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RACGP pushes for greater reproductive healthcare access

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Changes are required to reduced significant barriers to reproductive care, particularly in rural and remote communities, the RACGP has told a Senate Inquiry.
 
The call for greater access, contained in an RACGP submission to the Senate Inquiry into Universal access to reproductive healthcare, features a number of recommendations, including: 

• making the full range of contraceptive options accessible and affordable to all
• adding medicines for medical termination to the Prescriber Bag to improve access in rural and remote areas
• allowing greater quantities of contraceptive pills to be dispensed at one time
• financial support for GPs who wish to train in surgical abortion and insertion/removal of long-acting reversible contraceptives (LARCS), and incentives for GPs who provide these services in rural and remote areas
• extending temporary telehealth items for non-directive pregnancy support counselling beyond 30 June 2023
• harmonising state and territory legislation for medical and surgical termination.

RACGP President Dr Nicole Higgins, who is also an advisor to the National Women’s Health Advisory Council, said improving access to abortion and contraceptive services is vital.
 
‘Safe abortion and contraceptive services must be affordable and accessible for all those who need it,’ she said.
 
‘However, as a regional GP, I know all too well that there are significant barriers to reproductive care for people in rural and remote communities, particularly those who wish to access termination services.’
 
Dr Higgins believes cost is a ‘key barrier’ to abortion services, and that the Federal Government can do a lot to improve affordability.
 
‘In Mackay, where I am, if a woman presents for an abortion later than nine weeks or has a failed medical termination, they have to go to Brisbane which is 1000 km away, at a cost of $650 plus flights and accommodation,’ she said.
 
‘Funding Medicare patient rebates for longer consultations [is crucial] because counselling on unplanned pregnancy and other reproductive health matters takes time.
 
‘Extending the relevant telehealth items for non-directive pregnancy support counselling … is especially important for those in rural and remote areas.’
 
In addition to cost, Dr Higgins said there are also barriers for rural GPs who want to provide reproductive healthcare.
 
‘This includes hospital services being too far away, a lack of access to blood products, lack of access to a gynaecologist to provide backup care in the rare event it’s needed, as well as difficulty accessing relevant drugs from pharmacies,’ she said.
 
‘Adding medicines for medical termination to the Prescriber Bag will make a big difference in improving access. This will enable GPs to keep a supply of these medicines for patients in need, so they won’t need to search for a pharmacy that stocks them, which is particularly important in rural and remote areas.’
 
Previous research has shown that around half of all pregnancies in Australia are unplanned, and it is thought half of those are terminated. Moreover, between one quarter and one third of Australian women will experience an abortion in their lifetime, with the majority feeling it was the right decision.
 
However, even though the rate of early medical abortion is greater among women in rural and remote Australia, a considerable proportion live in areas in which the PBS listed drug for medical termination up to 63 days’ gestation is never or rarely prescribed or dispensed.
 
A recent Marie Stopes report also showed that in 2021, just 2462 GPs were authorised to prescribe the combined medications, and Dr Higgins said incentives are needed to encourage more doctors to provide both medical and surgical abortion services.
 
‘GPs are often the first port of call for people seeking support for unplanned pregnancy, and other reproductive health matters, because they know and trust their GP and GPs are best placed to provide these services,’ she said.
 
‘There should be financial support for GPs who wish to train in surgical abortion, and incentives for GPs to deliver these services in rural and remote communities – this is an easy way to improve access across the country.
 
‘The RACGP has always said access to safe medical or surgical abortion services for those who need them is essential, no matter their postcode.
 
‘While we must respect the right of GPs and other healthcare providers to consciously object from providing such care, those who do object must treat patients with respect and refer them to other services to access this care.
 
‘There [also] needs to be clear referral pathways for both medical and surgical abortion services, particularly in regional and rural areas.’
 
Aside from removing barriers to abortion, Dr Higgins says more should be done to make the full range of contraceptive options more accessible and affordable.
 
‘Firstly, allowing greater quantities of contraceptive pills to be dispensed in one go will make a huge difference for those who need it. I know many wonder why this hasn’t happened a long time ago,’ she said.
 
‘The PBS should [also] list new and emergency contraceptives as a priority.
 
‘Currently, many newer forms of contraceptives, such as the new progesterone-only pill and vaginal ring, are not listed on the PBS, meaning only those who can afford to pay for a private prescription can access them and it’s out of reach for most.’
 
However, despite calling for more Government support, Dr Higgins warned against the creation of specific MBS items for medical termination of pregnancy services.
 
‘There is a real risk of privacy issues with specific MBS items for medical termination of pregnancy services, because it would appear on a patient’s Medicare record,’ she said.
 
‘We know privacy is a key concern for people accessing these services. And we want to improve access, not unintentionally make matters worse.  
 
‘These sorts of single health issue-focused MBS items are also inconsistent with the generalist approach to care GPs are trained to provide.
 
‘Rather than unnecessary new MBS items, the priority for funding should be supporting people to access comprehensive, continuous GP care, including contraceptive and abortion services, if and when they’re needed.
 
‘We should be focused on removing the barriers, so everyone can access these services no matter their postcode or income.’
 
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abortion contraception remote reproductive health rural

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