Topics

Abstract

Objective: To report the first live birth following uterus transplantation in Australia.

Study design: Case report.

Setting, participant: The first participant in the uterus transplantation research study program at the Royal Hospital for Women, the Prince of Wales Hospital, and Westmead Hospital in Sydney.

Main outcome measures: Clinical course after uterus transplantation; course of the subsequent pregnancy until delivery.

Results: The immunosuppression regimen following uterus transplantation on 10 January 2023 was similar to that used for low immunologic risk kidney transplantation. It included induction therapy (basiliximab on days 0 and 4, methylprednisolone on days 0 and 1), followed by maintenance therapy with oral tacrolimus, prednisolone, and mycophenolate mofetil (MMF). The prednisolone dose was steadily tapered over twelve weeks to a low maintenance dose (from 25 mg to 5 mg daily); MMF was replaced with azathioprine during week 9, and tacrolimus was continued throughout the pregnancy. There was no evidence of rejection. A frozen grade 1 blastocyst was transferred during a natural ovulatory cycle 101 days (fifteen weeks) after transplantation; clinical pregnancy was successfully initiated. The woman developed gestational diabetes at 20 weeks and was treated with insulin. A healthy boy was born by planned caesarean delivery at 37 weeks; he weighed 2990 g, with Apgar scores of 7 at one minute and 9 at five minutes. Intrapartum haemorrhage (estimated 2500 mL) led to iron infusion after delivery. The woman and her infant were discharged from the hospital five days after the birth. The infant was breastfed, but the woman experienced recurrent episodes of mastitis that were managed with oral antibiotics, and intravenous antibiotics during two hospital admissions. Eight weeks after birth she commenced weaning the infant. Neither the woman nor her infant experienced serious complications.

Conclusion: The first live birth following uterus transplantation in Australia indicates that the procedure could be adopted here as an assisted reproductive technology for women with uterine factor infertility.

Trial registration: Australian and New Zealand Clinical Trials registry, ACTRN12622000917730.

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1 Royal Hospital for Women, Sydney, NSW
2 The University of New South Wales, Sydney, NSW
3 Prince of Wales Private Hospital, Sydney, NSW
4 Children’s Hospital at Westmead Clinical School, the University of Sydney, Sydney, NSW
5 Women’s Reproductive Care, Coffs Harbour, NSW
6 Prince of Wales Hospital, Sydney, NSW
7 Westmead Hospital, Sydney, NSW
8 The University of Sydney, Sydney, NSW
9 Macquarie University, Sydney, NSW
10 NSW Health Pathology, Sydney, NSW
11 Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Correspondence: r.deans@unsw.edu.au

Open Access:

Open access publishing facilitated by University of New South Wales, as part of the Wiley – University of New South Wales agreement via the Council of Australian University Librarians.

Data Sharing:

Our research team are committed to sharing de‐identified data from our study if required. The full compilation of uterus transplantation data will become available following completion of the six uterus transplantations in this study. Access to data can also be provided on request, subject to a data sharing agreement that ensures appropriate use and the confidentiality of all participants.

Received 16 April 2024, accepted 3 September 2024

Acknowledgements:

We acknowledge the Royal Hospital for Women Foundation for supporting our clinical trial. The funding source did not play a role in the study design, data collection, analysis or interpretation, reporting, or publication. We acknowledge Ashraf Hanafy (Royal Darwin Hospital), collaborator on the clinical trial, and who contributed to the initial animal research protocols; William Ledger (Royal Hospital for Women), who contributed to the development of the ethics protocol; Rachael Jean Rodgers (Royal Hospital for Women), who provided IVF support for the uterine transplant clinical study; Germaine Wong (Westmead Hospital), who played a key role in supporting the immunotherapy regimen and ethics preparation, and was an active member of the trial team; Natasha Rogers (Westmead Hospital, Westmead Institute for Medical Research), instrumental in supporting the immunotherapy regimen, and an active member of the trial team; Laura Gerhardy (Nepean Hospital), who performed ultrasound scans during the pregnancy; Katrina Tang and Christine Loo (NSW Health Pathology), responsible for interpreting and reporting cervical biopsies; Trent Davidson (NSW Health Pathology) and Declan Gibney (Prince of Wales Hospital), who oversaw immunosuppression treatment; Donna Garland (Royal Hospital for Women), who contributed to the ethics application process; Wayne Hsueh (Royal Hospital for Women), who was involved in the ethics development for the clinical study; Andrew Lennox (Prince of Wales Hospital), the vascular transplantation surgeon for the clinical trial; Pernilla Dahm Kähler (Sahlgrenska Academy, University of Gothenburg, Sweden) and Niclas Kvarnström, the surgeons who attended and proctored the Australian uterus transplantation surgical team; and Richard Lawrence (Baringa Private Hospital, Coffs Harbour), who was responsible for the recipient's local outpatient care.

Competing interests:

No relevant disclosures.

