Bridget Archer (Bass, Liberal Party) Share this | Link to this | Hansard source

Is there a seconder for the motion?

Anne Webster (Mallee, National Party, Shadow Assistant Minister for Regional Health) Share this | Link to this | Hansard source

I second the motion and reserve my right to speak.

Louise Miller-Frost (Boothby, Australian Labor Party) Share this | Link to this | Hansard source

Well, I'm perhaps not pleased to speak to the neglect of the health sector, including rural health care, since 1990. Obviously this is a slow-moving issue that has been a long time coming. I was one of those women living in a rural location when I had my babies, in 1999. I lived in Karoonda, a town of 300 people in South Australia's Murray Mallee. Notably, my children represented a one per cent increase to the town's population when they were born. Of course, as a high-risk pregnancy I was always going to have them in a high-risk clinic in a major tertiary hospital in the city, but postpartum care for me and my babies was provided in rural hospitals and rural general practices.

The availability of women's health care, including but not limited to maternity care, is of vital importance to the status of women and the status of women's health across the country, and the Albanese Labor government recognises the importance of all women's healthcare needs, including but not limited to maternity care. After a decade of talk from those opposite about women's health, we're taking action. The 2024-25 federal budget has a significant focus on how the healthcare needs of women will be better met. We have committed over $160 million to tailor services, tackle healthcare bias and improve access to health care for women. Women's health and maternity health are not a one-size-fits-all exercise. Not only are there differences in the experiences between women in rural settings and women in cities; different women also have different preferences about how they want to experience their health care. Women have the right to exercise choice and control over their bodies, their healthcare experiences and their birthing experience. The Albanese government has recognised that a woman-centred continuous model of care offered by midwives is often the preferred model for many women.

Childbirth is an intense and an intensely personal experience. It can be exciting and also scary. The relationship a woman builds with her birthing team, often with her midwife in particular, is an important part of a positive birthing experience with a healthy outcome for mother, baby and the family as a whole. To give more women access to their choice of care during pregnancy, we've invested over $56.5 million to add new items to the Medicare Benefits Schedule to support access to more flexible, high-quality and tailored midwifery care. This includes longer antenatal and postnatal consultations—which can be important in difficult pregnancies, pregnancy complications—to ensure a healthy mother and a healthy baby or, in my case, babies.

The Albanese government's investment will give women more choice and facilitate the building of relationships between mother and carer throughout the pregnancy journey. We're opening 12 perinatal mental health centres across the country to support women and families. The perinatal period can be a time of significant stress and change. A mentally healthy mum has positive benefits for the baby and for the family as a whole.

Funding to continue strategies to prevent preterm and early term birth in participating maternity services and First Nations communities will reduce the number of babies born too early. Preterm birth is not only associated with poorer birth outcomes but can affect the health of the baby their entire life, including in later adulthood.

Labor has developed the Woman-centred care: strategic directions for Australian maternity services to provide national strategic direction to support Australia's maternity care system and ensure it reflects contemporary practice. Australian families need to have access to safe, high-quality, respectful maternity care.

Workforce shortages can affect the ability to access safe, quality maternity care. Strengthening maternity workforce supply, training and development is essential. The Australian government is collaborating closely with the state and territory governments to develop a national maternity workforce solution. Cost-of-living support for nurses and midwifery students undertaking mandatory placements as part of their studies will also assist in the workforce strategy, encouraging more students to take up nursing and midwifery and enabling them to complete their studies. I note that Flinders University, based in Boothby, provides training places for nursing students across rural South Australia and the Northern Territory. This is an important part of encouraging graduates to choose rural sites for their careers.

There's a lot happening in this space after decades of neglect. It's about time health services for women got some focus, and this government is doing it.

