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RUBY:

From Schwartz Media, I’m Ruby Jones. This is 7am

It's being called the most important case for reproductive rights in the United States since Roe v Wade was overturned.

A judgment in a court case in Texas that could ban access to a non-surgical abortion medication is due any day now.

Closer to home, the exact same medication could become more widely available. The therapeutic goods administration is currently considering appeals to widen its accessibility, with a decision expected in the next few weeks.

Today, contributor to The Saturday Paper, Esther Linder, on the barriers to early non-surgical abortions in Australia, and whether it's time for a change.

It's Thursday, March 2.

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RUBY:

So Esther, there's a court case that's running in the United States at the moment, and it's being talked about as one of the most, or the most, important decisions on abortion access in the US since Roe v Wade. And it's all about access to one particular drug, mifepristone. So can you tell me a bit about what it is that's actually being decided?

ESTHER:

Sure. So mifepristone is the most common drug that's used for early medical abortion, which is a term for terminations of pregnancy that happen before the nine week mark. In the U.S. anti-abortion activists have taken a court case in Texas.

Archival tape – Protesters:

“My body, my choice!”

Archival tape – Reporter 1:

“If you thought the legal battle over abortion rights was only a story in 2022. Well, you're wrong. All eyes are on the state of Texas.“

Archival tape – Reporter 2:

“That little pill, which is barely bigger than an aspirin, is the new frontier of the fight over abortion access in this country.”

ESTHER:

They are trying to get mifepristone banned, essentially on the basis that the US’s Food and Drug Administration, which initially approved mifepristone for use back in 2000, saying that the FDA didn't assess it properly.

Archival tape – Reporter 2:

“Already, 18 states have established restrictions on the pills, with some trying to cut off mail access to the drug, and others threatening the pharmacists who provide the medication.”

Archival tape – Kamala Harris:

“Those who would attack this process and the ability of the FDA to make this decision, ought to look in their own medicine cabinet!”

ESTHER:

Obviously, given Roe v Wade, the precedent that sort of enshrined a right to reproductive health care, fell last year in a decision by the U.S. Supreme Court.

Archival tape – Reporter 3:

“It's estimated around 22 million — a third of America's women of reproductive age — are living in states where abortion is either unavailable or severely restricted.”

ESTHER:

This case has a lot of significance because it means that in states where abortion is still legal, such as New York, it might be almost impossible to access the actual drugs used. So while the actual procedure might be legal, the drugs won't be accessible.

Archival tape – Reporter 3:

“Of course the need for abortions hasn’t gone away, campaigners say it's just gotten harder and more dangerous.”

ESTHER:

The judge is due to hand down his final remarks and decision any day now. The Biden administration has said that they will fight the decision through an executive order or otherwise. But it's quite interesting because at the same time that the fight for reproductive, or basic reproductive, health care in the US is happening right now, in Australia there's a completely different conversation that's going on, and that's to expand access to reproductive health care.

RUBY:

Okay. Well, let's talk a bit about what the situation is in Australia. Right now in terms of access to a drug induced medical abortion - how easy or hard is it to get a prescription?

ESTHER:

Mifepristone was the subject of this massive back and forth during the Howard era, which meant that it was impossible to import. A lot of people might know it as RU-486. But in 2012 the Gillard government approved it for import, and then in 2013 it was added to the Pharmaceutical Benefits Scheme. So it's essentially meant that since then it's a lot more easy to access early medical abortion, and the relative rate of medical abortion is increasing compared to surgical abortions, which are a lot more complicated and require admission to a hospital.

I think there's a bit of a misconception that you can go to any GP and ask for the MS-2 Step, which is the package of mifepristone and misoprostol, which you take in succession to induce an early medical abortion.

In reality, if you're under nine weeks pregnant, you have to go and find a doctor, that is a GP say, that is specifically registered, not just in terms of their medical training, but is specifically registered with MS health to prescribe the drug.

And then. If you found that, you need to then find a pharmacist who is specifically registered to dispense the drug.

So there's this other entire layer of administrative burdens that sit over the basics of needing to access reproductive health care. What that means is that only say 10%, or so, of GP's in Australia are actually registered to prescribe the MS-2 Step.

RUBY:

Okay. But as you mentioned, there’s this push here in Australia to expand access to these drugs. So can you tell me a bit about how that’s being pursued?

ESTHER:

Absolutely. So MS health, which is the pharmaceutical not for profit company, that's the only importer and distributor of mifepristone in Australia. They've submitted a set of applications to the Therapeutic Goods Administration to expand access to abortion care.

From what I understand from MS health, the TGA is currently considering the applications, they're expecting a decision within the next month or so. And I think the rollout would probably take the rest of this year.

