Health
10.1 The Australian Government recognises that by improving the health of all Australian women, the health of the whole community is improved. In Australia, women generally fare much better than men on many indicators of health and wellbeing, including life expectancy. However, more effort is needed, especially to further improve the health of Indigenous women, women with disability, older women and women living in rural and remote areas.
10.2 Women are the greatest health consumers, and make up the greatest proportion of health service providers and carers in the Australian community.75 On average, women live for 4.8 years longer than men, so women are more likely than men to experience health conditions common to old age.76
10.3 In consultation with state and territory governments and the health and community sectors, the Australian Government is developing a national policy on women's health. The policy will address the specific health needs of Australian women, which is in line with the CEDAW Committee's recommendation in paragraph 27 of its 2006 Concluding Comments. The policy will focus on prevention, will be based on the principle that gender is a key determinant of health, and that the experience of being male or female in society affects people's health and how it is managed.
10.4 Acknowledging the importance of nurses and midwives to the community and the health system, the Australian Government appointed a chief nursing and midwifery officer for Australia in June 2008. The officer will raise the profile of nurses and midwives within government and ensure that the Australian Government is kept informed about nursing and midwifery issues at a national and international level. The officer will also contribute to the Government's Maternity Services Review, which was announced in 2007.
10.5 As well as working with the Australian Government to address the specific health needs of women, state and territory governments have implemented strategies and programs in their own jurisdictions. Strategies developed since Australia's 2003 report include South Australia's Women's Health Action Plan 2006-07.
10.6 New South Wales is currently developing a women's health implementation plan, which builds on the existing Strategic Framework to Advance the Health of Women, and Victoria has its second Women's Health and Wellbeing Strategy 2006-10, building on the Women's Health and Wellbeing Strategy 2002-06.
10.7 In response to a review of maternity services,77 the Queensland Government established a statewide maternity and neonatal clinical network and a new maternity unit. The network will be responsible for developing and implementing statewide initiatives, quality and safety benchmarking processes and improving clinical service planning. In 2007, the Northern Territory Government opened a new birthing centre in the Royal Darwin Hospital. The Australian Capital Territory Government is establishing a new women and children's hospital, which will include a neonatal intensive care unit, a paediatric unit and a maternity unit. The Western Australian Government's policy framework, Improving Maternity Services-Working Together Across Western Australia, outlines plans to develop more community-based care services, including new birth centres, and expand government-funded home birth places.
Australia's health care system
10.8 Australia has a mixed public and private health care system. The core feature is public, taxation-funded health insurance under Medicare78 which provides universal access to subsidised medical and pharmaceutical services, and free hospital treatment as a public patient. In Australia medical practitioners have two choices for billing services. They can bill patients privately or they can 'bulk bill' Medicare. If a practitioner agrees to the bulk billing method of paying for their services, patients assign their right to a Medicare benefit to the practitioner, who accepts the schedule fee as full payment for the service. The practitioner (or any other person or company) cannot make any additional charge for the service. A private health system assists people who choose to take out private health insurance with access to hospital treatment as private patients and with access to dental and allied health services. For more information about Australia's health care system, see paragraphs 508 to 511 in Australia's Common Core Document, June 2006.
