We all thought the debate about abortion was over, but the scarcity of trained abortion providers is a national shame that adversely affects rural and regional women.
This could be overcome if we allowed nurses and midwives to prescribe medical abortion medication, commonly known as RU486, which has been available since 2012 for abortions up to 63 days’ gestation.
Across Australia, only 5% of GPs are registered to prescribe the medication and this drops below 1% in regional areas. Whilst rural women are 1.4 times more likely to have an unplanned pregnancy. Surgical abortions can only be accessed in a limited number of hospitals, and it is even harder for those who cannot access the public system.
A person’s right to choose should not be dependent on their postcode.
We have successful sexual reproductive hubs that would be able to work far more efficiently if the nurses providing the care were able to prescribe the medication.
This proposal is consistent with the National Women’s Health Strategy (2020-2030) which seeks to increase equitable access to abortion care.
The permeating stigma around abortion affects not just patients but doctors too. The paucity of providers means some GPs in rural towns fear the community reaction to becoming the only prescriber in the region.
Rural people must travel long distances to receive care. This creates an emotional burden that their city peers do not carry. It’s not just a gender issue, it’s also part of the city vs country divide.
Nurses are already at the centre of abortion care. They prepare the patients, assess their suitability and can refer them for surgical abortions. They walk patients through the medical procedure but must find a medical practitioner to sign the script.
Nurses led care is not new. We have seen the success that nurse intervention has had in driving down the rates of HIV and Hepatitis C infection.
This is not how the Abortion Act was intended to work. it is one of the best in the country and reflects that the procedure should be based on medical evidence, not political considerations. Under the Act, nurses are legally able to assist in the process up 24 weeks’ gestation.
Yet, this depends on whether the medicines are listed on the Minister approved lists in the Drugs, Poisons and Controlled Substances Act. Unfortunately, they are not.
Our laws are a contradiction, in which we acknowledge nurses have a role to play, but then deny them the legal framework to do so.
The Victorian Health Minister, Martin Foley, can change this with the stroke of pen. Sadly, this is not the only barrier to a nurse led model for terminations.
The Therapeutic Goods Association (TGA) guidelines for mifepristone and misoprostol only allow medical practitioners to prescribe the medication. Leading reproductive health provider, Marie Stopes Australia, are preparing an application to change this.
The medication is not dangerous, we have seen over 100,000 successful medical abortions in Australia since it was approved in 2012. The restrictions do not reflect medical advice, but a moral conviction that infiltrates abortion access throughout the world.
The debate around abortion is over. Women and pregnant people have a right to choose, and we should not use the tentacles of bureaucracy to strangle this right.
We are experiencing a global healthcare worker shortage. Empowering our nurses will increase health access, equity and enable bodily autonomy for all.
The TGA need to update their guidelines, but it is vital Victoria is ahead of the change. Minister Foley can amend the Drugs, Controlled Substances Act regulations without legislation, and should do so as a matter of priority.
The overburdensome regulation is a moral imposition not a medical view.
It is crucial that our reproductive rights are not only supported by government but resourced. Victoria legislation must ensure our right to choose can be practiced no matter we live.
Fiona Patten is the Leader of Reason Party and is the Member for Northern Metropolitan Region in Victorian Legislative Council.
Jamal Hakim is the Managing Director of Marie Stopes Australia.