Anne Webster (Mallee, National Party, Shadow Assistant Minister for Regional Health) Share this | Link to this | Hansard source

In seconding this excellent motion by my colleague from Wide Bay, I do so as the shadow assistant minister for regional health and speak on behalf of the women of rural, regional and remote Australia who are victims of Labor's scorched earth approach to regional Australia. Talking about choice: many women face having to be away for the last six weeks or more of their pregnancy to ensure they can have a safe delivery. That is not to mention the strain the mothers' absence places mentally, emotionally and financially on her other children, on her partner, on her family and on her family business, such as the family farm. Fathers risk missing the birth of their child. If mothers remain at home, they risk having their baby outside a safe place for delivery.

In Blackall, Queensland the ABC reported in November that 20 women from the town with a population of 1½ thousand had given birth last calendar year, but none had been able to do so at their local non-birthing hospital. Mothers are expected to travel 200 kilometres away to Longreach or further afield. Reportedly, only seven of those women had their baby in Longreach and presumably gave birth even further away.

Epworth HealthCare in Geelong scheduled the closure of their maternity service in March last year. At one stage, St John of God Geelong Hospital was also facing being on bypass due, in part, to a lack of paediatricians in the area. A Royal Australian and New Zealand College of Obstetricians and Gynaecologists spokesperson said in August that services in the greater Geelong region haven't kept pace with an increasing population, saying, 'The college is aware that St John of God Geelong Hospital and University Hospital Geelong have, at times over the last few months, been on bypass for maternity patients and babies and have needed to transfer patients for whom they would ordinarily be able to provide care.'

It doesn't stop. In Whyalla, South Australia, the hospital was hit with a sudden closure of birthing services a year ago, requiring women to go a 76-kilometre additional distance to Port Augusta or, in some cases, almost 400 kilometres further, to Adelaide. Port Lincoln hospital does not have a full-time paediatrician, resulting in some mothers facing a 600-kilometre-plus trip to Adelaide to have their baby. Gladstone Hospital in Queensland was on bypass for over 11 months until last June, as had been both Biloela and Beaudesert hospitals that year. The absence of services in Gladstone and Biloela put additional pressure on Rockhampton's hospital birthing services. Also in Queensland, Innisfail, Mareeba, Ingham, Ayr and Dalby hospitals all had to suspend their birthing services for a few hours to several days in a 13-month period to last May. Imagine that on your last check-up. The situation was so bad that Queensland started offering $40,000 for GPs to train in obstetrics and offered interstate and overseas workers $70,000 to live in regional Queensland.

I turn now to a potential solution. A recently published study by Notre Dame university confirms that exposing doctors to rural practice in their early years, before they've made big decisions about marriage, mortgages and family, is crucial to keeping medics in the bush. The research followed 1,220 medical graduates from nine Australian universities to track where they were working five, eight and 10 years after graduation. General practitioner doctors were nearly three times more likely to be practising outside the cities after a decade, as the specialty has greater rural training opportunities. The majority, 71 per cent, of GPs who were in rural areas five years after graduation remained there at 10 years. This month, the Land newspaper profiled Dr Clare Hardie, a GP-obstetrician who was doing a clinical placement in Narrogin in Western Australia's Wheatbelt in 2015 when, in her own words, 'I met a fella who is going to live rurally for the rest of his life, so I guess I'm stuck in Narrogin.'

In conclusion, rural, regional and remote Australians, particularly women, deserve better from their government. As the election approaches, I look forward to sharing policies to move swiftly to give regional Australians the health care they deserve.

Brian Mitchell (Lyons, Australian Labor Party) Share this | Link to this | Hansard source

I thank the member for Wide Bay for raising this important issue and the constructive way in which he has raised it. There are few things more important than making sure women have access to safer health care for the birth of their precious baby. As the member for Wide Bay knows, the concerns that he highlights predate the election of the Labor government in 2022. I distinctly remember the massive cuts to rural public health under the coalition, of which the National Party was part. The first thing that the government that the Nationals were part of did was gut the body in charge of maintaining and improving rural health care. Does anybody remember the health consumers of rural and remote Australia? It's easier to silence criticism than respond to it.

