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February 2026 marks the twentieth anniversary of the overturning of the Harradine Amendment by the Federal Parliament in 2006. Thanks to the efforts of many people across the country, this parliamentary action opened the way for a cascade of reforms in abortion care for Australian women.
The 1996 Amendment to the 1989 Therapeutic Goods Act was a political measure initiated by Brian Harradine, independent senator for Tasmania, who held the balance of power in the Senate during the Howard government and who was a hostile opponent of abortion. At the time, mifepristone (better known then as RU486) had been used in Australia only for a small clinical trial by Monash professor David Healy. Harradine made a deal with then Prime Minister, John Howard — he would support Howard’s bill to privatise Telstra and in return Howard would bring in legislation forbidding the import, manufacture or use of mifepristone in Australia without the express permission of the Health Minister. The Amendment was passed and had the effect of completely blocking efforts to introduce mifepristone for medical abortion in Australia, despite increasing use of mifepristone in many overseas countries and its proven safety.
The parliamentary overturning of the Amendment
For ten years Australian women had no access to medical abortion with mifepristone, and were barely aware of its existence elsewhere, despite the best efforts of several parliamentarians, health professionals and abortion reform groups. During this time, abortion began to be discussed in mainstream media. Activity around the issue and public interest rose at the end of 2005, reaching fever pitch by the beginning of February 2006. There was also strong support for the drug as a safe alternative to surgical abortion from the Australian Medical Association.
On 9 February 2006, a private members’ bill to overturn the Amendment, sponsored by four cross-party senators — Lyn Allison (Democrats), Fiona Nash (Nationals), Judith Troeth (Liberals), and Claire Moore (Labor) — was passed by the Senate 45 to 28. The following week, the bill reached the House of Representatives, where Sharman Stone MP had been particularly active in support of the reform. The Prime Minister directed that no count be conducted, the vote was taken on voices alone, and the ayes had it. The Harradine Amendment was consigned to the history books.
Incorporating medical abortion into women’s reproductive healthcare
Despite this political success, so heated was the public discussion around the drug that no pharmaceutical company would risk importing or manufacturing it in Australia. A solution was initially found by individual doctors applying to the Therapeutic Goods Administration (TGA) to become Authorised Prescribers (AP) of mifepristone. As an AP, a doctor could prescribe in Australia drugs registered overseas but unavailable here. In July 2006 two of the authors, having obtained approval as APs from the TGA and imported the drug from New Zealand colleagues, began using mifepristone successfully in Cairns. In 2008 other doctors also gained AP status and in 2009 Marie Stopes International (MSI), a private provider of surgical abortion and family planning services, announced that they had gained TGA AP approval to use the drug in their clinics across Australia. MSI also embarked on a clinical study of the drug’s use, which was published in 2012, reporting on the outcomes of more than 11 000 women who had undergone early medical abortion using mifepristone/misoprostol. The procedure was found to be effective, safe and highly acceptable to women, and the rates of incomplete abortion and complications were similar to those of overseas studies.
Around this time, MSI established a pharmaceutical subsidiary, MS Health, who were successful in attaining TGA registration of mifepristone in 2012. In the following year, mifepristone was placed on the Pharmaceutical Benefits Scheme, further improving access for Australian women. Registration came with a stringent TGA-mandated risk management plan, which included the requirement for prescribers to complete mandatory education and be registered with MS Health, and for pharmacists to also be registered to supply the drug, proving to be particularly challenging for access in regional and rural areas. These regulations remained in place for the next decade, until their removal in 2023.
Implications of mifepristone availability for abortion care and practice
In 2006, abortion was still in the criminal legislation of all jurisdictions, states and territories, across Australia, excepting ACT. This was despite more than thirty years of lobbying by activist groups and some health professionals. Surgical abortion was available in large urban areas but doctors performing abortions did so only with the uncertain protection of case law. Abortion remained stigmatised and in a grey area for both doctors and the general public. The introduction of medical abortion, gradual though it has been, can in retrospect be seen as having greatly assisted decriminalisation of abortion laws — in Victoria (2008), Tasmania (2013), Northern Territory (2017), Queensland (2018), NSW (2019), South Australia (2021) and Western Australia (2023), although there were significant earlier reforms in SA and WA. Following decriminalisation, all jurisdictions have begun to increase services and provision of access for women to both medical and surgical abortion; the introduction of teleconsultations for medical abortion has helped increase access for rural women. Most medical schools now provide teaching about abortion to their students; the Royal Australian and New Zealand College of Obstetricians and Gynaecologists requires abortion care to be part of specialist training. Research into abortion practice and provision is reported in medical journals, notably the MJA. The societal stigma around abortion is being addressed.
Conclusion
There remain confounders for women requesting medical abortion in Australia that still hinder it becoming a routine part of Australian practice, but with nearly half a million prescriptions for mifepristone dispensed since 2012 Australian women have demonstrated their overwhelming support for the method.
Dr Michael Carrette is a Cairns gynaecologist in practice from 1973-2020. He was a Founding Fellow of the Royal Australian College of Obstetricians and Gynaecologists in 1978 and one of the first two Authorised Prescribers of mifepristone in Australia. He is a Children by Choice Honorary life member since 2015.
Caroline de Costa was professor of obstetrics and gynaecology at James Cook University, Cairns, 2004-2021, and is now an adjunct research professor at The Cairns Institute of JCU.
Dr Philip Goldstone has over 25 years experience as a clinician and educator in sexual and reproductive health. He is the Medical Director of MSI Australia and a clinical lecturer at University of Sydney. Dr Goldstone’s career has been largely devoted to provision of contraception and pregnancy termination services, and he has played a key role in improving access to medical abortion in Australia.
Mukesh C Haikerwal AC is an Honorary Enterprise Professor at University of Melbourne, Deputy Chair, of the Australian GP Alliance, former Chair of the World Medical Association (2011-15), former President of the Australian Medical Association (2005-07), former President AMA Victoria (2001-2003).
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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