March was a month filled with advocacy and collaboration, and I was fortunate to engage both with RANZCOG members and trainees, and other local and international healthcare organisations to share ideas and further the goals of the College.

The 14^th RANZCOG Council convened for its first meeting of 2026 in March. Our discussions spanned across the key priorities of the College, including responding to issues facing the specialty and women’s health, strengthening member value, and remaining accountable to our strategic priorities. These themes arose throughout the month, and below I’ve outlined just a few examples of the work being undertaken within the College and beyond.

Informed consent in maternity care

The on informed consent in maternity care poses an important opportunity for reflection for us all. Clinical procedures must always be supported by clear communication and voluntary consent, both which are essential components of respectful maternity care.

Trauma survivor, Larissa Gawthrop, was awarded $275,000 in damages by the Supreme Court of Victoria on 27 March,after being pressured into a vaginal examination by a midwife with the implication that care, including pain relief would be withheld if Larissa did not consent to vaginal examination. Importantly, the court distinguished subsequent vaginal examinations and instrumental vaginal birth as being consensual.

Although this case has caused some consternation within our community, it should not be a polarising issue. Informed consent is a critical part of safe, ethical, trauma-informed and patient-centred care. It is a fundamental principle that underpins trust between patients and healthcare providers. As clinicians, we must foster environments where patients feel heard, supported, and empowered to make informed decisions about their care.

Endometriosis awareness

Following the recent allegations raised regarding a gynaecologist, RANZCOG is working with Safer Care Victoria (SCV), the Australasian Gynaecological Endoscopy and Surgery (AGES) Society, Women’s Health Victoria (WHV), AHPRA, and government stakeholders to consider steps to strengthen collaboration and support evidence-based care.

As part of this effort, several initiatives have been delivered. On 23 March, RANZCOG, AGES, and Women’s Health Victoria co-hosted a webinar for clinicians. This session focused on supporting patients navigating endometriosis, addressed frequently asked questions from the WHV Endometriosis and Pelvic Pain Surgery Concerns Line, and explored recent developments in care. Attendees also had the opportunity to ask questions. A second webinar, held in partnership with Avant on 1 April, examined medico-legal considerations related to endometriosis and pelvic pain care.

These webinars for medical professionals were complimented by a public session for consumers, held on 24 March, which provided an opportunity for attendees to submit their own questions to the panel for discussion.

A theme that ran across all sessions was the erosion of trust that patients are currently experiencing, and how we must work to rebuild this. Transparent communication, shared decision-making, and evidence-based care are the cornerstones of our specialty, and we should all be reflecting on how we can better implement these practices day to day.

Another of my key takeaways is the value of building a network of fellow clinicians you can lean on for an additional source of opinion and advice. Whether it be to seek further expertise on a clinical presentation or to refer for multidisciplinary care, having a community you can rely on will only strengthen the level of care we are able to provide to women.

I urge all members and trainees to regularly review the College’s Australian Living Evidence Guideline: Endometriosis. As a living evidence guideline, this document is reviewed and updated every six months as new evidence is produced, to ensure guidance is driven by the latest research. The most recent update was implemented in March, resulting in changes to two recommendations.

I am pleased with the recent announcement that RANZCOG has been successful in securing funding from the Australian commonwealth government to support the development of more clinical resources and initiatives aimed at improving care for women living with endometriosis and persistent pelvic pain.

Specifically, it will enable ongoing evidence review for the College’s Australian Living Evidence Guideline: Endometriosis, and the development of a dedicated clinical guideline and patient information for persistent pelvic pain more broadly – recognising that many women experience pelvic pain unrelated to endometriosis.

Finally, the College’s Research and Policy Team, alongside Dr Marilla Druitt, Prof Cindy Farquhar, and Magda Bofill, has worked closely with SCV to inform the development of a SCV Clinical Practice Point which highlights the role of less invasive methods, such as ultrasound and MRI, for diagnosis of endometriosis, ensuring alignment with evidence from the RANZCOG Guideline.

AGES ASM

I had the pleasure of attending and presenting at the Australasian Gynaecological Endoscopy & Surgery Society (AGES) Annual Scientific Meeting 2026 in Auckland. The theme for this year’s conference was “Bridging the Divide – Surgical Experience vs Scientific Evidence”, with a focus on “embracing the power of emerging research and innovation, to guide and refine our surgical practice.”

The program featured a breadth of topics relevant to clinicians, such as highlighting the importance of consent in the patient journey and innovations in surgical practice using robotics.

����TV had a valuable meeting with AGES to discuss surgical training as a whole, and the College looks forward to continuing to collaborate with them on evolving surgical training to be the best it can be for all trainees in Australia and Aotearoa New Zealand.

Close the Gap Day

Thursday 19 March was Close the Gap Day, with the theme this year being “Community Voices: The Pathway to Justice, Equality and Healing.” This year’s Close the Gap report highlights the disparities in women’s health experienced by Aboriginal and Torres Strait Islander peoples. This inequity is visible in recent statistics – according to a , Aboriginal and Torres Strait Island women are projected to reach cervical cancer elimination in 2047, 12 years after the Australian government’s 2035 target. Targeted and collective action is required to improve screening participation in First Nations communities, including promoting access to self-collection.

