The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG; The College) strongly opposes the private member’s bill introduced by Sarah Game MLC in the South Australian Legislative Council, which seeks to further restrict access to abortion services after 22 weeks and six days of pregnancy.

Abortion is healthcare

����TV’s position is unequivocal: abortion is healthcare. The decision to terminate a pregnancy is deeply personal and complex, requiring careful consideration of individual circumstances. These decisions must remain between a woman and her healthcare provider, not be dictated by political intervention. Medical professionals, not parliamentarians, are best equipped to assess the unique factors that inform these each individual decisions about abortion.

The reality of later abortions

Ms Game’s bill is based on a fundamental misunderstanding of the reality of pregnancy terminations after 22 weeks and 6 days. These procedures are extraordinarily rare, representing a tiny fraction of all abortions performed (48, or 1.0% of all abortions performed in South Australia in 2024¹). When they do occur, they almost always invariably involve circumstances of severe fetal abnormalities incompatible with life, or serious threats to the pregnant woman’s health and life.

Of these 48 abortions performed in South Australia in 2024, 34 were to protect the physical or mental health of the pregnant person, 15 due to fetal anomaly, and one to save the life of a pregnant person or another fetus.¹ The College is deeply concerned that Ms Game’s bill is premised either on an ignorance of this reality, or a wilful misrepresentation of the facts as they exist in data.

One of the many troubling aspects of how this bill has been presented is that the mental health of the pregnant person will no longer be considered relevant rationale for a decision to terminate.��

– Dr Nisha Khot, RANZCOG President-Elect

“This is enormously problematic. Mental health is health, and it is no less important to the overall well-being and ability to safely carry a pregnancy to term, than is physical health. The College categorically rejects this assumption and reiterates its unreserved support for accessible sexual and reproductive healthcare services that meet the needs of our patients and their families,” said Dr Khot.

Women and their families facing these tragic circumstances are already experiencing profound distress. They do not make these decisions lightly, and the suggestion that additional legislative restrictions are needed demonstrates a concerning lack of understanding of the medical realities involved.

Under current South Australian law, terminations after 22 weeks and 6 days already require approval from two medical practitioners who must agree that the procedure is appropriate given the clinical circumstances.��

Previous parliamentary rejection

The South Australian Parliament has recently considered and rejected similar restrictive legislation. In October 2024, the Legislative Council voted down Ben Hood MLC’s bill by a margin of 10 votes to nine, following extensive debate. That bill sought to amend abortion laws to require live delivery rather than termination for pregnancies after 28 weeks.

Ms Game’s current bill represents another attempt to curtail medical expertise and evidence-based practice, despite the parliamentary rejection of similar measures less than a year ago.

The College’s South Australia and Northern Territory Committee Chair Dr Heather Waterfall reiterates that her comments made in response to last year’s bill are just as relevant to this bill as well. “Abortion is an essential healthcare service, with the decision to proceed with termination best left to women and their doctors. This has always been true. It was true in 2024, and it remains true now,” said Dr Waterfall.

This bill is simply another attempt to roll back abortion protections and the freedom of women in South Australia to have autonomy over their own bodies and their health care decisions.

– Dr Heather Waterfall, RANZCOG South Australia/Northern Territory Committee Chair

Conclusion

����TV calls on the South Australian Parliament to reject this ill-conceived legislation. The current regulatory framework already provides appropriate safeguards while preserving the fundamental principle that healthcare decisions should remain between patients and their doctors.

The College urges parliamentarians to trust medical professionals to provide appropriate care within existing ethical and legal frameworks, rather than impose additional barriers that serve no medical purpose and may cause significant harm to vulnerable women and families.

Abortion access is a fundamental component of comprehensive reproductive healthcare. Any attempt to further restrict this access represents a backwards step that prioritises ideology over evidence, politics over patient welfare, and rhetoric over medical reality.

