Amid moves to improve abortion access across Australia, new research reveals that while more GPs are offering early medication abortion, many women still cannot access the service where they live.
The study, published in BMJ Sexual & Reproductive Health and led by Flinders University highlights inequities in access – particularly in light of overseas comparisons where early medication abortion accounts for up to 90% of procedures in many high-income countries, yet only around half of early abortions in Australia.
Medication abortion or medical abortion is a non-surgical option for ending a pregnancy in its early stages. It offers a less invasive, more accessible and convenient option early in pregnancy – within the first nine weeks or less than 63 days of gestation.
Despite a steady increase in uptake since key medicines were subsidised through the Pharmaceutical Benefits Scheme (PBS) in 2013, access through general practice remains inconsistent.
Lead author and pharmacist, Associate Professor Luke Grzeskowiak, says the findings highlight a gap between policy progress and real-world access – although points out there have been positive recent steps forward.
“Medical abortion is widely used internationally and offers a safe, effective option for early pregnancy care, but in Australia we are not yet seeing the same level of access,” says Associate Professor Grzeskowiak, from Flinders University’s College of Medicine and Public Health and SAHMRI.
The study – also involving experts from Monash University, La Trobe University and University of British Columbia, Canada – analysed data from more than 400 general practices nationwide between 2014 and 2021, tracking more than 1 million women.
Over that time, the number of women receiving medical abortion through GPs rose from about 1 in 10,000 to just over 2 in 1,000, while the share of practices offering the service increased from around 1 in 25 to about 1 in 5.
However, only about one-third of practices provided early medication abortion at any point during the study period.
“Our findings show that medical abortion access still depends heavily on your location,” says Associate Professor Grzeskowiak.
“Where you live continues to play a major role in whether you can access care through a local GP and for some people, that can mean travelling long distances or navigating unfamiliar services.”
The study also found higher rates among women aged 25 to 29, as well as those living in regional areas and in more disadvantaged communities, with rates around twice as high outside major cities.
“We are seeing higher use in areas where there may be fewer alternatives, such as limited access to surgical services, or where barriers like cost and distance are more pronounced,” says Associate Professor Grzeskowiak.
“More than half of patients were new to the practice where they received care, suggesting many had to seek out a new provider.
“That tells us people are often having to go to considerable effort to find a GP who offers this service.”
Researchers say targeted action is needed to address gaps in access, including expanding telehealth, supporting GPs, and exploring new models of care.
“Thankfully since this study was conducted, efforts have since been made to remove prescribing restrictions and improve education and training for GPs. These moves take time to implement.
“It’s all about ensuring equitable access, regardless of where someone lives,” says Associate Professor Grzeskowiak says.
“There is still more work to do to make care consistent and accessible across Australia.”
Researchers hope to conduct follow-up studies to see whether inequities continue to ease in Australia.
The paper, ‘Longitudinal trends and characteristics of medication abortion provision in Australian general practice: a national open-cohort study using MedicineInsight, 2014 to 2021’ by Gizat M Kassie (Flinders, SAHMRI), Danielle Mazza (Monash University), Kristina Edvardsson (La Trobe University), Kirsten I Black (Monash University, University of Sydney), Laura Schummers (University of British Columbia, Canada), Wendy V Norman (University of British Columbia, Canada) and Luke E Grzeskowiak (Flinders, SAHMRI) was published in BMJ Sexual and Reproductive Health doi:10.1136/bmjsrh-2026-203337
Acknowledgements: This study was funded through a 2023 Flinders Foundation Health Seed. The authors would also like to acknowledge members of the SPHERE Centre of Research Excellence in Women’s Sexual and Reproductive Health in Primary Care (SPHERE CRE) for their contributions to this research, which is funded by the National Health and Medical Research Council (Project number APP2024717).