I encourage all members and trainees to reflect on your own practice and how you can take steps to improve equity and access within your local community. The College provides a range of resources to help facilitate this reflection and promote learning and action, including the Cultural Safety Reflection Tool, and Acquire eLearning Courses.

I also urge you to read the 2026 Close the Gap Report, available .

Council of Presidents of Medical Colleges (CPMC) Meeting

The Council of Presidents of Medical Colleges (CPMC) convened at the beginning of the month at Parliament House in Canberra. The meeting included a workshop facilitated by Professor Jenny May AM, the National Rural Health Commissioner, on increasing the rural and regional specialist workforce. This supports the existing work of RANZCOG in regional, rural, and remote workforce training and skills maintenance through programs such as Obstetrics and Gynaecology Education and Training (OGET).

The Council went on to discuss a range of priorities, including accreditation and training standards, SIMG assessment, and fee transparency. The latter resulted in a shared . The Hon Rebecca White MP, Assistant Minister for Health and Aged Care, addressed the Council to mark the launch of this framework and discussed the government’s broader priorities in improving access within the Australian healthcare system.

The framework supports and reinforces RANZCOG’s emphasis on providing equitable, patient-centred specialist care, and I advise all clinicians to familiarise themselves with its principles.

Healthcare advocacy in South Australia

In February, the South Australian College Chairs Committee, of which RANZCOG is a member, issued a three-point healthcare plan, urging parties to commit to the following:

1. Map the state’s healthcare gaps
2. Plan the medical workforce properly
3. Cut red tape that stops doctors working where they’re needed

Dr Magdalena Halt, SA Councillor and the College’s representative on the Committee, says that “Without a statewide strategy that properly maps need and plans the workforce, women and gender-diverse people are too often left waiting longer or going without essential healthcare altogether.”

In the wake of the SA state elections, I hope that all parties continue to work on these vital goals to ensure equitable access and high-quality healthcare across the state, improving outcomes for the people of SA.

RTCOG Annual Scientific Meeting

Also in February, I travelled to Bangkok to present at the Royal Thai College of Obstetricians and Gynaecologists (RTCOG) Annual Scientific Meeting. My presentation, “Beyond Decriminalisation: Abortion Care and Access in Australia” examined the regulatory context of abortion in Australia and Aotearoa New Zealand, recent developments, ongoing challenges, and training pathways for clinicians.

I outlined the College’s binational Clinical Guideline for Abortion Care and the impact this resource has had in implementing abortion services, particularly in Western Australia following decriminalisation in 2023. Attempts at legislative challenges to abortion access and care continue, however RANZCOG remains steadfast in its commitment to advocating for this essential aspect of healthcare. I was humbled to present this overview of our nation’s journey in this space and the College’s role in promoting access.

Collaboration within our specialty and with the broader healthcare community is vital to support excellent outcomes in women’s health. I am invigorated and inspired by the tireless effort and dedication of our colleagues both locally and internationally. Sharing ideas and experiences and collaborating on solutions is invaluable and I am eager to continue to build on the College’s relationships to support our ongoing efforts in education, training, advocacy, and more.

Dr Nisha Khot
����TV President

*RANZCOG acknowledges the need for more inclusive terminology for gender diversity. In this blog, use of the term “woman” should be interpreted to include all people requiring gynaecological and obstetric care.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the New Zealand College of Midwives (NZCOM) commend Health New Zealand | Te Whatu Ora and the Hon. Simeon Brown, Minister of Health, for implementing interim measures to reduce unaffordable copayments for maternity ultrasounds, as well as committing to developing longer-term, sustainable funding arrangements.

Late last year, as a significant increase in maternity ultrasound copayments loomed, NZCOM and RANZCOG wrote to the Minister of Health urgently requesting an interim solution to address copayments, as well as a full review of maternity ultrasound funding.

Today’s announcement of a $12.9 million funding boost for community-delivered maternity ultrasounds services, introduces arrangements with private providers – who deliver the majority of maternity ultrasound scans in New Zealand – to cap copayments at $30 dollars for those with a community services card (CSC) and $90 for non-CSC holders. This is a reduction from the previously proposed increases to $75 and $150 respectively.

The $92 fee currently paid by Te Whatu Ora to community-based ultrasound providers has not changed since 1997 and is substantially lower than public funding for other types of ultrasound scans, despite maternity ultrasounds often being more complex and requiring more time to complete. Providers have needed to charge women increasing co-payments to help cover their costs.

Now, Health New Zealand is finally boosting the funding it pays to community providers. Under the new approach:

• Co-payments must be capped at $30 for Community Service Card holders and $90 for non-CSC holders(includingGST).
• Hospital maternity ultrasound servicesremainfully funded, with no user charges.
• Existing regional subsidies, including those funded through hospitaland specialist services,regional commissioning or primary health,are toremain in place to ensure no woman is worse off during the transition.
• Providers who optinto the short-term contractwill continue to claim under the existing Notice and be eligible for a top-up payment, so that total funding including any co-paymentis up to $225.50 (incl GST) per scan for patients with aCSC, and $216.50 (incl. GST) for a non-CSC holder.

