Speech by Dr Catriona Melville | The Road to Abortion Equity

The Federal Senate has established an Inquiry into universal access to reproductive healthcare. The Inquiry was called because the government has acknowledged we have a crisis of sexual and reproductive health access.

On Wednesday 9 November 2022, we hosted an online forum to explore what the inquiry terms mean, how it applies in practice and provided a submission template which you can download here to assist people in writing their own.

Dr Catriona Melville gave the following speech at our webinar, which you can watch here.

I would like to acknowledge that I am speaking to you from the land of the Turrbal people and pay my respects to Elders past, present and extend my respect to Aboriginal and Torres Strait Islander people here today.

Some of our other speakers have summarised some of the key issues facing people endeavouring to have reproductive autonomy in Australia.

I would like to outline what I see as the key challenges and my wish list of solutions.

To begin with contraception, in order to improve access we need to extend PBS coverage to include methods such as the progestogen only pill which inhibits ovulation (e.g. drospirenone).

This is the only reliable oral alternative for people who can’t use the combined oral contraceptive bill and currently the only available option in Australia is not listed on the PBS and the cost precludes its use in many people.

The PBS should also subsidise the combined vaginal ring to increase access to choice of contraceptive methods.

We need to streamline the TGA approval processes for new contraceptive methods: this will enable our population to have access to methods such as the self-injectable progestogen or the combined contraceptive patch, which are available in other wealthy countries such as the UK and US, and have been available there for many years.

As we know LARC (long acting reversible contraception) methods are the most efficacious choices for contraception so we need to ensure there are affordable options for accessing these.

The current MBS rebates for primary care are not sufficient for these procedures so these need to be increased to reflect this, and to ensure our population can access these without paying a gap.

In Scotland people do not require a referral to attend a sexual and reproductive health service.

Self-referral to specific specialist services such as those providing abortion care and complex contraception would reduce the burden on primary care, reduce costs and streamline access for clients.

It already happens with the public sexual health clinics so I would ask that this can be extended to sexual and reproductive health specialist provided services.

Moving onto abortion…..

I was the lead for my public abortion service in Scotland where all abortion is free to all people who request it, as is all contraception!

So this is possible within the public system however we need policy makers to consider the following:

Abortion laws across Australia should be harmonised to create a level playing field and transparency for clinicians and consumers of health care.

Abortion care should be considered as part of a person’s reproductive lifespan given at least 1 in 4 people will undergo an abortion in their lifetime making it likely the most common gynaecological procedure in Australia.

Medical abortion provision should be increased as this model of care is accessible, affordable, acceptable and safe and can be delivered by a range of healthcare practitioners.

In order to do this we need to start with mandatory inclusion of sexual and reproductive health education in undergraduate degrees and postgraduate training programs including medicine, midwifery, nursing, general practice and obstetrics and gynaecology.

Non-GP specialists also need medical abortion skills as collaboration between primary and secondary care is essential to allow a seamless journey for a pregnant person.

Take for example the person who attends an early pregnancy assessment clinic with a threatened miscarriage but then discloses they want to terminate the pregnancy.

This should be facilitated within that department and hospital rather than send people back to find a GP who may be able to provide this service or may not — this creates barriers and delays essential care.

It is critical we do not silo abortion care and ensure collaboration exists between primary and secondary care settings.

Surgical abortion must always be retained as a choice and also a necessity for people who aren’t suitable for a medical abortion.

Lack of abortion services in many public hospitals means that trainees can’t access surgical abortion training.

Abortion provision for all indications — not just fetal anomaly — must be available in all public hospitals, ideally as a dedicated reproductive health service delivered by skilled professionals as part of a multidisciplinary team.

All public hospitals that provide maternity and gynae care have the skills to deliver 2nd trimester medical abortion care even if they don’t have the surgical skill set within their staffing as this is really no different from caring for someone with a 2nd trimester miscarriage, which these services commonly provide care for.

So in summary I would like to see access to a more comprehensive choice of effective contraceptive options in Australia by increasing PBS access, streamlining TGA approval processes and increasing MBS rebates for LARC provision.

I would also like to see abortion care delivered free at the point of care via self-referral and by a range of healthcare professionals and in a range of settings with clear pathways for all Australians who request this care and this must absolutely include our rural and remote people and those without Medicare access.

Dr Catriona Melville (FRCOG, FFSRH, DipGUM, FRANZCOG), is a specialist in Sexual and Reproductive Health (SRH) and the Deputy Medical Director of MSI Australia.

Catriona completed speciality training in Obstetrics & Gynaecology in the West of Scotland and has spent much of her working life in NHS Scotland, pioneering integrated SRH care, before relocating permanently to Queensland with her family in 2016.

Catriona is the author of Sexual & Reproductive Health at a Glance (Wiley-Blackwell), an Associate Editor for The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) and Deputy Chair of RANZCOG’s Sexual and Reproductive Health Special Interest Group.