SPEECH TO THE NATIONAL WOMEN’S HEALTH SUMMIT

Governments and women’s health: Today I have been asked to talk about how governments can promote and advance women’s health. 

Federal, state and local government have an important role to play in advancing women’s health because of the policy levers at their disposal. It is how these levers are used –if they are even used at all – that will determine how successful Australia is in advancing women’s health.

Now of course government is only one part of a much broader collective effort – including you all in front of me here today. It’s the clinicians, the advocates, the health professionals across the country that are working day after day to improve the lives of women at an individual and group level.

The role of government is to make this work easier for you. To empower you  with the resources and policy settings to make a difference.

I know there can often be a sense of disillusionment about government and policy makers ability to enact real change. And I think it is important to reflect on some of the progress we have made.

A specific example – paid parental leave.

Paid parental leave falls within the social services portfolio. But at its core, it is about health. The health of mums, the health of babies.

The Whitlam Government had introduced paid parental leave for Commonwealth public servants and over the years some businesses had set up their own schemes.

But some 30 years later, a national paid parental leave scheme was still not a reality.

In 2007 Labor took a proposal for a Productivity Commission inquiry into Paid Parental Leave to the election – after my colleagues such as Jenny Macklin and Tanya Plibersek fought for its inclusion in the ALP Platform.

The Productivity Inquiry was established with the support of then Employment Minister Julia Gilllard, and after very tough internal debates, Labor’s PPL offered working women 18 weeks of paid leave from the 1 January 2011.

Where this gets interesting from a health perspective is in the 2014 findings of the evaluation of the program. The evaluation found that:

PPL had a clear effect of extending mothers time at home with newborn up to about 6 months after the birth of their baby.

There were improvements in mothers’ mental health.  Many clearly identified the importance to them of a secure income for their own mental health and for their relationships with their partners.

There were improvements in mothers’ physical health, with increased time on paid leave delaying mothers’ return to work and giving mothers more time to physically recover from the birth, and to adjust to a new baby.

There are couple of conclusions I want to draw from this example. Firstly, that long-lasting and significant change can take time. Paid parental leave wasn’t a new idea.  It took decades to secure the policy that was implemented by Jenny Macklin, and of course, there has still been recent political discussion to secure it into the future.

But the second point that it of course illustrates very powerfully is that it is often those interventions well beyond the immediate health system that can make the most significant and long term change to the health of women, 

Progress over the past decades to improving the health of women and girls – and the very fact that we have a National Women’s Health Policy – did not come about by accident.  It was and remains a central focus of the women’s movement.  It required concerted and sustained effort and I think it is a great shame that much of that work in the past few years has stalled. 

Gender equity matters across all areas of public policy.

There needs to be a broad gender equity framework within which governments operate. We cannot lose sight of the fact that if we do not tackle issues such as the gender pay gap, endemic – and often subtle – discrimination against women and girls, and violence towards women – then very little will change.

Our political institutions are emblematic of the problem.  I am proud that with the arrival of Kristina Keneally in the Labor Party Caucus – we now have 46 per cent of the Labor caucus female - with Ged Kearney we will be at 47 per cent –  and we are on track to reach 50 per cent six years ahead of our affirmative action target. 

The reason I mention this is that while you have challenged me to discuss what governments can do to promote and advance women’s health  - the challenge for all of us, every organisation you represent, is to make gender equity a central part of the way in which we approach decision making. 

Having women at the table matters.  It influences what you choose to concentrate your efforts on.

One of my pet policy hates is the fact that the Government has yet to come up with a solution to tackling the ridiculous situation where tampons and sanitary products are not treated as health products for GST purposes. 

We had a flurry of activity when Hockey announced he wanted to fix it – mind you after 100,000 women had signed a petition calling on the government to do so – and then it all became too hard and nothing happened. I doubt there has even been a discussion in Cabinet since about how to resolve it. 

The fact that Australian women pay 10 per cent more for basic health products like tampons, pads and other sanitary products is an issue of gender equality and one we should resolve.

We are a long way off getting gender equity back into decision making. 

Women do have unique health needs, which often require specific and distinct policy responses.

Cervical cancer screening, breast cancer research funding, funding for the Australian Longitudinal Study on Women’s Health – these are specific and targeted commitments for women.

Recently the Government announced it would develop a national action plan for endometriosis – something we strongly welcomed.

And I was proud to recently announce that Labor would provide $12 million towards funding ovarian cancer gene testing, treatment and research if we are elected.

These are important targeted announcements.

But we also need to recognise that broader systemic issues of inequity have a significant impact on women’s health. Next week, to mark International Women’s Day, Labor’s Deputy Leader and Shadow Minister for the Status of Women will be at the National Press Club addressing many of these very issues.

I want to speak briefly about one of the great unfinished health policy areas for women - reproductive choice.

Abortion is one of the most common medical procedures. But Australia has a patchwork of abortion laws and holes in service provision.

Labor’s addition of the drug RU486 to the Pharmaceutical Benefits Schedule in 2013 has improved access to medical terminations. But medical terminations are only available up to nine weeks and are not always the best option for the patient. Women should have the choice of medical or surgical termination.