NZCOM Chief Executive, Alison Eddy cautions that $90 copayments for non-community services card holders will still be unaffordable for some women on low incomes, especially those with high-risk pregnancies requiring multiple scans.

During the course of a straightforward pregnancy, two routine ultrasound scans are recommended, however when there are concerns about the wellbeing of the baby, as many as eight scans may be required. At $90 copayment per scan, it’s easy to see how this can still amount to a very significant cost burden for families.

– NZCOM Chief Executive, Alison Eddy

Both RANZCOG and NZCOM have raised concerns about outdated maternity ultrasound funding and ever-increasing copayments for many years, highlighting the risks that families are unable to access clinically necessary maternity ultrasound scans because of cost, and that this will result in avoidable tragic consequences for mothers and babies.

����TV New Zealand Vice President, Dr Emma Jackson says, “It’s great to see that for the first time in years funding has been put in place nationally to assist in reducing maternity ultrasound copayments, but most importantly it is a relief to see commitment to addressing maternity ultrasound funding properly, so that women can access the essential ultrasound scans they need for the safety of their pregnancy without cost being a barrier.”

����TV and NZCOM are committed to working with the Ministry of Health and Te Whatu Ora on a full review of maternity ultrasound funding and we hope to see copayments for clinically necessary maternity ultrasound scans become a thing of past soon.

– RANZCOG New Zealand Vice President, Dr Emma Jackson

For more information, please refer to .

Media enquiries

Bec McPhee
Head of Advocacy & Communications, RANZCOG
bmcphee@ranzcog.edu.au
+61 413 258 166

Alison Eddy
Chief Executive, NZCOM
(03) 372 9736

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG, the College) is pleased to announce that it has been successful in securing funding from the Australian Commonwealth Government to support the development of clinical resources and initiatives aimed at improving care for women living with endometriosis and persistent pelvic pain.

Recent investigations and the increased focus on care in Victoria have highlighted the need for urgent improvements, resources, education, and training across the wider system.

����TV has continued its ongoing advocacy in this area by engaging directly with key stakeholders, including the Hon. Mark Butler MP, Federal Minister for Health and Ageing; the Hon. Mary-Anne Thomas, Victorian Minister for Health; the Royal Australian College of General Practitioners (RACGP); Safer Care Victoria; consumer representatives; and others, to address how specialist capability and confidence can be strengthened to improve patient outcomes.

As a result, the government has today announced that it will commit a $7.45 million package to support specialist and primary care capability enhancement, among other services and initiatives. This funding will support RANZCOG and RACGP to make improvements to clinical guidance and care standards for persistent pelvic pain and endometriosis, as well as provide education and training for specialists, GPs and other health providers included in multidisciplinary care.

Dr Nisha Khot, RANZCOG President, welcomed today’s announcement, saying, “Improving care for women with pelvic pain and endometriosis has long been a priority for the College. The College has worked closely with the Government to secure this funding. We commend the Government for investing in much-needed initiatives that will strengthen clinical guidance, support multidisciplinary models of care, and better equip clinicians to deliver safe, evidence-based care.”

Endometriosis and pelvic pain have been underfunded and under-researched for too long. While there is still much more to be done to improve understanding and close gaps, this investment represents an important step toward better supporting clinicians and improving outcomes for women living with these complex conditions.

–Dr Nisha Khot, RANZCOG President

Dr Marilla Druitt, RANZCOG Victorian Committee Chair, and President of Pelvic Pain Victoria, says “Education and training are critical to improving how we manage pelvic pain. Investment in building the knowledge and skills of a broad range of clinicians across specialties will strengthen clinical capability, support best-practice multidisciplinary care, and ultimately lead to better outcomes for women.”

����TV looks forward to working closely with government, clinicians, consumers, and key stakeholders to implement these initiatives and ensure they translate into meaningful improvements in care. The College remains committed to supporting clinicians with the guidance, education, and tools needed to deliver high-quality, evidence-based care, and to improving outcomes for women living with endometriosis and persistent pelvic pain.

Media enquiries

Bec McPhee
Head of Advocacy & Communications
bmcphee@ranzcog.edu.au
+61 413 258 166

In women’s healthcare, the scales have long been tipped.

Tipped not by chance, but by inequitable systems designed and maintained to deliver unjust outcomes for women and girls – outcomes determined by whether pain is believed, whether care is affordable, or whether essential services are available at all.

The legislative, regulatory and institutional frameworks that govern our health systems are embedded with bias, and gender bias remains one of the most pervasive. This International Women’s Day, RANZCOG reflects on the significant gender disparities in healthcare, tying in with the , ‘Balance the Scales.’

