Women’s Health Priorities for the 2025 Federal Election

Women’s Health Priorities for the 2025 Federal Election

Monday 14 April 2025

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG; the College) is the lead standards body in women’s health in Australia and New Zealand, with responsibility for postgraduate education, accreditation, recertification, and the continuing professional development of practitioners in women’s health, including both specialist obstetricians and gynaecologists, and GP obstetricians.

��TV is also a leading voice in advocating for women’s health. This federal election presents a unique opportunity to put a women’s health agenda at the forefront of national policy.

In his speech presenting the 2025 federal budget, the Treasurer, the Honourable Dr Jim Chalmers MP, said, “for our Government, women’s health is not a boutique issue or a question of special interest – it is a national priority.”¹The Coalition has committed to honouring the Labor Government’s women’s health funding package.²There is overdue consensus that the federal government must do more to support women’s health. The funding already committed by both major parties is very welcome, but RANZCOG believes that a significant amount of work still needs to be done to ensure women, and their families receive timely and effective care, immaterial of their geographic location or social situation.

To truly drive our health system forwards for women, RANZCOG has identified the following key areas for attention in the next parliament, regardless of the outcome of the election:

Preserving women’s choice and access

Australia has one of the best performing health systems in the world, which is often attributed to its well-functioning hybrid model, with universal public health care funded through Medicare and supporting systems ably complemented by a robust private health sector. This provides women with universal coverage, while preserving individual choice for those who seek it. But the balance is straining under the weight of financial pressures increasingly burdening the operation of the private health sector. Without a robust and accessible private health sector, the public system will come under serious threat. The Commonwealth Fund’s report places that Australian health system at joint #1 overall (out of ten comparable countries), but ranking ninth in access, showing that this domain of care is already significantly at risk.³

This pressure is nowhere more prevalent than in women’s health. Closures of private maternity units are coming thick and fast in the news. The closures of these units throw many patients whose due dates are approaching into crisis mode in the short-term, while reducing the choice of birthing options for women in the long-term. There is often only one private maternity unit in many regional and rural communities, meaning that closures have serious consequences due to lack of alternatives. These closures often have a detrimental impact on public services within these cities and towns, with specialists moving on to areas that can support a mix of private and public employment.

In gynaecology, Australia also has a serious issue with wait times for gynaecology surgery in the public system, with many women languishing in the system while their health worsens. If capacity is further removed from the private system, this already acute problem is only going to deteriorate.

Private health insurance is in need of legislative reform, especially with obstetrics coverage. The current regulatory environment restricts the private insurance coverage of obstetrics to gold-tier plans, or the most expensive plans, and pregnancy comes with a 12-month waiting period. This is inequitable. It has the effect of reducing choice for women, by making private obstetric coverage unaffordable for many, forcing a default choice for the public system. This in turn makes access challenging, as many public maternity units are under capacity pressures. An urgent review of the risk equalisation matrix that governs the exclusion of obstetric care from a wider risk pool, and legislative change, must be undertaken.

Achieving gender equity

The legislative, regulatory, and institutional structures that govern our health system are littered with deeply embedded biases; gender bias is one that is most prominent. This is not an indictment of the numerous healthcare professionals who dedicate their lives to women’s health; many are advocates in their own right, calling out instances of gender bias whenever they come across it.

Examples of bias include within the Medicare Benefits Scheme, where inequitable rebates are often provided for equivalent services for men that are comparable to services for women, such as pelvic ultrasound. Rebates for conditions that affect women only, such as endometriosis, have been historically inadequate. In the Pharmaceutical Benefits Schedule, the best and most up-to-date medications for menopause and contraception are frequently not listed or are listed after a lengthy delay following approval for use. This is changing, with recent budget announcements starting to chip away at the problem. But we don’t know what we don’t know. An in-depth gender-lens review of our health systems must be undertaken so we can identify the true scale of embedded bias and form a plan for eliminating it.

Women’s health conditions are often under-researched because of a similar history of gender bias. Even today, it is difficult to involve pregnant women in clinical trials for new medications, meaning outcomes of research studies often inadequately address women’s needs, and access is limited. This also needs to change.

Gender bias in health care affects women’s ability to affordably access the care they need, and with the best cutting edge medical research applications safely applied to them.

