A trial study involving contraceptive advice in pharmacies has been making the news in Australia recently. In the university-run trial, people wishing to access the ‘morning after pill’ or medical abortion pills could also be offered more information on contraceptives.
One article misrepresented the trial as one in which counselling was required before purchase, which sparked heavy debate online, with suggestions that this would block access to essential women’s health.
The lead researcher explains that contraceptive counselling will be offered by pharmacists to people who request a morning-after pill or an abortion pill, in order to promote knowledge of contraceptives. This is particularly of note, because those two pills are entirely different, medically and legally.
So what’s the difference between a contraceptive, the morning after pill, and abortion medications? And what’s the legality behind each one?
Content warning: this article describes abortion and miscarriage.
The information in this article is not medical advice. Before making any medical- or health-related decisions, always consult your doctor.
Contraceptives
A contraceptive refers only to methods that prevent a pregnancy. This could be in the form of a barrier, such as a condom, or hormones and devices that prevent fertilisation or implantation.
Plan B, or the morning after pill, is an emergency contraceptive that prevents pregnancy with hormones. It contains levonorgestrel: a type of synthetic hormone that mimics the naturally occurring hormone progesterone, which prepares the body for pregnancy.
It might sound counterintuitive for a pregnancy hormone to be used in a contraceptive – but bodies don’t want to get pregnant twice. Levonorgestrel mimics the pregnancy hormones that prevent eggs from being fertilised by sperm, or from ovulating at all.
This is why it’s considered to be crucial to take Plan B as quickly as possible after sexual intercourse, because if the egg is already fertilised before the pill is taken, the pregnancy may not be prevented.
There are two brands of morning after pill available in every state in Australia; both can be obtained over the counter at pharmacies without a doctor’s prescription.
Abortion medication
An abortion pill terminates an already established pregnancy, and so is medically, and legally, different from the morning after pill or other contraceptives.
Two types of abortions are available in Australia: medical and surgical. Medical abortions are done with orally taken pills, while surgical abortions (unsurprisingly) use surgical procedures. In general, medical abortions occur earlier in a pregnancy term, and surgical abortions later.
Medical abortion can often be done at home with two prescription oral tablets: mifepristone (formerly known as RU-486) and misoprostol.
Mifepristone is an antiprogestogen – that is, it blocks progesterone (the same pregnancy hormone activated by the morning after pill). When it blocks progesterone, the lining of the uterus degrades, much like what happens during menstruation.
Alone, mifepristone has low termination effectiveness – somewhere between 8% and 46%. Because of this, it is usually followed by misoprostol.
Misoprostol is a synthetic prostaglandin – these lipids have hormone-like properties when naturally occurring in animals. When taken a few days after mifepristone, it dilates the cervix and causes the uterus to contract, thereby expelling the degraded uterine lining and concurrently causing a miscarriage.
Together, the two pills are over 95% effective at causing miscarriage in early pregnancies. Late term abortions require a surgical abortion.
This is different from a surgical abortion, which is a surgical procedure where, under sedation, a tube is inserted into the uterus via the cervix, and the lining and contents of the uterus are removed with a low suction.
How available are abortions in Australia?
Access to a medical and surgical abortion is heavily regulated in Australia and laws vary by state or territory.
Abortion is decriminalised in all Australian states, which means you can’t go to jail or be fined for having an abortion, but access to a safe abortion is still restricted in most states after a certain gestational period.
The ACT is the only state or territory that does not place abortion under its Crimes (or equivalent) Act, and has no restriction on access for the full gestational term (although access may be limited after 16 weeks).
In all states, a doctor’s prescription is required to obtain an abortion pill, but only some doctors are trained to do this. Generally, however, a GP can refer a patient to another specialist doctor.
| State or territory | Status of abortion (either medical or surgical) | Details |
| Australian Capital Territory | Legal and accessible up to 16 weeks through a GP. No gestational limit. | Must be provided by a medical doctor, and Canberra Hospital may provide abortions for late-term pregnancies. |
| New South Wales | Legal. Accessible up to 22 weeks. | Since 2019, legal upon request up to 22 weeks but requires the approval of two doctors beyond this. |
| Northern Territory | Legal. Accessible up to 14 weeks. | Legal with a single doctor’s approval up to 14 weeks, and with approval of two doctors up to 24 weeks. Illegal after this unless the pregnancy is life-threatening. |
| Queensland | Legal. Accessible up to 22 weeks. | As of 2018, abortion is decriminalised. Legal upon request up to 22 weeks and with the approval of two doctors thereafter. |
| South Australia | Legal. Accessible up to 22 weeks and six days. | Fully decriminalised in 2021. Legal with the approval of two doctors before 23 weeks, provided there is physical or mental risk caused by the pregnancy. A conscience clause allows medical practitioners to not participate. |
| Tasmania | Legal. Accessible up to 16 weeks. | Decriminalised in 2013, and lawful upon request up to 16 weeks. Approval from two doctors is required beyond 16 weeks. Conscientious objectors may be fined if they do not refer patient to another practitioner. There are limited places that an abortion can be obtained. |
| Victoria | Legal. Accessible up to 24 weeks. | Since 2008, available from request up to 24 weeks, and requires two doctors’ approval thereafter. |
| Western Australia | Legal. Accessible up to 20 weeks. | Requires referral from a doctor up to 20 weeks, and heavily restricted after 20 weeks. Parental consent is required for people under 16. Western Australia is the only jurisdiction within Australia not to have safe access zones, however, as of June 2021 a bill is pending. |
The information in this article is not medical advice. Before making any medical- or health-related decisions, always consult your doctor.
More on reproductive health:
- Contraception planning for women with heart disease
- Aiming for a gender-equal world
- Woman forced to carry anencephalic foetus
Originally published by Cosmos as What’s the difference between a morning after pill and an abortion pill?
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