Additional comments from the Australian Greens

1.1The National Women’s Health Strategy 2020–2030 recognises that access to maternal, sexual and reproductive health care is fundamental to positive health, wellbeing, social, and economic outcomes. Yet, as evidence to this inquiry made abundantly clear, the quality, availability and affordability of this healthcare is not the same for everyone. Too often, whether you can access maternal, sexual and reproductive healthcare depends on your postcode, your income, your visa status, or your cultural background.

1.2This inquiry was motivated by the need to end this postcode lottery. We heard evidence from across Australia about the barriers people face and what needs to be done to address them.

1.3Around the country, there are examples of maternity services in local hospitals being closed or suspended, forcing families to travel for basic healthcare. Many First Nations women have to travel hundreds of kilometres away from country and family to give birth.

1.4The efforts of decades of campaigning has seen abortion decriminalised and recognised as healthcare, yet this inquiry heard that abortion services can be prohibitively expensive (particularly if you don’t have a Medicare card), or simply unavailable in some regional areas. Access difficulties are compounded by different rules between jurisdictions, conscientious objections, shortages of practitioners trained to provide surgical abortions or registered to prescribe medical abortion, and lack of information. It should not be this difficult to access healthcare.

1.5Pregnancy care and fertility procedures are healthcare. Contraceptive counselling is healthcare. Menopause treatment is healthcare. Abortion is healthcare. The Greens believe such healthcare should be accessible, affordable, safe, legal, compassionate, and free from stigma, no matter who you are or where you live.

1.6The Greens are very pleased that the committee has recognised the gravity of the situation and the need for action. The committee recommendations set out an ambitious and comprehensive workplan to tackle the barriers to access, and we urge the Government to get on with this critical task.

1.7These comments briefly outline opportunities to ensure that the measures outlined in the committee recommendations can effectively ensure universal access to sexual, maternal, and reproductive healthcare.

Free contraceptives

1.8We heard consistently through the inquiry that cost and information were key barriers to people being able to choose a contraceptive method that was most effective for them, taking account of their personal circumstances, including underlying health conditions, relationship status, travel, and interaction with other medications. What works well for one person may not work well for another.

1.9Everyone should be able to access the contraceptive option that works best for them.

1.10Increasing awareness of, and access to, a full suite of contraceptive options has significant health and economic benefits in terms of avoiding unintended pregnancies and terminations. Programs in other countries that have made contraceptives, including oral contraceptives, condoms and long-acting reversible contraceptives, free have significantly increased uptake. This has also lowered the rates of pregnancy, birth, and terminations, particularly amongst younger people.

1.11We welcome the committee’s recommendations for contraceptive counselling and actions to make contraceptives more affordable. As part of the work of reviewing how to make contraception more affordable for all, we encourage the government to follow the lead of France, the UK and others and simply make contraceptives free.

Recommendation 1

1.12That the Australian Government funds the free provision of all approved contraceptive methods.

No out-of-pocket costs for abortions

1.13The Greens believe that abortion care is basic healthcare that should be free and available through the public health system.

1.14The committee heard countless stories of people faced with an unintended pregnancy having to pay many hundreds of dollars, some even as much as $17,000, including direct service costs and the indirect costs of travel, accommodation, time off work, childcare and post-abortion care. Those out of pocket costs present a very real barrier to access.

1.15We welcome the committee recommendation that public hospitals provide surgical terminations or a timely and affordable local pathway to an alternative provider. However, unless those alternative pathways are fully funded, people who cannot access a termination through their local hospital are at a significant disadvantage. This is likely to most acutely impact people in rural and regional Australia, and those without a Medicare card.

1.16We recommend that the Government ensure that any pathway to a legal abortion is fully funded, whether through provision in a public hospital or subsidies for alternative access. The ACT Government recently announced that it would deliver free universal access to abortion, and we urge other States and Territories to follow their lead.

Recommendation 2

1.17That the Australian Government work with states and territories to:

ensure abortion services are provided at no cost; and

maintain locally-administered public funds to assist patients to cover indirect costs where services are not provided in the local hospital.

Harmonisation

1.18One contributing factor to the postcode lottery for accessing an abortion is the patchwork of different laws across the country. The rules in your state can have a significant impact on the gestational limits for accessing a termination (ranging from 16 - 24 weeks), the medical consent required before an abortion will be performed, and whether you will be required to receive counselling before exercising your bodily autonomy.

1.19Harmonising laws to achieve consistent, best practice care across Australia would assist patients and practitioners.

Recommendation 3

1.20That the Australian, state, and territory governments work towards the harmonisation of pregnancy termination legislation across all Australian jurisdictions, based on best practice models of care.

Removing barriers for IVF and surrogacy

1.21The inquiry heard detailed evidence about current barriers for people seeking to become parents through assisted reproductive treatments and altruistic surrogacy arrangements, including same sex parents. We are encouraged by the committee’s recommendation to examine options to extend Medicare rebates for IVF services, and further recommend that the Government remove legal barriers to access.

Recommendation 4

1.22That the Government remove legal barriers to accessing IVF and altruistic surrogacy arrangements by:

amending the definition of infertility to align with the International Committee Monitoring Assisted Reproductive Technologies’ definition of infertility; and

deleting the word ‘particular’ from subsection 12(1) of the Prohibition of Human Cloning for Reproduction Act 2002.

Workforce shortages and scope of practice

1.23Nurses and midwives are well positioned to administer a range of contraceptives and fill gaps in maternity, sexual and reproductive healthcare services. However, without dedicated MBS items allowing them to recoup their costs, or PBS prescribing rights to ensure their patients can afford the contraception they prescribe, it is not viable for midwives to provide those services.

1.24For some midwives, exorbitant insurance premiums from a monopoly provider act as a further barrier to the viability of offering birthing services. This restriction is felt acutely in remote health services and ACCHOs who cannot afford to risk midwifery provision. As a result, many people in remote and regional areas have limited options to access local, affordable pregnancy care or continuity of maternity care.

1.25The Greens support the National Scope of Practice Review, and urge the government to ensure that the review examines MBS and PBS coverage, insurance costs, workforce development strategies and other practical barriers facing practitioners. Enabling nurses, midwives, and pharmacists to perform the full scope of sexual, maternal and reproductive healthcare work that they are capable of doing will have huge benefits for improving access across the country.

More work to be done

1.26This inquiry has revealed the scale of work needed to achieve universal access to high quality maternal, sexual and reproductive healthcare.

1.27In addition to the work set out in the recommendations, the Greens will continue to call for more research and investment into menopause, endometriosis, menstrual pain management, infertility, gender-affirming healthcare, and the gendered impacts of conditions like migraines and cancer.

1.28We will also continue to call for measures to address period poverty by making period products free.

Acknowledgments

1.29We extend our deep gratitude to all the people and organisations who shared their stories and experiences with the committee as part of this inquiry, and the advocates, practitioners and frontline service providers who continue to fight for safe, affordable access to maternity, sexual and reproductive healthcare for everyone. This is critical work, but it is not easy work, and we thank you for all that you do.

Senator Janet Rice

Chair

Senator Larissa Waters