The article below first appeared on The Conversation on August 30.
Angela Taft is an associate professor in public health at La Trobe University. She is the co-ordinator for Women's Health Special Interest Group at the Public Health Association of Australia, which has lobbied for the importation of RU486 for several years.
The Therapeutic Goods Administration (TGA) has registered RU486 (mifepristone linepharma) and GyMiso®(misoprostol) for wider use in Australia following an application for registration of the medicines by Marie Stopes International Australia. The registration has been a long time coming and this is a great step forward for women’s reproductive rights in Australia.
The drugs facilitate a medical termination of pregnancy and there’s always been a desire to bring them to Australia. There have been studies in other countries demonstrating that it was safe to do so, but its introduction has been delayed here because of a deal struck between the Howard government and former senator Brian Harradine.
The deal he struck with the Howard government was to support government legislation with the proviso that the introduction of RU486 would be blocked. The idea was that it would have to go through both houses of parliament for approval, which in effect blocked its importation into this country.
We haven’t needed this kind of permission in recent years since government has changed. And there have been long-standing efforts by many reproductive rights organisations and family planning organisations to try to facilitate RU486 being brought into the country. What was needed was an industry partner to actually produce it and that’s taken some time.
The problem has been the fact that we’re a small country and a manufacturer is difficult to find. The same situation happened in New Zealand, where some doctors actually had to get together to have a collaboration with a French manufacturer to produce for their very small market.
Australia has had a similar problem, it’s a small country and a small market and the drugs will be made available through MS Health, the not-for-profit pharmaceutical arm of Marie Stopes International Australia.
GPs who wish to prescribe the drugs can undergo online training and offer it as an option for women seeking termination. This will be particularly important in areas where there’s restricted access to surgical abortion or no abortion facilities.
They would have back-up through Marie Stopes International should there be any need for it, that is support from after-hours Marie Stopes providers.
I should say that this is what I understand and hope at this stage – the announcement has only just been made and the devil is in the detail.
It’s a very good step but everything depends on the organisation and the implementation. For example, GPs need good training, not just product training, but also noting time restrictions for women to have terminations set to a 49-day time limit, rather than the usual nine weeks and rural emergency hospital service training among other things. And it’s not on the PBS.
We should note that RU486 has been available in Australia since 2006 through the TGA Authorised Prescriber Scheme. But today’s announcement is potentially a great expansion of its use although a lot needs to be sorted out in terms of implementation. To use the example of abortion in Victoria: we’ve got legislation that says it’s decriminalised but if you don’t have the workforce and you don’t have implementation funds, the situation will be just as limited as it was prior to the legislative change.
Those of us interested in seeing this very important step being taken have known that it’s been coming for some time. But there are still members of parliament with very strong objections and I’m sure they’ve been watching the TGA very carefully and checking they dot every i, cross every t and jump every hurdle. But I’m not a member of the TGA or privy to their processes so I’m not sure really what the obstacles have been. I’m just delighted we’ve got here.
The general response will be what you always get to this issue. Abortion is highly emotive, there will be those who welcome it as an appropriate extension to women’s reproductive rights in Australia and there will be those who oppose it as facilitating the murder of babies.
From my point of view, one of the problematic things in Australia has been the contracting out of public hospital services to religious organisations. In Victoria, for example, religious organisations run hospitals without any associated requirements to provide a full range of reproductive services.
So there are hospitals here run by religious organisations that refuse to do sterilisations, vasectomies and abortions. This has meant that our access in public hospitals to abortion beds has really dropped. Other community-based organisations being able to offer the option of medical termination is extending women’s access, hopefully, to abortion in Australia should they need it.
This is potentially a great step forward should effective implementation follow. Public health, family planning and reproductive organisations will still always want to prevent abortion. But we know things go wrong. They just do. People have unprotected sex and they fall pregnant when they don’t want to. And we know that reducing unwanted pregnancies is going benefit women, their children, their families and communities.
The challenge in Australia is to extend sex education, make sure women know about and use emergency contraception, and in the end to make good quality abortion accessible. That’s why the extension of women’s medical options for abortion is really, really important.