CHILDREN BY CHOICE ASSOCIATION INCORPORATED

Medical Abortion Issues

Medical abortion has been the subject of media and political attention in recent years, due to the highly-publicised RU486 debate of 2006. The April 2009 charging of a couple charged in Cairns for accessing a medical abortion has brought it to public attention once again.

Options for medical abortion

The Federal Parliament vote to remove the health minister’s veto over RU486 raised awareness of medical abortion as an option for those seeking to terminate a pregnancy. However mifepristone (also known as RU 486, or the abortion pill) still has very limited availability, despite Marie Stopes International gaining permission to use the drug in its Australian clinics in late 2009. 

Some providers of pregnancy termination services offer medical abortion with a drug called methotrexate. This gives women terminating a pregnancy the option of choosing a medical or surgical procedure, but it is not available at all clinics. 

Is medical abortion a solution to access issues?

As medical abortion relies on abortifacient drugs, it can be carried out anywhere with facilities to care for women if they miscarry and could provide a partial solution to the lack of abortion services for women in regional and remote areas. With training, doctors who are uncomfortable or unskilled in surgical abortion would be able to provide medical termination procedures. However, due a number of factors many women in Queensland and Australia do not have access to medical abortion.

Access to medical abortion

As the public becomes more aware of medical abortion, several providers are reporting large increases in the number of women enquiring about it. One of the problems with increasing access to medical abortion is that the supply has not matched the growing demand.  This is partly due to the lack of practitioners and agencies prescribing or distributing methotrexate for abortion. Private clinics, along with Sexual Health and Family Planning, can apply through Queensland Health to be a prescriber, but few have done so. 

The supply of mifepristone, or RU486, is restricted to a small amount of doctors who have applied to the Therapeutic Goods Administration for permission and had their applications approved. As a result, Australian women have limited access to mifepristone although studies show it is more effective and has fewer side effects than methotrexate. 

Restrictions mean that licensed doctors are only able to prescribe mifepristone where continuing the pregnancy would create a life-threatening or similarly serious situation. Providers state that it is the preferred drug for medical abortion and would be used if it were readily available to them. 

Questions of legality

Up until late 2009, there were also questions around the legality of medical abortion, as evidenced by the charges laid over a medical abortion in Cairns in April 2009.  This uncertainty affected the willingness of GPs and clinics to offer medical abortion, as until its legal status was clearly defined they were at risk of prosecution. 

The Criminal Code contains a defence for abortion, in section 282, which stated:

‘A person is not criminally responsible for performing in good faith and with reasonable care and skill a surgical operation upon any person for the patient's benefit, or upon an unborn child for the preservation of the mother's life, if the performance of the operation is reasonable, having regard to the patient's state at the time and to all circumstances of the case.’

As the Code specifically refered to 'surgical operation', it was questionable whether this defence could be used in relation to medical abortion. The matter had not been legally tried in Queensland, with the charges laid in April 2009 yet to be heard in court.  Obstetrician and gynaecologist Dr Caroline de Costa said:

'The Queensland government attempted to clarify and legitimate the situation in a statement from the Premier and the Attorney-General in 2006, declaring that the fact of the Therapeutic Goods Administration (TGA) having approved the use of a drug (such as RU486) for the purpose of abortion made the use of the drug lawful in Queensland, but this has not been tested in court. Queensland doctors continue to find themselves in a grey area when they perform abortion, despite their holding an honest belief that a woman’s best interests are being served by the procedure.'

In September 2009, the Queensland Government introduced amendments to this section of the Code intended to provide medical abortion with the same level of protection as surgical termination. The amendments were passed with only one parliamentarian voting against them, and Section 282 now reads:

A person is not criminally responsible for performing or providing, in good faith and with reasonable care and skill a surgical operation on or medical treatment of:

A) a person or unborn child for the patient’s benefit; or

B) a person or unborn child to preserve the mother’s life;

if performing the operation or providing the medical treament is reasonable, having regard to the patient’s state at the time and to all circumstances of the case.

Despite these amendments, some concerns remain. Legality of abortion is an ongoing issue for both providers and the women seeking to access terminations each year. It is continuously raised as a major obstacle in delivering adequate and accessible services, and impacts on many other aspects of service provision. 

Medical vs. Surgical Abortion

The choice between medical and surgical abortion is influenced by many factors.  Medical abortion is sometimes preferred by women who do not want to undergo  surgery, are allergic to aneasthetic, or who would prefer to experience an abortion in their own home.  Surgical abortion is sometimes preferred by women who want to be asleep for the procedure, would prefer a quicker procedure with only one clinic visit, or prefer to have the procedure in a controlled medical environment.

The gestation of the pregnancy may mean that only one abortion option is available.  If the pregnancy is under about 6 weeks then the woman will either have to choose the medical option or wait until 6 weeks.  If the pregnancy is over about 9 weeks then usually only the surgical option is available.  Every woman has her own reasons for preferring a particular option and the choice to access either option is a very personal one.  

For more information about these options and the current status of medical abortion in Australia, see the information sheet: Medical Abortion: Is it a reality for Australian women?