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Research

Country revealing the way: evaluating Elder‐governed cultural therapy for Aboriginal and Torres Strait Islander young people with mental health conditions

Alasdair Vance, Janet McGaw, Jo Winther, Naomi Tootell, Herb Patten and Sandra Eades

Med J Aust 2025; 223 (6): . || doi: 10.5694/mja2.70019
Published online: 15 September 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Complementary therapies

Environment and public health

Health occupations

Mental disorders

Abstract

Objectives: To assess the effectiveness of an Elder‐governed cultural therapy program for Aboriginal and Torres Strait Islander young people with mental health conditions.

Study design: A cultural therapy program for Aboriginal and Torres Strait Islander young people was designed, delivered and qualitatively evaluated.

Setting: The cultural therapy was conducted in two locations: Royal Park, a traditional camping area for members of the Kulin Nation adjacent to the Royal Children's Hospital Melbourne; and a psychology and animal‐assisted therapy practice located on a rural property 50 km north‐west of Melbourne.

Participants: Twenty Aboriginal and Torres Strait Islander young people aged 7–18 years with mental health conditions completed the cultural therapy program between October 2021 and April 2024.

Main outcome measures: Yarns were conducted with the young people, their parent or carer and the cultural therapist before, immediately after and 3 months following completion of the therapy. In addition, fieldnotes and photographs were used to record the sessions. Effectiveness of the cultural therapy was assessed based on participation and engagement of the young person in the cultural therapy; their social and emotional wellbeing over the course of the cultural therapy; and their social and emotional wellbeing 3 months after completion of the cultural therapy.

Results: All participants willingly attended and actively engaged in the cultural therapy. Social and emotional wellbeing of participants improved over the course of the cultural therapy, and 3‐month follow‐up sessions revealed these improvements to be lasting. Centring Aboriginal ways of knowing, doing and being and actively engaging Country as a co‐therapist were key to the effectiveness of the therapy.

Conclusion: The cultural therapy was found to be beneficial for Aboriginal and Torres Strait Islander young people with mental health conditions and should be offered alongside but separate from Western mental health management.

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University of Melbourne, Melbourne, VIC

Correspondence:

Open access:

Open access publishing facilitated by The University of Melbourne, as part of the Wiley ‐ The University of Melbourne agreement via the Council of Australian University Librarians.

Acknowledgements:

This project is supported by the Australian Government Medical Research Future Fund, as part of the Million Minds Mental Health Research Mission (MRF1179461). The funder had no role in the study design; collection, management, analysis and interpretation of data; writing of the report; and decision to submit the report for publication. We would like to acknowledge the great help provided by the Elders on the governing board of the project.

Competing interests:

No relevant disclosures.

Author contributions:

AV, JMc, JW, NT, UHP and SE conceived and developed the research protocol. AV, JMc and NT wrote the first draft with constructive revisions provided by AV, JMc, JW, NT, UHP and SE. All authors contributed to composing the final manuscript and are accountable for all aspects of the work.

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Perspective

The contribution of evidence‐based practice and the practice‐based evidence approaches to contemporary Australian psychology: implications for culturally safe practice

Paul Gray (Wiradjuri), Dawn Darlaston‐Jones, Pat Dudgeon AM (Bardi), Kate Derry, Joanna Alexi, William Smith (Wiradjuri and Wemba Wemba), Tanja Hirvonen (Jaru and Bunuba), David Badcock, Shraddha Kashyap and Belle Selkirk (Noongar)

Med J Aust 2025; 223 (6): . || doi: 10.5694/mja2.70028
Published online: 15 September 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Indigenous health

Statistics, epidemiology and research design

Global health

Mental disorders

Ethics and law

Psychological practice emphasises the importance of using the best available evidence to ensure accountability and promote positive outcomes for individuals and communities.1 These expectations are critical for community trust; however, without adequate consideration of broader processes of knowledge production, this focus can marginalise populations and perpetuate health inequities, such as those experienced by Aboriginal and Torres Strait Islander communities. Considering new professional practice expectations in psychology,1,2 this article examines the foundations of these standards and how they might be effectively implemented. We present a conceptual exploration of empirical and constructionist perspectives on evidence and introduce guidelines for practice‐based evidence (PBE), including theoretical and practical implications to yield the best available evidence1 that guides culturally safe practice when working with Aboriginal and Torres Strait Islander peoples.3

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1 Jumbunna Institute, University of Technology Sydney, Sydney, NSW
2 University of Western Australia, Perth, WA
3 Poche Centre for Indigenous Health, University of Western Australia, Perth, WA
4 University of Melbourne, Melbourne, VIC

Correspondence: belle.selkirk@uwa.edu.au

Open access:

Open access publishing facilitated by The University of Western Australia, as part of the Wiley ‐ The University of Western Australia agreement via the Council of Australian University Librarians.