Then, under the coalition's premiership, hospitals lost $57 billion in funding. That amounts to 37,000 fewer hospital beds or 68,000 fewer nurses or 33,000 fewer doctors. My neighbouring constituency of Bass—which Deputy Speaker Archer would be familiar with—saw $329 million taken from the LGH, exactly as planned. Between 2010 and 2021, most of that under the coalition rule, almost 140 rural hospitals across Australia closed. So no wonder there has been a reduction in rural maternity services.

The minister has referred previously to the recommendations within the Participating Midwife Reference Group report. It was published during the coalition government's term of office, and it's an excellent resource for the failings of the former government. The report noted that fewer than 10 per cent of women had access to continuous midwifery care and made several recommendations. It called for an increase in the number of midwives. That's what the Labor government has done. Labor will give every midwifery student $320 a week when on placements. That's on top of $50 million worth of scholarships. If you want to be a midwife, we will support you and we'll help you get there. The report called for the facilitation of telehealth consultations and the inclusion of GPs as eligible specialists, so that's what the Labor government has done. The sexual and reproductive telehealth item has been made permanent. This means more support for women in rural and remote areas to access reproductive health.

And now the big one: the report called for an end to the barriers to midwifery continuity of care, as did the member for Wide Bay. Specifically, it called for an end to mandated formal collaborative agreements. So that's what the Labor government has done. It was Labor's Assistant Minister for Health and Aged Care who introduced the Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Bill in March. It does exactly what it says. It passed in March. I'm sure the member for Wide Bay was pleased with that.

We know there's plenty left to do, which is why we are committed to getting qualified medical professionals including midwives into rural areas and getting them to stay. In our first budget in 2022, the Labor government created the Workforce Incentive Program for Rural Skills and this provides incentive payments for GPs in rural areas. The first payments were made this year. Labor also announced the John Flynn Prevocational Doctor Program, which increases the rotations of doctors and medical students to rural hospitals. It kicked off last year.

Just over the weekend we have announced $6 million dollars of funding towards the Birthing on Country Project in remote areas of the Northern Territory. Rates of prebirth for First Nations mothers almost twice that of non-Indigenous mothers. This funding will close this gap and provide long-term employment for rural health workers, and do it all within the framework of First Nations culture.

We are looking towards the future. That's why Labor introduced the Innovative Models of Care Program, which trials more efficient care practices in rural areas first. Some of that's underway in Tasmania. Rather than being afterthoughts, like under the former coalition government, rural hospitals under Labor are at the forefront of medical care. Labor has shown by our actions in just two years how importantly we take the issue of maternity services across rural and regional Australia. Not for a minute do we think the job is done, but I can assure the member for Wide Bay that the work is being done and actions are being taken. I look forward to his continued positive and constructive role in that effort.

Helen Haines (Indi, Independent) Share this | Link to this | Hansard source

I thank the member for Wide Bay for this important motion and acknowledge his work and that of his office for the Parliamentary Friends of Maternal Health, of which the member and I are co-chairs, alongside the member for Canberra.

The decline in maternity services in rural and remote Australia is of great concern to me and it's of great concern to the people of Indi who I represent. Before coming to this place I worked for decades as a midwife, and a large part of that time as a caseload continuity of care midwife. I saw firsthand the importance for mothers, fathers and babies of having maternity services close to home, and with midwives working to their full scope of practice.

Just last week I attended a community meeting in Mansfield, where locals expressed their opposition to proposed mergers of regional health services across Victoria. While these decisions will be made at a state level, it is really important for us here, as federal representatives, to understand what amalgamations could mean for maternity services. In Mansfield there is a real fear that if the health service was amalgamated, it wouldn't be long before it was seen as more efficient to centralise maternity services, with people forced to travel to Benalla or Shepparton or further afield to access maternity services and give birth. That would mean driving an hour away to give birth at a time when every minute counts. As the Mansfield GP-obstetrician, Dr Graham Slaney said, 'When maternity services are centralised, it is often the start of a cascading centralisation and reduction in other health services such as anaesthesia and surgery.' He added, 'Maternity services are a key drawcard in recruiting and retaining junior doctors, skilled midwives and nurses to our country towns.'

