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Medicare rebates for obstetric services are outdated, fail to cover the true cost of care, and attract lower rebates compared with other specialities.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