1. Government of South Australia: Preventative Health SA. Accessed 18 September 2025.

Media enquiries

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

Background

Syphilis is caused by the spirochaete bacterium Treponema pallidum (subspecies pallidum). It is typically transmitted through direct contact with infectious lesions or mucous membranes during anal, oral, or vaginal sexual contact, and can also be passed from mother to child at any stage of pregnancy.¹

During pregnancy, syphilis is associated with a high risk of adverse outcomes, including stillbirth, preterm birth, small-for-gestational-age infants, and vertical transmission leading to congenital syphilis. Congenital syphilis can present with serious features such as pneumonia, profuse nasal discharge, enlargement of the liver and spleen (hepatosplenomegaly), swollen lymph nodes (lymphadenopathy), elevated bilirubin levels (hyperbilirubinemia), cholestasis, meningitis, and seizures. Congenital syphilis can cause severe long-term sequelae for infants affected.^2,3

Surveillance and impact in Australia

Syphilis is a notifiable condition in Australia, subject to rigorous national surveillance and monitoring. The Chief Medical Officer declared syphilis a  on 7 August 2025, initiating a coordinated national response focused on expanded testing, community awareness, simplified treatment pathways, health equity, and workforce strengthening – especially in Indigenous and underserved communities.^4,5

As syphilis frequently presents without symptoms, a low threshold for testing is essential. Diagnosis relies on serological testing, though interpretation can be complex and may require specialist input. Early detection and treatment are critical to preventing congenital syphilis and reducing transmission across the population.¹

Congenital syphilis

In 2024, there were 5,960 notifications of infectious syphilis (acquired within the previous two years), including 1,025 cases among women aged 15–44. Between 2013 and 2022, notification rates in women increased nearly six-fold. Since 2019, cases of congenital syphilis have risen. In 2023, there were 20 reported cases in Australia, including 10 infant deaths. Aboriginal and Torres Strait Islander peoples continue to experience disproportionately high rates, more than five times those of non-Indigenous Australians – reflecting entrenched health inequities.^4,5

Untreated maternal syphilis carries significant risks for pregnancy outcomes. The likelihood of fetal infection increases as pregnancy progresses, rising from 26% if treatment is provided by 24 weeks to 60% if delayed until the third trimester. Adverse outcomes include stillbirth (21%), preterm birth (6%), and congenital syphilis presenting as clinical disease in the neonate (16%). Neurological sequelae may also occur, though only the most severe are typically apparent at birth.^2,3

Updated recommendations

The Communicable Diseases Network Australia (CDNA) emphasise that the management of syphilis requires coordinated action between Public Health Units and treating clinicians.

The following best-practice recommendations detail the prevention and management of syphilis during pregnancy:

• Universal first screening – Offer and recommend syphilis testing to all pregnant women at their first antenatal contact, regardless of assessed risk.
• Universal repeat screening – Repeat screening should be offered at 26–28 weeks and again at either 36 weeks or at birth (whichever comes first), regardless of risk.
• Catch-up screening – If earlier opportunities for testing are missed, offer screening at the next available occasion.
• Specialist input – For women who test positive, seek urgent advice from a sexual health or infectious diseases expert. Arrange prompt review and referral where appropriate, and ensure planning for neonatal assessment at birth.
• High-risk women – For those assessed as at increased risk, recommend testing at five points: the first antenatal visit, 26–28 weeks, 36 weeks, at birth, and again six weeks postpartum.
• Early treatment in high-risk women – For individuals assessed at increased risk of syphilis, consider offering treatment promptly based on screening results – without waiting for confirmatory testing – if there is a risk they may not return for follow-up.
• Confirmed infectious syphilis – Women with confirmed infectious syphilis should receive 2.4 million units of benzathine penicillin intramuscularly (in 2 divided doses) as soon as possible. Where possible, treatment should be administered at least 30 days before the expected date of birth. Repeat serology is recommended to confirm efficacy of treatment.
• Partner and contact management – Ensure partner testing and treatment, and initiate contact tracing. Where needed, seek support from a sexual health service or specialist in contact tracing.

Clinical implications

Maternity care providers play a critical role in preventing congenital syphilis. Consistent, repeated testing regardless of risk and timely treatment are essential, along with effective contact tracing, specialist referral, and neonatal assessment.

Professor Kirsten Black
Chair, RANZCOG Sexual and Reproductive Health Committee

Dr Stephanie Bond
Member, RANZCOG Sexual and Reproductive Health Committee

Further information

• Australian Centre for Disease Control.
• Australian Department of Health, Disability and Ageing.
• Communicable Diseases Network Australia (CDNA).
• Living Evidence for Australian Pregnancy and Postnatal Care.
• Queensland Health.
• Melbourne Sexual Health Centre.

