While medication abortion provision has expanded, the overall proportion of general practices offering it remains low, new research shows.
Medical abortions (MAs) through GPs rose twentyfold between 2014 and 2021 despite the fact that fewer than one in three general practices offered the service at all, researchers say.
The Flinders University-led study, published in BMJ Sexual & Reproductive Health, examined MA provision among females aged 14-49 from 2014 to 2021 across six states and territories – excluding SA and NT, where abortion was legal only at approved centres during that period.
The share of practices offering MA increased fivefold, yet only 124 of the 406 general practices – just 30.5% – provided at least one service throughout the study period..
Among the clinics that did provide MA, the rate of provision was twice as high in regional areas as in major cities, with the highest rates in low- to very-low-socioeconomic-status (SES) areas.
Study co-author Professor Danielle Mazza, who is head of the Department of General Practice at Monash University and a clinical researcher in women’s sexual and reproductive health, said this prevalence in regional areas could be due to restricted access to services.
“While we should be increasing accessibility of medical abortion, we also need to always enable choice for women because not all women are suitable [for] or want to have a medical abortion,” she said.
This includes women who are potentially unsafe in their home environment, are at risk of violence, don’t want their parents to find out, or face unstable housing, she said.
Notably, the overall proportion of general practices providing MA varied only slightly across SES groups.
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Another crucial finding was that the majority (56.9%) of women undergoing MA were new patients at the time of provision.
Professor Mazza said the time-sensitive nature of MA, which must be provided by nine weeks’ gestation, combined with it not being a routine part of comprehensive general practice care, means women often don’t know where to go for the service.
“With increasing availability of contraception and UTI treatments through pharmacies, it also means women may not have the opportunity to develop a relationship with the GP as well,” she said.
While health budget initiatives for long-acting reversible contraception have delivered centres of excellence, scholarships, and increased Medicare rebates, the same emphasis has not been placed on medical abortion, Professor Mazza said.
Victoria and Tasmania recorded the greatest growth in MA provision over the study period, which researchers attributed to Victoria’s progressive legal frameworks on abortion rights compared to other states.
MA accounts for only half of all abortions in Australia, whereas in comparable high-income countries it constitutes more than 90% of all abortions.
Professor Kirsten Black, a sexual and reproductive health expert and academic gynaecologist at the University of Sydney, said medical abortion is the default in some countries – such as Sweden, Finland and India – because it’s cheaper, more accessible and doesn’t require anaesthesia.
“It depends on the state, but in New South Wales, there’s only three [hospitals] in the state that provide surgical abortion. So [MA] really is the only option,” Professor Black said.
Higher numbers of medication abortions in regional areas, then, may be because rural areas lack the option for surgical abortion, she told TMR.
But the issue is multifactorial, including ongoing stigma around abortion provision, the relatively recent legal introduction of MA in 2006, and the fact that abortion has only been fully decriminalised across Australia in 2023, she said.
“If you want to be a GP [MA] provider, you still need hospital backup because MA is 95% effective, but it’s not 100%,” Professor Black said.
For GPs who don’t feel sufficiently supported by their public hospital, undertaking MA provision may be difficult, she said.
“It’s also a lack of integration as part of normal health care in hospitals, and it’s probably not well remunerated given the time it takes to conduct those consultations,” she said.
Moreover, doctors and pharmacists weren’t authorised to prescribe MS-2 Step without additional training or registration until mid 2023.
In the qualitative research Professor Black has undertaken, she said some GPs, particularly in rural areas, may not want to be known as the “abortion doctor”, or that doing so may conflict with a practitioner’s religious values.
“The fear [is] that they’d be stigmatised by their colleagues mainly,” she said.
A proposed mandatory refer-on obligation for GPs with moral objections to abortions was stripped from Dr Amanda Cohn’s 2025 Greens bill before it passed in the NSW upper house.
Professor Black said AusCAPPs, the Australian Contraception and Abortion Primary Care Practitioner Support Network, offers valuable support for primary care practitioners providing early medical abortions.
Data from the large-scale primary care database, MedicineInsight, informed the findings, tracking more than 1 million women.
Read the full study here.
