Medical abortion and the law

[Extract] 'Medical abortion' implies the use of approved drugs to induce expulsion of a pregnancy from the uterus, the procedure taking place under medical supervision. It is thus distinguished from surgical abortion, in which instruments are used to extract the pregnancy. 'Late' medical abortion (usually from 13-21 weeks of pregnancy, but occasionally later) is practiced widely in Australia, usually in cases where a diagnosis of severe foetal abnormality has been made; such diagnoses are not yet technically· possible earlier in pregnancy. Late medical abortion is mostly performed in hospitals or clinics using the drugs gemeprost, misoprostol and others. These drugs are synthetic fonus of prostaglandins, substances occurring naturally in the body whose functions include causing contractions of the uterus. More recently, methotrexate, a drug licensed for use in Australia for treatment of psoriasis and certain cancers, has been used in combination with the prostaglandin misoprostol, and misoprostol has been used alone, to bring about earlier abortions (5-9 weeks of pregnancy). In this situation, the methotrexate is administered by injection in a clinic or surgery; subsequently (usually about two days later) the misoprostol is administered vaginally, either by the doctor or by the woman herself. The abortion then occurs at home some hours later, in a process resembling a natural miscarriage. While misoprostol is licensed for use in Australia (as elsewhere overseas) only for the treatment of stomach ulceration, both misoprostol and methotrexate are used 'off-label' for abortion. The use of drugs 'off-label' is a widely accepted practice in the medical profession and is recognised as such by the Therapeutic Goods Administration ('TGA') and similar overseas bodies, such as the United States Food and Drug Administration. The cost of making multiple applications for licensing discourages phannaceutical companies from doing so