References

1. Communicable Diseases Network Australia (CDNA). National Guidelines for Public Health Units on Syphilis. Canberra: Australian Government; 2023.
2. Living Evidence for Australian Pregnancy and Postnatal Care. Australian Pregnancy Care Guidelines. [MagicApp]; 2023. Available from: .
3. Queensland Health. Queensland Clinical Guidelines: Syphilis in Pregnancy. Brisbane: Queensland Health; 2023.
4. Australian Centre for Disease Control. National Syphilis Surveillance and Response Plan 2023–2030. Canberra: Australian Government; 2023.
5. Australian Department of Health, Disability and Ageing. Chief Medical Officer’s Statement: Communicable Disease Incident of National Significance – Syphilis. Canberra: Australian Government; 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) welcomes the release of the Report of the Special Commission of Inquiry into Healthcare Funding, led by The Honourable Justice Richard Beasley (the Beasley Report; the Report).

This comprehensive review represents a pivotal moment for healthcare reform in New South Wales and opens the opportunity to strengthen our health system for the benefit of all women and families across the state.

A catalyst for transformative change

The Beasley Report’s 41 recommendations provide a solid framework for addressing the systemic challenges that have long impacted healthcare delivery in NSW. RANZCOG is particularly encouraged by the Report’s focus on workforce development, education and training pathways, and the critical need to support regional and rural healthcare services.

For women’s healthcare, these recommendations could not come at a more crucial time. The shortage of specialist obstetricians and gynaecologists, particularly in regional areas, has created significant gaps in access to essential reproductive health services, maternity care, and specialist gynaecological treatment. The Report’s emphasis on workforce planning and training reform aligns with RANZCOG’s longstanding advocacy for sustainable solutions to these challenges.

Strengthening regional healthcare delivery

����TV endorses the Report’s recommendations regarding regional workforce support and the expansion of specialist training networks. The creation of better rural and regional training pathways represents an approach that could fundamentally change how we prepare the next generation of specialists to serve communities outside metropolitan areas.

For too long, regional women have faced significant barriers accessing specialist obstetric and gynaecological care, often requiring long-distance travel for routine consultations and procedures. The Report’s vision for strengthened regional services offers genuine hope for reducing these inequities and ensuring that postcode does not determine access to quality women’s healthcare.

Our GP obstetrician colleagues, who provide invaluable maternity care across regional NSW, would particularly benefit from enhanced training pathways and support structures outlined in the Report. Strengthening the bridge between general practice and specialist obstetric care is essential for maintaining safe, accessible maternity services in smaller communities.

Training and education reform

The Report’s focus on education and training reform resonates with RANZCOG’s commitment to excellence in obstetrics and gynaecology education. The recommendations for expanding specialist training networks and creating more flexible, regionally-focused training opportunities could help address the maldistribution of specialists that has long challenged our healthcare system.

A call for swift implementation

While welcoming the Report is important, RANZCOG emphasises that the true test lies in implementation. The NSW Government now has a clear roadmap for reform, backed by extensive consultation and rigorous analysis. We urge swift action on the recommendations, particularly those addressing workforce development and regional service delivery, and training.

����TV stands ready to work collaboratively with the NSW Government, health services, and other stakeholders to translate these recommendations into meaningful change. The College’s expertise in obstetrics and gynaecology training, workforce planning, and clinical standards setting positions us to be a constructive partner in this reform agenda.

Looking forward with optimism

The Beasley Report represents more than just another review – it provides a genuine blueprint for creating a more equitable, sustainable, and effective healthcare system for NSW women and girls and broader community. For the specialist obstetricians and gynaecologists, GP obstetricians, and other healthcare professionals who dedicate their careers to women’s health, this Report offers hope for systemic changes that could transform how they deliver care.

����TV is optimistic about the opportunity this Report presents to reform NSW healthcare in ways that will benefit current and future generations. RANZCOG commits to playing part in ensuring these important recommendations translate into improved health outcomes for women and families across New South Wales.

Media enquiries

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

����TV has heard the concerns raised regarding our recently published��Australian Living-Evidence Guideline: Endometriosis��and the Patient Information Pamphlet, and we want to take a moment to directly address them.

