Introduction by Croakey: A prominent non-profit provider of abortion care has welcomed regulatory changes that increase women’s access to a medicine used in termination of pregnancy, and for the medical management of a missed miscarriage.
However, it is important that the Pharmaceutical Benefits Advisory Committee meeting in November recommends the medicine, MS-2 Step, for listing on the Pharmaceutical Benefits Scheme for missed miscarriage, says Adurty Rao, CEO of MSI Australia and MS Health.
Otherwise, many women will not be able to afford this medical treatment option for a missed miscarriage, and this will be particularly hard on women who live in regional and remote communities, are on low incomes, or experiencing domestic and family violence.
Adurty Rao writes:
For women in regional and rural Australia, accessing reproductive healthcare can mean hours on the road, time away from work, arranging childcare and finding money for travel and treatment. When care is time-sensitive, these barriers can determine not just where a woman receives care, but whether she can access the care she needs at all.
Two changes to reproductive healthcare recently took effect in Australia that are especially important for women who have traditionally struggled to access reproductive healthcare.
The Therapeutic Goods Association (TGA) has extended the treatment window for MS-2 Step from nine to 10 weeks of pregnancy. MS-2 Step is used in termination of pregnancy and includes two medicines – mifepristone and misoprostol.
The TGA has also approved the use of MS-2 Step for the medical management of missed miscarriage – the first time MS-2 Step has been approved for this purpose in Australia.
MS-2 Step is sponsored in Australia by MS Health, a non-profit pharmaceutical company established by MSI Australia to bring medical abortion to the Australian market.
These changes will matter most to women who have always found it hardest to get care: women in regional and remote communities, women on low incomes, and women experiencing domestic and family violence.
Medical abortion access
Access to medical abortion has improved since the TGA removed the extra prescribing and dispensing requirements for MS-2 Step in 2023. But it remains uneven.
A national study published in BMJ Sexual & Reproductive Health this year, drawing on records from around 400 general practices, found that only about one in three provided early medication abortion at any point between 2014 and 2021.
More than half of the women who had one were new patients at the practice that provided it. Provision was around twice as high outside major cities, where there are fewer alternatives.
A 2025 systematic review helps explain why so few GPs prescribe. It identified several barriers:
uncertainty about clinical guidance and preparedness
no systems-based approach linking GPs with pharmacists, sonographers and referral hospitals for emergency and after-hours support
time-based Medicare items that do not cover the counselling and coordination medical abortion requires
inadequate resourcing and professional isolation for rural providers.
The TGA’s decision to extend MS-2 Step’s approved use to 70 days’ gestation should help with the first of these by bringing regulation into line with clinical advice.
Since 2023, RANZCOG’s binational Clinical Guideline for Abortion Care has recommended mifepristone followed by misoprostol for early medical abortion up to 10 weeks. Until now, however, TGA approval and PBS subsidy stopped at 63 days. GPs who followed the guideline beyond nine weeks were prescribing off-label and carried the medico-legal uncertainty that comes with it.
With TGA approval and College guidance aligned, GPs now have a single, consistent standard to work to.
The decision does not, however, address the other barriers the review identified, such as the lack of a coordinated support system, inadequate Medicare remuneration and rural isolation.
Treatment options
TGA’s approval of MS-2 Step for missed miscarriage will support more options for women who want to seek care outside of the hospital system. A missed miscarriage happens when a pregnancy has stopped developing, but the pregnancy tissue hasn’t passed.
Pink Elephants’ Not Just A Loss report found that rural families often have to leave their town to receive treatment for a miscarriage, with some women in Western Australia travelling up to 500 km for surgery.
Women with missed miscarriage should be given the choice of the best treatment option for them, including a surgical procedure, a medicine or waiting for the miscarriage to happen naturally. Each option suits different women, which is why a real choice matters.
In much of regional Australia, a local GP or telehealth is the most convenient option as surgical services can be hours away. When an appointment, an ultrasound and a pharmacy that stocks the medicine all take longer to find, an extra week means fewer women miss the window and face the travel, cost and delay of a procedure.
Delay and cost go hand in hand, and the women who struggle most to get care quickly are often the ones least able to pay for it.
We see this through the Choice Fund, MSI’s national hardship fund. In 2025, it supported around 500 women who had been turned away by public services which had no capacity to treat them.
About two-thirds were living on less than $100 a fortnight after expenses, and 38 percent had experienced violence. For women like these, every extra day spent finding care can push it further out of reach.
An approved medical option that a woman’s own GP can prescribe, and her local pharmacist can dispense means more women can be cared for close to home, by people who know them, at one of the most challenging times of their lives.
TGA’s decision to approve MS-2 Step for missed miscarriage brings the listing of this medicine in line with clinical guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCG) and will give GPs more confidence in prescribing this medicine.
It is an important milestone in making this treatment option more available.
Funding matters
But registration alone doesn’t make a medicine affordable – that’s the job of the Pharmaceutical Benefits Scheme (PBS).
MSA welcomed the Pharmaceutical Benefits Advisory Committee’s (PBAC) recommendation to extend MS-2 Step’s PBS subsidy to 70 days, and we look forward to that listing taking effect.
We also urge the PBAC to recommend MS-2 Step for PBS listing for missed miscarriage when it meets in November. Until both listings are in place, many women will not be able to afford this medical treatment option.
For a woman who has just been told her pregnancy has ended, cost should be the last thing on her mind. She shouldn’t have to wonder whether she can afford the medicine her doctor recommends.
This decision reflects years of work by clinicians, researchers and advocates, and we’re grateful to all of them. At MSI, we often say that every pregnancy ends, and care should not end with it.
More time and more choice are a significant step forward. The next step is making sure every woman who needs reproductive health care can benefit.
• Adurty Rao is CEO of MSI Australia and MS Health
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