Chapter 2Enhancing access to contraceptives
Introduction
2.1Planned parenthood has important long-term benefits for both maternal and infant health. Empowering choice and control in reproductive decisions, including the use of contraception, forms a vital part of family planning and is a key foundation of the National Women's Health Strategy 2020–2030.
2.2The focus of this chapter is contraception, and how it can be best utilised to minimise unintended pregnancies and pregnancy terminations (terminations) and improve sexual health. The chapter starts with a discussion of the issue of unintended pregnancies. It then follows with an overview of the different types of contraceptives available domestically and a discussion of the benefits of long-acting reversible contraceptives, before considering the current regulatory environment. Finally, key barriers that were identified by inquiry participants are canvassed, followed by the committee's view on approaches to improve accessibility and reduce unintended pregnancies and their associated health and financial costs.
Family planning and unintended pregnancies
2.3It is estimated that one in four Australian women experience an unintended pregnancy during their lifetime, with rates even higher in non-urban areas. Anunintended pregnancy may be either an unwanted pregnancy, where no child was wanted at all, or a mistimed pregnancy, where the pregnancy occurred earlier than desired by the parents. Unintended and unwanted pregnancies may also result from traumatic episodes, including rape, incest and domestic violence.
2.4Unintended pregnancies may be attributed to non-use of contraception, inconsistent use or contraceptive failure, and can place significant physical, social and financial strains on women and their families. This is a major health issue and an area of unmet demand for Australian women.
2.5Due to more advanced technologies for reversible forms of female contraception, when compared to their male alternatives, women generally take greater responsibility for their use. This results in women commonly carrying greater financial costs as well as incurring any associated health burdens that may result, such as common negative physical side effects and the consequences of contraceptive failure.
2.6Contraceptives can be accessed from a variety of different dispensing environments, including primary care, community pharmacies, approved private and public hospitals, and sexual health clinics. Accessibility, however, can be impacted by numerous factors, including socioeconomic status, culture, religion, language, and health literacy. Additionally, women living in rural and remote areas are 1.4 times more likely to experience an unintended pregnancy, suggesting that access to contraception remains a problem in these non-urban regions.
2.7The Australian Government can play a key role in reducing the financial, social, economic, cultural and geographic barriers that exist, and ensure that all women are able to exercise choice and control in their decision making regarding contraceptive use.
Different forms of contraceptives
2.8It is estimated that around two in three Australian women between the ages of 18 and 44 years use some form of contraception, with 83 per cent having used contraception at some point in their lives. Younger women are more likely to experience unintended pregnancies and are also likely to use less effective methods of contraception, such as the oral contraceptive pill (OCP) and condoms.
2.9This section will briefly outline the different forms of contraception available, including oral contraceptives, long-acting reversible contraceptives, emergency contraceptives and contraceptives for men.
Oral contraceptives
2.10The OCP is one of the most commonly used contraceptive methods in Australia. There are two types available in Australia—the combined pill and the progestogen only pill. The combined pill contains the hormones oestrogen and progestogen, whereas the progestogen only pills contain only progestogen. These are hormones similar to those produced by the ovaries.
2.11Both are taken daily and are available on prescription. They are considered to be very effective forms of contraception when administered properly. If used correctly, they are at least 99 per cent effective and, even allowing for mistakes, they are still 93 per cent effective in preventing pregnancy.
2.12The OCP can have a number of side effects, including nausea, mood swings, irregular bleeding, thrombosis and bloating.
Long-acting reversible contraceptives
2.13Long-acting reversible contraceptives (LARCs) include hormonal intrauterine devices (IUDs), non-hormonal copper IUDs and hormonal implants. They are considered to be highly effective and suitable for most women of all reproductive ages. Despite its effectiveness and suitability, the uptake of LARCs is relatively low in Australia, with only 11 per cent of women aged between 15and 44 years using a form of LARC.
2.14It is recommended that the insertion of a LARC be completed by an experienced or sufficiently trained health professional. The procedure requires a consultation, various sterile instruments and materials, as well as the availability of a registered nurse or midwife.
2.15Medical practitioners and nurse practitioners can prescribe hormonal IUDs, while hormonal implants can be prescribed by medical practitioners, eligible midwives, and nurse practitioners. Other registered nurses and midwives cannot currently prescribe LARCs.
2.16Medical practitioners, nurse practitioners, registered nurses, and midwives who have completed appropriate training and education are also able to insert and remove IUDs and hormonal implants where these interventions are in line with their professional scope of practice. Notwithstanding this, however, nurse practitioners and participating midwives can only access the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) if they have a documented collaborative arrangement with a medical practitioner. As a result, patients using registered nurses or midwives for the insertion of LARCs face higher out-of-pocket expenses.
2.17The limited availability of health practitioners trained in LARC insertion and removal procedures likely impedes their uptake, particularly in rural and remote areas of Australia.
The benefits of long-acting reversible contraceptives
2.18While a high proportion of Australian women use contraception, unintended pregnancy rates continue to be high, with approximately 10 per cent of women reporting contraceptive failure. These failures can result in significant individual and societal costs.
2.19Although the OCP is considered a highly effective form of contraception when taken correctly, it has a relatively greater failure rate due to incorrect usage and the requirement that it be administered daily. The efficacy of LARCs, however, are far less user dependent and can almost eradicate contraceptive failure.
2.20International evidence suggests that increasing the uptake of these forms of contraception can reduce unintended pregnancy and termination rates across all stages of a person's reproductive life. It is estimated that these types of contraceptives are over 99.5per cent effective, and, although they require a higher up-front cost when compared to OCPs, LARCS are considered to be more cost-effective over time.
2.21Modelling suggests that if Australian women currently using the OCP were to switch to LARC methods, in line with the uptake in comparable countries, estimated net savings would be $68 million over five years. Further, if women using no contraception were to adopt LARCs, in line with the uptake in comparable countries, the value of avoided terminations and miscarriages was estimated at $20 million over five years.
Emergency oral contraceptives
2.22Emergency oral contraception is a method of contraception used after sexual intercourse to prevent pregnancy and is often referred to as the 'morning after pill'. There are two emergency contraceptive pills available in Australia: levonorgestrel and ulipristal acetate. If taken within the recommended timeframe, the emergency contraceptive pill is about 85 percent effective in preventing pregnancy, with ulipristal considered slightly more effective than levonorgestrel.
2.23Both levonorgestrel and ulipristal are available from community pharmacies without a prescription, and their cost can vary between $15 and $60 depending on whether the product contains levonorgestrel or ulipristal.
