Towards quality reproductive health care in every postcode

Australians do not currently have sufficient or equitable access to reproductive healthcare services, particularly in regional, rural and remote areas. The challenge of distance and a shortage of general practitioners (GPs) are key contributing factors to this situation, which means that innovative solutions need to be employed to ensure that all communities have access to quality reproductive health care provided by clinicians trained to meet their needs.   

A statistical report published last year by Family Planning New South Wales (NSW), analysing adolescent fertility rates (AFR) over the 10-year period from 2011 to 2020, showed that the rates have been halved nationally over the past decade, from 16 live births per 1,000 women aged 15–19 in 2011 to only 8 in 2020. However, there is considerable variation when the data is looked at by location, with non-metropolitan areas consistently having higher rates of pregnancy than the national average. In NSW in 2020, the AFR in non-metropolitan local health districts (14) was almost three times higher than rates in metropolitan areas (5). Four non-metropolitan local health districts in NSW bucked the national trend of declining adolescent fertility by recording increases in teenage pregnancy rates over the 10-year period.

Factors contributing to these differences are complex and multifaceted, but one of the key issues is lower availability of health services, particularly services that have clinicians trained to provide the full range of reproductive health care. There is clearly an urgent need for better access to reproductive health services in regional, rural and remote areas, including access to effective contraception, combined with other contributing strategies such as consistent comprehensive sexuality education for young people. It is important for people to have a range of contraceptive options available so they can choose methods most suitable to them. Choice of contraception depends on reliability, affordability, access and availability of doctors or nurses adequately skilled to provide a client’s preferred option.

Provision of long-acting reversible contraception (LARC) services led by registered nurses and midwives would assist in addressing these service and community needs. LARCs include contraceptive implants and intrauterine devices (IUDs), which prevent pregnancy for three to 10 years, depending on the type. Research demonstrates that appropriately trained nurses are well placed to provide LARC services and have similar patient safety outcomes to doctors.

LARCs are highly effective in preventing pregnancies, resulting in significantly reduced unintended pregnancy and abortion rates. While there is an upfront cost for insertion, they are more cost-effective over time. Research commissioned from the Centre of International Economics found that women who switched from the pill to LARCs would save between $114 and $157 annually. Over a period of five years, this adds up to $93 million in savings for consumers. If just 20 per cent of clients had these services provided by trained registered nurses instead of doctors, it would result in a $2.7 million saving to the government over five years. Utilising nurses and midwives to undertake LARC procedures would also reduce GP workload in rural and remote areas.

Ensuring equitable access to highly effective contraceptives, particularly LARCs, is a national health priority articulated in Australia’s National Women’s Health Strategy. Family Planning Australia has been conducting research in this area and advocating to the NSW and federal governments for many years to find ways to better support nurses to provide these essential services, particularly in rural and remote areas. Funding registered nurses to work independently through Medicare item numbers for LARC insertions and removals could dramatically increase access to LARC services, particularly in regions where there are shortages of GPs.

Other multidisciplinary models to build capacity and improve availability of services also need further investigation to ensure options for all people in every postcode in Australia to access affordable, safe and inclusive reproductive health services.

More information about Family Planning Australia can be found at www.fpnsw.org.au