We need models of maternity care that enable women to give birth close to home. In 2021 the Rural Health Commissioner, Professor Ruth Stewart, described in an editorial:

… more than 225 rural maternity units closed in Australia between 1992 and 2011 (more than a 40% reduction). These closures occurred in the face of accumulated evidence that small maternity services in rural areas are at least as safe as larger maternity services.

'This is a critical point,' she said, adding:

The narrative for closures is disconnected from the quality and safety evidence. These closures put birthing services further away for women in rural communities. Over those decades there was a 47% increase in babies born before arrival.

Essentially, that means on the side of the road. She continued:

The Queensland Rural Maternity Taskforce noted an increased risk of birth before arrival at hospitals for women who live 1 hour or more or less than 2 hours from maternity services.

We've known for a very long time that birth in small rural hospitals is not associated with higher risk of poor outcomes compared to birth in larger centres. Decades ago, Professor Sally Tracey did a population based study of 750,000 women and proved this categorically.

Recently, the Senate Standing Committee on Community Affairs's report Ending the postcode lottery: Addressing barriers to sexual, maternity and reproductive healthcare in Australiafound that, when women don't have access to maternity care that meets their needs within a reasonable travel time, there are consequences. International research has backed this up, associating travel time exceeding one hour with poorer outcomes for mothers and their babies as well as with increased interventions in childbirth. This is at a time when we are trying to get childbirth to have as few interventions as possible.

Australian women have repeatedly called for continuity of care and carer access to evidence to make informed choices and to choose the model of care and make those choices collaboratively with their care providers. We have overwhelming evidence about the positive outcomes for mothers and babies through midwife led continuity-of-care models, countless RCTs, Cochrane Reviews and growing evidence that, in fact, good investment from this government now has positive outcomes for Aboriginal and Torres Strait Islander women through birthing-on-country programs. But models such as these should not be the exception; they should be the rule.

This motion calls for the removal of structural barriers to women receiving primary care, and I want to acknowledge that this government has done some great work in this area, the removal of collaborative agreements for nurse practitioners and midwives accessing Medicare being one example. But there's more to do, and an urgent piece of work right now is to address the issue of professional indemnity insurance for midwives. We know that in the federal budget there were some big investments announced for midwifery, including claim costs for indemnity insurance. We need to make sure we get this right and that we don't exclude women from home birth under this insurance arrangement. We need to be careful about the term 'low risk'. We need to get it right and consult carefully.

Marion Scrymgour (Lingiari, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on this important motion. The health status of all people is influenced by cultural, political, environmental and economic determinants. A true partnership approach not only builds a stronger health system but, importantly, ensures it is equipped to better meet the complex and multilayered health challenges facing Aboriginal and Torres Strait Islander people, particularly in my electorate of Lingiari. Nowhere is this more evident than in maternal health care.

NT Aboriginal women and their babies experience poorer health outcomes compared to non-Indigenous mothers and their babies. The rate of preterm birth is almost double that of non-Indigenous mums, and birthing-on-country models of care directly contribute to closing the gap in this critical area of health policy. The birthing and health centre in Galiwinku in the Northern Territory is an innovative, solution-focused project that supports Yolngu women's self-determination and control over their reproductive health as well as improved maternal health outcomes, with more babies born at healthy birth weight. This project will also create long-term employment for a Yolngu women's workforce.

Congress alukura, or birthing-by-grandmothers law, has been an important feature in Alice Springs for many decades. Recently, a new alukura birthing service has been opened by the Central Australian Aboriginal Congress. The Alukura Midwifery Group Practice allows women to keep the same midwife through their pregnancy and birth. Through a partnership with the Alice Springs Hospital, women can now have their congress midwife alongside them up to and during the birth of their child at the hospital.

Birthing on country gives Aboriginal and Torres Strait Islander babies and their families, most particularly their mums, the best start in life. For more than 60,000 years, Aboriginal and Torres Strait Islander women have birthed their babies on traditional lands. Future generations of women and babies will thrive and flourish through a holistic approach to health that incorporates traditional practice, through connection with land and country, with Western knowledge systems of medicine.

