The North Eastern Public Health Unit (NEPHU) has come together with Women’s Health In the North, Women’s Health East, North Western Melbourne Primary Health Network, and 1800 My Options, with a shared mission to enhance access to abortion healthcare in the region.
This initiative seeks to support and encourage healthcare providers to increase access to early medical abortion (EMA) care for patients. Particular need to improve access has been identified in the local government areas of Hume, Whittlesea, and the Yarra Ranges.
This initiative sits within the NEPHU Population Health Catchment Plan, as part of the ‘Improving Sexual and Reproductive Health’ priority area.
Supporting early medical abortion in primary care
The primary care setting is well suited for medical abortion, offering patients continuity of care with providers they know and trust. However, access to such services remains limited in parts of Melbourne’s north east. Currently, early medical abortion is publicly offered by only three General Practice clinics in Hume, three in Whittlesea and four in the Yarra Ranges (Women’s Health Victoria, 2024).
Early medical abortion has been shown to be a safe and reliable method for terminating pregnancy (Leichomban & Bawiskar, 2023). A systematic review and meta-analysis found that medical abortion led by a primary care provider and completed at home is safe and effective, showing no difference in success rates compared to administration at a specialist sexual and reproductive health service (Gambir, Garnsey, Necastro, & Ngo, 2020). Studies from Australia and overseas show a high level of patient satisfaction and acceptability regarding EMA (Goldstone, Michelson, & Williamson, 2012) (Berer, 2005).
What is early medical abortion (EMA)?
Early medical abortion (EMA) refers to the termination of pregnancy using medication prior to nine weeks’ gestation. MS-2Step is the brand name of EMA medication (mifepristone, misoprostol) available in Australia.
In 2023, previous restrictions to MS-2Step provision were lifted by the Therapeutic Goods Administration. The PBS scripting process for MS2-Step has moved to Streamlined Authority (rather than an authority script). MS-2 Step can now be prescribed by any GP or Nurse Practitioner with appropriate qualifications and training, without the need for certification. Training for MS2-Step/EMA is still recommended, however, and is available free and online through MSI Australia.
Importantly, prescribing MS-2Step/EMA does not increase insurance premiums for GPs, as EMA is considered a non-procedural treatment. Standard billing practices apply to early medical abortion prior to nine weeks’ gestation. In the rare event of complications, patients can present to their nearest hospital’s emergency department, as they would if seeking treatment for spontaneous miscarriage and its complications (Mazza et al., 2020).
Options for clinics seeking to improve patient access to EMA
Healthcare providers and clinics in the north east metropolitan region are encouraged to consider becoming an EMA provider, and/or providing patients with information about other options.
Becoming an EMA Provider
Healthcare professionals can complete free training and become a prescriber of MS-2Step (mifepristone, misoprostol) with MSI Australia (formerly Marie Stopes Australia). Clinics can publicly register their services with 1800 My Options, a phoneline and website that maintains a geomapped database of healthcare providers offering sexual and reproductive health services. Clinics can also advertise EMA services on their own website.
Provide patients with other options
Clinics can place posters and pamphlets from 1800 My Options in waiting rooms. A range of resources for patients, including materials translated into ten community languages, can be ordered from 1800 My Options. Clinics can familiarise themselves with local services available for referral of patients seeking abortion healthcare. A comprehensive list of services is available on the 1800 My Options website.
References
Berer, M. (2005). Medical abortion: Issues of choice and acceptability. Reproductive Health Matters, 13(26), 25-34.
Gambir, K., Garnsey, C., Necastro, K. A., & Ngo, T. D. (2020). Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: A systematic review and meta-analysis in response to COVID-19. BMJ Global Health, 5(12), e003934. Retrieved from here
Goldstone, P., Michelson, J., & Williamson, E. (2012). Early medical abortion using low-dose mifepristone followed by buccal misoprostol: A large Australian observational study. Medical Journal of Australia, 197(5), 282-286.
Leichombam, R., & Bawiskar, D. (2023). Exploring the safety and efficacy of medical termination of pregnancy: A comprehensive review. Cureus, 15(10).
Mazza, D., Burton, G., Wilson, S., Boulton, E., Fairweather, J., & Black, K. I. (2020). Medical abortion. Australian Journal of General Practice, 49(6). Retrieved from here
Women’s Health Victoria. (n.d.). Service mapping: 1800 My Options. Retrieved from here
