Additional comments from Senator Tammy Tyrrell

1.1My position is simple: there should be safe, equitable and affordable access to reproductive healthcare for everyone who lives in Australia.

1.2What we’ve heard during this inquiry is that governments, State and Federal, are failing to deliver on this front. As a result, people are having trouble accessing contraception, experiencing difficult pregnancies, and facing hard decisions over their bodies and their future.

1.3The committee has heard there are people who can’t afford their preferred contraceptive. Some people can’t easily access a practitioner to insert a long‑acting reversible contraceptive (LARC). Others can’t afford to pay for a LARC because of the upfront cost of insertion and removal, and the associated costs of consultation with a medical practitioner. In both circumstances, these people will often get the pill instead of a LARC. However, there are also issues with the pill, like side effects and affordability. In many cases, people who can’t afford a pill with fewer side effects will instead opt for the cheaper option with more side effects because their preferred pill is not listed on the Pharmaceutical Benefits Scheme.

1.4Coming from a state that is largely classified as rural and remote, I’m especially concerned about an observation already made in this report, that ‘[w]omen living in rural and remote areas are 1.4 times more likely to experience an unintended pregnancy, suggesting that access to contraception and abortion services remains a problem in those areas’.[1]Access to contraception is critical for preventing further unwanted interactions with the health system as a result of an unintended pregnancy.

1.5The committee has also heard that there are people who can’t afford to pay for abortion services, because they struggle to pay the upfront fee for which they’ll later be rebated. In Tasmania, some people can’t afford to pay the $150 out of pocket cost for a medical termination, let alone the $350 upfront cost for which they will receive a partial rebate.

1.6What is a welcome change, is that surgical abortions are now free in Tasmania. Dr Erica Millar observed that on this issue, ‘Tasmania is a leader that other states should be following’.[2]Dr Millar also said that she wasn’t aware of data on whether there are more surgical than medical abortions as a result of this change.[3]I would be interested to know if more people are now accessing surgical abortions instead of medical abortions, simply because they are free. The need for data on this particular issue is reflected across the board: we need to collect more data on reproductive healthcare. If we have more data, we can make more targeted improvements.

1.7The committee also heard that there are people who face other barriers with access to reproductive healthcare. These include the distance to travel to a service that offers ultrasounds, or the distance to travel to a GP that can prescribe the medical abortion pill, or the pharmacist who dispenses it.

1.8These problems are happening all over Australia, but they are worse in the regions. The further you are away from a big city, the harder it is to get quality healthcare. That is the case for all healthcare, and reproductive healthcare is no different.

1.9For example, our Women’s and Newborn Health pharmacist workforce in Tasmania is just not good enough:

The Royal Hobart Hospital employs a Paediatric and Neonatology Pharmacist but does not currently have a Women’s or Reproductive Health pharmacist to provide clinical pharmacy services. The maternity ward at Royal Hobart Hospital does not have a clinical pharmacy service attached to it.

Launceston General Hospital has a paediatric pharmacist and no Women’s and Newborn Health pharmacist. Similarly in North West Tasmania, there are no Women’s and Newborn Health pharmacists despite maternity services being provided through contractual arrangements at North West Private Hospital.[4]

1.10It’s fairly obvious that we don’t have adequate health services in Tasmania, and it is no secret that as a result, Tasmanians travel to the mainland for healthcare. This has been happening for some time. Tasmanians mostly go to Victoria, and I learnt that Tasmanians are also accessing a Victorian telephone service, 1800My Options, because the services in my state are not sufficient to respond to the needs of Tasmanians.[5]

1.11The committee has heard that there are a lot of problems with reproductive healthcare, but it has also heard that there are a lot of solutions. These solutions should also be available to all people in Australia, regardless of their proximity to the big cities, or visa status.

1.12In the first instance, all oral contraceptives should be on the PBS, and LARCs should at least be cheaper and easier to access, if not free to access.

1.13Another solution is that termination services should be freely available, and accessible—both medical termination, and surgical termination.

1.14Pregnancy care should also be expanded, including through continuity of midwifery care with a known midwife.

1.15The Federal Government could also do more to expand the powers of midwives and nurse practitioners. Powers could be expanded to allow these medical practitioners to perform LARC insertion and removal. Midwives and nurse practitioners should also be reimbursed for conducting these procedures under the relevant Medical Benefits Scheme item number. This would alleviate the pressure on the healthcare system and increase accessibility to healthcare for individuals.

1.16Although we are seeing improvements with access to reproductive healthcare, there is a lot that remains to be done. This report contains a number of excellent recommendations that, if implemented, would vastly improve equitable access to reproductive healthcare for all people in Australia, regardless of who they are or where they live. I look forward to working with the Government on progressing these recommendations.

Senator Tammy Tyrrell

Senator for Tasmania

Footnotes

[1]Organon, Submission 3, p. 3.

[2]Dr Erica Millar, Committee Hansard, 28 April 2023, p. 65.

[3]Dr Erica Millar, Committee Hansard, 28 April 2023, p. 65.

[4]Society of Hospital Pharmacists of Australia, answer to question taken on notice, 28 February 2023 (received 8 May 2023).

[5]Women’s Health Victoria, answer to question taken on notice, 28 February 2023 (received 5May2023).