Rapid uptake of early medical abortions in the Northern Territory: A family planning-based model

Background: Abortion law reform does not necessarily translate into services, especially for those in regional areas. Although abortion has been legal in the Northern Territory (NT) since 1974, prior to 2017 legislation change, early medical abortions (EMAs) were effectively prohibited in primary care. In July 2017, Family Planning Welfare Association of the Northern Territory (FPNT) was awarded funding to provide EMAs free of charge for Medicare eligible clients. Aims: To describe the demographics and clinical outcomes of clients accessing the EMA service in the first 12 months after legislation change. Materials and 

Methods: Retrospective audit of FPNT’s Unplanned Pregnancy Database from 1 July 2017 to 30 June 2018 and analysis of the NT Government’s Termination of Pregnancy 12 Month Data Report. Results: Of 742 abortions in the NT in the first 12 months after legislation change, 426 were EMAs prescribed at FPNT. Eleven percent of these (47/426) were for Aboriginal or Torres Strait Islander women and 15% (64/426) were for women from Remote or Very Remote Australia. Outcomes were definitively documented for 326 (77%); 5% of these required further misoprostol and 99% had a complete abortion without surgical intervention. Eighty-six percent (281/326) commenced effective hormonal contraception following their EMA. 

Conclusions: Providing funding to a Family Planning service was effective in devolving the majority of abortions from tertiary to primary healthcare and increasing the use of effective contraception. Some women remain under-represented, particularly women from more remote areas of the NT. Further work is required to ensure equity of access to services for these women.