2.24If a person is unable to take either of these pills, they can have a copper IUD inserted by a trained doctor or nurse within five days of unprotected sex. This also has the added benefit of being an effective form of long-term contraception.
Contraceptives for men
2.25There are currently no hormonal male contraceptive therapeutic goods approved for use in Australia, and either condoms or vasectomies remain the only available forms of contraception for men. Notwithstanding this, there are a number of studies on male contraceptive options, including injections of artificial versions of two naturally occurring male hormones, testosterone and progesterone, that stop the body from producing sperm. Most of these studies have shown that male hormonal contraception is an effective method to prevent pregnancy.
2.26In its submission to the inquiry, the Department of Health and Aged Care (theDepartment) stated that the Therapeutic Goods Administration (TGA) was not aware of any male contraceptive products for which regulatory approval is currently being sought. It also noted that, for a new prescription medicine to be approved, a sponsor must submit a comprehensive dossier with clinical and scientific data supporting the safety, efficacy, and quality of the product. This would typically include data from large clinical trials.
Regulation of contraceptives in Australia
The approval process administered by the Therapeutic Goods Administration
2.27The TGA is responsible for the assessment and regulation of medicines and products in Australia, including contraceptives. The Australian Government also supports access to these products via PBS subsidies and MBS rebates.
2.28The TGA assesses and approves two main categories of contraception:
medicines, including prescription and over-the-counter medicines; and
medical devices, including products that are not medicines but have a physical or barrier effect on the body.
2.29For medicines to be lawfully supplied in Australia, a sponsor must submit an application so the TGA can establish the acceptable safety, quality, and efficacy of the medicine. Once the medicine is approved, it can be included in the Australian Register of Therapeutic Goods (ARTG)—a register of therapeutic goods which can be legally supplied in Australia—and distributed in Australia by the sponsor.
2.30There are a number of regulatory pathways available to sponsors, including some with expedited approval times depending on the circumstances. Theprescription medicines registration process involves eight phases, including two rounds of assessment and independent expert advice on issues concerning the application, if applicable.
2.31There are various types of contraceptive medicines included on the ARTG, including the following:
combined oral contraceptive pill;
progestin only oral contraceptive pill;
transdermal patch;
vaginal ring;
hormonal IUD;
injectables; and
hormonal implants.
2.32Contraceptives which are medical devices and included in the ARTG include the following:
fallopian tube clip/band;
contraceptive cervical cap or diaphragm;
contraceptive sponge;
male/female condom with or without spermicides; and
non-hormonal IUD.
2.33Australia has a national classification system, known as scheduling, that controls how medicines and chemicals are made available to the public. Schedules are published in the Poisons Standard and are given legal effect through state and territory legislation.
2.34Contraceptives such as the combined OCP and LARCs are classified as prescription medicines under Schedule 4 of the Poisons Standard. Under this standard, a pharmacist can only dispense these types of medicines in accordance with a health practitioner's prescription, unless the law of a local jurisdiction permits otherwise.
Pharmaceutical Benefits Scheme subsidies
2.35Once a sponsor has a medicine included on the ARTG, it is the sponsor's decision whether to make a submission to the Pharmaceutical Benefits Advisory Committee (PBAC) for approval under the PBS. The PBAC is an independent expert body appointed by the Government, and its members include doctors, health professionals, health economists and consumer representatives. Its primary role is to recommend new medicines for listing on the PBS, and no new medicine can be listed unless it makes a positive recommendation.
2.36When recommending a medicine for listing, the PBAC takes into account the medical conditions for which the medicine was registered for use in Australia, its clinical effectiveness, safety, and cost-effectiveness when compared to other treatments.
2.37There are some cases where a sponsor may choose to not make a submission to the PBAC for approval under the PBS, for example because of the cost involved and the economic impact on them or because they are still trying to settle into the Australian market.
2.38There are currently 23 brands of contraceptives listed on the PBS Schedule. The majority of these brands relate to oral contraceptives; however, the schedule also includes LARCs and injectables. Although subsidies are available for hormonal implants, injections, and hormonal IUD LARCs, copper IUDs are not currently covered by the PBS. In total, there are currently 26 contraceptive brands marketed in Australia which are not on the PBS.
2.39For the majority of PBS-listed medicines, patients make a single co-payment for one month's supply of medicine; however, for PBS-listed oral contraceptives, patients pay only one co-payment for four months' supply. Up to two repeats may also be prescribed, allowing for the provision of up to one year's supply of medication without requiring a new prescription from a prescribing health practitioner.
2.40From 1 January 2023, general patients who have a Medicare card pay up to $30 for their PBS medicines, whereas concessional patients pay up to $7.30. The Government pays the remaining cost, known as the Commonwealth subsidy, where applicable. In 2021–22, the Government spent over $54 million on PBS‑listed contraceptives.
Medicare Benefits Schedule rebates
2.41The Government also supports access to services associated with the provision of contraceptives through MBS patient rebates for appointments with nurse practitioners, midwives, and GPs (general practitioners), as well as specialist consultations and procedural services.
Barriers to accessing contraceptives in Australia
2.42Inquiry participants highlighted numerous barriers that individuals encounter when attempting to access effective contraception in Australia. As discussed in greater detail below, these included:
a lengthy and expensive TGA approval process;
regulatory restrictions limiting the role of pharmacists;
high financial costs;
inadequate incentives for medical practitioners to bulk-bill;
contraceptives not available on the PBS;
ineligibility to enrol in Medicare;
a lack of community awareness of LARCS and available health practitioner training;
limited access in rural and remote regions and First Nations communities;
limited access to relevant services in public hospitals;
limited support for nurses and midwives; and
a lack of male contraceptive options.
Regulatory barriers
Lengthy and expensive TGA and PBAC approval processes
2.43It was argued during the inquiry that the assessment and approval of new and effective contraceptive methods in Australia can be a long and expensive process. Family Planning Alliance Australia (FPAA) stated that this can result in 'significant delays' to the community being able to access new contraceptive options. It submitted that the 12‑month vaginal ring and desogestral mini pill are already available in parts of Europe, Asia, and the United States, and that the mini pill also has a low‑cost generic option available worldwide, except in Australia.
2.44Women's Health in the South East argued that the TGA has historically taken a 'very conservative and cautious approach' to the approval of new contraceptives. Given this, it said:
Australia now lags comparable settings such as the United States and the United Kingdom, where new contraceptive methods, such as the combined contraceptive patch, and self-administered progesterone injection, have been introduced.