Where inequities persist in women’s healthcare

From bias in medical research to systemic funding disparities, gender inequity is deeply embedded in our health systems. Across Australia and Aotearoa New Zealand, a considerable gender gap exists in the affordability of care, access to specialist services, and genuine choice in treatment options.

This injustice is embedded within the Australian Medicare Benefits Schedule (MBS) itself. Currently, the Medicare rebate for performing a penile doppler or scrotal ultrasound is higher than the rebate for performing a fetal doppler scan – which some women require multiple of, especially in higher-risk pregnancies. Despite the complexity and clinical necessity of this type of scan, the federal government places less value on this service for women than it does for scans of male reproductive organs, reflecting a system that routinely undervalues women’s healthcare. Women are left to bear the added financial burden of accessing these essential scans during pregnancy.

There is currently no dedicated Medicare rebate for MRI in the investigation of pelvic pain, despite endometriosis affecting around one in seven Australian women during their lifetime. As a chronic and often debilitating condition, timely imaging can support earlier diagnosis and appropriate care.

Gender inequity in healthcare does not exist in isolation. For many women, these disparities are further compounded by intersecting factors such as cultural background, language, socioeconomic status or geographical location. Aboriginal and Torres Strait Islander women in Australia and Māori wāhine in Aotearoa New Zealand often experience additional barriers and worse healthcare outcomes than non-Indigenous populations due to systemic bias and discrimination. A lack of culturally safe care can further erode trust and confidence in an already sensitive area of medicine.

Many other groups also face barriers to accessing care. Migrant and refugee women, and those experiencing financial hardship or geographic isolation, can encounter additional challenges when seeking timely and appropriate healthcare.

Addressing the gender gap therefore requires an intersectional approach to policy and service reform, ensuring that overlapping inequities are recognised, that care is trauma-informed and culturally safe, and that the women most affected by these systemic barriers are not left furthest behind.

Systemic gaps in access

Pregnancy should be one of the most carefully supported periods in women’s healthcare – particularly as government concern grows over falling fertility rates. In reality, maternity care is increasingly shaped for many by financial and logistical pressures, fuelled by rising out-of-pocket costs due to MBS items not being reviewed and adjusted for inflation, unfavourable insurance policies, and shrinking service availability.

Timely and affordable services are non-negotiable in maternity care, yet women are paying escalating gap fees for essential scans and specialist appointments. At the same time, many are travelling long distances to access maternity units.

Recent closures of private maternity units across Australia, particularly in Tasmania and the Northern Territory, have rapidly narrowed birthing choice for pregnant women, including those who have top-tier insurance cover in place and yet cannot access private care because of where they live. Ongoing closures of private maternity services across the country are on account of systemic gender bias in funding and insurance.

When a private maternity unit closes, significant strain is placed on the public hospital system, causing pregnant patients to face disruption, displacement and increased travel to access time-critical care. In rural and remote communities, these closures can have cascading effects, with clinicians often leaving the area if they can no longer practise privately, leaving little or no obstetric and gynaecological service provision at all.

Choice is also diminishing in access to adequate medicines and devices used in pregnancy. Pregnant women remain routinely excluded from modern clinical research trials for new medications, meaning evidence often inadequately reflects their needs.

Many medicines used in pregnancy are decades old, prescribed off-label, and are commercially unattractive to pharmaceutical companies. As a result, shortages are common and the exclusion from clinical trials results in off-label medicines being unable to be subsidised on the PBS. The consequence is a system where pregnant women risk going without treatment and have fewer, less innovative options – not because the need is smaller, but because they have been consistently overlooked in medical advancement.

����TV’s commitment to balancing the scales

A healthcare system that delivers lesser value for women is unacceptable. Until gender equity is achieved, RANZCOG will continue to advocate to ensure governments in Australia and Aotearoa New Zealand prioritise critical issues impacting women’s health. The College consistently advocates for policy reform to deliver accessible, comprehensive care and to ensure the long-term viability of both public and private obstetrics and gynaecology in practice.

Central to this work, it’s crucial to listen not only to data, but to clinical expertise and lived experience. RANZCOG platforms clinicians’ and consumers’ viewpoints in its national consultations, such as the recently convened Collaborating for Women’s Choice: Sustainability for Private Maternity roundtable, incorporating these perspectives into discussions with government, policymakers and other key stakeholders. The College has also led a roundtable addressing medicine and device shortages focusing on short-term and long-term strategies to strengthen supply and access.

Funding reform will continue to be a core pillar of engagement with both the Australian and Aotearoa New Zealand governments. RANZCOG has long been calling for an urgent review to eliminate gender disparities in MBS items to ensure that women’s health care is valued equally. The College continues to advocate for reforms to MBS funding arrangements that better reflect the true cost and complexity of obstetric and gynaecological care.

In Australia and Aotearoa New Zealand, RANZCOG is working to address growing affordability barriers to obstetric ultrasounds. In New Zealand, the College to ensure all pregnant women can access clinically necessary scans.

