Abortion has now been decriminalised nationwide – what next?

In this article, originally published in RACGP’s newsGP, I discuss how the decriminalisation of abortion marks a significant shift in recognising abortion as a health rights issue.

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‘Decriminalising abortion is a gender equity and health issue.’

That is Dr Magdalena Simonis, a GP with a special interest in women’s health, speaking with newsGP.

Although welcoming the recent decriminalisation of abortion in South Australia – the last state to do so – Dr Simonis said more progress is needed, especially as New South Wales was only a short step ahead, changing the law in 2019.

‘Women’s sexual and reproductive health is recognised worldwide as a priority health issue,’ she said.

‘It’s about time Australia reached the level of maturity to proceed to the next level, which means increased education of the public around sexual and reproductive health, training of doctors, funding of services, and increasing capacity and accessibility for all women and adolescent girls.’

Dr Simonis is calling for Australia to better align with the World Health Organization’s (WHO) Medical Management of Abortion statement, which says all individuals who can become pregnant – including women, girls and those with varying gender identities – who seek medical abortion care should be provided with all of the necessary information to make an informed decision.

In doing so, this will ensure ‘the promotion of their health and human rights’, including those related to sex and gender equality, and the right to non-discrimination.

Dr Simonis said that with abortion now decriminalised nationwide, it is time to ‘step up’ education and training in medical termination of pregnancy (MTOP) for general practice as part of women’s health and sexual and reproductive training modules.

‘GPs and female patients in all states can now confidently discuss option for patients with unplanned unwanted pregnancies, without fear of stepping outside of their legal comfort zone,’ she said.

‘Even GPs who choose not to work in this area, need to be able to direct women to service providers and respectfully offer them a list of practitioners who can facilitate and administer the necessary treatment.’

Despite GPs being ‘central’ to providing women with sexual and reproductive healthcare, Dr Simonis estimates that only around 1500 of Australia’s 35,000 GPs are registered prescribers of medical terminations.

Around half of all pregnancies in Australia are unplanned, and it is thought half of those are terminated. Between one quarter and one third of Australian women will experience an abortion in their lifetime, with the majority feeling it was the right decision.

The WHO estimates that even if all contraceptive users used contraception perfectly in every sexual encounter, there would still be six million unintended pregnancies every year.

According to Dr Simonis, there is insufficient workforce information about provision of MTOP services and referral pathways across general practices.

And, she says, more needs to be done to improve access – and provide equitable access – to these services, including groundwork education around effective contraceptive choices.

‘We need to identify and help women who may be at risk of unintended pregnancy, particularly those who are vulnerable, [such as] young women experiencing reproductive coercion, women using illicit drugs or [those] who are experiencing partner violence,’ Dr Simonis said.

Surgical abortion is a rebatable procedure under Medicare, while medication abortion is not covered by Medicare, although the medications for this procedure, mifepristone and misoprostol, are listed on the Pharmaceutical Benefits Scheme.

A recent Marie Stopes report shows that just 2462 GPs are authorised to prescribe the combined medications as part of the MS-2 Step.

Although laws have changed, access to surgical and medical abortion remains somewhat restricted, particularly outside major cities, Dr Simonis said.

‘So far, the legal barriers have imposed restrictions to access and service provision, which means that this is a very under-serviced area across the nation,’ she said.

‘For some, access for surgical termination means long waiting times and many hours of travel to access this only through the major hospital systems.’

To help provide better, equitable access, GPs can provide the assurance that women actively seek, and undergo MTOP training to better support their patients.

‘Training of GPs in MTOP has been staggered, but it can be recommended if patients enquire about unplanned pregnancies,’ Dr Simonis said.

A more recently available option for women experiencing unwanted pregnancy is telehealth, or ‘home abortion’.

‘Telehealth can be especially helpful for sexual and reproductive health issues and it is in this domain where the need for this service has increased, especially during COVID-19 restrictions,’ Dr Simonis said.

‘It can grant marginalised women access to termination services which their own regular GP cannot provide and should be maintained and extended, particularly for these circumstances.

‘Telephone and online services that provide women with a database of practitioners who specialise in sexual and reproductive health [as well as] access to psychologists and GPs who provide non-directive counselling need to be expanded nationally to equitably provide support for rural, remote and marginalised women and girls.’

Dr Simonis is advocating for change, not just to the healthcare setting but to the individual to instate empowerment and autonomy of health access and rights.

‘If one’s usual GP is a conscientious objector, then it is the duty of that GP to refer the patient to a colleague or a service provider that can support the women or adolescent,’ she said.

‘Many GPs who have an interest in women’s health have been told stories of girls and women being chastised by their regular doctor … as disappointing as this is, we cannot expect such ingrained beliefs to change readily.

‘However, they must not become the reason for failing to deliver a medical service in a timely and respectful way.’

These sentiments were echoed in Parliament by South Australia’s Attorney-General Vickie Chapman.

‘[The passing of the Bill] makes abortion a health issue, not a criminal one, and makes explicit the higher standard of medical care and decision making that already exists in South Australia,’ she said.

‘This is about giving women choice. It’s about removing outdated barriers to access for women, while ensuring safeguarding measures are in place where necessary.’

Originally published: www1.racgp.org.au/newsgp/professional/abortion-has-now-been-decriminalised-nationwide-wh