The Early Pregnancy Loss Coalition (the representative peak body for organisations working in the miscarriage space) says a landmark national audit of Early Pregnancy Assessment Services (EPAS) is compelling evidence that miscarriage care needs urgent national reform.
The Deloitte Access Economics audit, completed in September last year, was funded by the Federal Government as part of a budget package requested by the EPLC.
The report found there are at least 84 dedicated EPAS clinics across Australia, overwhelmingly concentrated in metropolitan areas, leaving rural and regional patients at a significant disadvantage. The audit also assessed early pregnancy care provided through other settings, including emergency departments and GPs.
Only 44 per cent of patients surveyed said their individual needs were met all of the time, while just 34 per cent always felt sufficiently informed about their treatment and care.
“We are incredibly grateful to the Federal Government and the Department of Health, Disability and Ageing for undertaking this crucial work,” EPLC Executive Director Isabelle Oderberg said.
“This report confirms what patients, clinicians and advocates have been saying for years: Australia does not have a consistent system of care for people experiencing miscarriage.”
“Every three and a half minutes an Australian family is touched by miscarriage, yet this audit shows services are under-resourced, staff lack consistent training, and there is no national model of care.”
The report found significant gaps in psychosocial and follow-up care. Just 40 per cent of patients reported receiving information about or a referral to mental health support, while only 24 per cent received follow-up focused on their mental health as well as their physical health.
Many EPAS clinics have no on-site psychosocial support, with one EPAS provider telling the audit: “In terms of bereavement support and follow-up care, there is nothing”.
EPLC member organisation Red Nose Australia is one of the services providing support to people experiencing miscarriage.
“We are here and we are ready to support patients if and when they need it,” Red Nose CEO Amy Cooper said.
“But with fragmented patient pathways and incomplete understanding of what services exist, patients are not being told their options for emotional and psychosocial support.”
The audit found there is no consistent pathway into early pregnancy clinical care, with patients moving between GPs, emergency departments and dedicated EPAS clinics depending on local services and referral practices.
Awareness of EPAS among GPs and emergency departments was low, with GPs often referring patients to emergency departments even where an EPAS is available.
Most dedicated EPAS clinics require a referral and operate only on weekdays during business hours, with limited or no support outside those hours.
“Patients cannot schedule their miscarriages during business hours. When services close at five o’clock or don’t operate on particular days, people experiencing pain, bleeding and pregnancy loss are left with nowhere to go except an emergency department,” Oderberg said.
Dr Alexandra Bonner of EPLC member organisation Early Pregnancy Network Australia, said the findings reflected the reality clinicians see across the health system.
“Early pregnancy complications are among the most common reasons women need gynaecological care, yet access to specialist early pregnancy services remains fragmented and variable,” Dr Bonner said.
“When a dedicated service is not available, the emergency department becomes the default front door. Women experiencing pain and bleeding can wait hours in a general ED, often before seeing a clinician with limited access to early pregnancy expertise.”
Despite best-practice care calling for separate waiting areas, the audit found only half of surveyed dedicated EPAS clinics had waiting rooms separate from maternity and antenatal services.
“Someone who has just been told their pregnancy has ended may be sitting beside heavily pregnant patients or even patients who’ve recently given birth, further compounding grief and trauma,” Oderberg said.
The audit also identified significant gaps in education and training. Early pregnancy care is not included in the formal university education of doctors, nurses or midwives, and EPAS providers reported that non-specialist junior doctors often rotate through EPAS clinics because early pregnancy complications are perceived as not complex or high risk.
The audit found a “lack of systematic, tailored support for priority populations, including First Nations people, LGBTQIA+ people, culturally and linguistically diverse and recently arrived migrant communities, and people with disability.”
“Without understanding where the gaps are, we cannot fix the system and this report is a crucial piece of that puzzle,” Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) President Dr Nisha Khot said.
“RANZCOG is ready to work with the EPLC, government and other stakeholders to improve care for all patients, including priority population groups, particularly in the areas of miscarriage education for healthcare professionals and patient pathways.”
The audit makes eight recommendations, including national guidance for EPAS; increased staffing and infrastructure; standardised trauma-informed education and training; telehealth and midwifery-led models; and national data collection and reporting.
EPLC is calling on Commonwealth, state and territory governments to work together to implement the recommendations and establish a nationally consistent minimum standard of early pregnancy care.
“The evidence is now on the table. We know what the problems are. We know what better care looks like,” Oderberg said. “The task now is to make sure every Australian experiencing miscarriage or another early pregnancy complication can access timely, compassionate and evidence-based care.”
ENDS/
About the Early Pregnancy Loss Coalition (EPLC)
The Early Pregnancy Loss Coalition (EPLC) is Australia's national representative peak body for early pregnancy loss. Founded in 2023, the EPLC brings together organisations working across the miscarriage space to improve the care, support and recognition provided to people and families affected by miscarriage and early pregnancy loss. The EPLC is a registered charity and is guided by an expert advisory group.
Through evidence-informed policy, collaboration and advocacy, the EPLC works to ensure every person experiencing early pregnancy loss receives compassionate, equitable and high-quality care, regardless of where they live.
The EPLC's organisational members are:
• Australian College of Midwives
• Australian College of Nurse Practitioners
• Australian Nursing and Midwifery Federation
• Australasian Society for Ultrasound in Medicine
• Australian Women's Health Alliance
• Bears of Hope
• Centre of Perinatal Excellence (COPE)
• Doctors for the Environment Australia
• Early Pregnancy Network Victoria
• Jean Hailes for Women's Health
• Miscarriage Australia
• Miscarriage Information Support Service (M.I.S.S.)
• MSI Australia
• Multicultural Centre for Women's Health
• Mums Matter Psychology
• PANDA (Perinatal Anxiety & Depression Australia)
• Pink Elephants Support Network
• Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG)
• Red Nose
• SMS4Dads
• The Still Nest
• Women’s Health Education Network
• Women's Health Victoria
• Women's Healthcare Australasia
