Medical Abortion in Australia

Until early 2006, the Federal Health Minister had the right to veto any application to allow medication abortion drug RU486 to be used in Australia. On 16 February 2006, the RU486 Private Members Bill passed through the Federal Parliament’s House of Representatives, removing this veto and giving the appropriate medical and scientific experts at the Therapeutic Goods Administration the power to assess RU486 and determine Australian women’s access to the drug.

In 2012, the TGA approved a licence to import and distribute mifepristone to Australia, and the following year it was listed on the Pharmaceutical Benefits Scheme. However, little is known about how much women’s access to abortion has improved as a result of these changes, and medication abortion remains difficult to access for many.

Background

In the early 1990s mifepristone (widely known as RU486, and sometimes referred to as ‘the abortion pill’) was available in Australia through the World Health Organisation’s international trials of the drug [1].  The results of the trials demonstrated that mifepristone was a safe and effective method of pregnancy termination for women [2]. Mifepristone has also been legal and easily accessible in many countries around the world since the 1980s.  As expectations grew that the drug would be approved for use in Australia following the international trials, lobbying was undertaken by anti-choice activists to ensure that medication abortion did not become widely available to Australian women. [3]

The mid-1990s saw the Howard Government in power in Australia, with conservative Tasmanian Senator Brian Harradine holding the balance of power in the Senate.

As a result of a political deal, Harradine pledged his support for Government bills, including the privatisation of Telstra, in return for the introduction of restrictions on women’s reproductive rights [4].  One of these restrictions was a ministerial veto on the importation of mifepristone and other medication abortion drugs; another was the introduction of the AUSAid Family Planning Guidelines.

In June 1996, the Therapeutic Goods Act was amended to introduce special procedures for drugs such as mifepristone, which are intended for use in medication abortion [2]. Under this amendment the Health Minister was required to approve the importation, evaluation, registration and listing of these drugs, and any such ministerial approval had to be tabled in both houses of Federal Parliament within five sitting days. No requirement for ministerial approval applied for drugs not intended for use in medication abortion.

This type of restriction applies to very few therapeutic drugs, and discouraged pharmaceutical companies and organisations from applying to distribute mifepristone in Australia. The normal process for approval requires an application from a drug company to the Therapeutic Goods Administration (TGA), the federal body which oversees the use of medications in Australia. More information on the TGA and its duties can be found on their website.

Once an application is approved by the TGA, the company applying has the right to distribute the drug in Australia, meaning doctors have the right to prescribe it and patients to use it. The expense involved for the sponsoring company can be significant. With ministerial approval necessary as well as a successful TGA application, companies were unwilling to undertake this expense for mifepristone, when the Minister may have moved to overturn the approval by the Therapeutic Goods Administration [5]. There were no guidelines for Ministerial approval and the Federal Minister for Health at the time, Hon Tony Abbott MP, was known to be anti-abortion.

Overturning the Ministerial Veto

The debate began in October 2005 when the Australian Democrats Senate Leader Lyn Allison indicated that she would seek to amend the TGA to remove the Harradine restriction [6].  At the same time, Cairns obstetrician and gynaecologist Dr Caroline De Costa announced that she was applying to the Therapeutic Good Administration to become an authorised prescriber of mifepristone. [7]

The push to remove the restriction was then strongly taken up by Liberal MP Dr Sharman Stone, both in the media and with her parliamentary colleagues [8].  Dr Stone’s position was soon supported by a number of key parliamentarians, such as then-Ministers Helen Coonan, Kay Patterson, Dr Brendan Nelson, and Labor’s Julia Gillard (then Shadow Health Minister), Senators Jan McLucas and Claire Moore, and Greens Senator Kerry Nettle.  Democrats Senator Lyn Allison continued to be at the forefront of debate around RU486.

Women’s and health organisations such as Children by Choice, Reproductive Choice Australia, the Australian Medical Association and the Royal Australian New Zealand College of Obstetricians and Gynaecologists spoke out in favour of the lifting the ban. In conjunction with the Australian Reproductive Health Alliance, Reproductive Choice Australia produced a briefing document RU486/Mifepristone: A factual guide to the issues in the Australian debate.

