The ban on medical abortions by specialist obstetricians in Queensland Health hospitals is now in its third month. The ban, currently in force in all public hospitals with a maternity unit, mostly affects women found in mid-pregnancy to be carrying a fetus with severe abnormalities; women so affected have been sent to clinics interstate when they make a decision for late abortion.

The ban was put in place when doctors became concerned about the implications of Queensland’s archaic abortion laws for their practice of medical abortion, following the ongoing prosecution of a young Cairns couple for allegedly procuring the woman’s abortion. Also affected by the ban are women with serious medical conditions that would be worsened by their continuing the pregnancy.

While some discussion continues between doctors, their representative organisations, and the Queensland government, it would seem that little progress has resulted. The suggestion has been made several times by doctors that the Premier refer existing abortion law to the Queensland Law Reform Commission. The state’s abortion law is still couched in terms dating from the mid-19th century that would be quaint if they were not so repressive for the women of 2009. The job of the Law Reform Commission is, presumably, to reform the law; there would seem to be an urgent need for the commission to have the opportunity to reform sections 224-226 of the Queensland Criminal Code.

Obviously, undergoing a late abortion in what was a wanted and often planned pregnancy is an experience fraught with pain, both physical and emotional, for the woman concerned. Having to travel interstate to do so, away from family and friends, doubles the agony. The cost to Queensland Health is also considerable. It is estimated that the number of women who have had Queensland Health-funded travel and interstate abortion since this saga began is now in three figures.

Paradoxically, in every other part of the country, women’s access to medical abortion using mifepristone (RU486) is increasing. At “Mifepristone in Australasia”, a conference in Wellington, New Zealand, on October 16-17, Australian doctors and nurses joined colleagues from New Zealand and Europe to learn where and how the drug is being used in the region, and to improve their knowledge of the practice of medical abortion.

Mifepristone is now fairly widely available in NSW, South Australia and the ACT, and increasingly so in Victoria and Western Australia. However, there has so far been no application to the Therapeutic Goods Administration (TGA) by a company wishing to market the drug in Australia, as is normal practice with other recognised drugs developed overseas. All approval of the prescription of the drug by the TGA is under its Authorised Prescriber regulations. These allow a doctor or group of doctors to import and use the drug in their own practices, but not to market it or provide it for use in other centres.

The Authorised Prescriber process is cumbersome and requires regular oversight by the TGA and by local ethics committees of the doctors’ prescription of the drug, but using this route has succeeded in having the drug considered by the TGA, who clearly have found mifepristone safe for Australian women. More than 80 Australian doctors now have TGA approval for Authorised Prescriber use of the drug.

Urban women have greater accessibility than rural women to mifepristone abortion — as they do to every other kind of abortion. At the Wellington conference a spokesperson from the Marie Stopes International group of clinics stated that in the period August-October more than 700 mifepristone abortions had been performed in their Australian clinics with minimal complications. Increasing numbers of women in South Australia (where abortion is largely provided in the public sector, and mostly in Adelaide) are also choosing mifepristone medical abortion, rather than the alternative of surgical abortion. It is likely that by the end of 2009 the number of Australian women who have made this choice will be in the thousands.

It is known that many more individual doctors are preparing applications to the TGA for Authorised Prescriber approval. Mifepristone can safely be used by any practising doctor who is able to care for women with a spontaneous miscarriage, which would include many doctors in rural areas, and it would be particularly desirable to have mifepristone available for rural women who have difficulty accessing surgical abortion that is mostly only available in the larger cities. Mifepristone is also a relatively cheap drug, as is the drug misoprostol which is always used with mifepristone for medical abortion; thus mifepristone/misoprostol abortion should hopefully also become financially accessible for all Australian women.

Whether an overseas drug company will apply to the TGA to market the drug here remains to be seen. This process is expensive and there are many bureaucratic hurdles to jump. Already more than one European company supplies the Australian market via the Authorised Prescriber legislation; this process costs the companies nothing in application processes (which are completed by doctors themselves), and it may suit them to continue this way. Through the Authorised Prescriber process the TGA tracks every tablet of mifepristone legally entering the country and receives reports of all outcomes and any adverse side-effects. This is highly desirable for any drug, particularly one that has been more controversial in Australia (because of the Harradine legislation) than in any other country on the planet.

History shows clearly that when a woman has made a decision for abortion for herself, but is unable to access that abortion in her normal environment, she will try to travel where safe legal abortion is available, and if that too is not possible, she may seek abortion illegally. We currently see the truth of this in Queensland: women are travelling, at the state’s expense (and the costs are considerable) for late medical abortion, and in Cairns a young woman awaits the frightening ordeal of a jury trial because she allegedly arranged the import of mifepristone from overseas and used it to procure an abortion for herself. She was unaware of the availability of medical abortion in Cairns at the time, and so finds herself charged with illegally using the same drug that is now legally provided for several hundred Australian women every month.

Undoubtedly many other Queensland women have travelled interstate privately to access medical abortion in the past few months, and undoubtedly not a few more have accessed abortion drugs from overseas via the internet — a practice that anecdotally is certainly known to occur in Australia. Let us hope that the situation in Queensland is resolved before death or serious damage occurs to any Queensland woman confused or intimidated by the present parlous state of the Queensland abortion laws.

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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