Women's health in Australia
10.9 Between 2000 and 2005, health spending per capita in Australia increased in real terms by 4.5 per cent per year on average, a growth rate slightly lower than the OECD average of 5 per cent.79
10.10 In 2006, the overall life expectancy at birth in Australia stood at 81.1 years, more than two years higher than the Organisation of Economic Co-operation and Development average. Australia has the fourth highest life expectancy among the organisation's member countries, following Japan, Switzerland and Iceland.80 Life expectancy for a girl born in 2004 to 2006 was 83.5 years compared to life expectancy of 78.7 years for boys.81 Female life expectancy has increased by 2.4 years from 1994 to 1996 and by 9.1 years since 1976.82
10.11 n 2004-05, most Australian women (84.5 per cent) rated their health as excellent, very good, or good.83 The leading disease groups accounting for the burden of disease in females ('lives lost from premature mortality' or 'lived with ill-health/disability') in 2003 were malignant cancers, cardiovascular disease, mental disorders, nervous system and sense organ disorders, chronic respiratory disease, diabetes, and musculoskeletal conditions.84 It is estimated that disability affects about one in five Australians and rates are higher for women than for men after age 65 years.85
10.12 The risk of maternal death during pregnancy and the six weeks following birth is very small in Australia. From 2003-05, there were 65 maternal deaths nationally in Australia.86 However, Indigenous maternal mortality rates were two and a half times higher than for other women. There were 21.5 deaths per 100,000 Indigenous women giving birth, compared to 7.9 per 100,000 for non-Indigenous women.87
Disadvantaged groups of women
Indigenous women
10.13 The Australian Government shares the CEDAW Committee's concerns about lower life expectancy among Indigenous women, included in the Committee's 2006 Concluding Comments in paragraph 30. The life expectancy at birth for Indigenous women is 64.8 years; and for Indigenous men it is 59.4 years.88 In the 2008-09 Budget, the Australian Government committed $334.8 million towards closing the 17-year life expectancy gap between Indigenous and non-Indigenous Australians within a generation, including $101.5 million extra for maternal and child health services.
10.14 Furthermore, on 3 July 2008, COAG agreed to sustained engagement and effort by all governments over the next decade and beyond to achieve the Closing the Gap targets (health, housing, education and employment) for Indigenous people. As a first step, COAG agreed in principle to a National Partnership with joint funding of around $547.2 million over six years to address the needs of Indigenous children in their early years. The National Partnership will include more funding to improve the antenatal care provided to mothers of Indigenous babies.
10.15 In July 2008, the Australian Government established the National Indigenous Health Equality Council, which will advise the Government on developing and monitoring health-related goals and targets designed to help close the life expectancy gap and reduce the unacceptably high rates of child mortality in Aboriginal and Torres Strait Islander people.
10.16 As a first priority, the Government has asked the council to consider workforce development issues and make recommendations in respect of workforce development and sustainability.
10.17 The National Indigenous Health Equality Council will also provide national leadership in responding to the Government's commitment to closing the gap on Indigenous disadvantage by providing advice to Government on working towards the provision of equitable and sustainable health outcomes for Indigenous Australians.
10.18 In 2004-05, 26 per cent of Indigenous women reported their health as fair or poor.89 Eighty-five per cent of Indigenous women reported at least one long-term health condition, compared to 77 per cent of Indigenous men. Compared to non-Indigenous women, Indigenous women were more than 10 times as likely to report having kidney disease, more than four times as likely to report having diabetes or high sugar levels, and nearly twice as likely to report having asthma.
10.19 Indigenous women were more likely than Indigenous men to report high or very high levels of psychological distress (32 per cent compared to 21 per cent). After adjusting for age, Indigenous women are twice as likely as non-Indigenous women to report high or very high levels of psychological distress.
10.20 On 20 March 2008, the Australian Government and representatives of the Aboriginal and Torres Strait Islander Peoples of Australia signed a statement of intent to work together to achieve equality in health status and life expectancy between Indigenous and non-Indigenous Australians by the year 2030.
10.21 Current health initiatives, which will help to increase Indigenous people's health and life expectancy, include:
- the Healthy for Life program-to improve the quality and availability of child and maternal health services and to prevent, detect and manage chronic disease
- the New Directions: An Equal Start in Life for Indigenous Children program-to improve the health and education of Indigenous children and their mothers through access to comprehensive mothers' and babies' services, programs to address rheumatic fever, and accommodation for Indigenous women from remote areas who need to travel to regional centres to give birth
- the New Directions Mothers and Babies program-to improve Indigenous women's access to antenatal and postnatal care and improve Indigenous children's health
- the Health@Home Plus program-to improve health and wellbeing outcomes for Indigenous children and their families through the provision of a nurse-led home visiting program
- the Social and Emotional Well Being strategy 2004-09-to guide improvements in Indigenous people's mental health and their social and emotional wellbeing
- an investment of over $19 million over three years for a national Indigenous health workforce training plan-to encourage more Indigenous people to take up careers in the health sector.