Acknowledgements:

Professor Pat Dudgeon AM received a grant from the National Health and Medical Research Council (NHMRC) Medical Research Future Fund – Transforming Indigenous Mental Health and Wellbeing (APP1178803), which funded staff from the Australian Indigenous Psychology Education Project (AIPEP) and Transforming Indigenous Mental Health and Wellbeing (TIMHWB) to participate in the Working Group discussions, planning, writing and publishing the work. We would like to acknowledge staff from the Australian Psychological Society who contributed to early discussions on evidence.

Editor's note: This article was originally submitted for the 2025 Special Issue on Indigenous Health (published on 7 July 2025). As we received more articles than could be published in a single issue, the MJA and Guest Editor team (Professor Pat Dudgeon [Bardi], Professor Jaquelyne Hughes [Wagadagam], Associate Professor Michelle Kennedy [Wiradjuri], Professor Kelvin Kong [Worimi], Professor Odette Pearson [Eastern Kuku‐Yalanji and Torres Strait Islander], and Associate Professor Paul Saunders [Biripi]) have processed this article as per the Special Issue: with articles led by Aboriginal and Torres Strait Islander authors, and careful assessment, discussion, and guidance by the Guest Editors across all stages of the editorial and publication process.

Competing interests:

Pat Dudgeon AM is a Guest Editor for the 2025 NAIDOC Week MJA Special Issue and was not involved in any editorial decision making about this article.

Author contribution:

Gray P: Conceptualization, methodology, resources, supervision, writing – original draft, writing – review and editing. Darlaston‐Jones D: Conceptualization, methodology, resources, writing – original draft, writing – review and editing. Dudgeon P: Conceptualization, methodology, resources, supervision, writing – original draft. Derry K: Conceptualization, methodology, project administration, resources, writing – original draft. Alexi J: Conceptualization, methodology, project administration, resources, writing – original draft. Smith W: Writing – original draft, writing – review and editing. Hirvonen T: Conceptualization, methodology, resources, writing – original draft, writing – review and editing. Badcock D: Conceptualization, methodology, resources, writing – original draft. Kashyap S: Conceptualization, methodology, resources, writing – original draft. Selkirk B: Conceptualization, methodology, project administration, resources, supervision, writing – original draft, writing – review and editing.

1. Psychology Board of Australia. Code of Conduct. Melbourne: Australian Health Practitioner Regulation Agency, 2024. https://www.psychologyboard.gov.au/Standards‐and‐Guidelines/Professional‐practice‐standards/Code‐of‐conduct.aspx# (viewed May 2025).
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22. Rigney LI. A first perspective of Indigenous Australian participation in science: framing Indigenous research towards Indigenous Australian intellectual sovereignty. Kaurna Higher Education Journal 2001; 7: 1‐13.
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29. Wilcox MM, Pérez‐Rojas AE, Marks LR, et al. Structural competencies: re‐grounding counseling psychology in antiracist and decolonial praxis. Couns Psychol 2024; 52: 650‐691.
30. Australian Institute of Aboriginal and Torres Strait Islander Studies. AIATSIS Code of Ethics for Aboriginal and Torres Strait Islander Research. Canberra: AIATSIS, 2020. https://aiatsis.gov.au/research/ethical‐research/code‐ethics (viewed May 2025).
31. Cullen K, Rhodes P, Brockman R, et al. Decolonising clinical psychology: national and international perspectives. Clinical Psychologist 2020; 24: 211‐222.
32. Innes JM, Morrison BW. Artificial intelligence and psychology. In: Elliott A, editor. The Routledge social science handbook of AI. Routledge, 2021; pp 30‐57.
33. Harfield S, Pearson O, Morey K, et al. Assessing the quality of health research from an Indigenous perspective: the Aboriginal and Torres Strait Islander quality appraisal tool. BMC Med Res Methodol 2020; 20: 79.
34. Australian Health Ministers’ Advisory Council's National Aboriginal and Torres Strait Islander Health Standing Committee. Cultural Respect Framework 2016–2026 for Aboriginal and Torres Strait Islander Health. Canberra: Australian Health Ministers’ Advisory Council, 2016. https://nacchocommunique.files.wordpress.com/2016/12/cultural_respect_framework_1december2016_1.pdf (viewed May 2025).
35. Curtis E, Jones R, Tipene‐Leach D, et al. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. Int J Equity Health 2019; 18: 174.
36. Psychology Board of Australia. Guidelines for supervisors. Melbourne: PsyBA, 2018. https://www.psychologyboard.gov.au/Standards‐and‐Guidelines/Codes‐Guidelines‐Policies.aspx (viewed May 2025).
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38. McPherson S, Wicks C, Tercelli I. Patient experiences of psychological therapy for depression: a qualitative metasynthesis. BMC Psychiatry 2020; 20: 313.
39. Sanetti LMH, Collier‐Meek MA, Fallon LM. Fidelity with flexibility: treatment acceptability and individualized adaptations of evidence‐supported treatments. In: Maltzman S, editor. The Oxford handbook of treatment processes and outcomes in psychology: a multidisciplinary, biopsychosocial approach [online edition]. Oxford Academic, 2016; pp 289‐308.
40. Swift JK, Callahan JL, Cooper M, Parkin SR. The impact of accommodating client preference in psychotherapy: a meta‐analysis. J Clin Psychol 2018; 74: 1924‐1937.
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42. Gee G, Dudgeon P, Schultz C, et al. Aboriginal and Torres Strait Islander social and emotional wellbeing. In: Dudgeon P, Milroy H, Walker R; editors. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. Canberra: Commonwealth of Australia; 2014; pp 55‐68.
43. Newton D, Day A, Gillies C, Fernandez E. A review of evidence‐based evaluation of measures for assessing social and emotional well‐being in Indigenous Australians. Aust Psychol 2015; 50: 40‐50.
44. Ponturo A, Kilcullen M. A systematic review of evidence‐based psychological interventions and Aboriginal and Torres Strait Islander people. Clinical Psychologist 2021; 25: 198‐211.
45. Adams LM, Miller AB. Mechanisms of mental‐health disparities among minoritized groups: how well are the top journals in clinical psychology representing this work? Clin Psychol Sci 2022; 10: 387‐416.
46. Dudgeon P, Kelly K. Contextual factors for research on psychological therapies for Aboriginal Australians. Aust Psychol 2014; 49: 8‐13.
47. National Health Medical Research Council. Ethical conduct in research with Aboriginal and Torres Strait Islander Peoples and communities: guidelines for researchers and stakeholders. Canberra: NHMRC, 2018. https://www.nhmrc.gov.au/about‐us/resources/ethical‐conduct‐research‐aboriginal‐and‐torres‐strait‐islander‐peoples‐and‐communities (viewed May 2025).

