Gaps in health equity for women and gender-diverse communities. Transcript of Gabrielle’s speech to Parliament:
Women, trans people, non-binary folk and people who are gender diverse have historically been neglected, ignored and dismissed by our health system. In recent years this government has taken on the task of focusing on women’s health, and it is very comfortable committing publicly to addressing certain health inequities across the state that fall under women’s health. But unfortunately some health inequities have been prioritised over others, and other areas of health care that drive inequality, often ones that are clouded in shame, remain in the too-hard basket.
It is true this Victorian state government has announced a number of new clinics and services and sexual and reproductive health hubs, but last year the Auditor-General’s report showed that there were 17 local government areas with no access to medical or surgical abortions. It also showed that the sexual and reproductive health hubs have no consistency. Some provide accessible and frequent services while others provide very few. One of the newest hubs charges $500 up-front for a medical termination, and in government-funded hubs this should not be the case. They should be providing free services consistently.
If the government really wants equity of access to health
then Victoria’s sexual and reproductive health hubs need resourcing so that they can all provide free services and so that they can have funding for ultrasound machines, training for their staff and funding for enough staff, not just one nurse or a doctor who only attends one day a week.
Many stakeholders have expressed frustration that the government is choosing to open new clinics rather than work to bolster the services that already exist – because in fact there are many hospitals across the state that do receive public funds and yet refuse to provide the whole suite of health needs for women and trans and gender-diverse people. In fact, the fact that the government is funnelling public money into opening new hospitals in key growth areas and yet these hospitals refuse to provide postnatal contraception, refuse to provide surgical terminations and refuse to provide tubal ligation or family planning consultations is beyond comprehension.
In November last year the Minister for Health announced that three hospitals across Melbourne would begin to offer surgical abortions, and we are thankful for that announcement. But what was needed to make this happen? For the minister herself to plead with the hospitals to take it up. Why rely on the opinions and the effort of the minister of the day to ensure that a publicly funded hospital provides abortion services? Are we still unsure whether accessing a termination is an essential right? Why doesn’t this government stand up and say, ‘If you are receiving our money, public money, you must provide these services’?
Right now doctors, receptionists, nurses, sonographers and pharmacists can deny a whole host of healthcare services,
including medical and surgical termination of pregnancy, if they conscientiously object – because this Labor government protects the rights of individual practitioners so they do not have to participate in certain, often life-saving, aspects of their profession.
Labor is responsible for these people being denied basic health care, not only by individual providers but by entire institutions. Being turned away from receiving medical health care exacerbates what is already a stressful situation. It erodes our trust in the health system, and it delays care which can lead to complications and limit somebody’s options. This is especially the case for terminations. For abortion, accessing care quickly is the difference between paying $42.50 for a medical termination or up to $8000 to access surgery in later stages of pregnancy. The prices are even higher if you do not have Medicare or if you are on a temporary protection visa.
What is more, Victoria is facing a syphilis epidemic. Despite these new hubs, there is nowhere near enough testing to impact the number of new cases that are spreading throughout our communities. In this day and age no baby should ever be born with syphilis. Congenital syphilis has a very high rate of death or disability, and it is very easily prevented with a simple blood test and penicillin. But it has reappeared in Victoria after a long absence. It was once rare in cis women and people with cervixes, but syphilis has returned and sexual health hubs are having no impact. So this government can and should do more to eliminate syphilis in our communities.
This is essential, often critical, health care
and yet women, trans men, non-binary folk and gender-diverse people in need are often left to suffer, left unable to access care and left to be further stigmatised. This stigma is a result of outdated cultural norms and outdated state-based legislative barriers. The spectrum of trans and gender-diverse people needing such health care are often left out of so-called women’s health conversations, although many also have health needs that come under this umbrella term of women’s health. The medical system has failed by designing structures that cater only to the majority, but there is overwhelming documentation of trans and gender-diverse people facing difficulties navigating the health system, of being disproportionately impacted by adverse health outcomes and of not seeking medically necessary care due to the fear of mistreatment or prior experiences of harassment or mistreatment.
I would like to emphasise that this is not a criticism of our health workers. They are doing the absolute best they can with what they have been given. The government must provide adequate funding, more funding, to ensure access for everyone – funding that will enable the sector to break down the barriers faced by many women and trans and gender-diverse communities. Equating sexual and reproductive health – pap smears, chest cancer, cervical cancer, menopause, endometriosis, contraception – with only cis women can reinforce gender norms in a way that harms trans and gender-diverse people by excluding them from health care.
Again, the proliferation and protection of conscientious objection adds to stigma for members of our community who already face so many barriers to having their rights met. For First Nations people as well, for those from migrant and refugee backgrounds, if you live with a disability or if you live regionally and rurally, if any of these intersectional marginalisations apply to you and you need an abortion, an IUD inserted or any of those healthcare services, those barriers are compounded.
Marginalised people still face higher boundaries accessing health facilities that offer the services they need, that are open to them and that are inclusive, safe and respectful.
While Labor celebrate – and we will join them in celebrating – the small steps that they have taken to support women’s health, I would encourage them to consider all parts of the sector and the parts of their own health departments that have traditionally fallen under the term ‘women’s health’, and I would ask them to consider whether their workforce, their training, their capabilities and their processes, educational materials, advocacy work, engagement, workplace culture, research and service provision are sufficient, up to scratch and truly inclusive.
