Larissa Waters (Queensland, Australian Greens) Share this | Link to this | Hansard source

I move:

That the Senate take note of the report.

I rise to take note of the reportEnding the postcode lottery: Addressing barriers to sexual, maternity and reproductive healthcare in Australia. This was a committee inquiry conducted after I initiated the referral, and I thank the chamber for the support to conduct the inquiry. I would like to express my own and the chamber's gratitude to all of the people and organisations who shared their stories and experiences with the committee as part of this inquiry, and the advocates, the practitioners and the frontline service providers who continue to fight for safe, affordable access to maternity, sexual and reproductive health care for everyone. It is critical work. It is not easy work, and the committee certainly—and I hope the chamber—thanks you for all that you do. The consensus recommendations that were made by this multipartisan committee set out a comprehensive plan for improving access to reproductive, sexual and maternity health care for everyone. The Greens really look forward to working with the government to get those important recommendations implemented.

Evidence to the inquiry made abundantly clear that the quality, the availability and the affordability of this health care is not the same for everyone. To often, whether or not you can access maternal, sexual or reproductive health care depends on your postcode, your income, your visa status or your cultural background. The inquiry was motivated by the need to end this postcode lottery. We heard evidence from across Australia about the barriers that people face and what needs to be done to address and remove those barriers. Around the country, there are, sadly, many examples of maternity services in local hospitals being closed or suspended or put on bypass, forcing families to travel sometimes hundreds of kilometres for basic health care. Many First Nations women have to travel hundreds of kilometres away from country and family to give birth.

Likewise, whilst the efforts of decades of campaigning have seen abortion decriminalised and recognised as health care, this inquiry heard that abortion services can be prohibitively expensive—especially if you don't have a Medicare card—or simply aren't available in some regional areas. Access difficulties are compounded by different rules between jurisdictions, conscientious objections, a shortage of practitioners trained to provide surgical abortions or registered to prescribe medical abortions, and a lack of information. It should not be this difficult to access health care.

Pregnancy care and fertility procedures are health care. Contraceptive counselling is health care. Menopause treatment is health care. Abortion is health care. The Greens believe that such health care should be accessible, affordable, safe, legal, compassionate and free from stigma, no matter who you are or where you live. We're very pleased the committee has recognised the gravity of this situation and the need for action. The committee recommendations set out an ambitious and a comprehensive work plan to tackle the barriers to access, and we really urge the government to get on with this critical task.

I want to touch on some issues that the committee made some good strong recommendations on but the Greens think we in fact need to go further on. Firstly, on free contraception, we heard consistently through the inquiry that the cost of contraception and information, or lack thereof, was a real barrier to people being able to choose a contraceptive method that was most effective for them, taking into account their personal circumstances, including any underlying health conditions, their relationship status, travel and any other interaction with other medications. What works well for one person doesn't necessarily work well for another. Everyone should be able to access the contraception that works best for them. Increasing the 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 but also for other reasons. Programs in other countries have made contraceptives, including oral contraceptives, condoms and long-acting reversible contraceptives, free, and they have significantly increased uptake—no surprises there! They have also lowered the rates of pregnancy, birth and terminations, particularly amongst young people. Whilst we welcome the committee's recommendation for contraceptive counselling and for actions to make contraception more affordable, as part of the work of reviewing how to make it more affordable we suggest the government simply follows the lead of France, the UK and others, and makes contraception free.

In relation to out-of-pocket costs for abortions, we strongly believe that abortion is health care and should be free and available through the public healthcare system. The committee heard countless stories of people faced with an unintended pregnancy having to pay many hundreds of dollars. One person told us they had to pay as much as $17,000, which included direct service costs and the indirect costs of travel and accommodation, time off work, child care and post-abortion care. Those out-of-pocket costs are a real barrier to access. We welcome the committee recommendation that public hospitals provide surgical terminations or a timely and affordable local pathway to an alternative provider, but, unless those alternative pathways are fully funded, people who can't access a termination through their local hospital are at a significant disadvantage. This will most acutely impact people in rural and regional areas and those without a Medicare card. We recommend that the government ensure that any pathway to legal abortion is fully funded, whether that's through provision in a public hospital or whether it's subsidies for alternate access. The patient doesn't mind where they get their health care; they just, in our view, have a right to the health care. I note the ACT government recently announced it would deliver free universal access to abortion. We commend them for that, and we urge other jurisdictions to follow that lead.

One 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 weeks all the way up to 24 weeks. Sometimes medical consent and different levels of it are required before an abortion can be performed. There are different rules about whether you need to receive counselling before you exercise your bodily autonomy. Our strong view is that harmonising laws to achieve consistent, best-practice care across Australia would assist both patients and practitioners. We would like to see the federal government take the lead and coordinate with the state and territory governments to work towards harmonisation of pregnancy termination legislation across all jurisdictions based on the best standard of care, not the lowest common denominator.

In the time I've got left, I want to mention that we have real workforce shortages, and there's a scope-of-practice review underway that we have some hope will help address that squeeze. Nurses and midwives are well positioned to administer a range of contraceptives and to fill gaps in maternity, sexual and reproductive healthcare services. But, without dedicated MBS items allowing them to recoup their costs or PBS prescribing rights to ensure that patients can afford the contraception that they prescribe, it's not viable for midwives to provide those services. I note that, for some midwives, exorbitant insurance premiums from a monopoly insurer act as a further barrier to the viability of offering birthing services. That's felt really acutely in remote health services and ACCHOs, or Aboriginal community controlled health organisations, which can't 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. So we are very encouraged by the national scope-of-practice review, and we really urge the government to ensure that that review examines MBS and PBS coverage, insurance costs, workforce development strategies and other practical barriers facing practitioners. Enabling nurses, midwives and pharmacists to perform to the full scope of sexual, maternal and reproductive healthcare work that they're capable of doing will have huge benefits to improving access across the country.

In conclusion, this inquiry revealed the scale of work needed to achieve universal access to high-quality maternal, sexual and reproductive health care. The Greens will, of course, continue to call for more to be done—in particular, for more research and investment into menopause, endometriosis, menstrual pain management, infertility, gender-affirming health care and the gendered impacts of conditions like migraines and cancer. We'll also continue to call for measures to address period poverty and making period products free. I want to conclude by, once again, thanking the community members who took the time to give evidence to the inquiry and, importantly, the other committee members, who delivered a consensus report with some very strong and beneficial recommendations. It's now up to government to get on with implementing them, and we really look forward to working to see that happen.

I seek leave to continue my remarks later because I know I have some colleagues who'd like to contribute on this matter as well.

Leave granted; debate adjourned.