Universal access to contraception is a key component to empowering women and people who menstruate to control their fertility, but too often in Australia, that access can depend on where a person lives and how wealthy they are.
This “postcode lottery” can be particularly detrimental to Australians who live in regional or rural areas where there might not be adequate access to providers or services for reproductive healthcare.
“We want to make sure that regardless of your postcode, you can access the services wherever you need, and that there’s pathways to do that,” says Professor Deborah Bateson, an internationally renowned clinician and researcher in sexual and reproductive health, speaking to Women’s Agenda.
Professor Bateson is among many advocating for the government’s support in an ongoing Senate Inquiry into reproductive healthcare in Australia.
“Contraception is really one of the most effective ways to empower women,” she says. “To empower women to be able to join the workforce to be able to earn money to complete their education– we really want to make sure that every woman has that choice, so that she can make that choice for herself.”
The Senate Inquiry report into ‘Universal access to reproductive healthcare’ was released in May of last year and placed a great emphasis on the role of Long-Acting Reversible Contraception (LARC) such as intra-uterine devices (IUDs) or implants in improving the health, social and economic outcomes for women in Australia.
LARC options are all more than 99 per cent effective and there is a rapid return to usual fertility as soon as LARC are removed. More benefits to these options- hormonal implants, hormonal IUDs and copper IUDs- include that they are long lasting and don’t require people to do anything else to prevent pregnancy.
A number of recommendations were made in the report to encourage greater take-up of LARC, including increased Medicare reimbursement, a new Medicare item number for contraceptive counselling, enhancing training for health care professionals and increasing the number of helath care professionals that are able to insert/remove LARC devices, improving school education programs and collecting more comprehensive data about unplanned pregnancies.
In Australia, Professor Bateson says LARC uptake is falling behind other countries. The lastest national data suggests around 11 per cent of women using contraception would use a LARC method like an IUD or implant. She notes that cost is one of the key barriers for women in Australia, whereas in other countries, such as Sweden, LARC is free.
Disjointed referral pathways, a lack of trained providers and a less than optimal experience of the LARC insertion for many women is also contributing to the low uptake rate in Australia.
“Nurses are putting in IUDs in family planning clinics very effectively, very efficiently, with great skill and quality, but there’s no scope of practice for nurses– in the general practice setting it’s very limited,” says Dr Bateson. “There’s no remuneration pathway, so we’ve got a whole unused workforce, who could actually be very effectively filling these gaps, particularly in rural areas.
To address these barriers, Professor Bateson points out that “we’ve got to really look at those policies around supporting nurses, we’ve just got to have greater exposure to training in LARC methods and methods of reception at university and colleges in postgraduate training.”
Adding to the importance of education around LARC and other contraceptive options, she says that all too often, misinformation is passed along to patients, such as “who’s suitable for an IUD”.
“We know that sometimes it’s perceived that young women who haven’t had children aren’t suitable for an IUD and we know that that’s not the case,” she says. “So we need to overcome that misinformation.”
Ultimately, Professor Bateson says that the issue around access to contraception boils down to the critical need to inform women and allow them to make their own choices.
“We know that unintended pregnancies are around about 30 per cent,” she says, adding that she wants patients to “be able to have the choice of using a method of contraception that’s going to suit them because there’s lots of different choices of contraceptive methods and it’s not one size fits all”.
Implementing the recommendations found in the Senate’s report is a critical first step to improving reproductive healthcare in Australia, and Dr Bateson, alongside other advocates, is urging the government to offer support as soon as possible– including before the next federal budget in May 2024.
She says there’s a buzz in the reproductive health and sexual wellbeing sector around the potential of these inquiry recommendations to create real, widespread, positive impacts for women in Australia.
“We had our parliamentary, sort of roundtable, and there were many doctors, nurses, service managers, providers there, and there was a great excitement by the sector about these recommendations,” she says, adding that there’s “a real will to make this happen, to improve things for women”.
“Everyone’s very aware of the gaps and it’s just wonderful that everyone’s actually pulling together in the same direction. Everyone’s got a shared agenda.”