Federal Health Minister Tony Abbott attempted to manipulate the debate by requesting limited advice on the use of RU486 from the Chief Health Officer [9]. Abbott twisted the information provided to him, suggesting that rural and regional health services and GPs were not equipped to provide mifepristone to women. This claim sparked outrage from the medical community, and organisations such as the Rural Doctors Association strongly defended their members’ capacity to appropriately provide medical care for women [9].

By mid November it looked like a vote was going to be held on the ban by the end of the year.  Reproductive Choice Australia strongly argued that the vote should not be based on conscience, but any amendment should be sponsored by the Government as a policy position and voted on party lines, like all other health legislation.  In early December, the Prime Minister agreed to allow parliament to debate the issue in February 2006, in the form of a private member’s bill and a conscience vote.

A conscience vote gives each MP the right to decide their position, rather than voting along party lines. Pro-choice supporters were active in contacting their representatives and ensuring support for the lifting of the restrictions was heard.

The Results

The final vote on the Bill was carried on voices only and the support by MPs was overwhelming.   Below is the House of Representatives vote result on the second reading of the Bill.

AYEs:

Adams, Albanese, Bailey, Baird, Beazley, Bevis, Billson, Bird, J. Bishop, Bowen, Brough, A. Burke, Cobb, Corcoran, Costello, Crean, Danby, Edwards, Elliot, Ellis, Ellis, Emerson, Entsch, L. Ferguson, M. Ferguson, Fitzgibbon, Gambaro, Garrett, Gash, Georganas, George, Georgiou, Gibbons, Gillard, Grierson, Griffin, Haase, Hall, Hatton, Henry, Hoare, Hockey, Hull, Hunt, Irwin, Jenkins, Jensen, Johnson, Jull, Keenan, Kerr, King, Laming, Lawrence, Ley, Lindsay, Livermore, Macfarlane, Macklin, May, McArthur, McClelland, McMullan, Melham, Moylan, Nairn, Nelson, O’Connor, Owens, Pearce, Plibersek, Price, Prosser, Quick, Ripoll, Roxon, Rudd, Scott, Sercombe, T. Smith, S. Smith, Snowdon, Southcott, Stone, Swan, Tanner, C. Thompson, K. Thomson, Ticehurst, Turnbull, Vamvakinou, Washer, Wilkie, Windsor, Wood.

NOs:

Abbott, Anderson, Andrews, Baker, Baldwin, Barresi, Bartlett, B. Bishop, Broadbent, T. Burke, Byrne, Cadman, Causley, Ciobo, Downer, Draper, Dutton, Farmer, Fawcett, Ferguson, Forrest, Hardgrave, Hartsuyker, Hayes, Howard, Katter, D. Kelly, J. Kelly, Lloyd, Markus, McGauran, Murphy, Neville, O’Connor, Panopoulos, Pyne, Randall, Richardson, Robb, Ruddock, Schultz, Secker, Slipper, Somlyay, Tollner, Truss, Tuckey, Vale, Vasta, Wakelin.

Visit the Federal Parliament website for more information on the bill as well as transcripts of speeches.

Children by Choice would like to pay tribute to the courage, strength and commitment of the four senators who sponsored the RU486 Private Members Bill in the Senate:

Senator Claire Moore (ALP QLD)

Senator Fiona Nash (NAT NSW)

Senator Lyn Allison (Dems VIC)

Senator Judith Troeth (LIB VIC).

These senators worked very hard promoting the importance to Australian women of the Bill and enlisting their Senate and House of Representatives colleagues’ support.  See this Inside Story article for a good analysis of the senators’ work on this issue, or this piece from The Age where the senators explain why they became involved in this bill. Our special thanks go to Senator Claire Moore and her staff for their support of Children by Choice during the debate.

Availability of Medication Abortion Following Legislative Change

Between 2006 and 2012, no pharmaceutical company successfully applied to import and distribute mifepristone in Australia.  This meant the drug was administered under the Authorised Prescribers Act, which governs the prescriptions of medication not distributed by a company within Australia. It is believed that around 90 doctors across Australia became Authorised Prescribers during this time.

