Put all LARCs on PBS to improve uptake

3 minute read

Access to contraception and abortion services is mired in red tape, unnecessary costs and squeamishness.

Women’s sexual health advocates have urged the government to expand PBS subsidies to all long-acting reversal contraceptives in a bid to improve access.

At a public hearing of a Senate committee inquiry into universal access to reproductive healthcare, Professor Sue Matthews, CEO of the Royal Women’s Hospital in Melbourne, and Associate Professor Patricia Moore, head of the RWH’s abortion and contraceptive services unit, pointed out that Australia was “lagging behind” many other developed countries.

“In the UK, the IUD, the IUS, the contraceptive injection and the hormonal implant are all available free on the National Health Services and widely accessible through a GP, sexual health clinic, practice nurse or young person’s clinic,” their submission to the committee said.

“There are many barriers to LARC use in Australia, and access to comprehensive advice and services is highly variable.”

Professor Matthews told the committee the PBS subsidy was withheld for some forms of long-acting reversible contraceptives (LARCs) and about half of the 41 available oral contraceptives. 

“Our system penalises people who need to use particular forms of contraception,” she said. “While we have three methods of emergency contraception in Australia, only two oral methods are subsidised. The emergency copper IUD, which is considered the most effective of the three, is not available through the PBS.”

Early medical abortion is another area where Australia lags not just the UK but the US.

“While early medical abortion is safe and effective, only around 23% of abortions in Australia are medical abortions,” said Professor Matthews. “In the UK, where all abortion care is free, the figure is 73%, and even in the US, where there’s way less access to reproductive health, it’s 39%. It’s better than in Australia.”

Regulatory barriers imposed by the TGA also impeded access, Professor Matthews told the committee.

“Only doctors can prescribe medical abortion medication, but currently only 7% of GPs across Australia are registered to provide medical abortions, and this decreases significantly in rural Australia.”

Even though mifepristone is subsidised through the PBS, many women access medical abortions through the private system, and the cost can range between $500 and $800, depending on which state you live in and whether the medication is taken at home or in a clinic.

The RWH submission made extensive recommendations to the committee, including mandating that public hospitals operating at Level 2 or higher service capability have provision of abortion and contraception services tied to their funding.

Other major recommendations included:

  • Reviewing TGA requirements including allowing nurse practitioners, midwives and clinical nurse consultants to prescribe medical abortion; expanding the gestational age criteria to 10 weeks instead of nine weeks; removing the requirement that healthcare professionals receive specialised training to prescribe medical abortion medication and removing the need to seek an “authority script” from the PBS; and providing women with medical abortion medication pre-pregnancy for “in case” usage.
  • Reviewing the MBS item numbers for sexual and reproductive healthcare to reflect the skill, expertise and time required;
  • Mandating that educational institutions and professional colleges develop and implement evidence-based sexual and reproductive health curricula and clinical practice guidelines;
  • Reduce the cost of essential sexual and reproductive healthcare by providing PBS subsidies for all long-acting reversable contraceptives and increasing the variety of oral contraceptives available on the scheme;
  • National approach to the collection, monitoring and analysis of abortion data in all states and territories across public and private providers to inform funding, service and system reform.

The committee will report to parliament on 11 May.

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