2.45The Royal Australian College of General Practitioners (RACGP) said that the high costs of registration could be a deterrence for some pharmaceutical organisations entering the Australian market and could potentially result in reduced domestic access to otherwise safe and effective contraceptives that are already available in other similar jurisdictions.
2.46The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) also noted the expensive nature of the approval process and the limiting impact it can have on the accessibility of contraceptives by women in Australia.
2.47In her evidence to the inquiry, the Chief Executive Officer of Family Planning Australia, Adjunct Professor Brassil, noted the 'length and turgidness' of the approval process, and argued that it could be 'very much speeded up'.
2.48Several witnesses noted that pharmaceutical companies cannot be compelled to apply to the PBAC for PBS listing of their medications. Asked about particular hurdles that could discourage companies from seeking inclusion on the PBS, a Senior Vice President and National Councillor at the Pharmacy Guild, MsNatalie Willis of the Pharmacy Guild of Australia (Pharmacy Guild), told the committee:
I would only be guessing, but I would imagine it is because they have to meet a cost-effectiveness challenge. They have to be put up against existing oral contraceptives that have been on the market for decades, and somehow prove that they are a more cost-effective or more effective option. In the case of contraception, where it either works or it doesn't it's a little bit difficult to prove that it works better. A lot of the other measures of effectiveness are subjective. I think it's probably a difficult process to be able to navigate.
2.49However, the Department submitted that the costs of the PBAC process are 'in no way prohibitive for pharmaceutical companies' and posited:
In some cases, pharmaceutical companies choose not to go through a PBS listing because they want to charge a different amount; they want to be able to set their own prices. In some cases, it may be that they don't think the market is big enough. The reasons will vary.
2.50It was also highlighted that there are duplicative processes between the TGA and the PBAC. On this issue, the TGA's Chief Medical Adviser, AdjunctProfessor Robyn Langham AM, stated the following:
I know that there are often parallel and duplicative processes that run within the two. The PBS often don't just do an evaluation of cost alone, but do have their own almost parallel assessment of efficacy and safety
Regulatory restrictions limiting the role of pharmacists
2.51Various regulatory restrictions limiting the role of pharmacists were raised as key barriers to contraceptive access across Australia. For example, OCPs are currently listed as prescription medications under Schedule 4 of the PoisonsStandard, and pharmacists are unable to prescribe these forms of contraception. This requires patients to obtain a prescription elsewhere, commonly through their GP.
2.52This situation was seen as particularly problematic given the ongoing shortage of GPs, with evidence from the Pharmacy Guild suggesting that 11 per cent of women miss their OCPs due to difficulty in accessing a GP for a new prescription, and that the average number of days that patients wait for their GP appointment had increased in every state and territory in Australia between 2019 and 2022.
2.53This chronic shortage of GPs was also highlighted in a recently released report by the Australian Medical Association (AMA) which confirmed that the supply of GPs is not keeping pace with growing community demand, and that Australia is facing a shortage of more than 10600 GPs by 2031. The Senate Community Affairs References Committee also explored this issue for outer metropolitan, rural, and regional areas in an inquiry during the 46th parliament and came to similar conclusions.
2.54The 2023–24 Budget provided significant measures to strengthen and support the medical and health workforce. This included higher incentives to expand multidisciplinary team care in general practice, more Medicare Urgent Care Clinics and better access to after-hours primary care.
2.55The Pharmacy Guild argued that the requirement for patients to have a valid prescription for the ongoing supply of OCPs, even while stable on therapy, created an additional barrier and may lead to inconsistent administration of oral contraceptives—which could result in an unintended pregnancy.
2.56The Pharmacy Guild also submitted that patients taking non-PBS listed oral contraceptives are disadvantaged by having to rely on state and territory emergency supply legislation for urgent ongoing medicine supply—with jurisdictional variations in the amount that can be supplied making access inequitable. For example, some jurisdictions only allow a pharmacist to supply three days' worth of medicine, whereas others allow up to one months' worth.
2.57To improve contraceptive accessibility across Australia, a number of inquiry participants called for an expanded role for pharmacists. On this proposal, MsNatalie Willis of the Pharmacy Guild, said:
At a time when Australia's healthcare system is being stretched like never before both financially and in terms of patient access, it's imperative that all healthcare professionals are working to their top of scope. Service gaps in contraceptive and reproductive health care could be addressed by allowing appropriately trained community pharmacists to work to their full scope of practice using their professional training, skills and knowledge to be able to prescribe, dispense, administer and review medicines, including contraceptives.
2.58It was also noted by the Pharmacy Guild that community pharmacies are the most accessible health destinations in Australia, with approximately 97percent of people in capital cities having access to at least one pharmacy within a 2.5‑kilometre radius, and 66 per cent of the rest of the Australian population living and working within a 2.5‑kilometre radius of one. It was highlighted that the majority of pharmacies have extended opening times, including after-hours and on weekends, and many also have consultation rooms that can provide for private consultations.
2.59Endorsing the perspective that pharmacists should have an enhanced role, NewSouth Wales (NSW) Health recently announced a state‑wide pilot for appropriately trained community pharmacists to prescribe certain medications for urinary tract infections and to allow the resupply of previously prescribed low‑risk oral contraceptive medication for women aged between 18 and 35, inclusive.
2.60A similar trial designed to allow pharmacists to practice to their full scope has also been announced by the Queensland Government for Northern Queensland. This pilot is expected to commence in the latter half of 2023 and run through to May2025.
2.61In contrast, the RACGP argued that pharmacists are not trained to conduct consultations regarding contraception and do not have access to a patient's full medical history, and the AMA expressed its strong objection to the down‑scheduling of oral contraceptives to permit over‑the‑counter dispensing and pharmacists being able to prescribe various contraceptive medications.
2.62It was also noted that two applications submitted to the TGA in 2021 to amend the Poisons Standard to down schedule OCPs were unsuccessful, with the delegate deciding at that time that OCPs were unsuitable for down-scheduling due to the complexity of risk factors, adverse effects, and interactions that necessitate regular medical reviews with a GP.
2.63The Government has announced a National Scope of Practice Review (the Review), which has been designed in response to the Strengthening Medicare Taskforce Report. The Review will commence in late 2023 with the intent to review 'barriers and incentives for all health professionals to work to their full scope of practice'.
Financial barriers
High financial costs for contraceptives
2.64The high financial costs of accessing contraceptives were seen as a key barrier to their universal access. The Queensland Nurses and Midwives' Union stated that this problem was particularly acute for young, socioeconomically disadvantaged women, and refugees, and that it could be compounded by further associated expenses, such as GP appointments.