10.22 The states and territories have also implemented many services to address the health needs of Indigenous women. For example:
- The New South Wales Government has implemented the Aboriginal Maternal and Infant Health strategy and the Alternate Birthing Services program.
- The Victorian Government runs the Koorie90 Maternity Services program.
- The Queensland Government has implemented the new Indigenous Health Package and the Healthy Women's initiative focusing on Indigenous women in rural and remote areas.
- The Northern Territory Government employs nurses and Indigenous Health Workers as Women's Health Educators and runs the successful Strong Women Strong Babies Strong Culture antenatal education program.
- The South Australian Government is developing culturally appropriate maternity services for Indigenous women and an antenatal educational resource to increase access to culturally appropriate antenatal education.
- The Western Australian Government runs the Kulunga Research Network to improve outcomes on issues ranging from fetal alcohol syndrome to Indigenous self-esteem. The comprehensive Western Australian Aboriginal Child Health Survey analysed the complex range of factors affecting Indigenous children's health and wellbeing in the state.
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Rural and remote women
10.23 As geographic remoteness increases, so do the rates of mortality and morbidity among females in Australia.
10.24 In February 2008, the Australian Government completed an audit of health workforce shortages in rural and regional Australia. The Government will use the findings to guide the ways to improve health services in rural areas.
10.25 The Medical Specialist Outreach Assistance program addresses the comparatively higher burden of disease of people in rural and remote communities by reducing waiting lists for patients to get treatment. A range of specialists travel to rural and remote locations to provide fertility, sexual health, and general gynaecology and obstetric services. In 2006-07 more than $970,000 was allocated to these types of services in all states and the Northern Territory. This funding enabled more than 9,100 women in rural, remote and very remote locations to consult with a specialist.
10.26 The Australian Government continues to fund the Rural Women's General Practice Service and it is providing up to $247 million over four years from 2007-08 to 2010-11 for the Royal Flying Doctor Service. The flying doctor service primary and community health care services for women include pre-natal and post-natal support, cervical screening, breast and skin examinations, family planning consultations, health promotion, counselling, and child health services, such as immunisation programs.
10.27 In 2008, the Rural Health Specialist Obstetrician Locum Scheme received a funding increase of $5.9 million over three years to provide women in rural areas with more access to quality obstetric care.
10.28 The Northern Territory Government ensures pregnant women in remote areas receive support from primary health care staff in their own communities through visiting medical practitioners and a number of specialist remote midwives. Programs like the Patient Assistance Travel Scheme assists patients from remote areas to access emergency and specialised health care. As well, specialisation in medicine and continuing advances in sophisticated equipment and technology have led to centralised facilities operating from major centres.
10.29 New South Wales has implemented initiatives under the NSW Rural Health Plan which have had a positive impact on many women's lives, with more services now being offered closer to where people live, including specialist services in regional centres that were previously only available in cities. The Rural Antenatal Care project is a new initiative for pregnant women living in rural and remote areas, which provides free antenatal care for pregnant women in shared care arrangements between obstetricians, general practitioners and midwives.
10.30 The Queensland Government is committed to improving access to health information and services for rural women, including for Indigenous women living in remote communities.
10.31 Under the Rural and Remote Women's Health program, operated by the Royal Flying Doctor Service, a visiting general practitioner provides services to women in rural and remote Queensland. Also, women in 72 communities across rural and remote Queensland have access to women's health clinics. The Mobile Women's Health Nurses Service provides a range of women's health services, particularly cervical screening to women living in rural and remote areas of Queensland. Current areas of work within Queensland Health relate to improving rural maternity services, including planning for a mobile antenatal and postnatal outreach service.
10.32 The South Australian Women's Information Services conducts outreach visits to rural areas to meet with service providers and rural women's health nurses, links rural women to service providers through its toll-free information line, provides information 'hubs', and distributes information on financial literacy and domestic and family violence. The Rural Women's Telephone Counselling Service offers confidential information, referrals and phone counselling for women who live outside metropolitan areas.