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Linguistic manoeuvres: obstetric violence camouflages harm and loss of consent from birth

Harsha Ananthram, Liz Sutton, Rebecca Matthews, Nadine Montgomery, James Titcombe and Ajay Rane

Med J Aust || doi: 10.5694/mja2.70045
Published online: 8 September 2025

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The recent inquiries into birth trauma in New South Wales (NSW) and the United Kingdom (UK)1,2 have led to increased scrutiny of maternity care standards. These inquiries found that a failure to listen, poor communication, and care that lacked balanced information, adequate pain relief and kindness were hurting birthing women. Women also experience harm from unsolicited interventions. The antenatal provision of good quality information is critical to consent at birth. Informing women about available choices during pregnancy, or the decoding of the birth experience after birth, risks being hindered by hyperbolic discussions focused on “obstetric violence”. In this article, we problematise the term “obstetric violence” and suggest that it may confuse harm done to women by the promotion of “normal birth”. In this article, “woman” represents all women and birthing people.

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1 James Cook University, Townsville, QLD, Australia
2 University of South Australia, Adelaide, SA, Australia
3 University of Reading, Reading, UK, United Kingdom of Great Britain and Northern Ireland
4 Levy and McRae, Glasgow, UK, United Kingdom of Great Britain and Northern Ireland
5 Cumbria, Cumbria, United Kingdom of Great Britain and Northern Ireland

Correspondence: liz.sutton@unisa.edu.au

Competing interests:

One of the authors, Nadine Montgomery, was the pursuer in the Montgomery v Lanarkshire case mentioned herein. One of the authors, James Titcombe, is associated with the Harmed Patients Alliance, and has authored a book and various articles on the issue of patient safety in maternity care. He has advised inquiries into standards of maternity care. He is a bereaved father.

Author contribution statement:

Ananthram H: Conceptualization, writing ‐ original draft, writing ‐ review and editing. Sutton L: Writing ‐ original draft, writing ‐ review and editing. Matthews R: Writing ‐ original draft, writing ‐ review and editing. Montgomery N: Writing ‐ review and editing. Titcombe J: Writing ‐ review and editing. Rane A: Writing ‐ review and editing.

