E&OE TRANSCRIPT
SPEECH
Australian Centre for the Prevention of Cervical Cancer | MELBOURNE, VICTORIA

Subjects: Women's health, reproductive health, women's representation in politics.

 

Thank you for that introduction, Alicia. And thank you for everything you have done for the feminist movement here in Australia.

Before I begin, I want to acknowledge the traditional custodians of the land on which we meet, the Ngunnawal and Ngambri peoples, and pay my respects to Elders past and present.

I extend that respect to other First Nations people with us today.

In a year where First Nations women have played such an important role in our national political conversation, it would be remiss to not acknowledge the First Nations women of the Federal Parliamentary Labor Party.  

The first Indigenous woman elected to the House of Representatives, Labor’s Minister for Indigenous Australians, Linda Burney.

Malarndirri McCarthy, Marion Scrymgour and my fellow Victorian, Jana Stewart. We all owe you a debt of gratitude for your advocacy, passion, and perseverance.

From the bottom of my heart, thank you.

EMILY’s List

I would also like to acknowledge the CEO of EMILY’S List Australia, Pamela Anderson. We are working together very closely with regular meetings and appreciate her support and input.

It’s a pleasure to be here to deliver the annual EMILY’s List Australia Oration.  

When I look back at the women who have delivered the Oration over the past decade, it’s difficult to not feel a weight of responsibility. Women who have shifted the dial, pushed the boundaries, and overcome patriarchal structures to deliver progressive change for women and girls. Rosie Batty, Gillian Triggs, Sally McManus, Linda Burney and, of course, Julia Gillard.

As you would know, Julia was our first female Prime Minister but what you might not know is that she was an inaugural EMILY’s List member in the 1990s.

Back then, the proportion of women in Parliament was rarely over single figures. The notion of a female Prime Minister was something that would not enter public consciousness for some time.

While Labor had introduced world-first reforms in the 1970s and 1980s to advance women’s liberation, including no-fault divorce, supporting mothers’ benefit, removing tax from the contraceptive pill, the Family Law Act 1975, the Sex Discrimination Act and Affirmative Action Agency.

Representation of women in Labor parliamentary caucuses and party positions across the movement was low.

At the same time, the state of reproductive health was – to put it bluntly – dire. Abortion was criminalised in every state and territory. And reproductive health was shrouded in secrecy, stigma and shame. The Howard Government was taking steps to further restrict access to reproductive healthcare.

It was in this context that EMILY’s List was founded in 1996 in Australia, just over a decade after its establishment in the USA, predominantly as a fundraising body to get progressive women elected to parliaments to advance feminist principles, including reproductive freedom.

In a time when it might not have been popular, EMILY’s List was founded so that Australian women could be supported politically to have control over their own bodies and choices in their lives.

As you know it stands for Early Money Is Like Yeast – referring to the fundraising strategy of getting money in early that would then drive others to donate and grow the fund.

I like to think the same applies to policy. Early policy paves the way for more and more progressive policy. That is as it happens what we are aiming for here, unfortunately with Roe v Wade we are seeing regression in the US, with some women being thrust in dire situations in certain states.

But here in Australia, we’ve achieved a fair deal, mostly of course with Labor Governments.

Abortion is legal nationwide, and we’ve improved access to reproductive health.

Young women today talk openly and freely about their choices.  

Thanks to the fight by sisters for affirmative action In Parliament, women represent 53 per cent of Labor’s caucus. Labor’s Senate team is 69.2% per cent women – can you believe it?

Underscoring these achievements is the work of EMILY List’s and the thousands of women who have worked collectively – strategizing, organising and mobilising - to get progressive women elected.

Thank you, EMILY’s List for everything you have done.

Women and girl’s health in Australia

You all know that it takes time to dismantle systems, overcome biases and transform our society. Basically, to smash the patriarchy.

We have been smashing it on many fronts – even in this parliament we have – on childcare, paid parental leave, DV legislation including paid leave, pay equity, the Respect at Work measures, and so much more.

But today, I wanted to talk to you about the work I am doing in my role as Assistant Minister for Health and Aged Care to address gender bias in the healthcare system. Or as I like to refer to it – Medical Misogyny

Prior to my career in politics and with the ACTU, I was a nurse and I saw firsthand how women fared poorly in the system. But it was when I first became involved in the health portfolio that it was brought to my attention just how ingrained the bias was.

Good people out there are doing the research, advocating for change, working to change things. And I felt the responsibility to add my voice and role to the movement.

Women and girls make up more than half of our population, yet our health has been overlooked and underdiagnosed for too long.

And if you have intersectional barriers, like being a trans man with a uterus, or a migrant woman or a person with a disability, navigating the health system is even more plagued with challenges.

