This month marked a major win for reproductive healthcare in Australia. The Therapeutic Goods Administration finally made it easier to access abortion pills by following expert advice and allowing doctors and pharmacists without specialist certification to prescribe MS-2 Step, also known as RU486.
It has been a long, slow road to get here.
Mifepristone (MS-2 Step), which is most commonly used in conjunction with misoprostol for early medical abortion, was put on the Pharmaceutical Benefits Scheme in 2013 for less than $40 but has been prohibitively expensive and difficult to access for too many patients for the past decade.
As some of Australia’s leading voices on sexual and reproductive health wrote in 2019: “There is no good reason why mifepristone, which has minimal side effects and is supplied uniquely as a single tablet, needs to remain indefinitely as a special drug.”
In the hundreds of articles I have written over the past seven years about the dire state of abortion access in Australia, many barriers have slowly broken down. Women are now protected from religious picketers, abortion has been moved from criminal codes to health legislation in all jurisdictions, and as of this month medical abortion access has been improved so many people won’t have to spend hundreds, sometimes thousands of dollars organising childcare, travelling interstate and overpaying on medical fees to take two pills.
But Labor can no longer hide from the biggest remaining fight. The recent recommendations from the Senate inquiry into sexual, maternity and reproductive healthcare echo what experts have said for years: public hospitals should be equipped to provide surgical terminations (“or timely and affordable pathways to other local providers”). In 2019, then-opposition spokesperson for women Tanya Plibersek said a federal Labor government would require public hospitals to offer termination services as part of their Commonwealth funding arrangement. But the policy was swiftly withdrawn and wasn’t taken to the last election.
Nearly one in five Australian women who have been pregnant will have an abortion by age 45 and yet the service is still predominantly provided by the private sector. In a country so proud of its universal healthcare, what other common medical procedure would we expect people to pay for? Why are women’s organisations still fundraising to subsidise abortions for unhoused pregnant people or those experiencing violence? Why can patients in South Australia and the Northern Territory access abortion for free in public hospitals and yet everywhere else people spend hundreds or thousands of dollars on private providers? Why are we comfortable with hospitals that receive federal funding turning women away?
“Should abortions be funded by public hospitals?” a reporter asked then-prime minister Malcolm Turnbull in 2018 after Tasmania’s main surgical abortion clinic closed, forcing people to go interstate at huge expense. “I’ll leave this issue,” he said and palmed it off to the state government.
In July, in the wake of the US Supreme Court’s devastating decision on Roe v Wade, Prime Minister Anthony Albanese said it was a “good thing” that abortion rights were not a “matter for partisan political debate”. But when asked if he would require public hospitals to offer abortion, he said “No” and, like Turnbull, palmed it off as a “state matter”.
He is well aware of the federal levers that can be pulled to improve healthcare for the most disadvantaged — again, Labor promised to do just that by holding public hospitals to Commonwealth funding requirements in 2019.
The right to accessible, legal and affordable abortion has long come second to the self-interest of politicians in this country. Premiers and prime ministers from across the political spectrum have dragged their feet or been entirely out of step with experts, patients and the public for decades.
Abortion is common as far as medical procedures go and yet has been treated as a fringe issue, a political hot potato, always coming second, even to the partial privatisation of Telstra. (In 1996, anti-abortion independent Brian Harradine, who held the balance of power in the Senate, agreed to support John Howard’s one-third float of the telecommunications company if the government tweaked legislation to grant the health minister veto to prohibit the import, manufacture or use of abortion drug RU486.)
Politicians from the major parties have kicked abortion decriminalisation down the road — relying on independents or the Greens to spearhead legislation, they have hidden behind fearmongering by religious lobbyists. Most importantly, they have acted out of line with most of the people who elected them.
In March 2019, while giving reporters a tour of offshore detention facilities on Christmas Island, then-Prime Minister Scott Morrison said he was disappointed abortion was being raised on the eve of an election in a “very politically charged context”.
“I don’t find that debate one that tends to unite Australians,” Morrison told reporters at his press conference The Sydney Morning Herald estimated cost taxpayers $2000 a minute.
In fact, Australians are pretty united on this. Poll after poll after poll after poll after poll after poll suggests they overwhelmingly support safe and legal abortion, making plain what has been known for a long time: the make-up of views on abortion in our state and federal parliaments do not proportionately reflect those of the electorates.
Abortion is not as divisive here as it is in the US. The Australian Abortion Stigma Study from the College of Medicine and Public Health at Flinders University found most people support access to abortion care without restrictions. When the survey was weighted to reflect the whole population, 97% of non-religious participants and 87% of people who were religious but rarely attended religious services supported abortion.
There used to be a postal abortion service that was a lifeline for women in regional and rural areas who couldn’t afford to travel for MS-2 Step. Sometimes with medical abortions, the first pill (mifepristone) ends the pregnancy but the second pill (misoprostol) fails to expel it, so the patient needs a D and C (dilation and curettage), an operation that every obstetric and gynaecological ward around the world performs every day, for both spontaneous or induced miscarriage.
The head doctor for the postal abortion service called me multiple times about patients who had turned up at hospitals seeking a D and C and were turned away. I asked the hospitals why they weren’t accepting the women. They either ignored me or quietly accepted the patients.
“Whose values and morals does this woman have to abide by?” the doctor said of one patient, who as we spoke was driving six hours to seek medical care at the only hospital that would accept her.
As Australia’s long-acting reversible contraception uptake increases and MS-2 Step becomes more readily accessible, the number of surgical terminations is likely to continue to decline, but there will always be some demand. There will always be people who had barriers in receiving medical care in time or received devastating foetal anomaly diagnoses long after the nine-week eligibility period for RU486.
Whose values and morals do these taxpaying patients have to abide by to receive this medical care? Not those of most Australians.
Has Labor squibbed on this? Should it get its act together? Let us know by writing to letters@crikey.com.au. Please include your full name to be considered for publication. We reserve the right to edit for length and clarity.