Workforce sustainability is another critical factor in improving access to services. The College is advocating to bolster recruitment and retention in the broader O&G workforce. The RANZCOG-led Obstetrics and Gynaecology Education and Training (OGET) program, funded by the Australian Government, supports the provision of safe, local maternity services for women in rural and remote Australia by providing upskilling and skills maintenance opportunities.

The FRANZCOG Rural Obstetrics and Gynaecology Specialist Advanced Training pathway aims to encourage specialists into rural practice, equipping them with the unique skills and knowledge required to service diverse populations in these communities. These efforts are reinforced by RANZCOG’s Rural, Regional and Remote Women’s Health Strategy, which provides a framework to ensure that women in remote regions have access to equitable and culturally safe maternity and gynaecological services.

Viewing workforce sustainability more broadly, it’s critical to note that the O&G workforce is a female-dominated profession. Improvements in parental leave policies and practices for the medical profession must happen to ensure that current and future generations of obstetricians and gynaecologists can build sustainable careers while balancing their own pregnancy and parenthood journeys. Furthermore, 24/7 childcare must also be available to maintain clinicians’ availability for service provision.

It’s clear that the scales will not balance themselves. Women’s health services should never be niche, undervalued or optional – they are essential for half of the population, after all.

Reproductive healthcare will be accessed by most women across many decades of their lifetime, and funding, research and service planning must reflect both critical need and clinical complexity.

This International Women’s Day, and each day to follow, RANZCOG joins the call for urgent action to dismantle the gender gap and achieve equitable health outcomes for all.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), is concerned about the impact of the New Zealand Government’s recently announced ban on new prescribing of GnRH analogues (puberty blockers) for young people who are seeking gender affirming healthcare. Dr Emma Jackson, New Zealand Vice President says “This decision appears to be made based on ideology not evidence and could have a devastating impact on the wellbeing of vulnerable young people.”

Puberty blockers temporarily suppress the hormones that cause pubertal development, giving young people and their families time to make informed decisions about wellbeing, without the pressure of irreversible bodily changes. Under the changes announced puberty blockers will remain available for those who are already receiving them for gender affirming care and the changes do not impact prescribing of puberty blockers for children with early onset puberty. But those seeking care for gender dysphoria will no longer have access to puberty blockers.

In November 2024 the Ministry of Health released an evidence brief which identified some limitations in the quality of evidence regarding the risks and benefits of GnRH analogues. Dr Emma Jackson comments that “limitations in evidence quality are common across a number of areas of medicine, and don’t warrant a ban on access, especially when the consequences of a ban are significant.”

����TV responded to Ministry of Health consultation in December 2024 with a clear statement:

����TV supports the current practice of prescribing puberty blocker medication for gender affirming care of rangatahi/young people, and does not support any restrictions in prescribing, nor does RANZCOG see any need for “safeguarding” of prescribing.

����TV restates this position. Health care should be based on best available evidence and decisions should remain between clinicians, patients and their whānau. RANZCOG urges the Government to remove the ban on potentially lifesaving health care for young people requiring gender affirming healthcare.

Media enquiries

Catherine Coooper
����TV Executive Director Aotearoa New Zealand
�ʳ�DzԱ�:��+64 21 137 0748
����������:��ccooper@ranzcog.org.nz

As private maternity services across Australia face significant instability and the already stretched public system absorbs increasing demand, the need for systemic reform is undeniable. Gender bias embedded within funding and insurance structures is contributing to crushing cost increases, closures of private maternity units, and ultimately, rapidly diminishing choices for pregnant people and their families.

In response to this escalating crisis, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG, the College) convened ‘Collaborating for Women’s Choice: Sustainability for Private Maternity’, on 17 November, a Roundtable meeting to urgently propose solutions. This pivotal meeting brought together the Honourable Rebecca White MP, Assistant Minister for Assistant Minister for Health and Aged Care, consumers with lived experience, service providers, private hospitals, government, policymakers, and other key stakeholders to develop solutions that protect true choice for women in their birth journeys.

As a result, RANZCOG has developed several recommendations for urgent reform to sustain and restore the long-term viability of private maternity care and choice for women and their families.

These include:

Solution 1 – Remove gender bias in the system.

• Reform MBS obstetric item rebates to reflect true cost and eliminate gender bias
• Remove restrictive caps on Extended Medicare Safety Net Arrangements to support consumers seeking maternity care

Solution 2 – Improve affordability of private insurance.

Solution 3 – Adopt collaborative models of multidisciplinary team-based maternity care.

Solution 4 – Ensure sustainable funding for maternity services in private hospitals.

Solution 5 – Secure and enhance an adequate workforce, including specialist obstetricians, paediatricians, anaesthetists, as well as midwives, nurses and the wider range of allied health professions that support maternity.

Solution 6 – Work with women’s community and consumer groups to co-design maternity information initiatives.

A comprehensive overview of the discussions and proposed solutions is detailed in the College’s Private Practice Roundtable Report.

This work builds on RANZCOG’s inaugural roundtable held in 2024, Preserving Women’s Choice and the Future of Private Obstetrics & Gynaecology, which focused on private obstetrics and gynaecology in Australia.