1. New South Wales Parliament. Select Committee on Birth Trauma [website]. Parliament of New South Wales, 2023. https://www.parliament.nsw.gov.au/committees/listofcommittees/Pages/committee‐details.aspx?pk=318> (viewed Mar 2024).
2. All Party Parliamentary Group on Birth Trauma. Listen to mums ‐ ending the postcode lottery on perinatal care. Westminster, UK: APPG, May 2024. https://www.theo‐clarke.org.uk/files/2024‐05/Birth%20Trauma%20Inquiry%20Report%20for%20Publication_May13_2024.pdf (viewed Aug 2025).
3. Sutton E, Detering K, East C, Whittaker A. Women's expectations about birth, requests for pain relief in labor and the subsequent development of birth dissonance and trauma. BMC Pregnancy Childbirth 2023; 23: 777.
4. Creedy DK, Shochet IM, Horsfall J. Childbirth and the development of acute trauma symptoms: incidence and contributing factors. Birth 2000; 27: 104‐111.
5. Pickles C. “Obstetric Violence,” “Mistreatment,” and “Disrespect and Abuse”: reflections on the politics of naming violations during facility‐based childbirth. Hypatia 2023; 38: 628‐649.
6. Savage V, Castro A. Measuring mistreatment of women during childbirth: a review of terminology and methodological approaches. Reprod Health 2017; 14: 138.
7. Davis‐Floyd R, Premkumar A, editors. Obstetric violence and systemic disparities: can obstetrics be humanized and decolonized? Oxford, UK: Berghahn Books, 2023.
8. Dietsch E, Shackleton P, Davies C, et al. ‘You can drop dead’: midwives bullying women. Women Birth 2010; 23: 53‐59.
9. Einhorn S. From a woman's point of view. How internalized misogyny affects relationships between women. Group Analysis 2021; 54: 481‐498.
10. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. NSW Legislative Council: Inquiry into birth trauma. Submission, 11 August 2023. https://www.parliament.nsw.gov.au/lcdocs/submissions/80709/0238%20RANZCOG.pdf (viewed Mar 2025).
11. NSW Government. Maternity ‐ towards normal birth in NSW [Rescinded]. Policy Statement, 29 June 2010. https://www1.health.nsw.gov.au/pds/ArchivePDSDocuments/PD2010_045.pdf (viewed Aug 2025).
12. Gamble J, Creedy D. Psychological trauma symptoms of operative birth. Br J Midwifery 2005; 13: 218‐224.
13. Ananthram H, Vangaveti V, Rane A. Have we lost sight of the women? An observational study about normality‐centred care in Australian maternity services. Aust N Z J Obstet Gynaecol 2022; 62: 40‐46.
14. Olieman RM, Siemonsma F, Bartens MA, et al. The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review. BMC Pregnancy Childbirth 2017; 17: 195.
15. Muraca GM, Ralph LE, Christensen P, et al. Maternal and neonatal trauma during forceps and vacuum delivery must not be overlooked. BMJ 2023; 383: e073991.
16. UK Supreme Court. Montgomery (Appellant) v Lanarkshire Health Board (Respondent) (Scotland) [website]. UKSC/2013/0136. 2015. https://www.supremecourt.uk/cases/uksc‐2013‐0136.html (viewed Aug 2025).
17. Jade citator search results. [1992] HCA 58; 175 CLR 479; 23 NSWLR 600; 109 ALR 625; (1991) Aust Torts Reports 81–113 [website]. https://jade.io/citation/2463644 (viewed Feb 2025).
18. Sandall J, Turienzo CF, Devane D, et al. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database Syst Rev 2024; 4: CD004667.
19. Sandall J, Soltani H, Gates S, et al. Midwife‐led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2015; 9: CD004667.
20. Ockenden D. Ockenden Report ‐ Final: findings, conclusions and essential actions from the independent review of maternity services at The Shrewsbury and Telford Hospital NHS Trust. London, House of Commons: Dandy Booksellers Ltd; 2022.
21. Gerber MR. Trauma‐informed maternity care. In: Gerber MR, editor. Trauma‐informed healthcare approaches. Cham: Springer International Publishing, 2019; pp. 145‐155.
22. Keedle H, Peters L, Schmied V, et al. Women's experiences of planning a vaginal birth after caesarean in different models of maternity care in Australia. BMC Pregnancy Childbirth 2020; 20: 381.
23. Keglowitsch K, Meagher M. Making room for births that are not good: lessons from cesarean shame shame. International Journal of Feminist Approaches to Bioethics 2022; 15: 22‐39.

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Perspective

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Reducing unprofessional practices in referrals to abortion care: proposing a minimum professional standard

Shelly Makleff, Bronwen Merner, Kirsten I Black and Louise Keogh

Med J Aust || doi: 10.5694/mja2.70043
Published online: 8 September 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

General medicine

Ethics and law

Unprofessional abortion referral practices are a threat to person‐centred abortion care. Evidence globally shows that unprofessional abortion referral practices can generate misinformation, communicate judgement, and hinder timely access to care — causing distress and harm to abortion seekers.1,2,3,4,5,6 These harmful referral practices occur across the health care workforce and are not limited to individuals claiming a conscientious objection.1,2,3,4,5,6 This suggests a need to define best practice for abortion referral and encourage professionalism in referral practices. Addressing this gap, this perspective article: (i) applies the principles of medical professionalism to abortion referral, (ii) proposes a minimum standard for professional abortion referral, and (iii) identifies strategies across the health system to promote person‐centred referrals.

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1 University of Melbourne, Melbourne, VIC
2 University of Sydney, Sydney, NSW

Correspondence: shelly.makleff@unimelb.edu.au

Open access:

Open access publishing facilitated by The University of Melbourne, as part of the Wiley ‐ The University of Melbourne agreement via the Council of Australian University Librarians.

Acknowledgements:

We acknowledge the contributions of participants of prior studies, who generously shared information with us that has informed the ideas shared in this commentary. We also acknowledge our collaborators on various other projects that have also inspired the thinking in this piece.

Competing interests:

Kirsten Black is chair of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Sexual and Reproductive Health Special Interest Group.

