Ongoing fear and apprehension towards medication use in pregnancy can be traced back to the thalidomide tragedy in the 1960s, which also served as the catalyst for major regulatory reforms underpinning many of the safety categorization systems that remain in place to this day. Widely praised for its simplicity, the Australian categorization system for prescribing medications in pregnancy, or ‘pregnancy categories’ is amongst the most widely used first-line information relied on by prescribers. However, there is growing discontent with the use of pregnancy categories to guide prescribing decisions and concerns they can lead to more harm than good. This presentation will explore different ways in which the current Australian categorisation system for prescribing medications in pregnancy perpetuates inequalities in access to safe and effective medications in pregnancy, while outlining key policy and practice reforms needs to improving clinical care and health outcomes for women and their babies.