In speaking about this important issue, I want to acknowledge all the nurses, midwives, doctors and specialists that play a vital role for Aboriginal and Torres Strait Islander women in making sure that mums end up with healthy babies. I want to take what time I have to pay tribute to the important work and dedication over many years of two women in particular: Molly Wardaguga and Professor Sue Kildea. Molly, who I met many years ago, in the early 2000s, was an Aboriginal health worker who delivered many of the young people that we see around Maningrida. Professor Sue Kildea was an avid young nurse at that time—and she'd probably kill me for saying that—at Maningrida, in the Northern Territory. I have recently spoken to Sue, who has continued this passionate work of Molly, who passed in the early 2000s. Sue has continued to advocate the work and the Birthing on Country program.

I do want to acknowledge many of our RNs that are working tirelessly in the Northern Territory with community controlled Aboriginal health services to turn around the low birth rates and to look at its importance and how we can advance birthing and health centres in Galiwin'ku. Women on Christmas and Cocos have also raised with me some of the barriers that they face, such as having to come off the island and move to Perth, thousands of kilometres away from their families, to have their children. Often that can come at great expense to those families.

I want to finish this speech by saying that every woman deserves a choice in their birthing journey, and it doesn't matter whether they're Aboriginal or Torres Strait Islander, they're non-Aboriginal women or they're Muslim women. It does not matter who we are; I think all women deserve a choice in their birthing journey.

Michael McCormack (Riverina, National Party, Shadow Minister for International Development and the Pacific) Share this | Link to this | Hansard source

I thank the member for Lingiari for her insightful words. She, as much as anybody, would know how difficult it is for women, particularly for Aboriginal women, in her sprawling Northern Territory electorate to give birth. Having a baby can be very stressful for mothers, and I commend the member for Wide Bay for bringing this motion to this House. It notes 'the reduction in the provision of maternity services in rural Australia', and that is so very much so, unfortunately.

Within the current Riverina electorate boundaries, five towns are of a size where you would think there would be good and modern maternity services, but there are none at all. This forces expectant mothers to, in some cases, drive hours upon hours to get to a hospital, and in this day and age that is simply not good enough. Parkes, West Wyalong, Junee, Gundagai and Harden-Murrumburrah have no maternity services. The Parkes maternity ward closed in June 2019 due to a lack of doctors. The mayor in Parkes, Neil Westcott, bemoaned to me only the other day that, for a town the size of 12,000 people, they deserve better.

The Cootamundra community was told just last month that maternity services will be off the table under proposed changes under the Murrumbidgee Local Health District's draft health services plan for the Cootamundra health service. This was on public display until yesterday. I've spoken to the Cootamundra-Gundagai mayor, Councillor Charlie Sheahan, who actually ran for state Labor. He shares his community's extreme concerns—and they're mine as well; I share those views—that the draft will become the plan and will leave his community, the Cootamundra community, devastated. He's right, and it's simply not good enough. No country town should have any health services reduced, let alone a town the size of Cootamundra. It has 7,153 people, and they deserve better. It's got an encouraging projected population growth on the back of projects such as the planned expansion of the local meatworks, and, as Councillor Sheahan said to me, this could attract thousands more residents to the district. Why should people living in rural and regional areas have fewer and inferior services to Australians living in metropolitan areas? There's no right or proper answer to that question. They simply should not.

I've written to the Assistant Minister for Rural and Regional Health and, whilst I appreciate that this is very much at the feet of the Minns state government, I felt compelled to raise this issue with Minister McBride to impress upon her the importance of, at the very least, maintaining health services in regional and rural areas, because that is her portfolio.

Now, the Cootamundra community has been told that pathology, maternity and surgery are not going to happen any longer under these proposed changes, and it's simply not good enough. I can't express that enough. I really criticise the Minns government for doing this at a time when Cootamundra's projected population is growing. The Daily Advertiser newspaper on 21 May, under the heading '"Short-sighted" plan leaves community uneasy over hospital's future', talked about fears of vital local health care having cuts spreading across the community. The article said:

A MLHD spokesperson said a health service plan outlines the services required to reflect the community's health needs into the future and makes recommendations about the best way to deliver these services.

