The dearth of healthcare workers in rural communities impacts women in unique ways. Primary healthcare professionals are the first port of call when we seek care for a specific issue or if we need a referral to a specialist. Sexual and reproductive health (SRH) is an area of medicine that is considered ‘specialist’. However, if you were born with female reproductive organs, SRH is an area of medicine that can significantly impact your day-to-day life.
Menstruation, contraception, pregnancy, abortion, birth trauma, libido, endometriosis, polycystic ovarian syndrome (PCOS), pap smears, mammograms, hormone therapy, menopause – throughout a lifetime women, trans and gender diverse people will experience a range of stages and potential conditions requiring access to healthcare professionals trained in SRH. So why must rural women travel long distances and face exorbitant wait times for such a fundamental component of their health?
One answer is, of course, the general difficulty accessing primary health care in rural communities across the country. But this is only part of the problem. Concerns about privacy, stigma, cultural safety and poor SRH literacy among primary care professionals and the wider community all contribute to difficulty in receiving adequate health care for women in the bush – compounded for people with disability, language barriers, prior trauma and financial stress.
Rural healthcare practitioners are often not registered to provide medical termination of pregnancy and can lack knowledge and training about conditions like PCOS, endometriosis and birth injuries. But the deeper question is why? Why does our healthcare system dismiss and devalue women’s bodies when training, researching and implementing primary health care?
To those in the women’s health sector, this will read like a rhetorical question – but in case it needs to be articulated, the answer is gender inequity broadly and medical misogyny specifically. Medical misogyny refers to the subordination of women’s bodies and health-agency within the study, practice and systemic manifestation of medicine.
In order to innovate solutions to the appalling health inequities faced by women in remote, rural and regional communities we must embed gender equality throughout our healthcare system, and at a community level. Government departments and institutions must review policies and procedures and audit curriculums and research gaps to increase gender literacy within the broader healthcare system. Primary care professionals must be equipped with the knowledge and resources to provide culturally safe, trauma-informed SRH care to women in communities outside of major cities.
To address the shortage of primary healthcare services in remote and rural communities, capacity building should be provided to additional sections of the healthcare workforce, specifically nurses and Aboriginal health workers. Moving to nurse-led models of care in smaller communities would provide more options for women and take the strain off the broader healthcare infrastructure.
Finally, we must listen to the voices of women with lived experience of engaging with the healthcare system around SRH, to guide and inform the necessary reforms.
The provision of extra funding and resources to incentivise and increase the primary care workforce in rural areas is only one crucial step in addressing the barriers women face in accessing quality healthcare in the bush. SRH is an area of medicine fundamental to a significant portion of the population in every community in Australia – from the most populous cities to our furthest outback town. Until we meaningfully address gender inequity and medical misogyny, women, trans and gender diverse people will continue to be under-served by the healthcare system in rural communities.