Medical abortion: it is time to lift restrictions

In reply: We thank de Moel‐Mandel and Graham for their letter about our article on access to medical abortion.1 We support their recommendations, particularly around nurse‐led abortion provision.

In the United Kingdom, under the supervision of a registered medical practitioner, nurses now plan, lead and manage a significant proportion of care for women undergoing medical termination of pregnancy, although the legal requirements of the Abortion Act 1967 do not allow them to authorise the procedure.2 In countries where there is no legal or professional limitations to nurses’ role in early medical abortion, studies have found that provision by nurse midwives is more cost‐effective than that of physicians.3

In Australia, a number of services are moving to a nurse‐led model of care. The Cairns Sexual Health Service performs over 400 medical abortions each year and registered nurses carry out the initial evaluation and counselling, along with the follow‐up.4 Prescribing of the MS 2‐Step (mifepristone–misoprostol) medication and the consent process are currently done by medical practitioners, although it is expected that nurses will be providing the latter by the end of 2019. Nurses (as opposed to nurse practitioners) in Australia cannot prescribe under the Pharmaceutical Benefits Scheme, but can perform all the other work associated with non‐complicated medical abortions. Marie Stopes Australia — the largest provider of medical abortion in Australia — also uses nurses extensively for these medical procedures.

Without doubt, expanding nurse‐led provision is important. However, we believe the most significant change in provision will occur if mifepristone is removed from its current special status by the Therapeutic Goods Administration. This change more than any other will enable all Australian women, particularly those living in rural and remote areas, to access safe and timely early medical abortion.