The College sincerely thanks all participants in the roundtable for their valuable contributions. RANZCOG is committed to working with key collaborators to progress the report’s recommendations and ensure a viable future for Australia’s private maternity care system.

Media enquiries

Bec McPhee
Head of Advocacy & Communications
bmcphee@ranzcog.edu.au
+61 413 258 166

In light of the publication of the of the Victoria’s Government’s Inquiry Into Women’s Pain Bridging the Gender Pain Gap, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG, the College), the Australasian Gynaecological Endoscopy and Surgery Society (AGES), The Faculty of Pain Medicine ANZCA (FPM), the Australian Pain Society (APS) and the New Zealand Pain Society (NZPS) have issued a joint-statement on best-practice approaches to the management of endometriosis and pelvic pain.

The Inquiry gathered insights from over 13,000 women, girls, carers, healthcare professionals, peak bodies, and researchers to unveil the experiences of girls and women with pain conditions and in accessing pain relief. Recommendations set a clear roadmap for reform and will guide system-wide improvements to bridge the gender pain gap and ensure women’s pain is recognised, understood and addressed.This group recognises that women with pain are their own experts in pelvic pain and will endeavour to partner with them to improve their lives. We recognise that they have felt dismissed and we will do better in hearing their needs.

����TV, AGES, FPM, the APS & the NZPS welcome the recommendations laid out in the report and are committed to supporting multidisciplinary clinicians to provide the highest quality care for people affected by persistent pelvic pain. We acknowledge the five key lessons from the inquiry, including recommendations to make women’s healthcare easier to access, grow and train the workforce, strengthen research, and ensure care is free from bias and discrimination, and delivered in a trauma-informed, culturally and linguistically appropriate way.

Our approaches to clinical care should always be guided by the best available clinical evidence and recommendations, which is underpinned by recommendation 1.3 of the report identifying a need to, “improve clinical standards and support best practice.”

����TV developed and published the Australian Living Evidence Guideline: Endometriosis in May 2025; a national guideline compiling the best available scientific evidence to assist the detection, diagnosis and management of endometriosis, and a related condition, adenomyosis. The living evidence guideline incorporates new research, a broader scope, and wide-ranging multidisciplinary expert input including that of people with lived experience, gynaecologists, primary care providers, physiotherapists and pain specialists. Work is currently underway to adapt this guideline for the Aotearoa New Zealand context.

It’s important that we have nationally recognised standards of care and that we as clinicians make sure that across-the-board women receive the same standard of care, wherever they are. The College’s recently released guideline is a great place to start – this is evidence-based, and a ‘living guideline’, meaning it will be updated regularly with the latest research as it emerges.

– Dr Nisha Khot, RANZCOG President

A significant change as part of the guideline was the emphasis on non-invasive diagnosis with emerging evidence suggesting that a greater number of cases can be diagnosed with increasing accuracy using techniques such as transvaginal ultrasound and magnetic resonance imaging (MRI). Closely linked, this is backed up by the findings of the Inquiry which suggests that we, “improve non-surgical referral pathways … including access to non-surgical management and treatment options as part of a comprehensive care pathway.”

While laparoscopy can be an important diagnostic tool or treatment for some people with endometriosis and pelvic pain, the new RANZCOG guideline is clear that it should not be the only treatment option. Surgery should be performed only when clinically indicated, after careful discussion of benefits and risks by appropriately credentialed surgeons. There is evidence to support laparoscopic surgeries for the management of endometriosis and pelvic pain. In many cases, repeated procedures should be avoided, as they may not improve women’s pain or long-term outcomes and carry risks.

Sometimes we focus heavily on the surgical aspects of treatment, but persistent pelvic pain is often far more complex than what surgery alone can address. In fact, we know that multiple surgeries can sometimes worsen this pain. Any surgical intervention should be judicious, evidence-informed, and integrated into a broader interdisciplinary care plan that supports long-term wellbeing.

– Dr Michael Wynn-Williams, President of AGES

Endometriosis and persistent pelvic pain are complex conditions that affect each person differently. Both RANZCOG’s guideline and the Inquiry’s Report demonstrate that we must work collaboratively across multiple disciplines – including gynaecology, pain medicine, physiotherapy, psychology, and allied health – to ensure every person receives coordinated and holistic care tailored to their specific needs.

Research supports the value of an interdisciplinary approach to care for chronic disabling pain – but the reality is that many women struggle to even access a specialist, let alone allied health providers who provide that holistic care. To meaningfully improve access, we need to continue building workforce capability so that clinicians across disciplines feel confident and well-supported in applying contemporary pain science. Strengthening interdisciplinary practice is not only about improving care pathways – it is about ensuring women can receive truly holistic, coordinated, and person-centred care.

– Bernadette Smith, President of the Australian Pain Society

Dr Dilip Kapur, Dean of The Faculty of Pain Medicine (ANZCA) emphasises that persistent pelvic pain should be recognised as a persistent pain condition in its own right. As outlined in the FPM’s statement on the clinical approach to persistent pelvic pain including endometriosis-associated pain, best practice care requires timely access to whole-person, multidisciplinary management –incorporating medical, physiotherapy, psychological and pain science-informed interventions. Prioritising early, equitable access to these evidence-based approaches will improve outcomes and reduce harm.

