Caroline de Costa was one of the first doctors in Australia authorised to prescribe RU486 for the purposes of abortion. But there’s more to the story. She writes:
Abortion is a very important health issue for Australian women, and the more information women have the more able they are to make informed decisions for themselves, and to help friends who may have unplanned pregnancies. While in an ideal world all pregnancies would be planned and wanted, as you all know in the real world this is not always the case, and sometimes women faced with an unexpected pregnancy have to make the decision that they are not able to become a mother at this point in their lives. Sadly, also, in some planned and wanted pregnancies the modern tests we now have for abnormalities in the developing baby show severe or even fatal abnormalities, and the woman may choose to terminate her pregnancy.
Increasingly medical methods are being used, overseas and in Australia, for termination of pregnancy. “Medical abortion” is the term used to describe abortion induced by legal, approved drugs. The best drug currently available is mifepristone, still better known to the general public as RU486, which is always used together with another drug, misprostol, to bring about an abortion. The woman experiences this process much like a spontaneous miscarriage: there is some bleeding and pain (pain relief is always offered) as the pregnancy is expelled.
Up to 9 weeks of pregnancy this process can safely occur in the woman’s home, provided she has a support person with her and knows how to access emergency care in the uncommon event that she needs to do so. After 9 weeks of pregnancy the process needs to take place in a hospital with suitably trained and dedicated staff.
You will recall that RU486 was unavailable to Australian women for many years as a result of the “Harradine Amendment” – a piece of legislation that meant that importing and marketing the drug required the special permission of the Federal Minister for Health. In 2006 four courageous women senators (Claire Moore, Lyn Allison, Judith Troeth and Fiona Nash) from across the political spectrum brought a private members’ bill to the Senate and then to the House of Representatives that overturned the Harradine Amendment.
However the change in the law did not mean that mifepristone became immediately available. It still requires a drug company to apply to, and gain approval from, the TGA (Therapeutic Goods Administration) to market the drug. So far this hasn’t happened.
To make the drug available to Australian women some of us have used a special piece of TGA legislation, the Authorised Prescriber legislation, which allows us as doctors to import and use drugs recognised overseas but not available here, in Australia within our own practices. I first did this with Dr Mike Carrette in Cairns in 2006. Since then a free public clinic offering mifepristone has been developed in Cairns and I am also able to use the drug for women with severe medical conditions in pregnancy attending Cairns Base Hospital. However the very restrictive wording of Queensland abortion law continues to pose problems for individual women seeking abortion here and elsewhere in Queensland, and numerous women who don’t fall within the strict limits of this law have had to access abortion elsewhere, often travelling to Victoria where abortion has been decriminalised.
Over the past five years more than 100 doctors across Australia have joined myself and Dr Carrette to become Authorised Prescribers of mifepristone; they can be found in all states except Tasmania and the NT. However their ability to use the drug is confined to their own practices or hospitals, so while access for women to early medical abortion using mifepristone is relatively easy in capital cities including Sydney, Melbourne, Adelaide and Perth, it is limited or non-existent for women in other urban areas and in rural and remote areas.
I am hopeful that within months there will be a successful application to the TGA to market the drug nationally and it will become available. Mifepristone will then be potentially available to all general practitioners wanting to use it, provided that women they treat have access to emergency care if needed during the abortion process.
At the same time, it is important that we address the fact that Australia does have a high rate of abortion, especially in comparison to some European countries such as Holland, Belgium and the Scandinavian countries, all of which have liberal approaches to the provision of abortion, but also excellent contraceptive services and contraceptive information services, and high-quality sex education in schools. These are areas where Australia must improve performance if we are to increase the proportion of pregnancies that are both planned and wanted.
Dr Caroline Da Costa is Professor of Obstetrics and Gynaecology at the James Cook University School of Medicine and Dentistry in Cairns. She has a strong interest in women’s reproductive health rights.