Editorials
Information science Women's health Health services administration
Volume 215 - Issue 8

Increasing access to women’s sexual and reproductive health services: telehealth is only the start

Author:  Danielle Mazza

Med J Aust 2021; 215 (8): 352-353. || doi: 10.5694/mja2.51258
Published online: 18 October 2021

Community-based health services would ensure that appropriate care is available to some of our most vulnerable patients

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Community‐based health services would ensure that appropriate care is available to some of our most vulnerable patients

It seems incongruous that, although almost half of all general practitioners are women1 and abortion has been decriminalised in every state and territory in Australia, access to sexual and reproductive health services, including for abortion,2 contraception3 and menopause management,4 remains difficult for many women. Further, profound disparities in women’s sexual reproductive health care persist, with women in rural or socio‐economically disadvantaged areas, younger women, those who have experienced violence, and women from culturally and linguistically diverse backgrounds all having poorer outcomes.5,6

The COVID‐19 pandemic has only made the situation worse. Women, particularly those who are unemployed, have reported problems with access to contraception during lockdowns.7 Private clinics providing sexual and reproductive health services are vulnerable to transport disruptions,8 the reduced availability of providers, and a lack of personal protective equipment. Increased rates of family violence and economic hardship coupled with restricted movement during lockdowns, and anxiety about the future, mean that access to sexual and reproductive health services is more important now than ever.

In an attempt to reduce the impact of the pandemic, Medicare telehealth items were introduced in March 2020,9 subsidising, for the first time, community‐based sexual and reproductive health services delivered by telehealth. The report by Cheng and colleagues (Family Planning New South Wales) in this issue of the MJA indicates that telehealth delivery of these kinds of services is feasible and acceptable for patients.10 In their study, telehealth consultations typically focused on contraception, gynaecological problems, and early medical abortion, their non‐procedural nature lending them to telehealth service provision. Self‐testing protocols for cervical cancer screening11 and sexually transmitted infection testing can also be undertaken by telehealth, but face‐to‐face consultations are still required for women using long acting reversible contraception and for surgical abortion. Concordant with previous research,12 patients valued the increased comfort, convenience, and accessibility of telehealth services. However, Cheng and colleagues stressed that better integration of digital health systems and access to visual technology for consultations would have been helpful.10

Cheng and colleagues also found that larger proportions of people under 19 and students used telehealth services than in other groups.10 This has important implications for service provision for these women, who are at greater risk of poor sexual and reproductive health outcomes.13 However, the relatively low use of telehealth services by non‐English speaking people needs further inquiry; they may not be aware of these services or prefer face‐to‐face consultations, or their low use of telehealth may reflect lower levels of digital literacy, difficulties with internet access, or lack of privacy for consultations.14

On 1 July 2021, time‐based telehealth Medicare items for consultations involving sexual or reproductive health care matters or blood‐borne viruses were introduced,9 removing restrictions that had limited their availability to people who had visited a general practitioner or general practice during the preceding 12 months. These restrictions had discriminated against people in rural and remote areas, where service options were already limited, and against those who had not recently visited their local general practice. These new time‐based telehealth Medicare items will hopefully be retained after further primary care reforms involving patient registration15 are implemented.

However, while telehealth facilitates increased access to care, it is not the solution for all access problems. If equity of access, a key principle of the Australian National Women’s Health Strategy,16 is to be achieved, initiatives for making local community‐based services available to those at greatest disadvantage must be introduced alongside Medicare support for sexual and reproductive telehealth services. Governments must not only ensure that services are available, but also that quality and access standards (including for contraception and abortion care) are set, monitored, and publicly reported on a regular basis. This approach ensures accountability and progress, and is already undertaken in some countries.17,18,19 These standards could then be enforced by hospital service agreements, ensuring the provision of regional services for contraception, abortion, and menopause management. Hospitals would accept primary care referrals of patients with special needs and provide training for primary care practitioners. Finally, primary health networks could be funded to commission sexual and reproductive health services, similar to the manner in which they commission mental health and drug and alcohol services. This would ensure that local community‐based services were available to meet the needs of some of our most vulnerable patients.

 

Author

  • Danielle Mazza1
  • 1. Monash University, Melbourne, VIC

Correspondence: danielle.mazza@monash.edu

Competing interests

No relevant disclosures.

References

Provenance: Commissioned; externally peer reviewed.

View this article on Wiley Online Library