Ending the postcode lottery of reproductive health care

The Senate inquiry into universal access to reproductive health care has delivered its report — ‘Ending the postcode lottery: Addressing barriers to sexual, maternity and reproductive healthcare in Australia’.

Industry leaders have welcomed the report, but some say “more must be done”.

The inquiry found that Australians do not currently have consistent access to sexual, reproductive and maternal healthcare services, and that this particularly disadvantages people living in regional and remote Australia.

The Senate Committee developed 36 recommendations around four key areas:

1. Enhancing access to contraceptives
2. Reducing barriers to reproductive health care
3. Delivering appropriate and adapted care
4. Improving literacy and enhancing employee rights

Equitable Access

Access to medical and surgical abortion, plus long-acting reversible contraception, is one area of improvement addressed in the report.

Royal Australian College of GPs (RACGP) President Dr Nicole Higgins said, “As a Mackay GP, I know my patients who require a surgical abortion must travel over 1000 kilometres for care and that is not acceptable.”

“The Senate inquiry has highlighted the very profound and disturbing inequities and sometimes complete lack of access to sexual and reproductive health issues that exists in Australia. Abortion is an essential healthcare service and publicly funded hospitals need to provide these services,” said Professor Danielle Mazza, Head of General Practice at Monash University, Chief Investigator and Director of SPHERE Centre of Research Excellence in Women’s Sexual and Reproductive Health in Primary Care and Australian National Women’s Health Advisory Council special adviser.

“Workforce capacity building and regional accountability are key aspects to ensuring access to contraception and abortion services.

“Contraception and abortion services should be available at no cost and free of the regulatory barriers that hinder evidence-based practice as occurs in other countries such as England, Canada and Ireland.”

The Australian College of Nursing (ACN) CEO Adjunct Professor Kylie Ward FACN said, “ensuring equitable access to sexual, maternity and reproductive health care in this country is too important to play politics with, and we were heartened to see the strong multi-partisan political support during this committee process.”

Senior Lecturer Dr Ronli Sifris, Deputy Director, Castan Centre for Human Rights Law in the Faculty of Law at Monash University, commented, “While the availability of medical abortion should in theory help to overcome many of the existing access issues, the burdens placed on health professionals wishing to prescribe it has a deterrent effect.

“Removing some of the burdens that health professionals face and making medical abortion easier to access would hopefully resolve some of the existing access issues by, for example, lowering the cost of a medical abortion and making it easier to obtain outside of urban areas.

“While Australia’s laws are progressive, abortion remains stigmatised, practitioner attitudes and lack of training may be an impediment to access, and cost is a huge issue in most of the country.

“The Medicare rebate should be extended to cover IVF conducted for the purposes of surrogacy; the fact that it does not currently do so is discriminatory and unfair to people who are already facing significant challenges in their journey to have a child.”

Workforce and training

Ward welcomed the Senate inquiry’s findings that highlight the critical role Australia’s nursing workforce plays in the delivery of high-quality and safe reproductive health care.

“We were pleased to have had the opportunity to provide evidence to the committee and we’re grateful to have seen a number of our recommendations adopted by the senators involved,” Ward said.

“We look forward to working with governments both at the federal and state level to ensure that the committee’s recommendations are adopted in full and in a timely manner.”

ACN was also pleased that the committee recognised the importance of trauma-informed and culturally appropriate delivery of services.

The committee report noted that “Members of the Australian College of Nursing (ACN) raised concerns that there is a clear lack of trauma-informed training throughout tertiary education. They advised that numerous healthcare providers are not providing sufficient reproductive health care to refugee and migrant women” (p.92) and went on to say “ACN argued for improved cultural competency training whilst studying, as well as ensuring this training continues once qualified as a health practitioner” (p.92).

ACN said it will continue to advocate on behalf Australia’s nursing profession, and remains committed to shaping the policies of the future.

The report stated: “The committee recommends that the Australian Government, in consultation with relevant training providers, reviews the availability, timing and quality of sexual and reproductive healthcare training in undergraduate and postgraduate tertiary health professional courses, including vasectomy procedures, terminations and insertion of long-acting reversible contraception.”

RACGP’s Higgins said, “It is great news the report has recommended training support for GPs for the insertion and removal of long-acting reversible contraceptives as well as adequate remuneration for GPs, nurses and midwives to provide contraceptive services, including the insertion and removal of LARCs.

“In addition, I welcome the committee recommending the government review Medicare arrangements which support medical termination consultations with the aim of ensuring adequate remuneration for practitioners to deliver these services,” she added.

The committee also recommended further training and research to provide high-quality and tailored reproductive health care for the LGBTQIA+ community, people living with disability and First Nations people. 

More to be done

The RACGP welcomed the report and called on the government to end Australia’s ‘postcode lottery’.

“More must be done to break down barriers and ensure all women have strong access to reproductive health care no matter their postcode or income,” Higgins said.

She added that the report contains many promising recommendations the government can and should act on without delay.

“It’s also very positive to see the committee calling for the government to put in place options to make contraception more affordable. This is a particularly salient issue given high cost-of-living pressures squeezing many households across Australia. Anyone should be able to choose the contraceptive options that best suit them without having to worry about their hip pocket. The recommendation for a separate Medicare Benefits Schedule item number for contraceptive counselling and advice will help achieve this if it is set at a level that reflects the work involved.

“The RACGP welcomes the committee recommending Medicare Benefits Schedule telehealth items for sexual and reproductive health care, including pregnancy support counselling and termination care, be made a permanent fixture of our telehealth system. The Health Department has temporarily extended these items until the end of the year and said a long-term decision will be made following a post-implementation telehealth review. Let’s not wait for more reviews, let’s act.

“As chair of the RACGP’s Doctors for Women in Rural Health Committee Dr Christie Rodda has noted — these telehealth items provide choice to women in communities where healthcare access is harder. So, let’s make them permanent now, it’s the right call.”

Higgins called on the government to go even further in the years ahead.

“There are other steps the government can and should take to improve reproductive health care in Australia,” she said.

“We can start by adding medicines for medical termination to the Prescriber Bag or ‘doctor’s bag’ of emergency use medicines. The RACGP also welcomes the committee recommending improved access to a broader range of hormonal contraceptives that are not currently Pharmaceutical Benefits Scheme subsidised, including newer forms of the oral contraceptive pill, the emergency oral contraceptive pills and the vaginal ring.

“Looking ahead however, we are calling for copper IUDs to be available on the PBS, and the Medicare rebate for insertion of an IUD should also be increased to reduce or eliminate gap fees.

“The committee has suggested subsidising the non-hormonal copper IUD to improve contraceptive options for people with hormone-driven cancers and people for whom hormonal contraception options may not be suitable. We believe this is a good first step, but as I said the government should go even further and place copper IUDs on the PBS for all people who choose this option.

“We also call on the government to amend rules to allow GPs to bill MBS Level C and D time-based attendance items for antenatal attendances that extend beyond 20 minutes. Currently, there is a fixed Medicare Benefits Schedule fee for antenatal appointments no matter how long that appointment takes, so people who need a longer antenatal appointment receive a much smaller rebate compared to someone attending for a general appointment.

“Providing financial support to GPs who want to train in surgical abortion, which is the only option to terminate a pregnancy after nine weeks, should also be front-of-mind for the government.

“I look forward to working with the government to make this a reality,” Higgins said.

Image credit: iStock.com/relif