10.33 The Western Australian Country Health Service is the single biggest Area Health Service in the state, and the largest country health system in Australia. It services an area of some 2.55 million square kilometres with a combined regional population of 454,000 people, including 44,900 Indigenous people.
Migrant women
10.34 Migrants bring to Australia their own unique health profiles. Research has found that most migrants enjoy health that is at least as good as, if not better than, that of the Australian-born population. Immigrant populations often have lower death and hospitalisation rates, as well as lower rates of disability and lifestyle-related risk factors.91
10.35 In 2004, the Australian Government established the Community Partner's program, an aged care program for Australia's culturally and linguistically diverse communities, providing $23 million over four years. The program builds links between people from the community and helps aged care service providers understand the needs of older people within them.
10.36 State and territory governments provide a range of health programs and services for migrant and refugee women. The Tasmanian Government funds the Bi-cultural Community Health program, which addresses health issues affecting refugees, including female genital mutilation and other harmful traditional practices. There are refugee clinics in the north and south of Tasmania to support new arrivals, and liaison officers work in the major hospitals. The Tasmanian Government has also supported educational projects for young refugees focusing on education about their rights and responsibilities in relation to sexual health and relationships.
10.37 The Queensland Government has provided funding to the Queensland Refugee Health Service, which will start in 2008 with six refugee health clinics. The service will provide a coordinated statewide health service for refugees, special humanitarian entrants and asylum seekers. Through its Multicultural Assistance Program, the Queensland Government also provides grants to a number of community organisations for projects, including recent projects to address migrant and refugee women's health needs, support for African refugee families, seminars on female genital mutilation and violence against women, and the development of an information handbook for women from Cambodia and the Cook Islands.
10.38 An annual audit of services conducted by the New South Wales Government in 2006-07 showed that $45.7 million was spent on specific health services targeting ethnic communities. In the same period, the New South Wales Health Care Interpreter Service provided 412,477 occasions of service, most of which were to women.
Women with disability
10.39 The Australian Bureau of Statistics conducts the Survey of Disability, Ageing and Carers every five years. The most recent survey occurred in 2003. The survey collects information on people with disability, older people (aged 60 years or over), and people who care for an older person or a person with disability.92
10.40 Based on the survey results, an estimated 3.9 million Australians (20 per cent of the population) had some form of disability in 2003. Accident or injury was the top known cause of disability for males (18 per cent); disease, illness or hereditary causes led for females (16 per cent). Males were more likely than females to have work-related disabilities (15 per cent versus 6 per cent).
Older women
10.41 In response to population ageing, Australia is committed to improving older people's health. At age 65, Australia's females can now expect to live to 86.4 years old.93 Over 90 per cent of the gain in increased life expectancy for females is estimated to be time spent with disability, including 58 per cent of the gain being spent with profound or severe limitation.94
10.42 Coronary heart disease and cerebrovascular disease (notably stroke) were the two leading causes of death, accounting for about 30 per cent of all deaths among older males and females in 2005. These diseases are also major causes of disability among older Australians.95
10.43 Every year the Australian Government spends some $5 billion combating cardiovascular disease, mostly through the Medicare Benefits Schedule and through the Pharmaceutical Benefits Scheme, but also through a wide range of other programs, such as the National Health and Medical Research Council.
10.44 The Australian Capital Territory Government funds community-based exercise programs to improve older women's participation in physical activity to reduce the risk of health problems.
Health issues for Australian women
Antenatal and postnatal depression
10.45 Around one in 10 Australian women experience depression during pregnancy, and almost one in five experience it in the weeks and months after giving birth. From 2008-09, the Australian Government is providing $55 million over five years to implement a national perinatal depression plan.
Cancer
10.46 Australia has national population screening programs for breast, cervical and bowel cancers. Screening services are free to women in the target age group (for breast screening) and to men and women participating in bowel cancer screening. Medicare rebates are available for costs associated with cervical screening.
