To mark today’s International Day of Action on Women’s Health (May 28), a newly formed coalition of key stakeholders and clinician experts is advocating rapid policy and practice-based changes to improve the accessibility of early medical abortion (EMA) in Australia during COVID-19 and beyond.

Early medical abortion (EMA), along with contraception, has been declared an essential service during the pandemic but it is not always easy to access. This is particularly the case for highly time-sensitive EMAs that must be undertaken before nine weeks’ gestation in Australia. As a result of the pandemic access may be further challenged by delays in accessing ultrasounds, an inability to travel (especially for women living in remote and regional areas) and cost-barriers including those caused by job losses due to COVID-19.

The coalition, brought together by the NHMRC-funded SPHERE Centre of Research Excellence in Women’s Sexual and Reproductive Health in Primary Care and led by Monash University’s Professor Danielle Mazza, is advocating for a range of changes to support women who could potentially be affected by these challenges. They include:

• Extending the gestational limit that applies to a woman being able to have an EMA from 63 to 70 days
   
• Removal of requirements for Rhesus determination (a blood test that determines if you are RhD positive or RhD negative) and administration of Anti-D in known Rhesus negative women undergoing EMA prior to 70 days’ gestation
   
• Enabling EMA to proceed without the necessity of an ultrasound assessment under very stringent conditions and with patient consent in situations where obtaining an ultrasound is a significant barrier or poses a significant risk during the COVID-19 pandemic.

These changes would align with new guidance that has been issued for healthcare professionals across the UK, US and Canada to minimise exposure to COVID-19.

“The coalition consensus statement highlights critical issues that can make access to early medical abortion difficult for Australian women and provides policy and practice solutions and approaches that need to be implemented to overcome them,” Professor Danielle Mazza said.

In Australia and New Zealand, an ultrasound prior to EMA is mandatory. The coalition is recommending that while this remains the best approach, practitioners can proceed without the necessity of an ultrasound if the woman is carefully screened for risk factors for ectopic  pregnancy, the gestational age of the pregnancy can be accurately assessed and there is an agreed robust follow up pathway. In addition, the woman will need to understand the risks of foregoing an ultrasound and consent to proceeding on this basis.

“The safety and efficacy of EMA up to 70 days’ gestation is well established.  Increasing the current gestational limit on the use of the TGA-approved medication mifepristone and misoprostol (MS-2 Step) from less than or equal to 63 days up to 70 days’ gestation is supported, but requires urgent change to TGA approvals and the PBS subsidy,” Professor Mazza said.