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The new abortion legislation – what do GPs need to know?

9 Apr 2024
GP Connect News

Clinical feature from the Office of the Chief Health Officer

Major amendments to WA’s abortion legislation will result in a change of practice for general practitioners now the new law has come into effect (27 March 2024).  In Western Australia, approximately 80 per cent of abortions occur at less than 9 weeks gestation, and involve general practitioners (GPs) in the pathway of care.

This article describes the most significant changes to the abortion legislation in WA and how this will affect GPs and their practice.  Detailed information is available at www.health.wa.gov.au/Abortion

Changes in access to abortion services

Under the new laws only one health practitioner needs to be involved in abortion care provision up to 23 weeks.

This means that a GP may now provide information, do the appropriate clinical assessment, and commence early medical abortion processes or provide a referral for a surgical procedure, in the first consultation, when a patient presents requesting abortion.

Alternatively, a person requesting abortion may now self-refer to a private abortion provider without needing to consult a GP and obtain a referral.

Referrals may be required if referring to a hospital for abortion care, check the local referral pathway

Changes to gestational limits for abortion

  • The gestational limit for abortions without additional requirements has increased from 20 to 23 weeks’ gestation. Above 23 weeks, additional legislated requirements apply.
  • Up to 23 weeks’ gestation, only one medical practitioner is needed to agree to perform an abortion; after 23 weeks (ie from 23 weeks + 1 day), 2 medical practitioners are required to agree to the abortion.
  • GPs should note that at higher gestations, the procedures required are more complex and offered at fewer services. Referral to day clinics or hospitals will be needed.  Of particular note is that from 22 weeks’ gestation, RANZCOG recommends feticide, so additional procedures are needed. GPs are advised to review the local referral pathway and make timely contact with the nominated specialist team to co-ordinate care, particularly at later gestations.

 Counselling no longer mandatory for informed consent

The legal requirement for GPs to provide mandatory counselling so that the patient can provide specific consent for an abortion is be removed now the legislation has come into effect.

Discussions about abortion and consent will be managed as per any other healthcare consultation and usual professional practice standards apply.

Unintended pregnancy counselling is still available to those considering pregnancy options and is fully funded if accessed via WA Department of Health contracted providers. Telehealth options are available.

Consent for minors

Abortion care for minors will be managed as per other medical procedures involving children.  Children who are considered ‘mature minors’ may provide consent for an abortion independently of their parents or guardians.  If a child is not considered a ‘mature minor’ then they may choose to involve their parent/guardian, who can give consent or refuse consent on their behalf.

If a child who is not a mature minor does not wish to involve the parent or guardian, they can be assisted to apply to the Family Court or Supreme Court for an order to decide on the progression of the abortion.

For children under 14 years, advice can be sought from the Pregnancy Choices and Abortion Care service at Women’s and Newborn Health Service (08 6458 2222).

Consent for adults without capacity to consent.

Where a pregnant adult is unable to make reasonable judgements about abortion care, the law enables relevant parties to apply to the State Administrative Tribunal (SAT) to make a decision on their behalf.

A guardian previously appointed to the pregnant adult under the Guardianship and Administration Act 1990 (WA) is not permitted to give consent to an abortion on the pregnant adult’s behalf. A specific application to the SAT is required to seek decision and consent for an abortion.  For complex cases, advice can be sought from the Pregnancy Choices and Abortion Care service at Women’s and Newborn Health Service (08 6458 2222).

Early medical abortion in the community

Under the new laws, medical practitioners, nurse practitioners and endorsed midwives may prescribe the medical abortion medicine (MS-2 Step) as part of the care management pathway for early medical abortion and if it is within their scope of practice and training.

Amendments to TGA restrictions on prescribing MS-2 Step in 2023 mean that early medical abortion will be able to be prescribed by a prescribing  healthcare practitioner with appropriate qualifications and training, without the need for certification or inclusion on a register.  Pharmacies will be able to stock and supply the medication, if prescribed by a doctor, nurse practitioner or endorsed midwife.

