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The Senate inquiry into universal access to reproductive health care has delivered its report 鈥� 鈥樷��.

Industry leaders have welcomed the report, but some say 鈥渕ore must be done鈥�.

The inquiry found that Australians do not currently have consistent access to sexual, reproductive and maternal healthcare services, and that this particularly disadvantages people living in regional and remote Australia.

The Senate Committee developed 36 recommendations around four key areas:

1. Enhancing access to contraceptives
2. Reducing barriers to reproductive health care
3. Delivering appropriate and adapted care
4. Improving literacy and enhancing employee rights

Equitable Access

Access to medical and surgical abortion, plus long-acting reversible contraception, is one area of improvement addressed in the report.

聽President Dr Nicole Higgins said, 鈥淎s a Mackay GP, I know my patients who require a surgical abortion must travel over 1000 kilometres for care and that is not acceptable.鈥�

鈥淭he Senate inquiry has highlighted the very profound and disturbing inequities and sometimes complete lack of access to sexual and reproductive health issues that exists in Australia. Abortion is an essential healthcare service and publicly funded hospitals need to provide these services,鈥� said Professor Danielle Mazza, Head of General Practice at Monash University, Chief Investigator and Director of in Women鈥檚 Sexual and Reproductive Health in Primary Care and special adviser.

鈥淲orkforce capacity building and regional accountability are key aspects to ensuring access to contraception and abortion services.

鈥淐ontraception and abortion services should be available at no cost and free of the regulatory barriers that hinder evidence-based practice as occurs in other countries such as England, Canada and Ireland.鈥�

The (ACN) CEO Adjunct Professor Kylie Ward FACN said, 鈥渆nsuring equitable access to sexual, maternity and reproductive health care in this country is too important to play politics with, and we were heartened to see the strong multi-partisan political support during this committee process.鈥�

Senior Lecturer Dr Ronli Sifris, Deputy Director, Castan Centre for Human Rights Law in the Faculty of Law at Monash University, commented, 鈥淲hile the availability of medical abortion should in theory help to overcome many of the existing access issues, the burdens placed on health professionals wishing to prescribe it has a deterrent effect.

鈥淩emoving some of the burdens that health professionals face and making medical abortion easier to access would hopefully resolve some of the existing access issues by, for example, lowering the cost of a medical abortion and making it easier to obtain outside of urban areas.

鈥淲hile Australia鈥檚 laws are progressive, abortion remains stigmatised, practitioner attitudes and lack of training may be an impediment to access, and cost is a huge issue in most of the country.

鈥淭he Medicare rebate should be extended to cover IVF conducted for the purposes of surrogacy; the fact that it does not currently do so is discriminatory and unfair to people who are already facing significant challenges in their journey to have a child.鈥�

Workforce and training

Ward welcomed the Senate inquiry鈥檚 findings that highlight the critical role Australia鈥檚 nursing workforce plays in the delivery of high-quality and safe reproductive health care.

鈥淲e were pleased to have had the opportunity to provide evidence to the committee and we鈥檙e grateful to have seen a number of our recommendations adopted by the senators involved,鈥� Ward said.

鈥淲e look forward to working with governments both at the federal and state level to ensure that the committee鈥檚 recommendations are adopted in full and in a timely manner.鈥�

ACN was also pleased that the committee recognised the importance of trauma-informed and culturally appropriate delivery of services.

The committee report noted that 鈥淢embers of the Australian College of Nursing (ACN) raised concerns that there is a clear lack of trauma-informed training throughout tertiary education. They advised that numerous healthcare providers are not providing sufficient reproductive health care to refugee and migrant women鈥� (p.92) and went on to say 鈥淎CN argued for improved cultural competency training whilst studying, as well as ensuring this training continues once qualified as a health practitioner鈥� (p.92).

ACN said it will continue to advocate on behalf Australia鈥檚 nursing profession, and remains committed to shaping the policies of the future.