In August 2012, the TGA announced on that two drugs, mifepristone and misoprostol, had been approved for distribution in Australia for use in early medical abortion.

This meant that specialist obstetricians and gynaecologists, doctors who already had Authorised Prescriber status, and GPs trained by the license holder MSHealth, were able to prescribe mifepristone to women for use in termination of pregnancy up to seven weeks gestation.

In 2013, the Pharmaceutical Benefits Advisory Committee examined whether or not mifepristone should be included on the Pharmaceutical Benefits Scheme. This is a national scheme subsidising the use of some medications to Australians. We made a submission to this process arguing strongly in favour of the PBS listing, in order to increase women’s accessibility to early medication abortion. You can download our submission as a pdf.

As of 1 August 2013, mifepristone and misoprostol have been available on the PBS for medication abortion. In February 2015, both the TGA and the PBS approved applications from MSHealth to increase the listings to nine weeks gestation from seven, in line with international practice. The PBS subsidy brings the cost of the medication down to under $15 for healthcare card holders and under $50 for Medicare card holders. Although welcome, these developments appear not to have made huge strides in addressing the difficulties in abortion access for some women.

The PBS listing has had little effect on the cost of medication abortion provided through the private clinics which also offer surgical abortion services, and while a prescription from a GP may cost under $50 for most women, there are additional out-of-pocket costs including multiple consultations, ultrasounds and blood tests which considerably raise the cost for women. The average out-of-pocket cost for a medication abortion through a GP in Queensland is $250-$350.

There is no publicly available list of doctors who are certified to prescribe mifepristone (having appropriate specialist qualifications or having had completed the training with MSHealth). As such, it is unknown how many doctors have decided to include medication abortion as part of their practice. Queensland is lucky to have a small but committed number of known GPs who provide this service in their communities, and the number of them continues to grow, but there is always more work to be done. Other states and territories appear to have not been so lucky, but this is anecdotal from service providers. The lack of information about where to contact a provider continues to act as a considerable barrier for women, as does the scarcity in doctors publicising the fact they offer medical abortion.

Children by Choice continues to work with health professionals and organisations to expand women’s access to medication abortion. If you’re a provider and are interested in finding out more about offering this service, please see our for professionals information on medical abortion.

References

1. DL Healy, ‘Mifepristone: an overview for Australian practice’ Australian Prescriber 2009;32:152-4. Available online at http://www.australianprescriber.com/magazine/32/6/152/4.

2. KA Petersen ‘Early medical abortion: legal and medical developments in Australia’ Medical Journal of Australia 2010; 193 (1):26-29. Available online at https://www.mja.com.au/journal/2010/193/1/early-medical-abortion-legal-and-medical-developments-australia.

3. K Petersen ‘Politics v women’s health: RU486 and the TGA saga’ The Conversation, 12 September 2012. Available online at https://theconversation.com/politics-v-womens-health-ru486-and-the-tga-saga-9472.

4. B Keane, ‘The lethal legacy of Brian Harradine: his long war on women’s rights’ Crikey 24 April 2014. Available online at http://www.crikey.com.au/2014/04/24/the-lethal-legacy-of-brian-harradine-his-long-war-on-womens-rights/

5. G Gray Jamieson (2012) Reaching for Health: The Australian Women’s Health Movement and Public Policy Australian National University Press, Canberra 2012.

6. S Dowse, ‘A different kind of politics’ Inside Story, 19 December 2009. Available online at http://insidestory.org.au/a-different-kind-of-politics.

7. C McGrath, ‘Drug agency hears first RU486 application’ ABC PM, 21 December 2005. Transcript available online at http://www.abc.net.au/am/content/2005/s1535524.htm.

8. D Wroe, ‘PM faces revolt over abortion pill’ The Age, 17 November 2005. Available online at http://www.theage.com.au/news/national/pm-faces-revolt-over-abortion-pill/2005/11/16/1132016861341.html

9. C McGrath, ‘Abbott rejects abortion pill’ ABC PM, 15 November 2005. Transcript available online at http://www.abc.net.au/pm/content/2005/s1507408.htm.