Caroline de Costa was one of the first doctors in Australia authorised to prescribe RU486 for the purposes of abortion. But there’s more to the story. She writes:
Abortion is a very important health issue for Australian women, and the more information women have the more able they are to make informed decisions for themselves, and to help friends who may have unplanned pregnancies. While in an ideal world all pregnancies would be planned and wanted, as you all know in the real world this is not always the case, and sometimes women faced with an unexpected pregnancy have to make the decision that they are not able to become a mother at this point in their lives. Sadly, also, in some planned and wanted pregnancies the modern tests we now have for abnormalities in the developing baby show severe or even fatal abnormalities, and the woman may choose to terminate her pregnancy.
Increasingly medical methods are being used, overseas and in Australia, for termination of pregnancy. “Medical abortion” is the term used to describe abortion induced by legal, approved drugs. The best drug currently available is mifepristone, still better known to the general public as RU486, which is always used together with another drug, misprostol, to bring about an abortion. The woman experiences this process much like a spontaneous miscarriage: there is some bleeding and pain (pain relief is always offered) as the pregnancy is expelled.
Up to 9 weeks of pregnancy this process can safely occur in the woman’s home, provided she has a support person with her and knows how to access emergency care in the uncommon event that she needs to do so. After 9 weeks of pregnancy the process needs to take place in a hospital with suitably trained and dedicated staff.
You will recall that RU486 was unavailable to Australian women for many years as a result of the “Harradine Amendment” – a piece of legislation that meant that importing and marketing the drug required the special permission of the Federal Minister for Health. In 2006 four courageous women senators (Claire Moore, Lyn Allison, Judith Troeth and Fiona Nash) from across the political spectrum brought a private members’ bill to the Senate and then to the House of Representatives that overturned the Harradine Amendment.
However the change in the law did not mean that mifepristone became immediately available. It still requires a drug company to apply to, and gain approval from, the TGA (Therapeutic Goods Administration) to market the drug. So far this hasn’t happened.
To make the drug available to Australian women some of us have used a special piece of TGA legislation, the Authorised Prescriber legislation, which allows us as doctors to import and use drugs recognised overseas but not available here, in Australia within our own practices. I first did this with Dr Mike Carrette in Cairns in 2006. Since then a free public clinic offering mifepristone has been developed in Cairns and I am also able to use the drug for women with severe medical conditions in pregnancy attending Cairns Base Hospital. However the very restrictive wording of Queensland abortion law continues to pose problems for individual women seeking abortion here and elsewhere in Queensland, and numerous women who don’t fall within the strict limits of this law have had to access abortion elsewhere, often travelling to Victoria where abortion has been decriminalised.
Over the past five years more than 100 doctors across Australia have joined myself and Dr Carrette to become Authorised Prescribers of mifepristone; they can be found in all states except Tasmania and the NT. However their ability to use the drug is confined to their own practices or hospitals, so while access for women to early medical abortion using mifepristone is relatively easy in capital cities including Sydney, Melbourne, Adelaide and Perth, it is limited or non-existent for women in other urban areas and in rural and remote areas.
I am hopeful that within months there will be a successful application to the TGA to market the drug nationally and it will become available. Mifepristone will then be potentially available to all general practitioners wanting to use it, provided that women they treat have access to emergency care if needed during the abortion process.
At the same time, it is important that we address the fact that Australia does have a high rate of abortion, especially in comparison to some European countries such as Holland, Belgium and the Scandinavian countries, all of which have liberal approaches to the provision of abortion, but also excellent contraceptive services and contraceptive information services, and high-quality sex education in schools. These are areas where Australia must improve performance if we are to increase the proportion of pregnancies that are both planned and wanted.
Dr Caroline Da Costa is Professor of Obstetrics and Gynaecology at the James Cook University School of Medicine and Dentistry in Cairns. She has a strong interest in women’s reproductive health rights.
Top Comments
I'm a nurse. I work in a childrens' emergency department.
Do you know what I see a lot of?