2.65FPAA argued that the cost of LARCs, in particular, could be a prohibiting factor for many people, especially those without access to Medicare. Organon submitted that clinicians servicing rural and remote areas of Australia specifically identified this as an obstacle to increasing their uptake.
2.66Organon also referenced a study on post-abortion contraception choice which noted that some women—particularly those who were younger or from areas of high socioeconomic disadvantage—may have difficulty finding the extra money required for the upfront payment of their preferred LARC method.
2.67Given these barriers, numerous participants called for free contraception to be made available in Australia. It was argued that if contraceptives, including condoms, were provided for free, unintended pregnancies and terminations would reduce. It was also noted that such a policy could have the added benefit of reducing sexually transmissible infections within the community.
2.68Submitters indicated that a number of other comparable countries, including France, Sweden, the United Kingdom, and New Zealand, already offer no-cost contraception for various demographics, such as people under a certain age. In France's case, evidence suggested that once contraception was made free, the number of terminations decreased materially—from 9.5 per cent in 2012 to 6percent in 2018.
2.69Research undertaken in the United States also concluded that girls and women who were provided contraception at no cost—and educated about reversible contraception and the benefits of LARCs—had rates of pregnancy, birth, and termination that were much lower than national rates for sexually active teens.
2.70During the inquiry, it was argued that the current MBS rebates for contraceptive procedures performed by GPs do not provide sufficient remuneration for bulk‑billed services to be financially viable for GP practices and community service clinics. RANZCOG submitted that this has resulted in service providers having to charge their patients a gap payment to perform these procedures, which can be prohibitive to those individuals with limited financial resources.
2.71The Southern Regional Medical Officer at True Relationships and Reproductive Health, Dr Danielle Haller, said that the MBS item number for IUD insertions was 'woefully inadequate'. Expanding on this, she said:
… it takes 45 minutes at least for the consultation, including the paperwork and the insertion. An IUD pack that we need to use for that is $25, and a nurse is required for the full 45 minutes as well. All in all, we get $72 from the MBS for that particular procedure, so that definitely doesn't cover costs there.
2.72The President of the RACGP, Dr Nicole Higgins, said:
For the last 10 years [the MBS rebate] has been frozen, and the indexation was at only 1.6 per cent last year. So it is still effectively frozen as inflation goes up. For a long time general practice has subsidised Medicare on behalf of patients, because very often if we are going to bulk bill that means we are accepting that as full payment and we can no longer afford to subsidise.
2.73In its submission to the inquiry, the RACGP also highlighted that this lack of adequate remuneration was a potential cause for the low number of LARC service providers in Australia, particularly in rural and remote areas. To address this issue and ensure that GPs are adequately remunerated if they choose to bulk-bill, both RANZCOG and RACGP called for increased Medicare benefits.
2.74The committee notes the recent 2023–24 Budget announcements from the Australian Government, that included $3.5 billion to triple the bulk bill incentive to make healthcare more affordable for 11.6 million children under 16, pensioners and other Commonwealth concession card holders, as well as the introduction of a longer level E consult.
2.75The committee also notes that through the 2023–24 Budget, the Government has provided a $1.5 billion indexation increase to the Medicare rebates and invested $3.5 billion to triple the bulk billing incentive to address the decline in bulk billing rates over recent years.
2.76In addition to inadequate remuneration for GPs, other inquiry participants also highlighted the lack of financial support for nurse practitioners and participating midwives in the insertion of LARCs. This issue is discussed further in this chapter.
Contraceptives not available on the PBS
New oral contraceptives
2.77Oral contraceptives can either contain estrogen and progestogen, together, or progestogen only. For contraceptive use, the PBS only subsidises oral products containing ethinylestradiol (estrogen) combined with either levonorgestrel or norethisterone (progestogen), as well as progestogen only contraceptives containing either levonorgestrel or norethisterone alone.
2.78Like many medicines, oral contraceptive technologies have continued to evolve over time and products containing newer estrogens and progestogens to those currently listed on the PBS are now available.
2.79Ms Natalie Willis from the Pharmacy Guild said:
I don’t think an oral contraceptive has been listed on the PBS certainly in my 25 years as a pharmacist. The ones that are there are some of the original ones that are historically the go to. There’s been a considerable evolution of technology over that time, and the new pills offer greater benefits to women in terms of reduced side-effects, reduced dosages, better effectiveness for certain medical conditions other than contraception—these sorts of things. None of these oral contraceptives have been listed on the PBS, which is restricting access. Some of them can be as much as $70 or $80 for a three‑month course. That is certainly a barrier to access.
2.80The Chief Executive Officer of the Coffs Harbour Women’s Health Centre, MsShelley Rowe, said:
Currently we only have two that are covered by the PBS, one of which is rarely available. The rest of the oral contraceptive pills are private scripts, which is a huge gap in financial costs for women. For some women, that’s not viable, because it’s the difference between paying $1.50 to $3 a month and paying up to $25 to $29 a month. So it’s huge. For some women, that’s not doable.
2.81RANZCOG noted the limiting and inequitable nature of the PBS, which only covers the basic OCPs, when alternative formulations may be more appropriate for particular patients when they help reduce androgen symptoms, such as acne and hirsutism. It argued that with more choice there will be 'higher acceptability, satisfaction, and continuation rates'.
2.82Dr Danielle Haller, a regional medical officer at True Relationships and Reproductive Health, noted that some PBS-listed OCPs could be less effective as 'clients stop taking the pill because they get moody' or miss pills because of the limited timeframe within which some OCPs must be taken each day to retain their effectiveness.She also noted that a non-PBS listed OCP with no oestrogen 'has a great place for people who can’t take oestrogen, because they’ve had blood clots or migraines' but was significantly more expensive than PBS listed options.
2.83In its submission, the RACGP stated that not having newer forms of OCP listed on the PBS 'limits access of these contraceptives to people who can obtain a private prescription and pay to receive the script'.
2.84The Pharmacy Guild highlighted that, although a large study conducted in Europe and the United States found that some newer oral contraceptives have a more favourable safety profile than ethinylestradiol‑based oral contraceptives, these contraceptives are only available on non-PBS prescriptions in Australia. It stated that this can ‘place an unreasonable financial burden on patients wishing to use them’. The Pharmacy Guild further argued that:
For individuals where a non-PBS listed product is most appropriate, the cost of non-PBS listed products may become a barrier to the use of effective contraception, limit patient choice and cause inequity of access.