That's great, but come on. Let's face it: these communities are growing. All the LGAs in my area are growing, and yet, if it truly reflects the community's health needs, why take it away? Why cut it? It makes no sense.

The Spokesperson said the Murrumbidgee Local Health District, like other health districts, regularly updates its health service plans to ensure they accurately reflect the health needs of individual communities. It does not accurately reflect the health needs of the community when you've got a growing community with mums who want to give birth in their home towns but are forced to drive hours away to give birth in Wagga Wagga or elsewhere. It's simply not good enough, and these bureaucrats should pull their bloody heads in and realise that this community needs maternity services. They need them now and they need them going into the future.

Dan Repacholi (Hunter, Australian Labor Party) Share this | Link to this | Hansard source

There is nothing more important than bringing a new human into this world. It is vital that women have access to the best possible maternity services, whether they live in my electorate of the Hunter, the member for Sydney's electorate or the electorate of New England. The risk to mother and baby should not depend on where you live.

Health care and especially the topic of women's health care is something that is at the top of the list of priorities for any Labor government. We recognise and we understand how important maternity care is, and we know how important all women's healthcare needs are. We showed this in the last budget, where we had a major focus on how the healthcare needs of women can be better met. We've invested $160 million to tailor services, tackle bias and improve access for women.

We have also focused on making sure that expecting mothers are better looked after on one of the most important days of their lives. We are doing this by investing over $56.5 million to add new items to the Medicare benefits schedule to support access to more flexible, high-quality and tailored midwifery care. This includes longer postnatal consultations. This includes giving more women access to the care of their choice during pregnancy. A woman-centred, continuous model of care offered by midwives is often the preferred model for many women. This investment will give women more choice and facilitate the building of relationships between mother and carer throughout the pregnancy journey, which is an important part of making sure women have access to the maternity service that they need.

We also know that there are very particular issues when it comes to giving birth in regional areas. That's why we have committed funding to continue strategies to prevent preterm and early term birth in particular maternity services and First Nations communities, which will help to reduce the number of babies born too early.

The fact is that, when a woman is pregnant, she is the centre of everything that happens. This is the way it should be, and this is why we have developed Woman-centred care: strategic directions for Australian maternity services, to provide direction on a national scale to support Australia's maternity care system and make sure it reflects the way that care should be given in the modern day. Regardless of where you live, Australian families need to have access to safe, high-quality, respectful maternity care. As long as we're in government, we will fight for this every day.

If we're going to make sure that women in rural areas have access to the high-quality maternity services that they need, we need to take a good look at the issues they are currently facing and the barriers that are preventing people in rural areas from accessing these services. One of the biggest issues is workforce shortages. These workforce shortages can affect the ability to access safe, quality maternity care. If there are no midwives, there can be no maternity services. To fix these workforce shortages, we need to strengthen the supply of those in the maternity workforce. This can't be done without a focus on training and development. If there are more people trained to provide maternity services, there will be more women across Australia in our rural communities who will have access to the services that they need and deserve. We are aware of the need to increase the workforce and increase the number of people who are trained to provide these services, and we are acting to make a difference. All Australian governments are collaborating closely to develop national maternity workforce solutions. We are working with the states to make sure that these issues are addressed so that women nationwide are better supported.

I'm a dad and I know what it's like to be expecting a child, but obviously I don't know what it's like to be carrying one. But the one thing I do know is that it can be an extremely stressful and difficult time for many expecting mothers in all kinds of different situations. So providing maternity services goes far beyond just giving birth. The support needs to be available the whole way through the process, and that's why we're opening 12 perinatal mental health centres across the country to support women and families. We are a government that cares about families, women and their health, and our track record proves that.

Rebekha Sharkie (Mayo, Centre Alliance) Share this | Link to this | Hansard source

The time allotted for debate has expired. The debate is adjourned, and the resumption of the debate will be made an order of the day for the next sitting.

Federation Chamber adjourned at 19:12