The idea is that instead of only a certain number of GP's being registered to dispense, any GP could dispense the medication for an early medical abortion. The overall impact would be that it would be a lot easier to find a doctor who would be able to give you the medication rather than having to go online and search for someone and potentially be rejected multiple times.

It could mean the difference financially, emotionally, or otherwise, to being able to access abortion within a timeframe that is healthy, safe, and feasible for you.

If you only have one GP in your town and they aren't registered to prescribe mifepristone, it essentially could mean the difference between having an abortion and not being able to access that health care.

RUBY:

We’ll be back after this.

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RUBY:

Esther, when it comes to abortion access in Australia, just how different is the situation for women who live remotely versus those in major cities?

ESTHER:

One of the people that I spoke to for this story was a researcher named Anna Noonan, who works in regional New South Wales, and her research focuses on the fact that rural women are not only statistically more likely to have an unintended pregnancy, they're also overwhelmingly more likely to have trouble accessing reproductive health care. You know, obviously, there's the issue of conscientious objectors who are people that choose, based on their faith, not to prescribe early medical abortions. And that's completely a personal issue. But I think, you know, if a GP has decided based on the administrative burden or the logistical issues, that they just don't do it for the people that they serve in their town, yeah, it would make a huge difference because they're essentially saying, you know, I can't provide you with this basic reproductive health care, and that has a massive impact on the rest of someone's life if they then have to bear a child that they aren’t necessarily ready for.

And a GP in the Northern Rivers who is a provider of EMA, said that for her, it wasn't so much the logistics, it wasn't so much the registration, it was more the stigma and the association with abortion in her community.

RUBY:

And so are there any hesitations within the medical community about, I suppose, downgrading the restrictions around access?

ESTHER:

I wouldn't say reservations. I think it was more a concern or a push for while they want access to be expanded, it needs to be in a safe and accessible way. So I spoke to the president of the Royal Australian College of General Practitioners, Dr. Nicole Higgins, who said that she fully supports expanding access to reproductive health care, such as EMA, but she wants it to be done in a safe, affordable, and accessible way.

And I think that's also the thing with abortions that we don't necessarily talk about that much is, you know, if your local GP, if you're going through the Medicare system, you only have to pay $40 to $50 for the medication, and then potentially a little bit extra for ultrasounds and blood tests. But if you're going through the private system such as MSI Australia, you might have to pay up to $400-$500 for a procedure. And, you know, especially in rural Australia, that's not financially feasible for a lot of people.

Jamal Hakim, who's the managing director of MSI Australia and MS health, told me that it would be the biggest step forward in reproductive health care in over a decade, essentially. And I think what they're hoping is that this potential approval from the TGA would open the door for some other legislative changes within states, specifically changes that would allow other health care practitioners, such as nurses or Aboriginal health care workers to prescribe mifepristone as well.

RUBY:

Ok, if we could just go back to the beginning of our conversation, we were talking about the court case currently under underway in the US, and it's interesting that this particular drug — or these two drugs together — they've become a battleground in terms of abortion rights in very different ways.

In the US you have conservative anti-abortion forces that are rallying to try and ban it. But here in Australia you have advocates for access trying to push the TGA to make it more available.

So does it seem to you that battles over particular medication could be the next frontier in the fight for reproductive rights?

ESTHER:

Yeah, definitely. I think there are very different questions that we're asking in Australia, as opposed to the US. It's fascinating in a way that Roe v Wade, as awful as it has been for access to reproductive health care in the U.S, it has really sparked this sort of wave of rethinking things in Australia in terms of how we access health care overall.

Jamal Hakim, who's the managing director of MS Health, did tell me that the fall of Roe v Wade, was a catalyst for this kind of action and this kind of call for reproductive rights in Australia to go further than they are at the moment.

There's an ongoing Senate inquiry into access to reproductive health care, which is happening right now. And from the people that I spoke to, Roe V Wade has really pushed forward this critical lens as to how we view access to health care in Australia, and wanting to make sure that we're going forward, not going backwards, as the US is currently.

RUBY:

Esther, thank you so much for your time.

ESTHER:

Thanks Ruby.

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RUBY:

Also in the news today,

According to the latest figures from the Bureau of Statistics, Australia's economy grew 0.5 per cent in the final three months of 2022, this figure was well below what most economists had forcasted.

While household spending continued to rise at the end of last year, the growth rate started to slow in the face of rising interest rates and high inflation.

The Bureau of Statistics also found that the national household savings rate dropped for the fifth-consecutive quarter, from 7.1 to 4.5 per cent.

And…

ABC staff have voted to take industrial action for the first time in 17 years, over low wages and working conditions at the national broadcaster.

Hundreds of staff met on Wednesday and agreed to walk off the job next week for 40 minutes the same day the Reserve Bank board meets for the official cash rate announcement, next Tuesday.

I’m Ruby Jones, this is 7am, see you tomorrow.

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