Introducing early medical abortion in Australia: there is a need to update abortion laws

Abstract

Recent changes to Federal Therapeutic Goods Administration legislation have seen the limited introduction of the drug mifepristone to Australia for the purpose of early medical abortion. At the same time it has become evident that both methotrexate and misoprostol, licenced and available for other indications, are being used safely and appropriately for early abortion by Australian medical practitioners. Early medical abortion is widely practiced overseas where its safety and effectiveness are well supported by current evidence. However, abortion law in many states is still contained within the Criminal Codes and does not reflect current evidence-based abortion practice. In other states and territories restrictions on where abortions may be performed pose potential barriers to the introduction of mifepristone for medical abortion. There is an urgent need for abortion law to be clarified and made uniform across the country so that the best possible services can be provided to Australian women.

Medical abortion: the Australian experience

“…There is nothing irregular about this practice (there is no requirement that doctors report such medical abortions to any authority), but it does mean that the data currently available on the number of abortions performed in Australia, which is largely restricted to surgical abortions, is even more inaccurate than it initially appears. More recently, a sexual health clinic in Cairns, QLD, initiated a public abortion service using methotrexate/ misoprostol and reported good results; this clinic now has AP approval for the use of mifepristone and so has discontinued using methotrexate [9,20].…”

“…Mifepristone is, however, available in Australia under the Authorised Prescriber (AP) legislation, according to subsection 19(5) of the Therapeutic Goods Act 1989 [20,103]. This legislation, which has nothing to do with abortion, allows registered medical practitioners to import, and use in their practices, drugs that are recognised and registered for use overseas but are not available in Australia.…”

“…The AP legislation was first used for the importation of mifepristone into Australia in 2006 by two specialist gynecologists in Cairns (QLD) [9,16,17,20]. At that time, although the TGA was very professional in its processing of applications, the procedures involved were time-consuming.…”

Making it legal: Abortion providers' knowledge and use of abortion law in New South Wales and Queensland

“…Between April 2006 and 30th August 2012, mifepristone could only be obtained by individual practitioners through the TGA's Authorised Prescriber scheme. [15][16][17] On 30th August 2012, the TGA announced that approval to market the drug nationally had been given to MS Health, a company related to the Dr Marie (Marie Stopes International) group of clinics. 18 Also, over the past thirty years, there has been extensive development of techniques for the diagnosis of fetal abnormality, which can provide definitive diagnoses at gestations well before the point of fetal viability outside the uterus.…”

Termination of pregnancy for maternal medical indications: Failings in delivery of contraceptive advice?

“…8 A review of mifepristone use in Cairns Hospital, Australia found that eight of the ten terminations were performed for maternal medical indications. 9 There is no Australian data from a tertiary obstetric setting.…”