Emergency oral contraceptives
2.85There are currently two types of emergency oral contraceptive pills available in Australia: levonorgestrel and ulipristal acetate, and, according to evidence from the Pharmacy Guild, if taken within the recommended timeframe, they are approximately 85per cent effective in preventing a pregnancy.
2.86The two types of emergency contraceptive pills are available through community pharmacies without a prescription, they are not currently listed on the PBS and can cost anywhere between $15 and $60—depending on the specific vendor and which medication the product contains. This can create a significant financial barrier for many women, especially those on low incomes.
Long-acting reversible contraceptives
2.87Currently, a number of effective LARCs are not listed on the PBS, including the vaginal ring and the copper IUD. It was argued that this lack of rebate limits access to these forms of long-term, and, in the case of the copper IUD, emergency, contraceptive devices to those who can afford a private prescription.
2.88This issue was raised by a number of inquiry participants as a key barrier to accessing contraception, with RANZCOG and Children by Choice advocating for the PBS to subsidise the vaginal ring to improve its affordability. RANZCOG also noted that increasing community awareness of this form of contraception may be beneficial in the future when multipurpose vaginal rings—preventing not only pregnancy, but also, potentially, the human immunodeficiency virus and other sexually transmitted infections—become available.
2.89Of particular concern to Family Planning NSW (FPNSW) was the exclusion of the copper IUD from the PBS, resulting in higher costs, or total inaccessibility, for patients—even when this form of contraception was assessed as the most effective method for them. FPNSW and RACGP argued for it to be available on the PBS for those requiring, or desiring, a non-hormonal LARC, as well as for those seeking effective emergency contraception with a longer-term application.
2.90In her evidence to the inquiry, the Acting Deputy Secretary of the Health Products Regulation Group within the Department, Ms Tracey Duffy, indicated that inclusion of the copper IUD on the PBS would not be possible due it being a medical device. On this issue, she said:
[A copper IUD] is a device and [the] PBS is about pharmaceutical medicines. We don’t have an equivalent list for devices, other than the devices that are on the Prostheses List for the purpose of private health insurance. So there’s no equivalent PBS for devices.
Inability to enrol in Medicare
2.91Due to the PBS only being available to Australian residents who hold a Medicare card, temporary migrants, including international students and temporary workers, are not eligible to receive subsidised medication. The Multicultural Centre for Women’s Health (MCWH) noted the wide‑reaching negative impacts this policy can have on these migrant communities, including basic healthcare needs not being met, additional private health insurance and out-of-pocket expenses, and adverse psychosocial outcomes.
2.92The MCWH said that, even if the Government were to include additional contraceptives on the PBS, this would not improve affordability for these ineligible communities. In fact, evidence stated such a policy would likely widen the health inequity across various cohorts of people living in Australia.
2.93RANZCOG also raised this issue, stating that the cost of contraceptive services can be prohibitive for people who are ineligible for Medicare, especially if they require procedures in the office or under anaesthesia. It called for contraceptive services to be free for all clients ‘regardless of visa status’.
2.94MCWH also called for reform and submitted that:
Access to free or lower cost contraception, and a wider range of contraceptive options should be widely available to everyone, regardless of visa category. Extending Medicare should not be regarded as a radical or innovative solution but should be seen as a necessary requirement for universal access for all people living in Australia.
Accessing contraceptives
Lack of awareness and training opportunities
2.95It was argued that Australia has not sufficiently invested in community and professional education about the benefits and higher comparable effectiveness of LARCs over OCPs. FPNSW stated that, because of this lack of investment, neither health practitioners nor women were clear about the relative efficacy of LARCs and, as a result, often chose traditional methods of contraception. It concluded that this resulted in ‘higher rates of unplanned pregnancy, higher abortion rates and higher costs for contraception’.
2.96SPHERE said that this lack of familiarity and misinformation about LARCS among both women and health practitioners was another key barrier to their uptake.
2.97Evidence also indicated that there are minimal training opportunities available in community settings for the insertion and removal of IUDs and implants, and that there is no integrated approach to the provision of contraceptive care training. This was identified as a key barrier to the broader uptake of LARCs within the community.
2.98Professor Danielle Mazza highlighted the importance of the Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS) and called for its ongoing funding—which is due to cease in early2024. It was noted that this initiative brings together key stakeholders and offers peer networking, support for clinical issues, a resource library, checklists, training links, webinars, podcasts, case discussions, and a database of local providers.
Limited access in rural and remote regions and First Nations communities
2.99The committee heard that accessing health services continues to be a challenge within rural and remote regions, as well as First Nations communities. Additionally, long wait times to access GPs in these regions and communities remain problematic, especially for people seeking contraception access and script renewals.
2.100Rural and remote women are also more likely to experience domestic and family violence, and have higher rates of unplanned pregnancies, infant mortalities, and low birthweights and preterm babies. It was reported that these rates also increase with remoteness—an outcome which was thought to be associated with poorer access to health services.
2.101Contraceptive use among First Nations communities is reportedly lower than for non‑Indigenous Australians. A number of contributing factors were suggested for this, including potential apprehension due to historical experience with forced contraceptive use and the removal of children, stigmatisation, lack of sexual health education and limited access to contraceptives.
2.102While First Nations Australians have a range of options of primary healthcare providers, a large majority prefer to access care through an Aboriginal Community Controlled Health Organisation (ACCHO). This can be due to a variety of reasons, including locality, cultural safety, and holistic service offerings. Although it was reported that condoms are readily available from these organisations, the Aboriginal Health and Medical Research Council ofNSW (AHMRC) said the primary challenge was increasing access to LARCs and insertion services.
2.103The AHMRC noted that ACCHOs are currently restricted in their ability to provide these services due to limited access to GPs, gynaecologists, trained nurses, and midwives who can perform insertions and removals. It also noted the constraints on the reimbursement that can be claimed through Medicare when eligible nurses or midwives perform these services.
2.104Where an ACCHO is unable to provide these services directly, patients are often referred to non-community controlled services, which may be culturally unsafe and attract out-of-pocket costs—both of which discourage uptake.
2.105Evidence also suggested that the limited availability of health practitioners trained in LARC insertion and removal procedures in non-metropolitan Australia likely impedes the increased uptake of these effective forms of contraception.
2.106To address these issues, SPHERE proposed that a comprehensive and integrated approach to regional contraceptive care be developed and implemented. It envisaged that this would identify existing gaps in service provision at the local level, with specific consideration for the needs of regional, rural, and remote communities.