The evidence-based Guideline was developed by a dedicated group of researchers and clinicians, with consumer representation. The guideline provides evidence-based recommendations to health care practitioners who diagnose and manage people of all ages with suspected or confirmed endometriosis.

We understand that some aspects of the Patient Information Pamphlet have caused concern, particularly the definition of endometriosis. In light of the feedback, we have updated the Patient Information Pamphlet definition of endometriosis to reflect the definition in the Guideline.

Over 70 organisations, including endometriosis consumer organisations, were consulted, and feedback extensions were granted where possible. The consultation was undertaken in agreement with the Australian Department of Health and Aged Care. The Australian Coalition for Endometriosis and Endometriosis Australia were formally represented on the Guideline Development Group and invited to provide feedback on the Guideline.

����TV remains committed to excellence and equity in women’s health. We are grateful to those who contributed to this work and to those who will continue to shape it as a living evidence guideline.

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 today proudly published the ‘Australian Living Evidence Guideline: Endometriosis.’ RANZCOG has led the development of this pivotal resource, which provides the best available scientific evidence to assist the detection, diagnosis and management of endometriosis, and a related condition, adenomyosis. A quick reference guide and flowchart have been designed specifically to support primary care providers, and there are also new resources available for the public too.

Endometriosis is a chronic, inflammatory, gynaecologic disease marked by the presence of endometrial-like tissue outside the uterus. In 2023 the Australian Institute of Health and Welfare (AIHW) reported that 1 in 7 (14%) people assigned female at birth in Australia and aged 50-55 are diagnosed with endometriosis by age 44–49, and for women aged 29-34, 8.8% were estimated to have been diagnosed with endometriosis by age 26–31. Endometriosis is often under-recognised, and diagnostic delay and affordability of ongoing care can have a substantial impact on quality of life on individuals, their family, partner, and carers.

A living evidence approach

The updated living-evidence guideline replaces the first ‘Australian Clinical Practice Guideline for the Diagnosis and Management of Endometriosis’ developed by RANZCOG in 2021 with funding support from the Australian Government. This was part of the Government’s overarching National Action Plan for Endometriosis (2018) which comprises of three priority areas to address endometriosis: awareness and education, clinical management and care, and research.

In 2022, the Australian Government invited RANZCOG to update the original guideline and transition it into a living evidence format. The living evidence guideline builds on the evidence from the foundation guideline and incorporates new research, a broader scope, and wide-ranging multidisciplinary expert input including that of gynaecologists, primary care providers, physiotherapists, pain specialists, and people with lived experience.

Using living evidence ensures the clinical guideline can respond to emerging evidence relevant to the Australian context and highlight areas where there is either low certainty or absent evidence to signal where further research is needed. The College encourages the Albanese government to extend funding beyond 2025 to enable the guideline to continue to be updated over time to find and maintain the most recent scientific evidence.

Who was involved?

The Australian Living-Evidence Guideline: Endometriosis, and its associated resources have been produced by a dedicated team of experts led by Professor Cindy Farquhar, RANZCOG Dean of Research and Policy, using a rigorous, evidence-based development process underpinned by the internationally recognised the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. Materials have been reviewed by multiple expert groups including the Department of Health and Aged Care, the Australian Living Evidence Collaboration (ALEC), the University of Auckland, and other prominent consumer advocacy groups.

“The living evidence guideline represents a major step forward in providing consistent, high-quality care for Australians living with confirmed and suspected endometriosis and adenomyosis. Considering up-to-date scientific evidence, expanded diagnostic options beyond surgery, and a truly interdisciplinary approach, we’re better positioned to deliver more timely, personalised, and effective care.”

– Professor Cindy Farquhar, Chair of the RANZCOG Endometriosis Guideline Development Group.

Highlights from the updated guideline

• 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). Endometriosis has previously required a surgical procedure for diagnosis to be confirmed and so this could help reduce diagnostic delay.
• New recommendations to support early treatment in primary care, supporting GPs to begin first-line hormonal treatment while diagnostic investigations are under way. Primary care specific resources (the quick reference guide with summary flowchart), have been developed to improve access to key evidence-based recommendations for the diagnosis and management of endometriosis
• New recommendations specific to adolescents.
• New recommendations have been included for physiotherapy and psychological interventions.
• A free eLearning module for multidisciplinary care providers to support delivery of consistent, high-quality care across Australia will be available at the end of May.