The report stated: 鈥淭he committee recommends that the Australian Government, in consultation with relevant training providers, reviews the availability, timing and quality of sexual and reproductive healthcare training in undergraduate and postgraduate tertiary health professional courses, including vasectomy procedures, terminations and insertion of long-acting reversible contraception.鈥�

RACGP鈥檚 Higgins said, 鈥淚t is great news the report has recommended training support for GPs for the insertion and removal of long-acting reversible contraceptives as well as adequate remuneration for GPs, nurses and midwives to provide contraceptive services, including the insertion and removal of LARCs.

鈥淚n addition, I welcome the committee recommending the government review Medicare arrangements which support medical termination consultations with the aim of ensuring adequate remuneration for practitioners to deliver these services,鈥� she added.

The committee also recommended further training and research to provide high-quality and tailored reproductive health care for the LGBTQIA+ community, people living with disability and First Nations people.聽

More to be done

The RACGP聽welcomed the report and called on the government to end Australia鈥檚 鈥榩ostcode lottery鈥�.

鈥淢ore must be done to break down barriers and ensure all women have strong access to reproductive health care no matter their postcode or income,鈥� Higgins said.

She added that the report contains many promising recommendations the government can and should act on without delay.

鈥淚t鈥檚 also very positive to see the committee calling for the government to put in place options to make contraception more affordable. This is a particularly salient issue given high cost-of-living pressures squeezing many households across Australia. Anyone should be able to choose the contraceptive options that best suit them without having to worry about their hip pocket. The recommendation for a separate Medicare Benefits Schedule item number for contraceptive counselling and advice will help achieve this if it is set at a level that reflects the work involved.

鈥淭he RACGP welcomes the committee recommending Medicare Benefits Schedule telehealth items for sexual and reproductive health care, including pregnancy support counselling and termination care, be made a permanent fixture of our telehealth system. The Health Department has temporarily extended these items until the end of the year and said a long-term decision will be made following a post-implementation telehealth review. Let鈥檚 not wait for more reviews, let鈥檚 act.

鈥淎s chair of the RACGP鈥檚 Dr Christie Rodda has noted 鈥� these telehealth items provide choice to women in communities where healthcare access is harder. So, let鈥檚 make them permanent now, it鈥檚 the right call.鈥�

Higgins called on the government to go even further in the years ahead.

鈥淭here are other steps the government can and should take to improve reproductive health care in Australia,鈥� she said.

鈥淲e can start by adding medicines for medical termination to the Prescriber Bag or 鈥榙octor鈥檚 bag鈥� of emergency use medicines. The RACGP also welcomes the committee recommending improved access to a broader range of hormonal contraceptives that are not currently Pharmaceutical Benefits Scheme subsidised, including newer forms of the oral contraceptive pill, the emergency oral contraceptive pills and the vaginal ring.

鈥淟ooking ahead however, we are calling for copper IUDs to be available on the PBS, and the Medicare rebate for insertion of an IUD should also be increased to reduce or eliminate gap fees.

鈥淭he committee has suggested subsidising the non-hormonal copper IUD to improve contraceptive options for people with hormone-driven cancers and people for whom hormonal contraception options may not be suitable. We believe this is a good first step, but as I said the government should go even further and place copper IUDs on the PBS for all people who choose this option.

鈥淲e also call on the government to amend rules to allow GPs to bill MBS Level C and D time-based attendance items for antenatal attendances that extend beyond 20 minutes. Currently, there is a fixed Medicare Benefits Schedule fee for antenatal appointments no matter how long that appointment takes, so people who need a longer antenatal appointment receive a much smaller rebate compared to someone attending for a general appointment.

鈥淧roviding financial support to GPs who want to train in surgical abortion, which is the only option to terminate a pregnancy after nine weeks, should also be front-of-mind for the government.

鈥淚 look forward to working with the government to make this a reality,鈥� Higgins said.

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