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.