I see a lot of children born to parents who are not able to look after them. I see teenagers who have been tossed through the care system who tell me that they wish they could die, and that they wish they'd never been born. I've looked after children who've been brought to our department by police because either parent has not been coping and that child has been in danger. This means that they have been, or are likely to be harmed; physically, sexually or emotionally. By people who brought them into this world. By people who did not want children and by people who chose not to terminate the pregnancy. I'm not saying these people should or should not have terminated the pregnancy. That is not for me to judge. What I am saying is that these children are often put in worse experiences when they are in "care", than the harrowing experiences which caused them to be removed from their families in the first place.
I also care for a lot of profoundly disabled children. Severe cerebral palsy, developmental delays, severe epilepsy with seizures that can easily result in further brain damage. These children are in enormous amounts of pain, despite doses of pain relief that could knock out a large adult man. They're on 2, 3, sometimes 4 charts of medication that needs to be given at exact times throughout the day. Their families have often gone from double income, to single income with the added expense of a child with a profound disability, in a health system that does not support home-care of the profoundly disabled well at all. These children cannot do anything independently; from washing, feeding, weeing, pooing, and have to have their position changed regularly throughout the day and night to ensure they don't get pressure sores. These children are completely dependent on their parents and this doesn't go for a year or two. This goes on for however long they are alive. This goes on until they day they die. Which might be tomorrow, or it might be in 10 or 20 or 50 or 60 or 80 years. A lot of these children are on palliative care plans, so there's the added agony of knowing your child is going to die and waiting for it to happen. As well as this, there's not only the basics of parenting, but various medical paraphenalia that is required to manage these children; feeding tubes to stomachs, bi-pap machines, feeding tubes down noses, lines in arms and legs and chests and necks for IV access, etc etc. All of these can malfunction at any time, which will require a race to the local hospital to get it replaced/fixed/antibiotics for infections, etc. etc. etc.
So to all of the pro-life/anti-choice people, let me ask you this. Why aren't you lining up to foster the children who don't have homes? Why are community services having to place children in boarding houses because they have no where to go? Why are children admitted to hospital, without even being sick, because community services cannot find a home for them? Where are you, with all your values of changing lives, saving lives, etc. Why aren't you offering your hearts and your homes to these children who desperately need you?
Where are you when my palliative care, profoundly disabled children's parents are struggling financially? Why aren't you dontating in-home carers, helping buy wheelchairs, or even the menial things like feeds and medications and nappies? all the energy you are spending raising awareness and bringing attention to your plight of the unborn....you should be ashamed of yourselves. There are children and families who desperately need your media air time to get assistance for something that has been thrown on them and has turned their lives upside down.
I won't tell anyone that it's not their right to have a child, or chose to not have a child. Every patient I look after with the same level of care and compassion. But it doesn't help but break my heart when I see children who are literally in agony and I cannot do anything about it.
My challenge to you is, if you intend to protest about rights, foster a child, preferably one with a profound disability that is being managed in a group home (yes, they do have them for children). Then tell me about rights.
Ella, you have hit the nail on the head. If only all those pro-life people could walk a mile in someone else's shoes, they might reconsider their stance on this issue. That is what irritates me the most - it is never black and white. There are so many different circumstances to consider in relation to an unwanted pregnancy, such as teen pregnancy, rape, severerly disabled foetus, the mental health of the mother, financia reasons etc etc, that surely we should let doctors decide on a case-by-case basis whether abortion is the best decision, for that particular woman.
Thank god there are people like you who choose a career caring for other people, and make these kids' lives better, even for one day at a time.
Thank you for agreeing with me & not making me feel like I'm the only one in the world who thinks like this!
Beautifully said Ella...
You. Totally. Rock. Fucking awesome.
I'm pro-choice - I don't think its the government's job to interfere with women's rights to make decisions about their bodies.
I do agree with Dr Da Costa in relation to contraception too though. As a taxpayer I would happily support the provision of free advice and free contraceptives to all women to enable more choice.