Limited access to services in public hospitals
2.107Access to private sector healthcare providers is not always possible for people living in rural and remote areas, as well as for those people with limited financial resources. Given this, RANZCOG argued during the inquiry that the provision of public hospital based contraceptive services was important in ensuring equitable access across Australia.
2.108RANZCOG submitted that public hospitals should have clinics and theatre lists dedicated to the provision of contraceptive services to their communities, and that increasing access to free outpatient procedures, especially in rural and remote areas, was key to reducing the disparities that currently exist across Australia—with rural women being 1.4 times more likely to have an unintended pregnancy.
2.109In addition to this proposal, a number of inquiry participants advocated for postpartum LARC services to be available at hospitals prior to discharge, complemented by increased access to antenatal and postnatal contraceptive counselling.
Limited support for nurses and midwives
2.110Although registered nurse-led assessment, insertion and removal of implants and IUDs is already taking place in Australia, limited financial support was seen as a barrier to the provision of these services by these health practitioners. FPNSW submitted that nurses lack access to the MBS and other sustainable funding sources and stated that this severely limits the provision of LARCs and reduces access to these effective forms of contraception in areas of unmet need.
2.111Adjunct Professor Brassil said that FPNSW had undertaken research demonstrating that registered nurses and doctors who had gone through the same training program had had similar academic and clinical outcomes in the insertion and removal of IUDs and implants. Notwithstanding this, she said that discrepancies in remuneration arrangements continued to exist:
… there’s no income stream for nurses to provide these services, whereas GPs can charge Medicare. There are some very partial arrangements for funding nurses in GP practices, but they don’t cover full wages and they’re really quite inadequate for nurses to actually be able to sustain a career providing these services.
If we could have these highly trained and competent nurses available, particularly in areas where GPs aren’t available, we could provide the same level of services to our clients or our patients.
2.112A Women’s Health Nurse at the Lismore Women’s Health Resource Centre, MsAmala Sheridan-Hulme, said:
I don’t see, in my line of work, a shortage of nurses to actually fill roles, particularly in out-of-hospital community based organisations. The biggest issue that I see is that nurses aren’t included in Medicare rebates. So, whilst there are trained staff like me who can do cervical screening tests, Implanon insertions, IUD insertions, just to name a few—and there are a lot of other things that nurses can actually do, particularly midwives—there’s no incentive for either private clinics or non-government organisation clinics, I guess, to train up their staff to do this if they can’t get those rebates to make it worth their while.
2.113Dr Haller from True Relationships and Reproductive Health also recognised this lack of utilisation of an existing workforce due to inadequate remuneration arrangements. She said:
… there is underutilisation of the current resources that we have. For example, nurse practitioners who insert IUDs and Implanons can’t actually access the Implanon and IUD insertion MBS item numbers. [T]hey would be a great resource to do … those things.
2.114SPHERE also commented on this problem, stating the following:
Although registered nurses, nurse practitioners and registered midwives are well-placed to provide LARC insertion and removal services, as occurs in many other countries and in some settings in Australia, there is no remuneration available to support this model of task-shifting/sharing or to encourage nurses and midwives to undertake the training or provide this service.
2.115The Chief Executive Officer at Sexual Health and Family Planning ACT, MrTimBavinton, said:
… the Australian healthcare system does not deploy nurses well the way that Medicare is structured. To exclude most nursing services means we are not making best use of our nursing, from our EN [enrolled nurse], RN [registered nurse], advanced practice and our nurse practitioner workforce in Australia in this area, as in many others.
2.116The Australian Women’s Health Nurse Association stated that by better supporting nurses and midwives to work to their full scope of practice in contraceptive care, Australia’s health workforce could be expanded. TheMelbourne School of Population and Global Health argued that this would facilitate equitable access to LARCs and that these health practitioners were well placed to provide these services.
2.117A Senior Federal Professional Officer at the Australian Nursing and Midwifery Federation, Ms Julianne Bryce, said:
It is imperative that the contribution of nurses and midwives to sexual and reproductive health is recognised and their full scope of practice realised to improve the health of women living in Australia. Building on the existing nursing and midwifery workforce, nurse and midwife-led models of care offer a viable solution to the largely medical model to increase access to reproductive healthcare services for women living in metropolitan, regional, rural and remote areas.
Limited prescribing ability for midwives
2.118The Australian College of Midwives (ACM) submitted that the Australian midwifery workforce is currently an underutilised resource in Australia and that, if adequately supported, could play a crucial role in delivering universal access to reproductive and women’s healthcare, underpinned by choice and autonomy.
2.119The ACM argued that PBS coverage is limited for endorsed midwives (Ems) to provide contraceptives. It said that, although Ems can prescribe contraceptives listed on the PBS for Midwives, this list is ‘very limited’, and both IUDs listed on the PBS are not available for midwives to prescribe. This restricts accessibility of contraceptives for women in a trusted midwifery continuity of care setting.
2.120The ACM called this policy ‘discriminatory’, in that it necessitates private script pricing versus PBS pricing for women prescribed some contraceptives by a midwife. Further, it was argued that these restrictions do not allow the midwifery workforce to work to their full scope of practice, which can limit vital healthcare for women—particularly those living in rural and remote areas, and those with known barriers to access, such as First Nations people, migrant and refugee women, and adolescent mothers.
2.121The Australian Nursing and Midwifery Federation noted similar concerns, in which it stated that it is imperative for nurses and midwives to realise their full scope of practice to improve the health of Australian women.
Lack of male contraceptive options
2.122There are currently no hormonal male contraceptive therapeutic goods registered in Australia, and either condoms or vasectomies remain the only available forms of contraception for men. Further, the Department submitted that it is not aware of any male contraceptive products for which approval is currently being sought.
2.123This lack of alternatives was noted by inquiry participants, with FPNSW stating that there are currently ‘very limited options’ for male contraception, and the responsibility for birth control remains largely with women. It also highlighted that, although vasectomies are a viable option for men, access to this procedure can be very limited and is highly dependent on the availability of trained clinicians.
2.124FPNSW recommended that the Government provides funding to increase the number of clinicians training in vasectomies and continues to support research into viable options for men.
2.125The Melbourne School of Population and Global Health submitted that the lack of male-controlled contraceptive options limits men’s ability to ‘achieve their own reproductive health goals and engagement in pregnancy prevention’. It called for the Government to support clinical trials and studies exploring the development of new male-controlled contraceptive options.
Committee view
2.126During the inquiry, participants proposed a variety of initiatives aimed at reducing, and potentially eliminating, the barriers that people encounter when trying to access contraceptives.
