Abortion information

A pregnancy may be ended using surgical or medical techniques or a combination of both.

Medical abortion

Medical abortion refers to the use of medication to terminate a pregnancy.

In July 2023, the Therapeutic Goods Administration (TGA) approved an application from MS Health to amend restrictions on the prescribing of MS-2 Step (Mifepristone and Misoprostol). MS-2 Step is indicated in females of childbearing age for the medical termination of an intrauterine pregnancy, up to 63 days of gestation.

Previously, MS-2 Step was only able to be prescribed by a medical practitioner (a doctor) who had been certified to prescribe the medicine, and then dispensed by a pharmacist who was a registered dispenser. The TGA’s decision means that MS-2 Step can now be prescribed by any health practitioner with appropriate qualifications and training, without the need for certification. The legislation change also extends prescribing rights to nurse practitioners and endorsed midwives and, restrictions on dispensing that limited access to registered pharmacists have also been lifted. It is recommended however that those providing medical abortion care, undergo training that is available to registered health practitioners.

Medical abortion involves the use of two agents – Mifepristone, a synthetic anti progesterone, and Misoprostol, a prostaglandin analogue. The procedure involves oral Mifepristone which inhibits the action of progesterone in maintaining the pregnancy and therefore cause the embryo and placental sac to separate from the wall of the uterus.

Misoprostol, taken 24 to 48 hours after Mifepristone, induces contractions, cervical opening and causes the evacuation of contents of the uterus.

The combination of Mifepristone and Misoprostol for patients in early pregnancy results in complete abortion in 95 per cent of cases.⁽⁶⁾ The other five per cent of patients may need surgical evacuation for retained products of conception.⁽⁵⁾

Medical abortion can be offered in a primary care setting or through a clinic. After nine weeks gestation medical abortion is not available in the community but may be available as a hospital inpatient.⁽⁵⁾

Patients undergoing medical abortion will have medical supervision and access to surgical treatment if required. Having a further procedure may incur an additional cost.

Surgical abortion

Surgical methods include suction curettage (vacuum aspiration) or dilation and evacuation (D&E). Aspiration techniques can generally be used up to 12 to 14 weeks; however, as gestation increases, safe removal may require cervical preparation and a combination of techniques to remove the products of conception from the uterus.⁽⁷⁾ Surgical abortion is available in licensed day surgery clinics and in hospitals.

Availability of medical and surgical abortion

• Suitability for medical or surgical abortion requires consideration of a range of factors including gestation, the patient’s individual circumstances (for example: psychological impacts, social support); medical conditions; and the choice of abortion provider. All evidence indicates that both medical and surgical abortion are safe. The specific type of abortion provided (medical or surgical) will be determined by an individualised assessment.
• RANZCOG Abortion Decision Aid tool (PDF) was designed to guide discussions about the decision between a medical or surgical abortion and can be used when discussing abortion options with a patient.
• Early medical abortion is a service safe to offer in general practice up to 63 days gestation (noting that after 70 days as per RANZCOG guidelines (external site)⁽¹⁾ patients should be admitted to hospital for medical abortion) There are guidelines and training available to guide the establishment of an early medical abortion service with community based general practice and primary care settings. Many GPs already provide this service.
• Routine abortion is generally provided through private abortion clinics in the community. The provider may offer early medical abortion as an outpatient or a choice of medical or surgical abortion at a clinic.⁽⁸⁾
• KEMH does not provide a routine abortion service; however, it does have an abortion service to assist patients who are unsuitable for private abortion clinics due to:
  • medical co-morbidities
  • anaesthetic issues
  • a fetal abnormality identified in this pregnancy
  • social circumstances that exclude them from community-based abortion providers
  • being aged 14 years or less.
• Any young woman or person under 14 years of age requesting an abortion should be referred to KEMH. This is a specialised service available to all young people under 14 years from across WA.
• Patients with restricted financial circumstances that would preclude them from accessing private abortion providers may also be referred to KEMH for assistance. This will involve a consultation conducted via telephone between the Pregnancy Choices and Abortion Care Co-Ordinator and the person via a referral from their GP.

Risks of induced abortion

All of the available evidence indicates that induced abortion both via medical or surgical methods, especially in early pregnancy, is a low-risk procedure.⁽⁷⁾ The risks of death and serious complication with induced abortion are lower than the risks of carrying a pregnancy to term.^{(9, 10)} Please refer to the RANZCOG Clinical Guideline for Abortion Care 2023 (PDF)⁽¹⁾ for all risks and complications of induced abortion and carrying a pregnancy to term.

