A Pill for Equal Abortion Access

A Pill for Equal Abortion Access

The US can learn a lot from Australia’s new medical abortion policy.


Stigmatization of abortion, along with factors such as high cost, complicates the process of having an abortion. (Courtesy of Flickr, CC 2.0.)  

The Australian government announced today that it will most likely add RU-486, the abortion pill, to the list of drugs that are heavily subsidized under the country’s universal healthcare system.

The Pharmaceutical Benefits Advisory Committee, which was charged with reviewing the inclusion of the drug to the Pharmaceutical Benefits Scheme, advised the health minister to move ahead, which she said she would do after ensuring that Australia has “a steady, good-quality supply of the drug” and “that there is a cost-effective price of the drug.”

In the United States, RU-486, which also goes by the name mifepristone or misoprostol, is used for abortions until the nine-week mark, after which a surgical abortion is required (RU-486 should not be confused with emergency contraception, also known as “the morning-after pill,” which is not an abortifacient). In Australia, medical abortion is legal in all states, but that’s a recent development: The pill was effectively banned until 2006. Now that it’s legal, it is still prohibitively expensive for many patients, costing anywhere between $300 and $800.

If it makes the Benefits Scheme list, that figure will fall vertiginously, to between $12 and $36.

Meanwhile, in the United States, antichoice lawmakers continue to chip away at abortion access. While it’s technhically still legal to get an abortion, in many places it is all but impossible. The clinic is far away. The procedure isn’t covered by Medicaid or your private health insurer. You can’t afford to take off from work the time required to attend the mandatory pre-abortion “counseling” session, where the doctor gives you a medically unnecessary transvaginal ultrasound and reads a state-mandated script about the unique life you are ending, and wait out the legally required waiting period between that session and the actual procedure. There’s a crowd of screaming protestors outside the clinic, holding up posters of bloody full-term fetuses and calling you a murderer. You’re a teenager who isn’t able to secure parental consent, and a judge won’t grant you an exception. Legal, yes. But not accessible, unless you’re one of the lucky ones.

The abortion pill answers a lot of those concerns, and is especially valuable to patients living in isolated areas, where the nearest clinic or hospital is hundreds of miles away. It can take longer than a surgical procedure, and there is a recovery period, but it is far less invasive for the patient and does not require the services of a surgeon or even an OB/GYN: A GP can prescribe it.

The question, of course, is whether a patient can afford to fill that prescription. In the United States, the pill currently costs about as much as it does in Australia, and here as in Australia, that’s simply too much for many patients.

And far from making it more readily available, American lawmakers are hard at work restricting access to medical abortion. Last year in Michigan, Republican Governor Rick Snyder passed a healthcare law that bans the prescription of the pill through telemedicine, making it even harder for patients in isolated areas of the state to obtain abortions. Seven other states, including ones with relatively few population centers—South Dakota and Oklahoma, for example—have passed similar laws.

It should be noted that Australia is hardly a bastion of reproductive freedom. Technically, abortion is still a crime for women and doctors in the state of New South Wales and the state of Queensland, though the exceptions—physical and mental health of the mother—are loosely defined and widely invoked, and prosecution is incredibly rare. In all other states except the Northern Territory, it is legal until at least 20 weeks. In the NT, it’s legal only until fourteen weeks, except in the case of a medical emergency. In isolated regions, of which Australia has many, access is patchy. And, as I noted last year, the American penchant for “personhood” politics has made its way to Australia, albeit only to the most culturally conservative regions of the country—so far.

Addtionally, though Health Minister Tanya Plibersek has said that she will not rush the process of adding RU-486 to the list of subsidized drugs, there’s a strong case for doing it sooner rather than later. Australia is due for an election by the end of 2013, and it’s unlikely that Plibersek will be health minister for much longer. The next presumptive prime minister, Tony Abbott, is a social conservative who opposes abortion rights. When he himself was health minister, in 2005, Abbott opposed the legalization of the drug, and he has a history of antichoice statements that don’t inspire confidence in his current insistence that, this time around on RU-486, he’ll “accept the advice of technical experts.”

As for the US, the advice of technical experts has been repeatedly ignored, not just when it comes to the abortion pill but in the case of the morning after pill as well. In 2011, the Obama administration’s Department of Health and Human Services overrode the advice that generic emergency contraception should be available over the counter to patients of any age, requiring those under 17 to obtain a prescription. Earlier this month, a federal court overturned that decision, calling it “plainly political.”

In America, the abortion pill could serve to democratize reproductive healthcare, making it easier for doctors to provide and easier for patients to obtain. An Australian-style subsidy of the drug, while highly unlikely here in the US, would make abortion care more accessible for low-income patients and for patients living in isolated and rural areas, or in areas where surgical abortion providers don’t dare to practice.

In the case of abortion access, America could turn, as it has done with gun law reform and carbon taxation, to Australia for guidance. Or, we could continue to restrict abortion access, turning safe and legal abortion into a privilege reserved only for those who can afford it, while the rest are left vulnerable to unregulated medication and unlicensed doctors.

What could possibly go wrong?

Alongside America’s obesity epidemic exists an epidemic of fat-shaming that targets people of all weights, Chloe Angyal writes.

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