10.47 The number of women in Australia diagnosed with breast cancer continues to increase; it is the most prevalent form of cancer in women. More women, however, are now surviving the illness. Breast cancer is the most common cancer experienced by Indigenous women, but the incidence rate is lower than for the non-Indigenous population.96
10.48 Early detection through population-based screening and effective follow-up treatment has been a major contributing factor to breast cancer survival. The Australian and state and territory governments continue to fund BreastScreen Australia (the national population-based mammogram screening program) and run awareness raising campaigns.
10.49 In the 2008-09 Budget, the Australian Government committed $12 million over four years to recruit, train and employ 30 new breast cancer nurses in rural and remote areas. The Government has also allocated $31 million over four years to reimburse up to $400 for both new and replacement external breast prostheses for women who have had a mastectomy because of breast cancer.
10.50 In early 2008, the Australian Government launched a media campaign alerting women to the symptoms of ovarian cancer. The campaign was in response to a survey, which showed that many women are unaware of the warning signs of Australia's most fatal gynaecological cancer. In the 2008-09 Budget, the Australian Government committed $5.1 million over three years to the National Centre for Gynaecological Cancers.
10.51 The Australian and state and territory governments continue to fund the National Cervical Screening program. Since it began, the number of new cases of cervical cancer has fallen, as has the death rate. In 2004, 718 new cases of cervical cancer were detected and in 2005, 216 deaths were due to cervical cancer. During 2005 and 2006, Pap smears were provided to 3.5 million women aged 20 to 69 years, representing 61 per cent of all women in the age group.97
10.52 Over four years from April 2007, $571 million has been allocated to fund inoculation of girls aged 12 to 18 years with the human papillomavirus (HPV) vaccine, Gardasil, with a catch-up program available until June 2009 to women aged 18 to 26 years. The vaccine protects against most types of HPV that can lead to cervical cancer. The Australian and state and territory governments continue to publicise and reinforce the importance of regular Pap smears to ensure early detection of cervical cancer and precancerous cervical abnormalities.98
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Mental health
10.53 The Australian Government recognises that mental health is a major problem for the Australian community and is committed to reforming the mental health system. In February 2006, COAG agreed to a national action plan on mental health. The plan provided a strategic framework that emphasised coordination and collaboration between government, private and non-government providers to deliver a more seamless and connected care system so that people with mental illness could participate more in the community. For more information about Australian Government mental health initiatives, see paragraphs 552 to 555 in Australia's Common Core Document, June 2006.
Sexually transmissible diseases
10.54 Notifiable sexually transmissible infections (STIs) in Australia include HIV, gonorrhoea, infectious syphilis and chlamydia. In general, the notification rates of these infections are increasing.
10.55 During the period 2001 to 2007, using data adjusted for multiple reporting, there was a 43 per cent increase in the number of new HIV diagnoses in Australia. However, Australia has low HIV/AIDS prevalence in all populations, including among gay and other homosexually active men, injecting drug users and women self-identifying as sex workers, when compared with other countries. Of the 983 cases of newly diagnosed HIV infection in Australia in 2007, 140 cases or around 17 per cent were in women.
10.56 The population rate of diagnosis of gonorrhoea increased by 29 per cent over the period 2002 to 2006 but fell by around 11 per cent between 2006 and 2007. Approximately 34 per cent of the reported 7,604 cases in 2007 were in women. Infectious syphilis cases increased from a population rate of 3.1 in 2004 to 6.6 in 2007 per 100,000 population. Approximately 11 per cent of the reported 1,379 cases were in women. Within females, women aged 20-29 years had the highest numbers of reported cases of gonorrhoea.
10.57 Chlamydia was the most frequently reported notifiable condition in Australia in 2007, with 51,867 reported diagnoses. The population rate of diagnosis was 245 per 100,000 population, representing a 7 per cent increase over the previous year. Young, sexually active people are overwhelmingly the most at risk. Because untreated chlamydia can lead to infertility in infected women, the increased incidence and high prevalence in women aged between 15 and 29 years is of serious concern.99
10.58 The National Sexually Transmissible Infections Strategy 2005-08 guides the Australian Government's approach to prevention of sexually transmissible infections. The strategy is being reviewed in 2008.