Our specific and diverse health needs have been relegated in a system - thousands of years in the making - that is geared towards men. That is designed by men, about men, and historically delivered by men. Only recently that the diagnosis of hysteria was removed as legitimate.

 

Gender bias

There is growing evidence that systemic issues in healthcare delivery and medical research means women often suffer poorer health outcomes.

Women disproportionately experience delayed diagnosis, overprescribing, and a failure to properly investigate symptoms.

Symptoms of a heart attack, for example, are less likely to be recognised in women than in men, because symptoms are different! You are actually twice as likely to die of a heart attack if you are a woman, half as likely to be admitted to ICU with chest pain, and half as likely to be given adequate pain relief. The result is that women are less likely than men to receive appropriate treatment for heart disease. And not just cardiovascular disease but delayed diagnosis for numerous conditions and diseases.

Women’s voices and experiences are ignored and overlooked.

Endometriosis is an example I have spoken about before. Endometriosis affects at least 1 in 9 Australian women and can have a devastating impact on the daily lives of those with the condition. Sufferers wait on average 7 years before diagnosis. 7 years!

And some may never get the help they need. Women are told, “pain is part of your life, it’s your lot suck it up”.

Well, my friends this is not so!

The Australian journalist, Gabrielle Jackson, was motivated by her own experience of a fourteen-year journey for diagnosis and treatment of endometriosis to write her powerful book “Pain and Prejudice”.

To quote Gabrielle:

'Women are in pain… they're in pain with their periods, and while having sex; they have pelvic pain, migraines, headaches, joint aches, painful bladders, irritable bowels, sore lower backs, muscle pain, [and] vulva pain, … [but] women's pain is all too often dismissed, their illnesses misdiagnosed or ignored.”

And while opening a network of endometriosis and pelvic pain clinics for women across Australia – something I am proud of – is a first step to rebalancing our healthcare system so women get the attention and care they deserve, it’s a big down payment.

I was in Rouse Hill last week with the fierce Susan Templeman, member for Macquarie, to announce another clinic so women in Western Sydney can get the care they deserve.

There are clinics in every state and territory and so far, we have received really positive feedback.

I hope the Clinics will also bring attention in wider society to endometriosis and pelvic pain, so that those women who are suffering and might not know why, can get the help they need.

Medical misogyny

Gabrielle also notes how traditionally men have been centred as the norm in medicine.  She states:

“In medicine, man is the default human being (and) any deviation is atypical, abnormal, deficient.”

Others have said the system is designed the 50-year-old white man from Pennsylvania.

Gabrielle points out how the Greek philosopher, Aristotle, characterised the female body as a mutilated man.

It’s an apt point that highlights just how ingrained and historical these biases are. How ingrained medical misogyny is.

Let me be clear; as a woman, as a trained nurse and as a member of parliament, I do not believe that there is any nefarious conspiracy between individuals getting together in basements and plotting to make women suffer.

But I do agree with Gabrielle, and the leading researchers in this field, that women have been seriously under-served by medical systems that are supposed to give them both equity and confidence in their healthcare.

A combination of persistent social prejudice, medical ignorance and research exclusion is a health catastrophe for women and girls. For these reasons and many more, a key priority for the Australian Government is to better support, protect and promote the health and wellbeing of all Australian women and girls.

Our system has structural problems that need work and I’m committed to doing it.

Medical research

Medical research is such an important field for understand the health of our society and finding the cures and treatment for diseases and health issues for future generations.

But it’s also a field that has traditionally been dominated by men.

Unsurprisingly, focus in research has been on the male patient. There’s an interesting example out of Harvard which reveals that 70 per cent of people affected by chronic pain conditions are women, whereas 80 per cent of pain research is conducted on males.

Collecting research data from men and generalising to the female health experience has resulted in detrimental health outcomes, increased health costs, and negative social impacts for women.

Up until very recently clinical trials were only done on male mice! Ignoring sex and gender differences across the research lifecycle – from grant submissions through to clinical translation – can compromise the accuracy of medical science itself.

As a Government, Labor is maximising the impact of our health and medical research investments and addressing inequities.

To that end, our October budget confirmed more than $1.5 billion is available through the National Health and Medical Research Council, or NHMRC, and the Medical Research Future Fund for the coming year.

We have also announced major reforms to the way the NHMRC awards Investigator Grants, so they are distributed equally to women and men.

I also recently launched consultation a draft Statement on Sex, Gender, Variations of Sex Characteristics and Sexual Orientation in Health and Medical Research. A long title for an important initiative.

This statement will guide health and medical research to ensure that sex and gender –are considered in this research including the variables that need to be understood amongst the LGBTIQA+ communities. It means we can improve knowledge in gaps related to groups that have been historically underrepresented in research. It means that there will be no excuse for generalising research findings from men onto women and LGBTIQA+ people.