Author contribution statement:

Makleff S: Conceptualization, writing – original draft, writing – review and editing. Merner B: Conceptualization, writing – original draft, writing – review and editing. Black KI: Interpretation, writing – review and editing. Keogh L: Interpretation, writing – review and editing.

1. de Londras F, Cleeve A, Rodriguez MI, et al. The impact of ‘conscientious objection’ on abortion‐related outcomes: a synthesis of legal and health evidence. Health Policy 2023; 129: 104716.
2. Self B, Maxwell C, Fleming V. The missing voices in the conscientious objection debate: British service users’ experiences of conscientious objection to abortion. BMC Med Ethics 2023; 24: 65.
3. Makleff S, Belfrage M, Wickramasinghe S, et al. Typologies of interactions between abortion seekers and healthcare workers in Australia: a qualitative study exploring the impact of stigma on quality of care. BMC Pregnancy Childbirth 2023; 23: 646.
4. Vallury KD, Kelleher D, Mohd Soffi AS, et al. Systemic delays to abortion access undermine the health and rights of abortion seekers across Australia. Aust N Z J Obstet Gynaecol 2023; 63: 612‐615.
5. Keogh LA, Gillam L, Bismark M, et al. Conscientious objection to abortion, the law and its implementation in Victoria, Australia: perspectives of abortion service providers. BMC Med Ethics 2019; 20: 11.
6. Noonan A, Black KI, Luscombe GM, Tomnay J. “Almost like it was really underground”: a qualitative study of women's experiences locating services for unintended pregnancy in a rural Australian health system. Sex Reprod Health Matters 2023; 31: 2213899.
7. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Clinical guideline for abortion care: an evidence‐based guideline on abortion care in Australia and Aotearoa New Zealand. Melbourne, Australia: RANZCOG; 2023. https://ranzcog.edu.au/wp‐content/uploads/Clinical‐Guideline‐Abortion‐Care.pdf (viewed Jan 2025).
8. Medical Board Australian Health Practitioner Regulation Agency. Good medical practice: a code of conduct for doctors in Australia. Melbourne, Australia: Medical Board Ahpra; 2020. https://www.medicalboard.gov.au/Codes‐Guidelines‐Policies/Code‐of‐conduct.aspx (viewed Apr 2025).
9. Australian Medical Association. AMA position statement: conscientious objection ‐ 2019[website]. AMA; 2019. https://www.ama.com.au/position‐statement/conscientious‐objection‐2019 (viewed Jan 2025).
10. Lavelanet AF, Johnson BR, Ganatra B. Global Abortion Policies Database: a descriptive analysis of the regulatory and policy environment related to abortion. Best Pract Res Clin Obstet Gynaecol 2020; 62: 25‐35.
11. Sorhaindo AM, Lavelanet AF. Why does abortion stigma matter? A scoping review and hybrid analysis of qualitative evidence illustrating the role of stigma in the quality of abortion care. Soc Sci Med 2022; 311: 115271.
12. Foster DG. The turnaway study: ten years, a thousand women, and the consequences of having‐‐or being denied‐‐an abortion. New York: Scribner Book Company; 2020.
13. Srinivasan S, Botfield JR, Mazza D. Utilising HealthPathways to understand the availability of public abortion in Australia. Aust J Prim Health 2022; 29: 260‐267.
14. Afulani PA, Nakphong MK, Sudhinaraset M. Person‐centred sexual and reproductive health: a call for standardized measurement. Health Expect 2023; 26: 1384‐1390.
15. Turner KL, Pearson E, George A, Andersen KL. Values clarification workshops to improve abortion knowledge, attitudes and intentions: a pre‐post assessment in 12 countries. Reprod Health 2018; 15: 40.

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Consensus statement

Assessment of metabolic dysfunction‐associated fatty liver disease in primary care: a consensus statement summary

Leon A Adams, William W Kemp, Kate R Muller, Elizabeth E Powell, Stuart K Roberts, Luis Calzadilla Bertot, Stephanie Best, Gary Deed, Jon D Emery, Samantha L Hocking, Graham R Jones, John S Lubel, Sinead Sheils, Stephen M Twigg, Gerald F Watts and Jacob George

Med J Aust 2025; 223 (5): . || doi: 10.5694/mja2.70008
Published online: 1 September 2025

ARTICLE
AUTHORS
REFERENCES

Topics

General medicine

Digestive system diseases

Endocrine system diseases

Nutritional and metabolic diseases

Diagnostic techniques and procedures

Abstract

Introduction: Metabolic dysfunction‐associated fatty liver disease (MAFLD) is common. This evidence‐based consensus statement summary provides recommendations for the assessment and monitoring of adults with MAFLD in primary care.