Family planning
10.59 The Australian and state and territory governments fund family planning and antenatal services, which generally provide free sexual and reproductive advice. State and territory governments are responsible for legislation relating to the performance of abortions. Each jurisdiction has different legislation governing the circumstances when pregnancy can be terminated. The Australian Government respects the rights of state and territory governments to manage legislation relevant to their jurisdictions, and has not announced any plans to intervene in abortion legislation.
10.60 The need for a termination is essentially a matter for the professional clinical judgment of the medical practitioner concerned, acting in accordance with state and territory laws. Doctors have an obligation to advise patients of the possible physical and mental effects that might occur as the result of any medical procedure, including termination of pregnancy. It is ultimately an individual woman's decision, made in consultation with her treating medical practitioner, whether to terminate her pregnancy.
10.61 The Australian Government is aware of the current debate on decriminalisation of abortion in Victoria. In Victoria, law reform to decriminalise abortion is currently before the Parliament. In Western Australia, the Acts Amendment (Abortion) Act 1998 repealed four sections of The Criminal Code and enacted a new section 199 to remove offences relating to procuring abortion and placed regulations in the Health Act 1911 to regulate the performance of abortion. This amendment allows abortions when the woman has given informed consent; the woman will suffer serious personal, family or social consequences; or serious danger to the woman's physical and mental health will otherwise result. Abortion has been decriminalised in the Australian Capital Territory.
10.62 The Australian Government funds a range of family planning organisations and national bodies to promote women's choice and access to sexual and reproductive health services. Medicare ensures that all Australians have access to free or subsidised treatment by eligible health practitioners. For an individual to be eligible for a Medicare rebate, the termination must be provided in line with state and territory law.
10.63 Women experiencing an unintended pregnancy, or who are uncertain about whether to continue with a pregnancy, are able to access subsidised Pregnancy Support Counselling from an eligible general practitioner or psychologist, social worker or mental health nurse. The National Pregnancy Support Helpline also provides professional and non-directive advice 24 hours a day, seven days a week. The Western Australian Government also provides free counselling services for unplanned pregnancies.
10.64 Estimated national figures show that the number of induced abortions in Australia in 2003 was about 84,000. The highest number of induced abortions was estimated among women aged between 20 and 24 years and the lowest among girls aged younger than 15 years. The estimated induced abortion rate peaked at 21.9 in 1,000 women aged between 15 and 45 years in 1995 and has steadily declined since 1996.100
10.65 In 2006, there were 10,552 births to mothers aged younger than 20 years, accounting for 4.0 per cent of all births. As a proportion of all births, teenage births have declined since 2003.101 In 2006, the teenage fertility rate of Indigenous teenage women was more than five times the fertility rate of non-Indigenous teenage women.102
10.66 In response to high teenage pregnancy rates comparative to other Australian jurisdictions, the Tasmanian Government has funded a multi-agency teenage pregnancy prevention initiative, Making Choices, that aims to increase young women's awareness of pregnancy, relationship and parenting options.
10.67 The abortion drug, RU486, is not approved for marketing in Australia but individual doctors can apply to prescribe and supply it. Since April 2006, approval has been given to 33 doctors for the use of RU486 as Authorised Prescribers subject to state and territory law and to stringent conditions, including that the authorisation is closely monitored by the ethics committee of the hospital in which the practitioners work. Before the Australian Therapeutic Goods Authority103 can register a medicine for use for a specific clinical indication, it must receive, evaluate and approve an application from a sponsor. The agency has not received any application to register RU486 in Australia. The agency is not able to compel a manufacturer of a medicine or any other party to sponsor an application for registration in Australia.
Female genital mutilation
10.68 It is a criminal offence to perform female genital mutilation in Australia. For information about female genital mutilation, see paragraphs 7.19 to 7.21.