Doctor at a laptop
(Image: Adobe)

In March the government introduced temporary Medicare rebates for telehealth appointments in an effort to minimise face-to-face appointments for maladies that could be managed with an over-the-phone consultation during the pandemic.

This included a rebate for telehealth consultations for early medical abortion — the termination of a pregnancy in the first nine weeks of gestation using the abortion drug RU486. Now the country’s sexual and reproductive healthcare providers are petitioning the government to keep the rebate beyond its September expiry date.

“It was a very positive thing to come out of the pandemic,” says Family Planning NSW medical director Dr Deborah Bateson. “[This rebate] opens up access for women including for those in rural areas where services are limited.”

Bateson said for a few years women in some areas had been able to access abortion through telemedicine with private providers who set their own fees but now they can access low or potentially no-cost options if doctors are willing to bulk-bill ultrasound and blood tests.

In the seven years since medical abortion drugs were added to the Pharmaceutical Benefits Scheme (PBS) the federal government has done little to address inequities in sexual and reproductive health.

While abortion law is governed by the states, reproductive healthcare providers have long argued there’s much to be done federally when it comes to providing options for women — particularly those most marginalised — when they want to terminate a pregnancy.

Medical abortion drugs should have cost $38.80 since 2013 but in reality many women outside major cities pay hundreds of dollars to private providers, and only a fraction of GPs in regional areas are registered to prescribe it. 

Although the call is for the government to either let the telehealth item number exist beyond September or to create a new item number, Bateson said the latter would help address Australia’s poor data collection on abortion. 

Head of the general practice department at Monash University, Professor Danielle Mazza, said early medical abortion was time sensitive as it was only allowed before nine weeks’ gestation, after which the option is surgical.

“The telehealth item numbers offer women access to providers who are not in their immediate locality,” Mazza says.

“Women in rural and regional areas of Australia are the ones with potentially the least access to early medical abortion providers locally and who stand to benefit the most, but other women from more vulnerable groups — such as those experiencing domestic violence or those unable to meet costs of travel and childcare — will also benefit.”

The country’s biggest abortion provider, Marie Stopes Australia, has been delivering medical abortions via telehealth since the start of 2015 and has seen a 25% increase in the service during the pandemic.

“We strongly believe that [the service] needs to be supported through our health system,” says its managing director Jamal Hakim.

The Health Department said “options for extension and refinement” to telehealth debates will be considered.

Equitable access to abortion services for Australian women is supposed to be a key priority of the government’s national women’s health strategy of 2020 to 2030, but its approach to abortion and contraception has largely been one of inaction and avoidance.

Prime Minister Scott Morrison refused to engage with a debate about public provision of abortion when the Labor Party promised abortion services in hospitals at the last federal election, saying the issue didn’t “unite Australians”.

A quarter of the government’s $4 million reproductive health policy was for an organisation that teaches couples the Billings method, a Catholic-church endorsed approach to fertility.

Contraception is in fact a whole other rebate battle because Australia lags when it comes to the uptake of long-acting reversible contraceptives, and although the government recently subsidised a new one there’s little incentive for GPs to upskill on insertion as it is poorly remunerated. 

To help women safely terminate a pregnancy in the privacy of their home –without having to organise childcare and travel interstate at huge personal cost for a surgical termination — the government would need only to keep doing what services say it has been for decades: nothing.

Peter Fray

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