by Barbara BairdReproductive Health Matters 2015;23(46/Dec):169–176. DOI: 10.1016/j.rhm.2015.10.002http://www.rhm-elsevier.com/action/showMultipleAbstracts (Eng/Fr/Spa)Surgical abortion has been provided liberally in Australia since the early 1970s, mainly in privately owned, specialist clinics. The introduction of medical abortion, however, was deliberately obstructed and consequently significantly delayed when compared to similar countries. Mifepristone was approved for commercial import only in 2012 and listed as a government subsidised medicine in 2013. Despite optimism from those who seek to improve women’s access to abortion, the increased availability of medical abortion has not yet addressed the disadvantage experienced by poor and non-metropolitan women. After telling the story of medical abortion in Australia, this paper considers the context through which it has become available since 2013. It argues that the integration of medical abortion into primary health care, which would locate abortion provision in new settings and expand women’s access, has been constrained by the stigma attached to abortion, overly cautious institutionalised frameworks, and the lack of public health responsibility for abortion services. The paper draws on documentary sources and oral history interviews conducted in 2013 and 2015.Despite a generally robust public health system in Australia, albeit one subject to the pressures of neoliberal economic policy, there has been very little public health responsibility taken for the provision of abortion in the period since liberalisation. In 1990, 13% of abortions were provided in the public health system free of charge. The proportion of public provision has declined since 1990. Service provision has been dominated by general practitioners in private specialist clinics concentrated in the capital cities. In 2000, a subsidiary of Marie Stopes International, the UK-based global reproductive health NGO, entered the Australian abortion provision market. In 2015, Marie Stopes International Australia (henceforth Marie Stopes) clinics provide upwards of one third of all abortions in Australia and do so with the expressed intention of generating surplus funds to support their activities in developing countries.Whilst public provision has been minimal, Medicare, the federal government health insurance scheme, has provided a rebate for the cost of a privately provided surgical abortion procedure since its inception in 1974. This rebate, on average, halves the cost of a surgical procedure. Prices vary from clinic to clinic and increase sharply for pregnancies over twelve weeks. For a surgical abortion under twelve weeks the cost is, on average, between AU $400 and AU $500 after the rebate. For many poor women and those in non-metropolitan locations even this rebated cost is prohibitive, especially when travel costs are also involved. This disadvantage is compounded if women are also young, disabled, racially marginalised or without citizenship entitlements.After a parliamentary inquiry and significant lobbying a bill to remove the special conditions that applied to the import of mifepristone passed through the parliament in 2006…This legislative change did not necessarily mean that mifepristone would be imported. It did, however, allow doctors to undergo a time-consuming process to become Authorised Prescribers of mifepristone… Misoprostol was already available. Once authorised, doctors were able to import the drug from a not-for-profit company in New Zealand, which had been importing the drug from France since 2001. After a slow start, by 2012 about 200 doctors had been authorised in Australia, nearly all located in the larger capital cities. It is almost certain that most of these were already offering surgical abortions in existing private clinics or public hospitals…In 2015, mifepristone and misoprostol were approved for use up to 63 days of gestation…While the political process described above was unfolding, Australian women’s knowledge of and desire for medical abortion was growing… In 2013, the media coverage given to mifepristone’s newly subsidised availability immediately raised expectations among women that medical abortion would become a cheap option beyond existing clinic provision… Women were also obtaining the drugs for medical abortion outside formal channels in the years before they became more easily available. The most notable case concerned a 19-year-old woman and her boyfriend, who were arrested in Cairns, where, ironically, medical abortion was available at the time, under a never previously applied law that criminalised the practice of a woman inducing her own abortion…In the context of the ongoing absence of any central public health coordination of abortion services in all jurisdictions and in the face of the slow uptake of medical abortion by general practitioners, telemedicine stands out as a method of materializing access, particularly for rural women. Marie Stopes have started a modest trial to offer medical abortion via telemedicine but the most significant development in this respect has been the launch of the Tabbott Foundation in September 2015.INFOGRAPHICS: Children by Choice, Australia