Addressing regulatory barriers
2.127The committee strongly supports the TGA's role in ensuring that the medicines available in Australia meet appropriate standards of quality, safety and efficacy. This enables health practitioners to have confidence in the medicines that they prescribe to their patients, and for patients to have peace of mind, knowing that their medication has gone through a robust and rigorous approval process.
2.128Notwithstanding this, the committee notes that inquiry participants suggested that the current TGA approval processes can be overly lengthy and expensive and present a potential deterrence for pharmaceutical organisations in seeking approval to supply their products in Australia. The committee also notes evidence relating to the potential for efficiency gains between the TGA and PBAC, with the TGA acknowledging that there were parallel and duplicative processes across both entities.
2.129Given this, the committee is concerned that Australian consumers may not always have access to the most effective and safe contraceptive methods already available internationally and that Australia lags behind other comparable countries, such as the United Kingdom and the United States. The committee does however acknowledge that a sponsor cannot be compelled to make a submission to the TGA or PBAC for consideration.
2.130The committee considers that there is merit in the TGA reviewing its approval processes for new contraceptives to ensure that Australian consumers are not left behind and have access to the latest, most effective and safest contraceptive options available internationally.
2.131The committee recommends that the Therapeutic Goods Administration reviews its approval processes to ensure that Australian consumers have timely access to the latest and safest contraceptive methods available internationally.
Enhance the role of nurses, midwives, and community pharmacists
2.132The committee acknowledges there were mixed views on a number of proposals to enhance the role of pharmacists, such as contraceptive prescribing and down‑scheduling oral contraceptives. The committee recognises these concerns regarding patient safety, but is also concerned by reports that the average number of days that patients wait for a GP appointment has increased in every state and territory across Australia between 2019 and 2022, and that an estimated 11 per cent of women miss their OCP due to difficulties in accessing their GP for a new prescription. The committee also notes the investments through Budget 2023–24 to strengthen Medicare, including the recently announced National Scope of Practice Review.
2.133The committee notes that community pharmacies are considered to be one of the most accessible health destinations in Australia, with evidence indicating that they have extended opening hours—including after-hours and on weekends—and that 97 per cent of people in capital cities, and 66 per cent of people outside of capital cities, have access to a pharmacy within a 2.5-kilometre radius of where they live or work.
2.134The committee supports an increased role for community pharmacists in providing sexual and reproductive healthcare across Australia that would allow them to work to their full scope of practice in this area. The committee believes that the better utilisation of the skills and knowledge of community pharmacists would greatly assist in addressing unmet needs across the Australian community in the provision of contraceptive care and recommends that the Government’s recently announced National Scope of Practice Review consider options on how to best achieve this.
2.135The committee strongly supports the role that midwives play in providing reproductive and women’s healthcare in Australia. The committee also shares concerns raised by the Australian College of Midwives that PBS coverage is limited for endorsed midwives to provide contraceptives, thus restricting the ability of midwives to work to their full scope of practice.
2.136Consequently, the committee acknowledges the importance of enabling nurses and midwives to work to their full scope of practice, as highlighted by the Australian Nursing and Midwifery Federation.
2.137The committee also notes the recently announced state‑wide pilot in NSW that will allow participating pharmacists in that jurisdiction to prescribe medication for urinary tract infections to women under the age of 65 and to resupply low-risk oral contraceptive medication that has been prescribed for contraceptive purposes to women aged between 18 and 35, inclusive, by a GP or nurse practitioner in the last two years—even if the script has expired.
2.138The committee supports the Australian Government's National Scope of Practice Review, which will investigate barriers and incentives to health practitioners working to their full scope of practice. The Review will enable consideration of opportunities for workforce development and incentivisation. This is a national review working with states and territories and will identify regulatory and legislative barriers and provide recommendations to improve the scope of health practitioners practice in Australia.
2.139The committee also notes evidence related to the material discrepancies between the supply quantities allowed under state and territory emergency supply legislation and that permitted under existing continued dispensing arrangements. The committee recommends that the Australian Government, in consultation with state and territory governments, looks at how these discrepancies can be addressed.
2.140The committee recommends that the National Scope of Practice Review considers, as a priority, opportunities and incentives for all health professionals working in the field of sexual and reproductive healthcare to work to their full scope of practice in a clinically safe way.
2.141The committee recommends that state and territory governments work towards aligning supply quantities of Pharmaceutical Benefits Scheme (PBS) and non-PBS oral contraceptive pills allowed under state and territory emergency supply legislation.
Ensuring contraceptives are affordable
Make contraceptives more affordable
2.142Evidence provided during the inquiry indicated that the high costs of contraceptives were seen as a key barrier to their accessibility, and that this issue was particularly acute for younger demographics and those who were socioeconomically disadvantaged.
2.143To address this issue, the committee notes that a number of countries and jurisdictions have introduced no‑cost contraception for all their residents or for certain age groups—such as people under the age of 26 in France. It was indicated during the inquiry that research in the United States concluded that such an approach can be effective, and that girls and women who were provided no-cost contraception, and were educated about LARCs, had lower rates of pregnancy, birth and termination than the national rates for sexually active teens.
2.144The committee notes support from submitters regarding the proposal to provide free contraceptives, including OCPs, LARCs, and condoms, for people living in Australia under the age of 26. The committee notes the evidence received regarding the benefits of this proposal in reducing unintended pregnancies and terminations, while also lowering the spread of sexually transmissible infections.
2.145The committee recommends that the Australian Government reviews, considers and implements options to make contraception more affordable for all people.
Ensure health practitioners receive adequate remuneration to bulk-bill
2.146The committee recognises the importance of bulk-billing in promoting access to LARCs and improving their uptake in Australia. The committee agrees that the current remuneration provided by Medicare to perform LARC procedures is completely inadequate to make bulk-billed services financially viable for health practitioners. The committee notes evidence suggesting that the MBS rebate has been frozen for most of the last decade, with only a 1.6 per cent increase last year—well below the inflation rate. This is unacceptable and unsustainable.
2.147The committee notes the recent Budget 2023–24 announcements that included a $3.5 billion investment to triple the bulk bill incentive, $1.5 billion indexation boost to Medicare rebates and an introduction of a longer, level E consult.
2.148The committee also supports task sharing through the delivery of contraceptive care by nurses and midwives, including the insertion and removal of LARCs. Nurses and midwives represent the largest health workforce in Australia, are highly educated and capable, and continue to be at the forefront of healthcare delivery. By financially supporting these practitioners to work to the full scope of their practice, the committee considers that improved remuneration would greatly enhance contraceptive accessibility throughout Australia.
