With a Senate inquiry into reproductive health access about to start, an expert has flagged what’s wrong with the Australian landscape.
Australian women can face some stark challenges obtaining abortion services, a sexual and reproductive health expert says.
Professor Danielle Mazza, head of the department of general practice at Monash University and a leading authority on women’s health and primary care, told a webinar this week that patients and doctors faced problems including sparse and inconsistent services in the public sector; an inadequate number of providers; lack of skilled practitioners able to deal with complexity and late gestation cases; and a lack of opportunities for training.
This comes following last week’s announcement of a Senate inquiry into barriers to achieving universal access to sexual and reproductive healthcare and information.
A significant concern was access to MS-2 Step, Professor Mazza said.
The medication, a key product for the termination of pregnancies in Australia, contains the progesterone blocker mifepristone and the prostaglandin analogue misoprostol. The two are taken separately and are recommended for the termination of pregnancy up to 63 days after the most recent period.
“The over-regulation [of medications] has contributed to what is very limited current primary care provision in Australia, with estimates that only about 3000 GPs and about a quarter of community-based pharmacists are currently registered to be able to prescribe MS-2 Step,” Professor Mazza said.
“Because of that, there are quite large ‘abortion deserts’ across the country and very little transparency about the location of providers or dispensers available to women. The same could be said about long-acting reversible contraception, while legislative and funding barriers sit in the way of nurses providing these services.”
In 2019, Professor Mazza and her team produced a map – published in the MJA in 2021 – showing the location of these deserts. While SA at that time still prohibited the provision of medical abortion outside of a hospital setting, the map provided “a very clear, quite frightening picture of the abortion deserts that currently exist in Australia”. These included significant areas of the eastern seaboard and WA, while in the Northern Territory not even one GP was prescribing MS-2 Step in 2019.
“We estimated that about 30% of women in Australia lived in an area in which MS-2 Step had not been prescribed and that this rate went up to about 50% for women living in remote Australia,” she said.
The map was included in evidence presented to former health minister Greg Hunt in support of the introduction in July 2021 of new MBS item numbers for telehealth sexual and reproductive health care consultations.
“What is of even more concern,” Professor Mazza said, “is that we have very limited opportunities for skills-based training – actually seeing providers delivering services and participating in that service provision. That’s because very few public hospitals provide either contraception or abortion services these days. Sexual health services are mainly focused on sexually-transmitted infections and blood-borne viruses, not on mainstream contraception and abortion services.
“Our GP trainees talk about barriers to prescribing both contraception and abortion because of the very limited access to training – that they have limited opportunities to maintain their skills. When I can’t sleep at night, it’s often because I’m thinking about the fact that we are losing workforce capability because of limited opportunities for training.”
In Australia, she said, GP trainees can find it very difficult to get even basic training in contraception and abortion because they may be with a supervisor who doesn’t undertake this kind of work.
“We really need high-volume clinics in community settings to be able to train our health workforce,” Professor Mazza said.
“We also need to be able to link the management of abortion with the management of miscarriage – both in our training and in our clinical settings in hospitals, allowing more opportunity for healthcare professionals to become familiar with misoprostol and mifepristone in the management of those conditions.”
