Are we really still talking about this?

18 / 07 / 2013


Emily Lee-Ack sheds light on a recent survey into the availability of contraception, buy viagra family planning and reproductive services in rural areas. Unfortunately, cialis despite recent law reform on the issue, progress remains hindered by entrenched views and a lack of resources.


By Emily Lee-Ack

In 2012, the rural Women’s Health Services in Victoria undertook ground-breaking research into the availability of family planning services in rural and regional areas.  What, the group wondered, had been the impact of abortion law reform, and an increased focus on reproductive choice in Victoria??  What impact had a national debate on the availability of RU486 had on service provision and community awareness?

The research was conducted by a survey of health service providers, community health, local government, GPs and family support services.  Two hundred and twenty-five respondents from across Victoria completed the survey, representing each of the rural Victorian regions. 

Since the release of the survey, many of us have been surprised by how often we’re met with disbelief that access to services is still an issue for rural and regional women.  “But, surely we’ve solved that problem?” people ask.  This is usually when I tell them about the 16-year-old who was refused condoms in a store because he couldn’t produce ID.  Or the pharmacist who gave young women a lecture on their morality while dispensing emergency contraception.

Despite a generalised view that this is a problem which has been “fixed”, the survey suggests that entrenched problems remain.  Twenty-five percent of survey respondents say that lack of condom availability is a problem in their community.  Thirty-seven per cent say contraception availability is an issue.  Without these preventative measures readily accessible, is it any surprise that rural and regional women in Victoria experience greater rates of teen pregnancies than their metropolitan sisters?

Assuming you can get an appointment with a GP, what if you can’t get an appointment to see an appropriately qualified professional – because that service does not exist in your region?  Specialist sexual and reproductive health clinics or specialist medical staff (such as gynaecologists), are in short supply in rural Victoria.  Limited opening hours and long waiting times to see service providers force some women to seek services in Melbourne where they could access a service in a more timely manner.  “A lot of women are “shipped off” to Melbourne,” one respondent wrote, “This is archaic”.

Difficulties with distance and lack of transport are significant issues for access to family planning services.  In some areas, this has been related to a lack of public transport, and in others it relates to the arrangement of suitable private transport arrangements.  “In some areas, GPs and pharmacies aren’t open on particular days, so you have to travel…for emergency contraception”, one respondent noted.  This would be fine – if you have a driver’s license, a reliable car, enough money to cover petrol costs, and an understanding family/friends and/or employer.   Remove any of those elements, and your access can be seriously restricted – with life-altering consequences.

The high costs of contraception, as well as the additional cost of travel and time required to travel to appointments or services, is a considerable factor in sexual and reproductive health.  While this issue is a universal one for all people seeking contraception, it is exacerbated in rural and regional areas where there are few, if any, bulk billing providers.  “Young people are struggling with the confidence they need just to get through the door in a private GPs clinic,” one community member told me recently.  “Being there is a huge win.  But if they forget to ask to be bulk-billed, then they worry that they can never go back to that doctor again, because they haven’t paid”.

Confidentiality and anonymity have both been used to describe a problem regarding the pursuit of safe sexual and reproductive health practices. Seventy-two per cent of survey respondents say that privacy is an issue in their local area. Sometimes, this is about the space we offer to make sexual and reproductive health choices.  “I wandered up and down the supermarket aisles for 20 minutes, waiting for people I recognised to leave so I could grab a pregnancy test,” a community member told me.  “I’d NEVER go to the emergency department to get the morning after pill,” said another.  “It’s too exposed.  You can’t make a private decision like that with everyone in that room watching you, and wondering why you’re there”.

Lack of availability of information and lack of access to up to date information for both clients (from the medical and allied health professions) and individuals was identified as a critical issue in rural and regional areas.  This was particularly relevant in responses to the provision of abortion services, and there is a general lack of information about access to medication and surgical abortion. When survey respondents were asked about access to medication abortion almost half (48%) said they did not know if services where available. In some cases, gaps in provision of sex education were also identified.  “This is still seen as something you don’t talk about,” a survey respondent said.  “Schools and parents need more help with this,” a community member told me.  “They just don’t quite know what to do about it, and a lot of the time the teachers don’t feel comfortable talking about this stuff”.

Concern remains in rural and regional areas about the skills and professional development of the health sector where sexual and reproductive health is concerned.  “There are some great courses on family planning in Melbourne,” one community member said.  “But we can’t find the $200 we need to attend, and we’d have to pay for travel and accommodation on top of that”.  There was also particular focus on the perception that some service providers are not providing full services to some or all of their clients, as a result of cultural or conscientious objections. “We’re still sussing out the new GP, to figure out whether or not they’d be likely to have any problem with contraception or abortion,” one community member confided.  “Once we know, we’ll be sure not to refer people to them with that request”.

Linked to anonymity and privacy, there was ongoing concern by respondents to the survey that community attitudes were leading to the stigmatisation of those who sought family planning and sexual health services.  “Clients feel uncomfortable accessing services when provided by community members,” one survey respondent noted.  “It’s hard not to wonder if the person you’re talking to won’t tell someone else why you’ve been to the doctor,” one community member said. 

What is clear is that there is significantly more work to be done to ensure that women have equitable access to sexual and reproductive health services.  But the signs are positive that such a change is possible.  Leadership and vision from organisations and a desire for equity within the community can help change the lives of rural and regional women, ensuring that their access to health services matches that of their metropolitan sisters.  Only then will we be able to transform our conversation about sexual and reproductive health – centering on the pursuit of wellness rather than our current focus on the consequences of poor prevention.

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