Demographic Factors Influencing Eligibility for EMA in South Australia

Early medical abortion (EMA) can be performed by administration of mifepristone and misoprostol in an outpatient setting prior to 63 days gestation in Australia. While this is a flexible, efficacious and safe option for abortion, it requires early identification of pregnancy and efficient access to a clinical service. Outpatient EMA with mifepristone and misoprostol was introduced in Australia in 2012 for gestations < 49 days, and extended to 63 days in 2015.

The laws governing abortion in South Australia mandate routine data collection. A retrospective cohort study was conducted of all registered abortions in South Australia from 2012 to 2020. Women undergoing abortion before 7 weeks gestation between 2012 and 2014 and then from 2015 those undergoing abortion before 9 weeks gestation were considered EMA eligible. Demographic characteristics were then compared using multiple logistic regression.

Women who were eligible for EMA were significantly different from those who were ineligible based on gestational age. Women who were ineligible were more likely to be teenagers, live in rural and remote areas and live in areas of socio-economic disadvantage. In multivariable logistic regression teenagers were disproportionately less likely to be EMA eligible, with rural women and socially disadvantaged teenagers having the lowest rates of and eligibility for EMA.

Eligibility for EMA was affected by age, rurality and socio-economic disadvantage. Interventions to improve access should investigate and address the specific barriers facing these groups of women.