Whilst training is no longer mandated to prescribe MS-2 Step, it is highly recommended for those undertaking abortion care.

Note that under TGA Authority medical abortion using MS-2 Step is authorised up to 63 days (nine weeks) gestation. Beyond 63 days, patients will require either surgical or medical abortion in a facility, rather than in the community (refer RANZCOG guidelines for discussion of options).

Abortion care over 23 weeks

Requests for abortion over the gestation of 23 weeks have additional legal and medical requirements, including agreement between 2 medical practitioners after assessment of the individual’s circumstances.

Approval by a Ministerial Panel is no longer required.

GPs are advised to review the local referral pathway and make timely contact with the nominated specialist team to co-ordinate care as procedures above 23 weeks can be complex.

Mandated requirements for conscientious objectors

The new legislation allows health practitioners to conscientiously object to provision of abortion care. However, they are required to immediately tell the patient that they have a conscientious objection and then transfer the patient’s care or provide information, approved by the Chief Health Officer (CHO), on where to access that care.

The information sheet provided by the CHO is to be given to the patient if a GP conscientiously objects to providing care.

A useful resource is AHPRA Medical Board Good Medical Practice: A Code of Conduct

Duty of care: The provision to conscientiously object does not alter the duty required of a medical practitioner or prescribing practitioner to perform, assist with, make a decision about, or advise a patient about a termination of pregnancy in an emergency, where it is their duty to assist.

What if I am unable to perform an abortion?

Medical practitioners, nurse practitioners or endorsed midwives who are unable to perform or refuse to perform an abortion (for reasons other than conscientious objection) are required to:

  • refer the patient to a health practitioner or health service that they reasonably believe can provide the abortion service sought; or
  • provide the pregnant patient with information approved by the Chief Health Officer for this purpose.

This may occur if a practitioner feels that they do not meet essential qualification or training requirements or the facility in which they work does not offer the service or does not have appropriate equipment.  Note, the above ‘duty of care’ still applies.

Where can I get more information?

For further information please visit www.health.wa.gov.au/abortion

 

Useful resources

On non-directive counselling:

Useful resources continued

Useful information for GPs to consider

  • Read the 2023 RANZCOG Clinical Guideline for Abortion Care
  • Make RANZCOG Abortion Decision Aid tool available to share with patients
  • Refer to information for consumers and health practitioners on Department of Health WA websites, and Women & Newborn Health Service website & share consumer information with your patient community
  • Consider training in early medical abortion provision
  • Review HealthPathways WA to find the local referral pathway and information for your geographical location for unintended pregnancy & abortion care.
  • If early medical abortion (EMA) is provided in your practice:
    • Consider how front desk staff will manage patient enquiries and appointment scheduling once the changes are publicised
    • How will conscientious objection be managed within your practice team
    • If EMA is provided, will this be advertised – noting that providers of abortion care are protected by Safe Access Zones Legislation 2021 in Western Australia
    • If you provide abortion services, familiarise yourself with notification requirements – see the notification of abortion page on the WA Department of Health website.
    • If EMA is not currently available, training is provided by many organisations on provision of early medical abortion including MS-2Step AusCAPPS provides support and information for primary care providers of contraception and EMA
    • Note the revised guideline for Rhesus Antibody Testing: The National Blood Authority guidance states there is insufficient evidence for the routine use of Rh immunoglobulin before 10 weeks gestation. EMA is no longer listed as a sensitising event requiring immunoprophylaxis (National Blood Authority, 2021, RANZCOG 2023).
    • Consider using the free Translating and Interpreter Service via telephone when having consultations with those who do not have English as their first language
    • Review how and when to screen for reproductive coercion and family violence – online training is available, including the WNHS Family and Domestic Violence toolbox
  • Do you provide long-acting reversible contraception insertion and removal service? If not consider local providers / training that is available.

Resources for GPs

 

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