Abortion shouldn't be a post-code lottery

Professor Danielle Mazza

This week (11 May) the Senate’s inquiry into Universal Access to Reproductive Healthcare will release its recommendations. The focus of the inquiry, chaired by Greens Senator Janet Rice, has been on the glaring inequities in abortion and contraception access – particularly in rural and regional Australia where it is compounded by social disadvantage. Access inequity also occurs across state and territory borders with differences in legislation resulting in even more barriers, which is more reminiscent of the United States than we would care to admit.

So, while I’m sure the over-riding recommendation will be to improve access to abortion and contraception, it is not simply done, and it will be interesting to see how the Inquiry tackles this complex issue.

When Senator Rice first raised the motion for the inquiry to the Senate, she called for - in a post Roe v Wade landscape for women - the Australian government to have a more cohesive approach to accessing reproductive health, including a focus on contraception, sexual health care and education, and unbiased counselling which currently is a “postcode lottery….with different rules, costs, and availability, depending on where you live”.

It's hoped that the outcomes of the Inquiry will, at least, recommend policies and initiatives like those in Ireland, Scotland, England and Sweden, with free access to contraception and abortion and a workforce supported to deliver these services.

Our SPHERE Coalition submission to the Inquiry outlined key imperatives: make contraception free for women under 25; incentivise training of health care practitioners to deliver services in areas of need; ensure rural and regional access to contraception and abortion through regional-level planning and accountability; allow nurses and midwives to work to their full scope of practice in contraception and abortion; and track progress on delivery of the National Women’s Health Strategy by setting and reporting on targets.

We also reiterated the, often forgotten or assumed, need for service standards and key performance indicators (KPIs) for abortion and contraception services. KPIs make people accountable.

At the moment Australian health service standards in this area are at best ad hoc. There are no national or state based standards let alone any accountability for service provision at a regional level, making it almost impossible to track where abortion and contraception services exist for those who need them, and for health professionals who might need assistance in the management of their patients.

It’s hoped that the Inquiry will recommend national standards that can be implemented in hospital settings and reported on by state governments, in addition to standards and targets for community settings reported by primary health networks.

Hands down, one of the best ways to improve access across Australia is to provide free contraception to women under 25. Many new contraceptives aren’t available under the pharmaceutical benefit scheme because the pharma companies haven’t made a PBS application, possibly because our Australian market is quite small, or because the regulatory process is costly, or their application has been rejected.

Most women and girls under 25 can’t afford expensive contraceptives or intrauterine devices or implant insertion. If cheaper alternatives don’t work for them, they may end up not having safe sex, and having an unplanned and unwanted pregnancy. If they live outside a city or don’t have much money, they may not be able to afford an abortion either.

Even if and when access is opened up, we will need a workforce to provide these services. In Warrnambool there are 10 GPs but only two who provide abortion services. For a newly pregnant teen, how does she know where to go? Equipping practitioners with the skills and experience they need to provide this kind of care and incentivising practitioners to deliver services in areas of need is one approach. Allowing nurses to also provide these services will also assist but again there has to be state and federal consensus on this.

I’m heartened not just by the existence of the Inquiry but the quality of the submissions to it and the consistency of themes and policy solutions described. It is surely supported by the creation late last year of the National Women’s Health Advisory Council, chaired by Ged Kearney, who is strongly committed to achieving equity. The focus now needs to be not just on women’s health access as a platitude but in getting the job done.

Professor Danielle Mazza is one of Australia's leading clinician researchers in general practice. She holds the Chair of General Practice at Monash University.

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