A highly anticipated inquiry into reproductive health care has recommended significant changes to Australia's health system to make contraception, abortion and pregnancy care more accessible.
Among the recommendations are calls for incentives to get doctors to provide sexual and reproductive care, higher rebates for the insertion of contraception and increasing access to medical abortions.
The report is expected to form a significant part of the government's decision-making around increasing access to reproductive and sexual health care, a key element of the national women's health strategy.
Why this inquiry is important
Health Minister Mark Butler and Assistant Health Minister Ged Kearney — who is responsible for women's health — said they were waiting to see the recommendations of the inquiry before making substantial changes to abortion and contraception service delivery.
The Senate inquiry was established by the Greens but made up of senators from across the political spectrum.
All recommendations were bipartisan, including calls to increase the Medicare subsidy for inserting long-acting reversible contraception, and for incentives for health professionals to provide sexual and reproductive care.
Among the 36 recommendations, are calls to:
- Increase the Medicare rebate for healthcare workers inserting long-acting reversible contraceptives, such as IUDs, which doctors have said is much too low
- Make medical abortions (also known as abortion pills) more accessible by broadening the rules around who can prescribe and dispense them
- Make more hormonal contraceptives available on the pharmaceutical benefits scheme to make them cheaper for patients
- Establish a subsidy for non-hormonal copper IUDs
- To extend Medicare items for sexual and reproductive telehealth beyond December this year (currently, they are only funded until the end of 2023)
- Establish a national contraception, abortion and sexual health hotline referral service
- Increase birthing-on-country services for First Nations parents
- Ensure maternity care services in non-metro public hospitals are available
Labor senator Marielle Smith, who served as deputy chair of the inquiry, told the ABC that recommendations around pregnancy and post-natal care need to be urgently taken on board.
"Women are often forced to travel very long locations away from their families, away from their support networks, and I think that's a really big problem," she said.
"It leads to problems of dislocation, isolation, it can lead to domestic violence, it can lead to poorer health outcomes for women and their children.
"We have a recommendation in there, a very strong one, to make sure we're working with states and territories so that maternity care services can be provided in public hospitals, particularly in out-of-metropolitan areas."
Senator Smith said her personal connection to these matters drove her determination to see the situation change.
"My Aunty Lynette — who is from Port Lincoln — when she had her baby, she was separated from her for 17 long weeks.
"Her baby was premature and she couldn't get that access to health care close to home.
"This was 40 years ago, but we know women in regional and rural areas are still facing tremendous challenges when it comes to accessing appropriate maternal health care and maternal health care services in their town or nearby."
Long wait for long-acting reversible contraception
Contraception was a key focus of the inquiry, with many of its recommendations centred around increasing access to long-acting reversible contraception (LARC) in particular.
LARCs such as intra-uterine devices (IUDs) or the contraceptive implant are among the most effective contraceptives on the market, but Australia has low uptake compared to other countries.
Doctors have been calling for the government to subsidise non-hormonal IUDs and increase the Medicare rebate for IUD insertion and removal. Both have been recommended by this inquiry.
Senator Smith would not be drawn on whether the current rebate was sufficient, but said it was certainly something that needed to be looked at.
"We've made comments around a whole range of MBS [Medicare benefits scheme] and PBS [Pharmaceutical benefits scheme] thresholds on these kinds of services, not just for contraceptive care, but for others as well," she said.
"There's a range of things for the government to look at, but we really did pull out LARCs as a central piece of the recommendations of our report."
No agreement on what constitutes affordable abortion care
Also on the list of recommendations is to increase access to abortion via the public hospital system.
While abortion is legal in every state and territory, it is not easily accessible to everyone, with many patients struggling to afford the procedure or being forced to travel long distances to get it.
In 2019, Labor committed to linking public hospital funding to abortion provision but has since dropped that policy.
When the ABC asked what Labor planned to replace it with to follow through on its commitment to increase access to abortion, Health Minister Mark Butler said he was waiting to see the recommendations of this inquiry.
Greens senator Larissa Waters, who was also on the inquiry committee, said the bipartisanship illustrated by the recommendations was an exciting step towards solving issues with abortion access.
"All of the political parties have agreed that we need to fix these problems," Senator Waters said.
"I think the key recommendations really go to making abortion more accessible and more affordable no matter where you live.
"I'm so pleased that we've had multi-partisan agreement on these recommendations, which is a pretty big deal when it comes to women's rights considering the decade that we've all just endured.
"Public hospitals should provide access to a surgical abortion, and if they don't, they should provide referral to a local affordable option that is timely."
While there was bipartisan agreement on access, the committee could not reach agreement on what constitutes an affordable abortion.
"The bit that the Greens want to see a bit more work done on is that you're not out of pocket to access that service, and that's the bit that we couldn't quite get final agreement on from the government," Senator Waters said.
"But we did get agreement to the principle that public hospitals should provide abortions or if not, that they should provide a timely and affordable referral to a local provider."
Senator Waters said that, as with abortion, access to birthing services and care was a postcode lottery.
"We've heard horror stories, particularly from Gladstone in my home state of Queensland, where women are having to drive over 100 kilometres to the Rocky [Rockhampton] hospital, and they're having to give birth on the side of the highway."
Contraceptive device companies welcome inquiry
Organon's managing director Nirelle Tolstoshev welcomed the recommendations of the inquiry.
The company sells LARCs such as the contraceptive implant known as Implanon in Australia.
She said the report was a major milestone for women's health in Australia.
"It's about time that women's health and sexual and reproductive health is top of mind for policy makers, for the government and all stakeholders involved," she said.
"There are many recommendations in this report, and we understand that they can't all be done at once — however, we do think that there are two recommendations that really could be acted upon by the government almost straightaway.
"Firstly, to reimburse registered nurses, nurse practitioners and midwives for the insertion and removal of long-acting reversible contraception.
"The second recommendation that we think would make a real difference is to have an MBS item on the Medicare system so that GPs can have a longer consult around contraception to really create that discussion, so that women and people needing contraception can hear all of the options available and make an informed and empowered choice for their own reproductive choices, for their own life stage."
