Introduction by Croakey: The Federal Government is considering wide-ranging recommendations from a Senate inquiry aimed at promoting more equitable access to sexual and reproductive healthcare, and improving the safety and quality of that care.
The inquiry’s report, ‘Ending the postcode lottery: Addressing barriers to sexual, maternity and reproductive healthcare in Australia’, makes 36 wide-ranging recommendations across issues such as contraception, workforce training, scope of practice, and birthing services in rural and regional areas, and includes a call to increase Birthing on Country initiatives (see all recommendations here).
It also recommends that all public hospitals be equipped to provide surgical pregnancy terminations, or timely and affordable pathways to other local providers. This will improve equality of access, particularly in rural and regional areas and provide workforce development opportunities, it says.
The Senate Community Affairs References Committee recommends the Australian Government develops an implementation plan for the National Women’s Health Strategy 2020–2030 with annual reporting against key measures of success. This could include establishing a taskforce as part of the implementation plan.
The Government is also urged to implement a national support, information, and referral model for sexual and reproductive healthcare services, in consultation with state and territory governments. The committee envisages that such a national telephone service would leverage the experiences of existing initiatives, such as 1800 My Options and healthdirect, to ensure it is fit for purpose, delivers accurate local information, and builds on the experiences of services operating in those jurisdictions.
Recommendations highlight the need to improve services for First Nations peoples, culturally and linguistically diverse migrants and refugees, and people with disability. The committee also wants the Department of Health and Aged Care to consider sexual and reproductive healthcare for LGBTIQA+ people in the context of the 10-year National Action Plan for the Health and Wellbeing of LGBTIQA+ people.
The Federal Government is also urged to work with jurisdictions to improve the quality of sexual health and relationships education in schools.
In the article below, Carolyn Mogharbel, Manager of 1800 My Options at Women’s Health Victoria, urges the Government to commit to a time-frame in which the recommendations will be actioned, alongside long-term investment to ensure that changes are sustainable.
Carolyn Mogharbel writes:
In over 15 years of working in sexual and reproductive health in Australia, I have never been as hopeful as I am at the moment.
Thanks to the Senate inquiry into ‘universal access to sexual and reproductive health information, treatment and services that offer options to women to empower choice and control in decision-making about their bodies’, our country has 36 recommendations, based on six months of evidence from experts across the nation, about what we need to do to fix our sexual and reproductive healthcare system.
We now have the evidence and the momentum to build a system that can ensure that sexual and reproductive healthcare is accessible, available, culturally safe and appropriate for all Australians.
1800 My Options is Victoria’s phoneline for contraception, abortion and sexual health. It’s a vital service, funded by the Victorian Government and delivered by Women’s Health Victoria – leaders in state-wide women’s health and wellbeing. We receive over 600 calls every month from people seeking information about sexual and reproductive health, most trying to find out how to access an abortion.
Since establishing in 2018, our 26,000-plus callers have told us of their experiences seeking abortion care, ranging from supportive and easy experiences to lost time, confusion, and despair.
Our amazing team of 1800 My Options phoneline workers have heard it all. Callers tell us their positive experiences, where they found a caring nurse or GP who supported their choices and ensured they had the information and tools to exercise their reproductive rights.
They also tell us of delay and confusion when trying to access services. One rural teen was told, “you’re old enough to have sex so you’re old enough to have a baby,” then shown the clinic door without antenatal or abortion referrals.
Another caller saw three different GPs, none of whom provided abortions or knew who to refer her to in their country town. These delays meant her pregnancy was too advanced for medical abortion, so she travelled several hours for surgical abortion. One rural woman’s GP said she’d have to travel three-plus hours to Melbourne as they didn’t know about services available down the road; another was told that medication abortion is “unsafe for everybody”, and that she should travel more than four hours to Melbourne for surgical abortion.
Countless other callers report being simply told by healthcare professionals to “ring the local hospital” to seek services by themselves without assessment, adequate referral or support.
So many barriers
Australia enjoys bipartisan and public support for legal abortion. But callers to 1800 My Options regularly disclose barriers to abortion that they experience, such as financial insecurity, physical and mental health issues, and geographic access; and about the stress of needing to find childcare or transport too.
We hear the relief and thanks in the voices of our callers when we tell them “we can help you find the services you need, here are services that you can get to and afford, and here is what you need to do to have an abortion”.
We are thrilled at the inquiry’s recommendation that abortion seekers in other states could be similarly supported through nationally coordinated state-based phone-lines.
We also work with over 650 Victorian health services: GPs, specialists, nurses, pharmacists, counsellors and sonographers, who tell us about the challenges they face trying to ensure that their services can keep going. Barriers put in place – either intentionally or unintentionally – by the health system that abortion seekers entrust to access their abortion options.
Barriers include hospitals that provide extensive maternity services, except for abortion; shunning from colleagues when they learn of a doctor’s abortion provision; services with very short windows (during school or business hours) for service intake every week; lack of training to ensure they’re providing best practice care; reduced capacity to bulk bill even the most financially insecure patients; services that are hidden, unless you know somebody who knows exactly who to call and what to say; healthcare professionals that shame, judge and obstruct timely care and referrals; and services that don’t have enough staff to continue if a clinician takes much needed leave – resulting in delay in service access for weeks or months at a time.
We are now at a turning point for sexual and reproductive health.
The Government has been provided with unambiguous evidence-based recommendations affirming the right of all Australians to accessible sexual and reproductive healthcare, to end the postcode lottery and ensure we can all access contraception, abortion and sexual health services.
Government policy, funding and direction are now what we need to achieve the dream: that public hospitals, with their public funding, provide and prioritise access to timely abortion services. That our workforce is supported and trained to meet the sexual and reproductive health needs of their patients. That service seekers’ experiences are centred in the design of effective, culturally safe and accessible services. And pathways to care – through phonelines and also through clinical referrals – are accessible and clear so that delays and distress are a thing of the past.
Action needed quickly
Sexual and reproductive healthcare is a time sensitive issue. A fortnight’s delay for an abortion seeker may make care impossible – due to legislative gestational limits, gestational price increases, or local system limits – forcing that person to continue the pregnancy.
This inquiry took six months of hard work and consultation with experts across the country, and has provided us with the answers we need to fix the problems. We can’t afford to wait longer for system reform to meet population health needs when people across the country are unable to pay for abortions, contraception and other reproductive healthcare today.
An immediate response is required from the Government to commit to a time-frame in which the recommendations will be actioned, alongside long-term investment to ensure that changes are sustainable.
This timeframe needs to be two-fold. Firstly, it needs to have short-term actions, acknowledge the existing issues in the system highlighted by the report – with careful attention to inadequate, inaccessible and unaffordable services – to provide immediate stop-gaps.
Secondly, long-term changes must be developed in partnership with state and territory governments to ensure that there is clarity of responsibility between jurisdictions. There are numerous existing sexual and reproductive health services that can contribute to co-designing and implementing many of the recommendations contained in the report from their knowledge of system barriers, innovative practice and connections to and experience with service users.
We stand now at a moment in history where abortion is in the national consciousness, and real change finally seems possible to enable true access to sexual and reproductive healthcare for all Australians.
* Carolyn Mogharbel is the Manager of 1800 My Options at Women’s Health Victoria, and has over 15 years of health promotion and service delivery experience, with a focus on sexual and reproductive health. Carolyn is committed to access and equity in health services and reducing stigma in the health system, and to centring the experiences of all women and gender diverse people in health system development, delivery and evaluation.
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