Medical Abortion

Clinical feature by Dr. Alison Creagh, Medical Educator, Sexual Health Quarters

From 1 August 2023, any doctor* in Western Australia is permitted to prescribe medical abortion medications, MS-2 Step (mifepristone and misoprostol), and they are no longer required to complete an online training course every three years. In addition, pharmacists no longer need to be authorised to dispense these medications.

These changes are likely to significantly improve access to medical abortion for patients. However, it is important that each practitioner new to medical abortion think about their own process, to minimise the risk of complications. It is recommended to seek support from those with significant experience, and/or complete some training. Online training, while no longer a requirement, is still available at no cost from the drug manufacturer. More information is available here.

For those hoping to offer medical abortion soon, it is important to consider:

• Will I offer ’very early’ abortions (before the pregnancy tissue can be seen on ultrasound in the uterine cavity)? If so, how will I make sure the patient is well-informed about the risk of ectopic pregnancy?
• How will I make sure the patient has all the information they need to make an informed choice of procedure, how to take the medications, and what to do if any difficulties occur?
• How will I ensure that the patient understands the follow-up process, and the risk of complications?
• How will I ensure that follow-up is completed?

Until later this year (when the legislation is expected to change) the law in Western Australia requires providers have a referral from another doctor who has discussed the risks of an abortion, the risks of continuing the pregnancy, and the option of a referral to counselling about this pregnancy. There is also a requirement, within 14 days of the abortion being performed (or the medications being prescribed) for the medical practitioner performing the abortion to complete a notification form.

For resources about abortion for patients and for health professionals, see:

• King Edward Memorial Hospital – WNHS pregnancy choices and abortion care service (booklets for medical practitioners and patients)
• SHQ patient resource – I’m Pregnant: What Are My Options?

For more information about assessment, management, and referral for unintended pregnancy and abortion, see the following recently reviewed pathways from HealthPathways WA:

• Unintended Pregnancy and Abortion
• Medical Abortion
• Follow-up After Abortion

Sexual Health Quarters (SHQ) also have a course on medical abortion prescribing in development – if interested contact [email protected]

*Current WA law restricts both referral for, and the provision of, abortion, to medical practitioners. New legislation is before Parliament, which is expected to remove the restriction later this year.