This group acknowledges that many women across Australia and Aotearoa New Zealand – particularly those in rural and remote areas – have limited access to holistic care. Recommendation 5.6 of the Report sets out that the Victoria Government must “expand access to allied health particularly physiotherapy, in public hospitals, including as part of Women’s Health Clinics, pain clinics and maternity services.” This is crucial if we are to follow the principles of the APS and NZPS and adopt a biopsychosocial model of care that addresses the physical, emotional, and social aspects of living with chronic pain.

Pelvic pain is multifactorial and often persists after surgery, requiring a whole person approach. We must recognise and respond to the needs of women living with pain and adopt a broader view in the approach and treatment of pelvic pain, and women’s pain generally. The Victorian Women’s Pain Inquiry report offers a solid foundation for addressing this challenge at the policy level.

– Dr Karen Joseph, President of the NZPS

����TV, AGES, FPM, APS and NZPS welcome the release of the report and look forward to collaborating with both the Victorian Government and the other jurisdictions across Australia and Aotearoa New Zealand more broadly to deliver better health outcomes for women and girls living with pelvic pain.

Media enquiries

Bec McPhee
Head of Advocacy & Communications
bmcphee@ranzcog.edu.au
+61 413 258 166

Systemic gender bias in the Australian healthcare system means women or pregnant people are paying more for maternity care whilst their choices are diminishing amidst continuing closures of private maternity units.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG, the College) convened a roundtable on 17 November bringing together key stakeholders including the government, the private insurance sector, and other organisations with an interest in private obstetrics. The College is seeking to develop actionable solutions to address inequities and maintain choice for women.

What are the key issues?

Inequitable MBS coverage for obstetric services

Medicare rebates for obstetric services are outdated, fail to cover the true cost of care, and attract lower rebates compared with other specialities. For example, pregnancy ultrasound scans are frequently billed at rates which leave substantial out-of-pocket costs for women (see Appendix item 1 for examples).

Inequitable caps on EMSN

Another example demonstrating systemic gender-bias in the MBS is the Extended Medicare Safety Net (EMSN).^[1]The EMSN was designed to protect Australians from very high out-of-pocket medical costs. It covers up to 80% of out-of-pocket costs once an annual General Threshold ($2,600) is reached, but obstetric care and IVF are capped (see Appendix item 2 for examples).

The cap reduces the financial protection EMSN is supposed to provide, placing a disproportionate burden on women and pregnant people by leaving them with high out-of-pocket fees for accessing essential obstetric care.

Private maternity unit closures are shrinking choice and shifting burden to the public system

The continuing closure of private maternity clinics across Australia places increased strain on public facilities. Over the decade to 2023-24, the proportion of births in private hospitals has fallen from 30% of total births to just 20%.^[2] These excess births are largely being picked up by the public hospital system – already under strain in many jurisdictions.

Private health insurers are not remunerating private hospitals for the true cost of care

Private maternity services are experiencing increasing financial unsustainability. Despite record profits, health insurers frequently underpay private hospitals for obstetric services, and funding models fail to acknowledge the true costs associated with care – 24/7 doctors and midwives, as well as on-call neonatology, paediatric, and anaesthetic services. Subsequently private hospitals favour more profitable specialist services, such as orthopaedics, over those focused on women’s health.

As a result, at least fourteen private hospitals have closed their birthing units since 2018^[3] affecting metro, regional, and rural areas (see Appendix item 3 for a list of private maternity unit closures from 2018-2025).

Private health insurance is failing many women who pay for it

Many women purchase private health insurance specifically for access to private maternity care, and the benefits of continuity and choice. As closures continue, women who are insured are deprived of the very services/choice they have paid for, while continuing to pay premiums and sometimes additional out-of-pocket costs in the public system.

What is RANZCOG doing?

On 17 November 2025, RANZCOG re-convened stakeholders including the government, the private insurance sector, and other organisations with an interest in private obstetrics for a Private Practice Roundtable, seeking to develop actionable solutions for the private healthcare crisis. This follows the first roundtable in 2024.

Solutions the group are considering include:

• A review and reform of all MBS items specific to birthing.
• A review and reform of Extended Medicare Safety Net Caps to ensure it offers equitable financial protection for people accessing obstetric services.
• Revisiting funding models for maternity provision in private hospitals.
• Including obstetric coverage in the wider private health insurance risk equalisation pool.

Dr Heather Waterfall, Chair of the RANZCOG Private Practice Committee says, “There is evident gender-bias in the Australian health system; why can a man who has paid for his gold tier private health insurance walk into any private hospital and get a knee replacement but a woman or pregnant person who has paid that same premium for their insurance can’t access private maternity care? Urgent systemic reform is needed to ensure pregnant people have the ability to choose the model of care – public or private – which works best for them.”