Making contraception free

The time has come to consider a national policy of free contraception. The cost of contraception can be a barrier to many women. Cost may influence, or dictate, which type of contraception someone can choose to access, or whether it can be afforded at all. Everyone has different needs when it comes to contraception, with many products offering different levels of comfort and effectiveness for each individual person. The choice of contraception should be based only on what works best, not which is the most affordable.

Canada has recently adopted a federal policy of free contraception. Like Australia, Canada has a rate of unplanned pregnancies that sits at around 40%. Most unintended pregnancies end in birth. The direct health care costs of these unintended pregnancies is estimated to be around $320 million (CAD) per year. The new program is expected to cost $1.9 billion over the next five years (but also includes costs for free, publicly funded diabetes medication). It is possible that free contraception in Canada is already close to revenue neutral. A similar program in Australia would likely cost less in new money, as there is already some public coverage of a range of contraceptive choices, with more options being granted public subsidy recently. This policy will need further study to determine what is needed for the Australian context.

Supporting a sustainable health workforce

A health system can only be as good as the people who work in it. Thankfully, Australia’s high quality health system is filled with many highly trained and dedicated health professionals who are committed to delivering a high standard of care to their patients, no matter the challenges. But it would be a mistake to think that our health care system can achieve these high standards without supporting the sustainability of our workforce.

As populations age and health care demands become more complex, supporting our health workforce to keep pace with these changes must be at the forefront of policymaking. This means that health professionals of all stripes, including specialist obstetricians and gynaecologists and general practice obstetricians, need to be supported with training and education resources to help them to continue to adapt to the changing needs of their patient populations. This means expanding access to training in things like abortion care to allow for a truly multidisciplinary approach so women can access the essential reproductive health care they deserve, close to home. This also means supporting specialist O&G trainees with surgical theatre time in public and private settings, to ensure skills are gained and maintained.

Working in healthcare must be an attractive proposition wherever one is in the country. This means that we need to support our health workforce to build careers and lives in regional, rural and remote communities that are so often underserved. Building rewarding careers in regional communities can be a challenge. Health professionals, especially GP obstetricians, are far from tertiary hospitals, making maintenance of skills and belonging to a supportive professional network difficult. Likewise, the transition from being a trainee to a consultant can often be challenging in rural and remote areas without adequate infrastructure and support systems. While incentivisation will provide short term relocation support to trainees and specialists, longer term investment into ongoing professional development and skill maintenance as well as well as investments in infrastructure such as schools, childcare and housing is critical in attracting and retaining healthcare professionals to regional, rural and remote areas. Supporting programs that bring training to regional communities, such as RANZCOG’s multidisciplinary OGET project, is crucial.

Eliminating shortages of medicines and devices

Shortages of medicines and devices – across all health specialties – is a persistent and pervasive problem in Australian health care. The Therapeutic Goods Administration lists 416 medication shortages in April 2025 (with another 83 anticipated). This number has not moved much over the past several years. We have both an acute problem (medications in short supply or unavailable) and a chronic one (no improvement in the overall condition of short supply).

These shortages can have outsized impacts on women’s health. Medications used in pregnancy are often older, and off-label, meaning that they are used outside of their usual listed indications. An example of such a medication is Nifedipine (immediate release), which is vital to control the early onset of labour for women who need to travel or are otherwise delayed in accessing medical care. When listed use for a medication becomes untenable, or a medication is replaced with a newer drug, off-label use becomes impossible. Nifedipine (IR) is no longer available in Australia and there are no replacements. Restrictions on pregnant women being allowed to participate in clinical trials means that robust data on medications in pregnancy is lacking, which can often restrict availability of alternative options.

Even if medications or devices are available, public subsidy through the PBS influences cost considerations, and effectively may make some medications “unavailable” to some women by making non-subsidised options unaffordable.

A new way of thinking about how to ensure medications and devices in Australia are kept in good supply and shortages are eliminated or reduced as much as possible is needed. Options include developing a list of essential medications that are required by law to be in stock in the country and establishing a “public interest importer” which can ensure that these essential medicines are supplied without needing to rely on a commercial sponsor.

As mentioned in the above sections, RANZCOG is appreciative of the funding commitments made towards women’s health by both major parties. The College believes that the importance of health, and women’s health in particular, extends beyond political remits and viewpoints. A sustained effort and ongoing dialogue is critical in progressing positive outcomes for women and their families. RANZCOG welcomes such ongoing dialogue and remains committed to playing an active role in developing solutions that support progress.