At the moment there are many barriers to accessing both medical and surgical options. Location, cost, and the law are some. Depending where a woman lives, she might come up against all three. Roughly 80 per cent of terminations are done in private clinics. There are substantial gaps in public hospital provision. The availability of surgical terminations continues to be an issue for women in rural and regional areas - no matter which state they live in.

In many regional and remote communities, sometimes the only GP in town can’t or won’t help. Less than 1.5 per cent of GPs are trained to offer medical terminations. Medical terminations are already expensive. With the PBS subsidy, RU486 costs around $39 ($6.40 with a health care card) but the average price women actually pay upfront for a medical termination is $560. Travelling to the nearest city, or interstate, means extra costs for transport and accommodation. For a woman on a low income with little support from her family or community, this may be too much.

It seems tragic that a woman would bring a child into the world for no reason other than she couldn’t afford to have a termination.  

The Federal Government has a unique leadership and coordination role when it comes to health. The recent media coverage of gaps in access in Tasmania and Cairns has shown that poor access to termination is not an isolated issue and it is one the Government must tackle.

Access to affordable, safe and legal termination across Australia is critical to address, as is the fact that Australia has one of the highest rates of unplanned pregnancy

Contraceptive failure is the cause of 70 percent of unwanted pregnancies.

Only around 8 percent of Australian women use long acting removable contraceptives – compared to 32% in Europe. We know that LARCs are more effective and cheaper than the pill (noting they may not be the best option for everyone) but women and girls rarely have this option discussed with them.

This would seem to be an area where better promotion and education, and perhaps even MBS payment changes could see greater uptake of LARCs and less unplanned pregnancies.

Of course these aren’t the only issues in reproductive health – there are many other issues that need to be addressed. Lack of reproductive choice can sadly arise through violence against women – with reproductive coercion often forming part of this violence.

These are conversations we need to have, conversations that must be built into policy around reproductive health, if we are to make meaningful progress in reproductive choice in this country.

The other aspect I want to touch on is the health of Aboriginal and Torres Strait Islander women.

A few weeks ago in response to the Closing the Gap report, the Leader of the Opposition Bill Shorten said, and I quote – “When it comes to Closing the Gap, we cannot be content with aiming for anything less than proper equality.”

Things are not equal for Aboriginal and Torres Strait Islander women – the trends reflect this.

Aboriginal and Torres Strait Islander women continue to have poorer health outcomes compared to non-Aboriginal women in Australia.

The life expectancy for Aboriginal women is lower than non-Aboriginal women. 

Rates of pre-existing medical conditions, such as heart disease, diabetes mellitus and renal disease, are higher among Aboriginal and Torres Strait Islander women of reproductive age, compared with other women.

There is a disproportionate burden of adverse perinatal outcomes for Aboriginal and Torres Strait Islander mothers and their babies, including increased maternal mortality, pre-term birth, low birth weight and perinatal deaths.

There has been some progress in certain areas – such as the fact there has been a significant reduction in the proportion of Indigenous mothers who smoked during pregnancy from 50 per cent in 2009 to 45 per cent in 2015. But we must do more to address these trends.

At the heart of improving these statistics is the social determinants of health model.

In 2014, then Labor Senator Nova Peris illustrated this challenge when she this said – and I quote -

This is a confronting face that we all must face. Health progress will not – and cannot – be done in a silo.

This is particularly pertinent for Aboriginal and Torres Strait Islander women. We will not see changes in health outcomes unless they are accompanied by meaningful action in other areas. Violence, security of housing, access to services to name a few.

There are no easy solutions to these challenges – and while, due to time restraints, I have highlighted Aboriginal and Torres Strait Islander Women, there are many other groups of women who need tailored policy action to improve their health.

Migrant and refugee women.

Women with disabilities.

Rural and remote women.

All of which I am pleased are a focus of this conference.

And which I want to make a focus of the national agenda.

As I said before, women’s health can’t exist in a vacuum.

The national women’s health plan was last updated in 2010 – it hasn’t been touched in two terms of Government.

At the heart of the plan is the important concept that we need to support women through the entire lifecycle – from birth to death.

I think it is well beyond time to revisit the issues and concerns Australian women have about their health. We need a new approach to improving the health and wellbeing of all women in Australia, especially those with the highest risk of poor health.

Labor has a long standing commitment to the continuous updating of the National Women’s Health Plan and the Longitudinal Women’s Health Study.  It is a commitment I reiterate today.

The last plan was released by then Health Minister Nicola Roxon, and involved extensive engagement with women across Australia. I am pleased that you have all come together of your own accord to basically do that work. 

We’ve opened our doors on policy engagement this term of Government and I’m pleased to have met with many of you and thank you for your ideas and feedback.

We’ve had a national policy summit, with over 150 health stakeholders in Canberra and subsequent maternal and child health and women’s health roundtables. I hope this demonstrates that we are serious about improving women’s health – but we know we can’t do it alone.

The biggest danger in health is assuming progress is inevitable. That Australia’s good fortune and great universal health care system will lead to equality in health outcomes.

More than ever, we cannot rest on our laurels.

If you have seen the number and calibre of women sitting around the Labor Shadow Cabinet  table when a decision is made you’ll know that you have some strong advocates fighting for better health for all women.

But we know that we cannot do it alone – and that ultimately our job is to support you so that together we can to deliver the best outcomes for Australian women.

Thank you.