Gaps in access to medical abortion in general practice

This was one of the findings in a recent study that highlighted inequities in access to abortion care. It's a finding that comes as little surprise to Dr Simone Altaf.

Dr Altaf, who is medical director or women's health organisation Luma, said while access to medical terminations under 63 days had definitely improved, there were still restrictions.

“There's probably not as many GPs that have actually trained to offer the service, so therefore women are still limited trying to find clinics that do offer this service," she said.

“That may be quite restrictive, especially if they live in rural areas - in metro there's definitely more options, but in rural areas there's a real restriction of where women can go."

Medical abortion can be performed using MS-2 drugs up to day 63 of pregnancy, after that a surgical abortion is required.

While medication abortion accounts for up to 90% of early abortions in many high-income countries, it makes up only about half of early abortions in Australia.

The study, published in BMJ Sexual & Reproductive Health, analysed data from more than 400 general practices nationwide between 2014 and 2021, tracking more than one million women.

Over that time, the number of women receiving medical abortion through GPs rose from about one in 10,000 to just over two in 1000, while the share of practices offering the service increased from around one in 25 to about one in five.

However, only about one-third of those practices provided medication abortion at any point during the study period.

Associate Professor Luke Grzeskowiak from Flinders University’s College of Medicine and Public Health and the South Australian Health and Medical Research Institute was the lead author on the research.

“Medical abortion is widely used internationally and offers a safe, effective option for early pregnancy care, but in Australia we are not yet seeing the same level of access,” he said.

“That tells us people are often having to go to considerable effort to find a GP who offers this service.”

Assoc Prof Grzeskowiak said the findings highlighted a gap between policy progress and real-world access – although he points out there have been improvements.

“Our findings show that medical abortion access still depends heavily on your location,” he said.

“Where you live continues to play a major role in whether you can access care through a local GP and for some people, that can mean travelling long distances or navigating unfamiliar services."

The study also found higher rates of people accessing medical abortions among those living in regional areas and in more disadvantaged communities, with rates around twice as high outside major cities.

“We are seeing higher use in areas where there may be fewer alternatives, such as limited access to surgical services, or where barriers like cost and distance are more pronounced,” Assoc Prof Grzeskowiak said.

Luma medical director, Dr Simone Altaf.

Dr Altaf said while medicalised abortion is available through a GP, many women go directly to specialised services as it can be a more direct route.

She said GP clinics rarely listed whether medicalised abortion was offered at their clinic and it often differed between which individual GP a patient might see, so the process may involve multiple phone calls and/or appointments.

"Some GPs don't want to provide the service due to ethical reasons or religious reasons, but even if the GP just did a dating scan and some bloods, that would make a huge difference. Then they could give patients a list of places they could go with those results to then get the medication," Dr Altaf said.

Medical and surgical abortion

Dr Altaf said some women may opt for a surgical abortion over a medicalised one even if they were yet to reach 63 days gestation.

"Medicalised abortion means taking two doses of medications on two different days, and then having a heavy period bleed for probably four to 12 hours, it may not be convenient to them because a longer period is taken up with the procedure.

"Whereas in a surgical procedure, they have an anaesthetic in a clinic, they wake up, it's done and it's just on that one day.

"There's also a risk that you go through the medical procedure and it doesn't work for whatever reason. Either the medications have to be repeated or they then have to have a surgical procedure, so some women feel it's just more convenient to have a surgical procedure."

Dr Altaf said cost was also a factor in deciding between a medical or surgical abortion, especially to those without a Medicare card.

"They would be fully privately paying and with the cost of the scan and the medication, having a surgical procedure is probably equal or the same as a medical one if you don't have Medicare.

"Some of the people that are coming through our doors are women that are exposed to domestic violence or don't have the financial means to pay for these procedures, or they are at risk women."

Longer consults

Another factor which may be impacting GPs ability to offer medical abortions was cost.

Dr Altaf said a potential abortion required longer than a standard GP consult, which may make it challenging for more GPs to commit to providing this care.

“I think it is just about GPs having the time and maybe the Medicare rebate to offer the service as well,” she said. 

"In general practice, you have to see a large amount of people and these type appointments are not the quick appointments.

"Our first appointment is 40 minutes because we feel like it needs a lot of time to discuss a really important subject."

Training

While Dr Altaf urged GPs to undertake the training specific to the prescribing of MS-2 medication, the training is not mandatory.

In 2023 (after the period covered in the Flinders University study) the Therapeutic Goods Administration changed requirements for prescribing MS-2 so GPs were no longer required to complete mandatory training and registration specific to the medication.

However, Dr Altaf said doctors may not feel comfortable prescribing the medication without having done the training.

Prof Grzeskowiak acknowledged efforts made to remove prescribing restrictions but said such moves take time to implement.

“There is still more work to do to make care consistent and accessible across Australia," he said.

He said targeted action was needed to address gaps in access, including expanding telehealth, supporting GPs, and exploring new models of care.

Researchers hope to conduct follow-up studies to see whether inequities continue to ease in Australia.