Main recommendations: Adults with type 2 diabetes, obesity or two or more other metabolic risk factors should be tested for MAFLD. Hepatic steatosis should be evaluated using ultrasound, whereas the presence and complications of type 2 diabetes and obesity should be assessed according to current Australian guidelines. Cardiovascular disease, chronic kidney disease and obstructive sleep apnoea are common in people with MAFLD and should be considered as part of a holistic health assessment. Alternative causes of hepatic steatosis, including excess alcohol consumption, must be considered, and patients with elevated serum aminotransferase levels should be tested for hepatitis B and C infection and iron overload. The risk of advanced liver fibrosis requires assessment using the Fibrosis‐4 (FIB‐4) Index; a low score (< 1.3) is associated with a more than 95% negative predictive value for advanced liver fibrosis. People with an indeterminate FIB‐4 score (between 1.3 and 2.7) should undergo second‐line assessment with liver elastography or a direct liver fibrosis serum test or, if these tests are unavailable, should be referred to an expert clinician in liver disease. People with MAFLD and a high FIB‐4 score (> 2.7), an elevated direct liver fibrosis serum test, high elastography results or with clinical, laboratory or imaging evidence of cirrhosis should be referred for further evaluation. Individuals with a low FIB‐4 score (< 1.3), low elastography or direct liver fibrosis serum test results should be monitored with a repeat FIB‐4 test at least every three years. Monitoring of weight, body mass index and/or waist circumference and for emergence of type 2 diabetes (in individuals without) should be performed at least annually.

Change in management as a result of this consensus statement summary: Appropriate identification, assessment and risk stratification of people with MAFLD will aid referral pathways, further investigation and management.

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1 University of Western Australia, Perth, WA
2 Sir Charles Gairdner Hospital, Perth, WA
3 Alfred Health, Melbourne, VIC
4 Flinders Medical Centre, Adelaide, SA
5 Princess Alexandra Hospital, Adelaide, SA
6 QIMR Berghofer Medical Research Institute, Brisbane, QLD
7 Monash University, Melbourne, VIC
8 University of Melbourne, Melbourne, VIC
9 HealthcarePlus Medical, Brisbane, QLD
10 Centre for Cancer Research, University of Melbourne, Melbourne, VIC
11 University of Sydney, Sydney, NSW
12 Royal Prince Alfred Hospital, Sydney, NSW
13 St Vincent's Hospital, Sydney, NSW
14 University of New South Wales, Sydney, NSW
15 AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
16 Royal Perth Hospital, Perth, WA
17 Storr Liver Centre, Westmead Institute of Medical Research, Sydney, NSW

Correspondence: leon.adams@uwa.edu.au

Open access:

Open access publishing facilitated by The University of Western Australia, as part of the Wiley ‐ The University of Western Australia agreement via the Council of Australian University Librarians.

Acknowledgements:

Unrestricted grant funding was provided to the Gastroenterological Society of Australia (GESA) for completion of this consensus statement summary. Details of GESA's funding sources are available on the website (www.gesa.org.au). Editorial independence was maintained throughout the manuscript development. The funders had no input into the study planning, writing or publication and no role in study design, analysis, interpretation or reporting. The following collaborators contributed to the design, participation in the modified Delphi process and in the reviewing of the recommendations: Nicole Allard, Oyekoya Ayonrinde, Shopna Bag, Tim Davis, Anouk Dev, Elif Ekinci, Mohammed Eslam, Charlotte Hespe, Andrew Kirke, Graeme MacDonald, Suzanne Mahady, Avik Majumdar, John Olynyk, Milan Piya, Marno Ryan, Ashim Sinha, Simone Strasser, Alan Wigg, Sue Williams and Amany Zekry. We thank Meike Fruechtl (Project Officer) for her tireless administrative and logistic support and co‐ordination of steering committee and working group members.

Competing interests:

Leon Adams has received honoraria for participating on advisory boards and speaker fees during development of the metabolic dysfunction‐associated fatty liver disease (MAFLD) consensus statement summary from Pfizer, Gilead, Roche Diagnostics and Novartis. Mohammed Eslam has received personal fees from Pfizer and honoraria from Sanofi. Jacob George was on advisory boards and receives honoraria for talks from Novo Nordisk, AstraZeneca, Roche, BMS, Pfizer, Cincera, Pharmaxis and Boehringer Mannheim. Samantha Hocking has received honoraria from or participated on advisory boards for Eli Lilly, Novo Nordisk, iNova, Sanofi, AstraZeneca, Servier, Amgen, Nestle Health Sciences, Seqirus, Pfizer and Johnson & Johnson. John Lubel has received speaker fees from Norgine and Gilead, has presented at sponsored GP dinners (no personal fees) for Norgine and Dr Falk Pharma, has received sponsorship for a GP educational event (no speaker fee) from Viatris Pty Ltd, is an IPSEN advisory consultant and has received speaker fees for internal staff education, and received sponsorship from IPSEN to attend the EASL 2024 meeting in Milan, Italy. Norgine partially supported his PhD student to travel to an international conference. Kate Muller has received honoraria for participating on advisory boards and speaker fees during development of the MAFLD consensus statement summary from Chiesi, Eisai, AstraZeneca and Novo Nordisk. Elizabeth Powell has received honoraria for advisory board participation and support for an educational event from Novo Nordisk and has had access to the ELF test provided by Siemens Healthineers. Simone Strasser has received honoraria for participating on advisory boards and speaker fees during development of the MAFLD consensus statement summary from Chiesi, Eisai, Sirtex, Norgine, Roche Products, Roche Diagnostics, AstraZeneca, Otsuka and Pfizer. The University of Western Australia (employer of Leon Adams) holds a US patent for Hepascore. The university does not receive any royalties or benefits from this patent.