A focus on primary care

“We have been particularly focused on ensuring that guideline recommendations are implementable and focused on the concerns of primary care practitioners when diagnosing and managing patients presenting with symptoms of endometriosis. Having clear, evidence-based tools like the quick reference guide and flowchart will be a game-changer for primary care. It will help primary care practitioners feel more confident starting treatment early and ensure we’re on the same page with specialists when it comes to managing what is often a complex, variable, and long-term condition.”

– Professor Danielle Mazza AM, Head of the Department of General Practice at Monash University and member of the guideline development group.

Support for people living with Endometriosis

Whilst the living evidence guideline is a clinical document for use by healthcare professionals, new patient-facing resources have also been developed to help individuals understand the conditions and navigate their care journey.

“My own experience with endometriosis was difficult to navigate. Like so many others, I felt frustrated by my symptoms and alone in what I was experiencing. These resources will empower people living with endometriosis by providing clear, reliable information to help them start meaningful conversations, advocate for themselves, and participate more confidently in shared decision-making with their care providers.”

– Alexis Wolfe, Consumer Liaison on the guideline development group.

The Australian Living Evidence Guideline: Endometriosis was launched by Professor Farquhar during RANZCOG’s in Melbourne on 10 May 2025. The guideline, quick reference guide, and patient information resources are now available.

Australian Living Evidence Guideline: Endometriosis

Providing evidence-based guidance to support the diagnosis and treatment of endometriosis and adenomyosis.

Explore the guideline and a range of resources for patients and clinicians

Media enquiries

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

����TV released a Clinical Guideline for Abortion Care today, evidence-based guidance for Australia and Aotearoa New Zealand.

President-Elect Dr Gill Gibson, who chaired the guideline development group, said: “RANZCOG supports equitable access to sexual and reproductive health services, including abortion, a fundamental reproductive health right.”

The purpose of this guideline is to provide evidence-based recommendations to registered health professionals who provide advice and abortion care in Australia and Aotearoa New Zealand.

Recent legislative changes in Australia and Aotearoa New Zealand permit abortion to be performed in all jurisdictions, under certain circumstances, by registered health professionals who are working within their approved scope of practice.

Dr Gibson said: “The publication of this guideline is an important step towards universal access to timely, safe and high-quality abortion care.”

Importantly, the new guideline covers:

• Telehealth Advancements: There is scope for an increased role for telehealth in Early Medical Abortion (EMA). EMA services by telehealth have been reported to be safe and effective.
• Routine Testing: Routine testing of blood group for Rh D status, is not required for either medical or surgical abortion up to 10 weeks pregnant. The guideline also makes recommendations on use of ultrasound prior to an abortion.
• Pain Relief: All women undergoing a medical or surgical abortion should be offered effective pain relief.
• Antibiotic Prophylaxis: The guideline provides clarity that antibiotic prophylaxis is recommended for all women having a surgical abortion, but is not recommended for women having a medical abortion.
• Choice of Medical or Surgical Abortion: When considering a medical or a surgical abortion, women should be able to choose the method of abortion most acceptable to them as both methods are safe and effective. RANZCOG has developed a companion document to this guideline, to support their decision making.

Recommendations for Future Research

Where a paucity of evidence exists, the guideline has identified areas for future research, such as pain management for surgical abortions. Further research is also needed on the risk of complications for women with previous uterine surgery who are planning abortion.

Access to Abortion Services

The guideline states that access to abortion services should not be limited by age, ethnicity, language barriers, migration or detention status, geographic isolation, socioeconomic disadvantage, disability, sexual orientation or gender identity.

Development

This comprehensive guideline was developed by a dedicated team, following RANZCOG’s robust processes.

Dr Gibson said: “We are grateful to the patients, clinicians, researchers and policymakers for their expertise, enthusiasm and genuine engagement in this project. We especially would like to acknowledge the generous and thoughtful contributions of the members of the guideline development group.”

Download The Clinical Guideline for Abortion Care and the accompanying decision aid.

In 2021, RANZCOG published the first Australian clinical guideline on the diagnosis and management of endometriosis, funded by the Australian government.