By Michelle Thompson (CEO of Marie Stopes Australia)
In July last year the New York-based Commonwealth Fund ranked Australia's healthcare system number 2 in the world. The study found that our public/ private universal approach to the delivery of healthcare services has led to a healthier society than those we ranked against. When it came to equity, however, the same study ranked Australia well below average. In fact we came in at number 8 on the list of 10.
An acute example of inequity in our universal healthcare system is the delivery of sexual and reproductive health services, namely women's sexual and reproductive health and specifically abortion access. Abortion is one of the most common medical procedures for women, yet we have a problem providing for it in Australia. Varied state and territory laws, health policies and health funding means that infrastructure and clinicians to deliver services are either non-existent or reliant on private providers to establish and run these services.
As a national provider of sexual and reproductive health services, including medical and surgical abortions, we see stark contrasts in service delivery between states and territories and within these states and territories.
In Queensland, women in the far north and west of the state must travel days to access surgical abortion services. They have no service within a day's drive. In Tasmania women can no longer access surgical abortions without crossing to the mainland. And for the past year, the future of surgical and medical abortion access in the ACT hung in the balance with the ACT government silent on whether Marie Stopes would be able to continue to operate from a government health facility. We have heard this week that the future of the clinic is secure and that services can continue for ACT women.
The problem is that we are not, as a nation, getting it right when it comes to the delivery of sexual and reproductive health services. State and territory governments are often unwilling or unable to talk to us about abortion provision. It is either deemed too hard, too controversial or not the right time. That needs to end now. In 2018, we need to stop treating women's sexual and reproductive health services as being too hard, too controversial, or a case of bad timing.
Our universal health system in Australia relies on strong relationships between the public and private health sector. The private health sector has a long history of being commissioned to deliver services to Australians on behalf of government. We have seen this through the commissioning of private providers to run public hospitals and through the commissioning of primary health care including General Practice services. With sexual and reproductive health services, we have an opportunity to deliver them to public health patients using existing private providers under a commissioning model.
This approach will streamline healthcare service delivery and enable greater access to services. At the same time it will ensure that our public hospitals can remain focused on delivering tertiary referral services such as chronic disease management while also not placing further pressure on hospital emergency departments, operating theatres and ambulatory care centres.
At the end of the day sexual and reproductive health, including abortion, is primary health care and should be delivered as such. It's time to stop sweeping this important form of women's healthcare under the carpet. If the state and territory governments cannot deliver for women, then it is time for the federal government to step in.
Published on The Sydney Morning Herald on February 4, 2018
About sexual and reproductive health
"Women’s sexual and reproductive health is related to multiple human rights, including the right to life, the right to be free from torture, the right to health, the right to privacy, the right to education, and the prohibition of discrimination. The Committee on Economic, Social and Cultural Rights and the Committee on the Elimination of Discrimination against Women (CEDAW) have both clearly indicated that women’s right to health includes their sexual and reproductive health. This means that States have obligations to respect, protect and fulfill rights related to women’s sexual and reproductive health. The Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health maintains that women are entitled to reproductive health care services, goods and facilities that are: (a) available in adequate numbers; (b) accessible physically and economically; (c) accessible without discrimination; and (d) of good quality [see report A/61/338]."