Sexual and reproductive health in crisis

We have heard a lot about abortion recently. At federal level Senator Barnett is trying to have a Medicare item removed to reduce funding for abortion; and in Victoria, the parliament recently had a conscience vote on reforming their abortion laws. During this debate, many members of the Victorian Parliament asked: what is being done to prevent unplanned pregnancy?

The answer? Not enough.

The estimated national abortion rate of 19.7 per 1,000 females of reproductive age (15-44 years) is indeed high compared with other industrialised countries such as Germany (7.7) or the Netherlands (8.7).

But it gets worse.

The rate of births to teenagers in Australia is also high at 18.4 per 1,000 females of reproductive age, compared with Korea (2.9) or Switzerland (5.5), although lower than the UK (29.7) and the USA (51.1). Teenage motherhood is associated with a range of poor social, economic and health outcomes.

In Australia over the last decade, rates of chlamydia have increased more than four-fold and rates of gonorrhoea have almost doubled. We have also seen an increase in the number of new cases of HIV in recent years.

In addition, young people who identify as gay or lesbian, or are unsure of their sexuality, experience high levels of distress and depression.

Among sexually active secondary school students surveyed in 2002, 23 per cent of males and 28 per cent of females had experienced unwanted sex. Pressure from partners, drugs and alcohol were all factors. In addition, among women over the age of 15 years, almost 20 per cent have experienced sexual violence, with younger women experiencing the highest rates.

Over a quarter of females and around 5 per cent of males in Australia were sexually abused as children.

Health outcomes like this in a country like Australia are unacceptable.

Sexual and reproductive health issues cover the whole lifespan for all genders and sexualities. Sexuality should be a positive, healthy part of life, not an issue only considered in the context of abortion or disease. Conservative social attitudes often inhibit discussion of this in public life. The recent removal of abortion from the Crimes Act by the Victorian Parliament was a courageous and positive move which has brought these issues to the fore. It is an opportunity to do more and we must not let it pass us by.

In the 1980s in the early stages of the HIV-AIDS epidemic, the Australian Government worked with all levels of government, stakeholders, researchers and affected communities and showed strong leadership in not allowing local or parochial views to undermine the first National HIV-AIDS strategy. This partnership, preventive and human rights approach was recognised as best practice at the time, and is needed again now.

Australia has never had a comprehensive national sexual and reproductive health strategy, despite the (then) Department of Health and Aged Care recommending one in 2000.

Current strategies are disease focused and lack connection with inter-dependent factors such as drug and alcohol abuse, violence and the social determinants of health which make some populations within the community particularly vulnerable to poor sexual and reproductive health outcomes.

In particular, while the prevention of sexual transmissible infections gets some attention and government spending, there are no national, uniform, minimum standards for sexuality and sexual health education in our schools. Most education Ministers in the States and Territories have no idea what, if any, sexuality and relationships education is taught in each school.

Access to a full range of contraception is not available in many parts of Australia and community awareness of contraceptive methods, particularly emergency contraception (the “morning-after pill”) is low.

Compare this with the Netherlands where young people receive comprehensive sexuality education throughout their schooling and can easily access contraception at little or no cost. These initiatives, according to the International Planned Parenthood Foundation, have produced the best sexual and reproductive health outcomes in the world.

The Public Health Association of Australia (PHAA) in conjunction with Sexual Health and Family Planning Australia (SH&FPA) and the Australian Reproductive Health Alliance (ARHA) earlier this year released a Background Paper and Call to Action for a National Sexual and Reproductive Health Strategy.

It outlines a clear, evidence based, prevention focused approach which aims to improve knowledge; access to quality health services across the lifespan; and a range of health outcomes.

This Call to Action has been sent to the Australian Government and to all members of the Victorian Parliament during the recent debate on abortion law reform. The time for leadership on this issue is now.

Poor sexual and reproductive health outcomes cannot be solved overnight, but there is much that can be done. The potential for positive change is huge. Reducing the number of women facing the stress of an unplanned pregnancy - therefore reducing the abortion rate is just one outcome we would all like to see.