Some recent sex disaggregated research discoveries have highlighted that:

• Women can be (and are) over medicated because drug trials were only performed on men, and
• That women were more likely to reject hip replacements because the prostheses were designed for a male pelvis and scaled down.

A life course approach to health will reveal many things, like a correlation between PND and Menopausal depression that the longitudinal study into women’s health found.

Lack of research is just as alarming, what we don’t know about things like menopause generally, menorrhagia or heavy menstrual bleeding, auto immune conditions where women are 80 % of sufferers means treatments are far from optimal.

Lack of research on drugs and pregnancy – only just starting a conversation about new ways to do this that minimises risk. There’s PCOS, endo, migraine, I could go and on.

Sexual and reproductive health

But let’s take the issue of sexual and reproductive health care – something dear to EMILY’s list.

The Senate Inquiry into the universal access to reproductive healthcare was supported by Labor. We are working through the recommendations and will have a response before the next budget. Some recommendations have already been implemented.

One I am particularly pleased about is the new guidelines for MS2Step.

Access to medical abortions as you know were not easily available.

The guidelines for their use were barriers, including the training and registration requirements for GPs and Pharmacists which saw only 10 % of GPs being registered and only 30% of pharmacists registered to dispense. Along with a requirement to be living two hours from a hospital.

Those hurdles were changed by the TGA with all doctors being able to prescribe and all pharmacists being able to dispense.

Added to that, Midwives and Nurse Practitioners can also prescribe once state legislation is ready for it. I’m pleased to say most states are moving quickly on this.  

Actually, one hurdle with the inquiry has been getting the state governments over the line to do the bits that are their purview.

The ACT has moved to make sure access to surgical abortions is freely available with free LARCs inserted after each abortion.

Victoria has opened two more surgical abortion lists – public hospitals that haven’t offered them.

WA has had major legislative changes.

I understand QLD will introduce changes so NPs and Midwives can prescribe MS2Step.

SA is implementing a health info line like Qld and Victoria. And there are conversations about a national service.

NSW is reviewing their legislation and looking into this further.  

NT have abortion services in the public hospitals and offer free transport to and from the hospital.

All states have agreed in principles to all recommendations from the Inquiry.

I am pleased to say that the states do seem to be picking up their game when it comes to sexual and reproductive health care.

So much to still do, birth trauma, fertility, pregnancy loss – actual data collection!

We are hoping to have a good offering for women’s health in the next budget.

National Women’s Health Advisory Council

But by now you can probably see just how gigantic the task of women’s health is. I can’t do it on my own.

As EMILY’s List has shown, addressing gender inequities, and dismantling the patriarchy is a collective task. It’s why I launched the National Women’s Health Advisory Council.

The Advisory Council is committed to improving Australia’s health system for women and girls and will guide the National Women’s Health Strategy, ensuring we focus on the matters which will make a real and tangible difference to the lives of women and girls everywhere.

The Council is providing strategic advice and recommendations directly to Government. Our membership is strong, and laser focused. It’s a mix of peak stakeholder organisations, consumer groups, academics, and medical and professional bodies.

It takes in the diversity of our society because we know that there are intersecting forms of discrimination that can impact on the way women experience the world.

Addressing disadvantage

An area the Council is looking at in particular is the women and girls who, despite best efforts, continue to fall through the cracks in our health system.

I’m talking about the health disparities between men and women which compound healthcare challenges for women and girls who already face additional disadvantage – including First Nations women, the LGBTIQ+ community, migrant and refugee communities, women and girls with disability, and those who live in rural and remote regions. We have a lot of work to do to provide better, more targeted care but I have no doubt we will get there.

#Endgenderbias survey

So, to find out more about bias in the health system we commissioned a survey. Not just any survey.

For the very first time, all Australian women were invited to share their experiences of the health system in a community consultation survey.

We received almost 3,000 responses, and I thank the individuals who shared deeply personal and often traumatic stories. The results gathered through this survey will be used to inform the Council’s advice and recommendations to improve health outcomes for women and girls in Australia.

We can’t fix what we don’t know, and this is the critical next step in helping us understand people’s experiences. Gaps in care result in major health issues and disparities in treatment that are largely preventable.

We can, and must, do more to fix this.

The data from the survey is being crunched and I will have more to say about the survey results, and the necessary actions we will take, in the new year.

I am feeling very positive about the next steps. Change is never easy, but the time has come to end gender bias in health care and the momentum is with us.

Conclusion

Everyone deserves access to quality, affordable and safe healthcare regardless of their gender.

And, most importantly, women and girls deserve to be heard and believed because a pat on the head and a Panadol is not going to cut it. Not on my watch.

Thank you so much for having me here today. And thank you again to EMILY’s List Australia for all the work you do.

Thank you.