review.
Then we have another issue: many of the health professionals who will now have the ability to prescribe the medication work in hospitals. Hospitals that get public funding but don’t actually have any termination of pregnancy services. Some won’t even prescribe the contraceptive pill. This can be due to Catholic ownership and management or to individual or institutional conscientious objection.
There is also the stigma associated with abortion, because yes, it’s still very much out there, and where it exists, it is truly toxic. Who wants death threats doing their job? But as Professor Deborah Bateson from the Faculty of Medicine and Health at the University of Sydney and former medical director of Family Planning NSW points out, it can also stigmatise the patient when seeking follow-up care because, though complications from medical abortion are rare, as with all medical procedures, they can happen.
“They can turn up to a local hospital and there can be challenges with actually accessing appropriate emergency care, because it’s, you know, been discovered or found out that they’re presenting following an induced abortion and that can be stigmatising,” she explains.
There are financial considerations in this space too, because in the current (borked) system, having an abortion doesn’t come cheap.
As Children by Choice’s chief executive, Daile Kelleher, told me: “While this is a good step forward for access, until real action is taken to address affordability there will still be people unable to access abortion in Australia.
“Every week our service speaks to people who struggle to pay for an unexpected GP appointment, ultrasound and the hundreds of dollars needed for terminations of pregnancy. These changes are welcome, but more needs to be done.
“We have decriminalised abortion across Australia so it’s time to see the state and federal government’s commitment to this healthcare.”
I don’t believe any hospital should be getting public funding if they don’t provide these services. If they’re providing maternity care, they can provide termination of pregnancy services. Both are equally essential and non-negotiable parts of healthcare.
Kelleher says the changes announced on Tuesday won’t mean more access in public hospitals “unless action is taken to ensure there is a requirement for all health services to provide healthcare for all pregnancy outcomes”.
The final report from the Senate inquiry handed down in May had 36 recommendations covering a broad range of topics, including measures to improve abortion and IUD access, contraception for men and access to subsidised IVF.
There is no issue within reproductive justice that stands alone. They all intersect to create a net of coverage and care. Pull one string on the net and, before you know it, you have a hole. Through that hole inevitably fall the people who need the care most. And choice is the centre of this equation.
For instance, better access to medical abortion shouldn’t be an excuse for hospitals to decline to provide the option for surgical abortion. Surgical abortion is still necessary for people who are not eligible for a medical abortion. But it should also be available to those who choose to have one instead of a medical abortion. Because choice must be at the centre of any patient-centric care model.
The ability for all people from all walks of life and all cultural backgrounds to be able to control when and when not to procreate is incredibly complicated, nuanced and needs immediate and urgent attention in this country.
From what I have seen and heard behind the scenes, the assistant minister for health, Ged Kearney, is well-placed to bring about some of this change, as the respected chair of the National Women’s Health Advisory Council.
The Senate inquiry recommendations were broadly welcomed and supported by the sector, but it’s time to stop playing small fry and get on with the enormous task at hand.
The mountain is sitting in front of us, if we can move quickly past the molehills.
• Isabelle Oderberg is a journalist, editor, writer and media professional. Her first book is Hard to Bear: Investigating the science and silence of miscarriage