1. Services Australia (2025), Accessed 11 Nov. 2025,

2. Australian Private Hospitals Association (2025), Accessed 11 Nov. 2025,

3. ABC News (2025), Accessed 11 Nov. 2025,

Media enquiries

Bec McPhee
Head of Advocacy & Communications
bmcphee@ranzcog.edu.au
+61 413 258 166

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG, the College) has partnered with Birth Trauma Australia (BTA) to launch the Birth Trauma Education Project. The project is a response to the recommendations from the NSW Parliament’s Select Committee’s on Birth Trauma Inquiry, and ongoing collaboration with the Australian Department of Health, Disability and Ageing.

The inquiries made it undeniably clear that, despite efforts to prevent it, birth trauma remains a persistent challenge faced by birthing people and those involved in providing maternity care. RANZCOG and BTA seek to make a meaningful difference to address the core causes of birth trauma through the creation of much-needed multidisciplinary training resources with a focus on trauma-informed care.

Funded by the Commonwealth Government, RANZCOG and BTA have developed the Birth Trauma Education Project, combining online learning modules with in-person multidisciplinary workshops. The pilot training program is being delivered virtually via webinar on 1, 4, and 5 December 2025.

Onsite training will also be delivered in Wonthaggi Hospital Bass Coast Health (Vic), King Edward Memorial Hospital (WA), and Wagga Wagga Base Hospital (NSW) in November and December 2025.

The virtual program is available and free to attend for all healthcare professionals in Australia who are involved in maternity care. Members of RANZCOG’s CPD Home who complete the training will be eligible to claim CPD hours. Learn more about the Project, and register for one of the upcoming webinars here.

Discussions are also underway in Aotearoa New Zealand to build on this project – the College is working collaboratively with Birth Trauma Aotearoa, the New Zealand College of Midwives, and other key stakeholders to research experiences of birth trauma in Aotearoa which will inform the development of an education program specific to Aotearoa New Zealand. RANZCOG continues to advocate for prevention of birth trauma through education, assessment, and access to physiotherapy treatment, especially during pregnancy.

Contact us
For more information, contact the Birth Trauma Education Project team.
Email: elearningsupport@ranzcog.edu.au

Media enquiries

Bec McPhee
Head of Advocacy & Communications
bmcphee@ranzcog.edu.au
+61 413 258 166

In the wake of several recent tragedies linked to freebirth, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Australian College of Midwives (ACM) have called upon Commonwealth and state and territory ministers for health to enact legislation consistent with the model adopted in South Australia under the Health Practitioner Regulation National Law (South Australia) (Restricted Birthing Practices) Amendment Act 2013.

Freebirth is the intentional practice of giving birth without a registered healthcare professional, such as a midwife or doctor, present. It is different from a homebirth, which is a planned birth at home with a registered healthcare provider. The absence of appropriate clinical support during freebirth has led to preventable harm and loss of life.

The South Australian legislation defines “restricted birthing practice” as, an act that involves undertaking the care of a woman by managing the three stages (or any part of those stages) of labour or childbirth or of managing the third stage (the placenta) … only a registered midwife or medical practitioner (or a student under supervision) may perform such a practice.

Adopting this legislative model across jurisdictions would advance the safety of birthing women and people and their babies, enhance professional accountability, and clarify the roles and responsibilities of obstetricians, GP obstetricians and midwives.

What RANZCOG and ACM are asking of Ministers

• Introduce and pass legislation which expressly restricts labour- and birth-management (including the three stages of labour, birth of the baby, and the third stage) to appropriately trained, registered practitioners (i.e. obstetricians/gynaecologists, GP obstetricians, and/or midwives).
• Ensure that unlicensed or unregulated persons are prohibited by law from undertaking the management of labour and birth as defined in the legislation.
• Harmonise regulatory frameworks across all states and territories to ensure women receive the same protections regardless of where they give birth in Australia.
• Promote transparency, accountability and safety in birthing services.

While choice and model of care are important, such choice must operate within frameworks that ensure safety, quality and accountability. This proposed legislation would affirm that principle.

Dr Nisha Khot, RANZCOG President.

Dr Heather Waterfall, an O&G in regional South Australia, and Chair of the RANZCOG South Australia & Northern Territory Committee spoke of her experience, “Women and babies deserve safe, evidence-based care. By enshrining in law the requirement that birthing services be provided by registered professionals working to defined standards, we have elevated system-wide practice.”

ACM respects individual women’s right to autonomy in birth. Harmonising national legislation as proposed, will ensure all women can have confidence in the transparency, safety and accountability of care during birth, in the same way, all across Australia.

Dr Zoe Bradfield, ACM President.

����TV and ACM urge health ministers to come together to support, enact and implement legislation aligned with the South Australian model. Doing so will strengthen maternal and newborn safety, support professional practice, and contribute to equitable birthing care across Australia.

We stand ready to work in partnership with governments, health services and those with lived experience to assist in implementing and operationalising such legislation.

Media enquiries ACM

Victoria Forrest
Marketing & Communications Manager
media@midwives.org.au
+61 432 939 121