Medical abortions will finally be easily available to Australian women when the drug RU486 (mifepristone and misoprostol) is listed on the Pharmaceutical Benefits Scheme (PBS) from August 1, 2013. But without a national data collection system, we still won’t be able to monitor the quality, safety or access to abortion.
The listing has the potential to allow more equitable access to abortion services as the cost of the drugs falls from around $300 to about $36. It will also enable a wider group of practitioners to deliver abortion services and may lead to improved access to abortion for women in rural areas.
This is good news, but it’s not enough. Right now, we don’t even know how many abortions are done in Australia each year, either overall or in sub-groups, such as different age groups or areas of residence.
This means claims that abortion rates are increasing or decreasing, overall or in some populations such as teenagers or older women who mistakenly believe they are no longer fertile, are just that – claims that cannot be tested or verified.
It also means we can’t evaluate whether health promotion efforts to prevent unplanned and unwanted pregnancies (and reduce abortion rates) are effective. Or whether they are cost-effective or if there are trends that reflect problems with access.
The lack of data also means we have no way of monitoring the availability of service in different areas, particularly outside large cities. We have anecdotal reports that women struggle to access abortion in rural towns, and this access may improve with the introduction of medical abortions. Or it may not.
Without data, we just can’t know.
Indeed, without quality data we can’t comprehensively monitor clinical outcomes, such as complications. And that makes it more difficult to improve quality of care if and when that’s needed.
These deficiencies have existed for decades for surgical abortions. They are even more pressing now that medical abortion may be possible to get through your local doctor.
Routine collection of statistics about medical services ensures transparency of access, accountability about outcomes and helps plan where, when and how services need to be delivered.
That’s why we have routine data collection for hospital admissions (National Hospital Morbidity Database), joint replacements (Australian Orthopaedic Association Joint Replacement Register) and immunisations for children (Australian Childhood Immunisation Register), among many other things. Such data collections are at the core of a modern health-care system.
These data sets allow us to look at quality and safety of care. They allow us to measure how long people wait in emergency departments, the number of complications from different surgeries, how well different joint replacements work, and how many and what types of adverse events happen in hospitals. The compiled statistics are important sources of information for doctors, patients and planners.
We need the same for abortion statistics. In South Australia and Western Australia, we have the beginnings of the solution. In these states, there are notification systems that require information about surgical abortions to be systematically recorded. We now need the same data – uniformly and confidentially collected – nationally. And it must cover medical abortion information as well.
Early medical abortion (abortion in the first seven weeks of pregnancy using a combination of the drugs mifepristone and misoprostol) involves an initial dose of medication plus a follow-up dose to be taken at home 24 to 48 hours later. Women are strongly encouraged to have a follow-up visit two weeks later to confirm pregnancy termination and to exclude complications.
The procedure has been shown to be highly effective and safe and is in use in many countries including France and the United States. Prior to recent changes, a number of practitioners obtained access to mifepristone through the authorised prescriber scheme. Marie Stopes clinics became one of the main providers through this scheme.
The notification systems in South Australia and Western Australia need to be expanded to cover surgical abortions and medical abortions provided through all GPs, hospitals and clinics nationally. As with other collections of health statistics, information would need to be confidential and secure so it can’t be used to stigmatise women.
Published aggregated numbers in regional or remote areas would need to be large enough so that individuals in small towns couldn’t possibly be identified.
The decision to fund RU486 on the PBS acknowledges the importance of a full range of reproductive services for women’s health and well-being (mifepristone is on the World Health Organisation list of essential medicines). Now we need to make sure abortion is not just available, but covered by the same systems of quality assurance and evaluation as any other medical service.
This is has a correction. It previously said early medical abortions had only be available in Australia through Marie Stopes clinics prior to RU486 being listed on the PBS.