2.149The committee recommends that the Australian Government ensures that there is adequate remuneration, through Medicare, for general practitioners, nurses, and midwives to provide contraceptive administration services, including the insertion and removal of long-acting reversible contraceptives.
Expand the Pharmaceutical Benefits Scheme
2.150The committee is concerned with evidence suggesting that the PBS is outdated and does not include newer OCPs, the two types of emergency oral contraceptives and a number of effective LARCs. This creates inequities and barriers for people wanting to access different methods of contraception.
2.151The committee was concerned to hear the evidence that a new OCP has not been listed on the PBS in over 25 years, resulting in women not being about to affordably access more modern forms of the OCP. The committee understands that some modern OCPs may be more appropriate for particular patients, have reduced negative side effects and can be effective in reducing androgen symptoms, such as acne and hirsutism.
2.152The committee supports calls for the Government to work with industry to provide additional support for people to be able to access LARCS not currently accessible on the PBS. These contraceptive options are proven to be 99.5per cent effective, less user dependent, and more cost‑effective over time. Evidence demonstrated that increasing uptake of LARCs can reduce unintended pregnancies and termination rates across all stages of a women’s reproductive life.
2.153The committee is of the view that increasing community awareness and uptake of the vaginal ring, in particular, may be beneficial for future developments if multipurpose rings become available which, in addition to preventing unintended pregnancies, can also reduce the transmission of sexually transmitted infections. The committee also recognises the effectiveness of the copper IUD and that, in addition to being an effective form of long‑term contraception, it can also be utilised as an emergency contraceptive option for women who would prefer, or require, a non-hormonal alternative.
2.154The committee notes that, although there were calls for the copper IUD to be included on the PBS, evidence from the Department indicated that this would not be possible due it being a medical device. The committee considers that this technical distinction should not restrict women's access to this effective form of contraception and that the Government should look at ways to provide an equivalent subsidisation to that which would be provided if it were permitted to be included on the PBS.
2.155In conclusion, while the committee recognises that the TGA and PBAC cannot compel a sponsor to submit an application, the committee considers that improved consumer choice will result in higher acceptability, satisfaction, and continuation rates of effective contraception within the community. Given this, the committee recommends that the Government works with industry to expand and improve the PBS to include newer forms of the OCP, the emergency OCPs, and the vaginal ring, and that an equivalent support be provided for the copper IUD.
2.156The committee recommends that the Department of Health and Aged Care and the Pharmaceutical Benefits Advisory Council work with the pharmaceutical industry to consider options to improve access to a broader range of hormonal contraceptives that are not currently Pharmaceutical Benefits Scheme subsidised, including newer forms of the oral contraceptive pill, the emergency oral contraceptive pills and the vaginal ring.
2.157The committee recommends that the Department of Health and Aged Care considers and implements an option to subsidise the non-hormonal copper intrauterine device to improve contraceptive options for people with hormone-driven cancers and people for whom hormonal contraception options may not be suitable.
Expand accessibility for people ineligible for Medicare
2.158The committee is concerned about the negative impacts that Medicare ineligibility may have on people residing within Australia, and that this can result in basic healthcare needs being left unmet and additional costs being incurred by vulnerable people.
2.159The committee notes calls by inquiry participants for effective and low-cost contraceptives to be available to all people residing in Australia, regardless of whether they are enrolled in Medicare, and regardless of their visa status. This issue, as well as the broader problem of sexual and reproductive healthcare access for non-Medicare eligible residents is further discussed in Chapter 4, along with the committee's view and recommendation aimed at addressing it.
Improving access to contraceptives and community awareness
Improve community awareness of LARCs and provide training opportunities
2.160Given the significant benefits that LARCs can provide, the committee is concerned about the ongoing lack of awareness and knowledge—both at the broad societal level and within the health practitioner community—regarding the effectiveness of LARCs compared to more traditional contraceptive methods, such as the OCP.
2.161Evidence indicated that only 11 per cent of Australian women utilise these forms of contraception and that Australia lags behind other comparable countries, such as the United Kingdom where 46 per cent of women utilise these methods.
2.162The committee notes the significant benefits that LARCs may provide, both clinically and in long-run costs, for women for whom these methods are preferred and appropriate, and supports the proposal for a comprehensive public health campaign to increase community awareness, knowledge, and uptake, and to counter existing social media misinformation.
2.163The committee also recognises the importance of AusCAPPS and recommends that the Government continues to fund this important initiative past 2024, when the existing funding arrangements are due to cease.
2.164The committee recommends the Australian Government works with the Royal Australian College of General Practitioners and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists to improve access to workforce training for the insertion and removal of long-acting reversible contraceptives to support their increased utilisation in Australia.
2.165The committee recommends that the Australian Government considers the continuation of funding for the Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS) to provide ongoing support and professional development for practitioners.
Address service gaps in rural and remote regions and First Nations communities
2.166The committee recognises that immediate action must be taken to address the completely unacceptable situation that currently exists across regional, rural, and remote Australia, where women and girls living in these communities have poorer health outcomes than their metropolitan counterparts and experience a multitude of additional barriers when attempting to access contraceptive services and products.
2.167The committee is very concerned that individuals living within these communities continue to experience longer wait times to access their local GPs, and that they are more likely to experience higher rates of unplanned pregnancies, infant mortalities, and preterm babies.
2.168The committee recognises the importance of ACCHOs in delivering culturally safe and holistic care to their local communities and the role that they play in improving awareness and uptake of contraceptives. Given their importance, the committee is concerned with evidence indicating that these organisations are restricted in their ability to provide these services.
2.169The committee considers this to be a priority area for the Government and that it should work with other stakeholders to ensure that these communities receive the same level of choice and access to contraceptives as people living in metropolitan areas. Given this, the committee supports the proposal that the Government develop an integrated regional approach, in consultation with the relevant Primary Health Network for the provision of contraceptive care, with a focus on those individuals living in regional, rural, remote, and First Nations communities. This is discussed in more detail in Chapter 4.
2.170The committee recommends that the Australian Government considers and implements a separate Medicare Benefits Schedule item number for contraceptive counselling and advice for all prescribers, including midwives.
Improve access to male contraceptive options
2.171The committee notes that the lack of accessible male contraceptive options results in the responsibility of birth control falling on women. Given this, the committee suggests that the Australian Government increases its support for research into other viable reversible contraceptive methods for males.
2.172The committee recommends that the Australian Government and/or relevant organisations support research into the availability and development of contraceptive options for males.