GPs no longer have to do extra training to prescribe MS-2 Step, but women in rural and remote Australia still miss out.
A cohort of high-profile primary care researchers believe they will be able to prove that medication abortion is safe for women who live hours away from an emergency department.
If they’re successful, Australia’s “abortion deserts” could be eliminated once and for all.
The country hit a major milestone in July, when the PBAC released an out-of-session recommendation to deregulate mifepristone and misoprostol (MS-2 Step, MS Health Pty Ltd), allowing it to be prescribed and dispensed without additional training requirements.
It’s still only indicated for use in pregnancies up to nine weeks (63 days) of gestation, but GPs no longer have to complete a short course every three years to prescribe the medicine.
The changes also made it possible for nurse practitioners to prescribe the medicine.
As of December 2021, just 7% of GPs had done the training, most of whom were in metropolitan areas.
Canada previously had similar restrictions, which it removed in November 2017.
“We did some research in Canada once those restrictions were lifted and we found that the proportion of abortion providers to reproductive age women increased fourfold overall – four times as many providers – once they didn’t have those restrictions,” Canadian GP Dr Wendy Norman told The Medical Republic.
The change was even more pronounced in rural areas, where there was a 20-fold increase in providers over the following three years.
Dr Norman, who leads Canada’s contraception and abortion research team at the University of British Columbia, was in Sydney for international GP conference WONCA, where she presented on her upcoming research.
The project is a collaboration with Australia’s SPHERE research team, led by Professor Danielle Mazza, and Sweden’s Karolinska Intitutet.
It will look at whether the advisory in the “contraindications” section of the product information that patients should have access to emergency medical care in the two weeks following termination is actually supported by the data.
“It’s very hard to imagine that people living two, four, six or eight hours away from a hospital would be considered to have access … our understanding is, from the guidelines that were initially put in place in your Northern Territory, that access was considered within about two hours,” Professor Norman said.
“This actually excludes around 12% of the population in Australia.”
The complications from MS-2 step are similar to a miscarriage – and, Dr Norman pointed out, women in remote and rural areas are expected to deal with spontaneous miscarriage.
It’s understood that around 5% of medical abortions end up requiring surgical intervention, most commonly for loss of blood or retained products of conception.
Dr Norman believes that the risks might be lower.
“We presented in Paris at the International Society for Obstetrics and Gynaecology … a couple of weeks ago, and there were researchers there and obstetrician gynaecologists from around the world,” she said.
“Nobody had been having deaths due to this problem, anywhere.
“We think that the risks that are on paper for even needing a transfusion … might be so low once we can characterise them that we could remove these restrictions from the package labels.”
Through this research, Dr Norman also hopes to be able to define what early warning signs women can look for as a signal that they should start to get closer to a hospital.
The study itself will follow a case-control design and look at data from Canada, Australia, Scotland and Sweden.
“Scotland and Sweden have been providing medication abortion for decades before Canada or Australia did,” Dr Norman said.
“Bring together all of these [countries] will be able to give enough data to answer our questions.”
WONCA was held in Sydney from 26-29 October.