Author contribution statement:

Adams LA: Conceptualization, data curation, funding acquisition, methodology, project administration, formal analysis, supervision, writing – original draft, writing – review and editing. Kemp WW: Conceptualization, supervision, writing – original draft, writing – review and editing. Muller KR: Conceptualization, supervision, writing – original draft, writing – review and editing. Powell EE: Conceptualization, supervision, writing – original draft, writing – review and editing. Roberts SK: Conceptualization, supervision, writing – original draft, writing – review and editing. Calzadilla Bertot L: Data curation, formal analysis, writing – original draft, writing – review and editing. Best S: Conceptualization. Deed G: Conceptualization, writing – original draft, writing – review and editing. Emery JD: Conceptualization, writing – original draft, writing – review and editing. Hocking SL: Conceptualization, writing – original draft, writing – review and editing. Jones GR: Conceptualization, writing – original draft, writing – review and editing. Lubel JS: Conceptualization, methodology, writing – original draft, writing – review and editing. Sheils S: Conceptualization, writing – original draft, writing – review and editing. Twigg SM: Conceptualization, writing – original draft, writing – review and editing. Watts GF: Conceptualization, writing – original draft, writing – review and editing. George J: Conceptualization, funding acquisition, methodology, supervision, writing – original draft, writing – review and editing.

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Ethics and law

Ante‐mortem interventions for deceased donation: legal barriers and uncertainty in Australia's decision‐making frameworks

Shih‐Ning Then, Dominique E Martin and Helen I Opdam

Med J Aust 2025; 223 (5): . || doi: 10.5694/mja2.70020
Published online: 1 September 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Ethics and law

Surgical procedures, operative

Definitive decision making about deceased donation of organs and tissues usually occurs towards the end of a person's life. If possible, pathways to organ donation will depend on the clinical circumstances: donation after neurological determination of death (“brain death”), or donation after circulatory determination of death (DCDD). DCDD typically applies when ceasing life‐sustaining interventions is planned, and when death is expected within a timeframe permitting recovery of organs for transplantation (ie, controlled DCDD).1 People undergoing voluntary assisted dying may also choose to pursue DCDD.2

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1 Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
2 Deakin University, Geelong, VIC
3 Austin Health, Melbourne, VIC
4 Australian Organ and Tissue Authority, Canberra, ACT

Correspondence:

Correspondence: shih‐ning.then@qut.edu.au

Open access:

Open access publishing facilitated by Queensland University of Technology, as part of the Wiley – Queensland University of Technology agreement via the Council of Australian University Librarians.

Competing interests:

Shih‐Ning Then and Dominique Martin have acted as paid consultants to the Australian Organ and Tissue Authority in developing guidelines. Helen Opdam holds the role of National Medical Director of DonateLife (Organ and Tissue Authority).

Author contributions:

Then SN: Conceptualization, writing – original draft and review and editing, formal analysis of the paper. Martin DE: Conceptualization, writing – review and editing. Opdam HI: Writing – review and editing.

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Perspective

A precautionary approach to social media: protecting young minds in an evolving digital world

Ivana Stankov, Yonatal Tefera, Melissa Bradley, Alison Pickering, Emma Willoughby and Carmel Williams

Med J Aust 2025; 223 (5): . || doi: 10.5694/mja2.52722
Published online: 1 September 2025

ARTICLE
AUTHORS
REFERENCES

Topics

Information science

Mental disorders

Environment and public health

Social determinants of health

The negative impact of social media on children's mental health has raised concerns at the highest levels1 despite limited causal evidence. To mitigate concerns, Meta (a social technology company that owns several social media platforms) created “teen accounts”,2 several European nations are considering age‐based restrictions, and Australia legislated a world‐first social media ban for children under 16 years.3

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1 University of South Australia, Adelaide, SA
2 Health Translation SA, Adelaide, SA
3 South Australian Health and Medical Research Institute Limited, Adelaide, SA
4 University of Adelaide, Adelaide, SA
5 Preventive Health SA, Population Health Government of South Australia, Adelaide, SA

Correspondence: ivana.stankov@unisa.edu.au

Open access:

Open access publishing facilitated by University of South Australia, as part of the Wiley ‐ University of South Australia agreement via the Council of Australian University Librarians.

Competing interests:

No relevant disclosures.

Author contributions:

Stankov I: Conceptualization, writing – original draft, writing – review and editing. Tefera Y: Writing – review and editing. Bradley M: Writing – review and editing. Pickering A: Writing – review and editing. Willoughby E: Writing – review and editing. Williams C: Writing – review and editing, supervision.

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