Contraception

A request for abortion is an opportunity for clinicians to discuss a patient’s future fertility intentions and use of effective contraception after abortion. It is important that patients are provided with information and counselling to help them make informed choices on suitable contraceptive methods after abortion.⁽¹¹⁾ FSRH Clinical Guideline: Contraception After Pregnancy (external site) (Chapter 3: Contraception after Abortion)

Effective reliable contraception reduces the rate of unintended pregnancy, and consideration of long-acting reversible methods is recommended by professional guidelines:

• RANZCOG - Clinical Guideline for Abortion Care 2023 (PDF)
• FSRH UK - Clinical Guideline: Combined Hormonal Contraception (external site)
• RCOG UK - Best Practice in abortion care paper (external site)

Contraception can be initiated at the time of early medical abortion or follow-up or provided at the time of surgical abortion. If there is a delay in provision of the chosen contraceptive method, a temporary / bridging method of contraception could be considered.

See below links for additional information and resources on contraception after abortion.

• Contraception after an abortion (external site)
• RANZCOG Clinical Guideline for Abortion Care (PDF)
• RANZCOG Abortion Decision Aid tool (PDF)
• The Complete Multilingual Guide to Contraception in Australia (external site)

Reproductive coercion

Family, domestic and sexual violence is the use of a range of tactics by an abuser to create vulnerabilities, and to achieve power over a partner through coercive control. This includes physical violence or other forms of violence including emotional and psychological abuse.

Reproductive coercion is behaviour that interferes with the autonomy of a person to make decisions about their reproductive health. It includes any behaviour that has the intention of controlling or constraining another person’s reproductive health decision-making, for example:

• controlling or sabotage of another person’s contraception.
• pressuring another person into pregnancy
• controlling the outcome of another person’s pregnancy, e.g., forcing someone towards abortion, adoption, care, kinship care or parenting.
• forcing or coercing a person into sterilisation, including tubal ligation, vasectomy and hysterectomy.

Health professionals can assist by being aware that people seeking an abortion might have been exposed to reproductive coercion or family, domestic or sexual violence.⁽¹²⁾ If suspected or disclosed, please refer the patient on to an appropriate service which could be the Women’s Domestic Violence Helpline, a Women’s Health Centre (list of contacts to nearest centre available at the bottom of this webpage, see Resources), or a Family and Domestic Violence Hub (external site). The service will be able to support the individual with a risk assessment and provide further supports as required.

See KEMH Women’s Health Strategy and Programs Family and Domestic Violence Toolbox for more information on intimate partner violence and resources.

Information on coercion and the appropriate support and referral pathways is also available on Clinician Assist WA (external site).

Sexual Health Quarters Safe to Tell (external site) has a number of resources, e-learning for clinicians and contact and referral information for patients experiencing reproductive coercion and/or intimate partner violence.

The Royal Australian College of General Practitioners has clinical resources and training on identifying and responding to intimate partner violence RACGP - Intimate partner abuse and violence: Identification and initial response (external site)

Additional training and resources for reproductive coercion and intimate partner violence include:

• Reproductive abuse | 1800RESPECT (external site)
• Domestic and Family Violence Response Training (external site)

Adoption

Information on adoption is provided as some people may wish to consider adoption or kinship care as an alternative to parenting or abortion.

Adoption practices are shaped by society, culture, religion, politics and economics and have changed over time. Adoption has significantly declined in Australia for a variety of reasons, including increased support for single parent families, the emergence of family planning and legislative changes which provide alternative legal options. There were 310 adoptions in Australia in 2018-19; 57 were adoptions from overseas and 253 were adoptions within Australia. Of these, 211 were known child adoptions (ie; adopted by a step-parent, relative or carer) and 42 were local adoptions. There has also been a significant shift away from the secrecy that was associated with adoption to a transparent system which focuses on the needs of the child.⁽¹³⁾

Since 1995, all adoptions in Western Australia have occurred within a policy of ‘openness’ where the birth mother is involved in each aspect of the adoption. Current research indicates that continued contact increases the birth mother’s satisfaction with the process.⁽¹⁴⁾

The Turnaway Study, a five-year longitudinal study of 956 women and pregnant people seeking abortion care in the United States of America, including 231 pregnant people denied abortion due to gestational limit, found that amongst pregnant people seeking abortion, adoption is infrequently chosen.⁽¹⁵⁾

It has been suggested that pregnant people tend to choose adoption when there are fewer options available.⁽¹⁵⁾ Patients should be advised that abortion, parenting, exploration of kin support and adoption are all potential options.⁽¹⁴⁾

For more information on adoption see the Department of Community Development - Pregnant and considering adoption for your child? (external site)

Non-directive pregnancy counselling

Non-directive counselling is a form of counselling that recognises in many situations, people can resolve their own problems without being provided a solution by a counsellor. The service involves a safe and confidential process that allows the patient to explore concerns they have about the pregnancy and the counsellor to provide unbiased, evidence-based information about all options and services available to the patient, where requested.

Medical practitioners and eligible psychologists, social workers and mental health nurses are able to complete non-directive pregnancy counselling training, which will enable them to provide the service and access Medicare benefits for non-directive pregnancy support counselling services. Refer to the current Medicare Benefit schedule, and Royal Australian College of General Practitioners non-directive pregnancy counselling training for further details.