Australian midwives are calling for expanded roles, including prescribing medical abortions, as they warn of “abortion deserts” where women cannot access the healthcare they need.
In an inquiry hearing on Friday, midwives are also set to call for broader rights to prescribe contraceptives.
The Greens’ leader in the Senate and spokesperson on women, Larissa Waters, introduced the motion for a Senate committee inquiry into universal access to reproductive healthcare after the US supreme court overturned Roe v Wade.
Dr Zoe Bradfield, a senior research fellow at Curtin University and vice-president of the Australian College of Midwives, said midwives were “ready to go”.
“Midwives are scoped to provide life-course care from menarche to menopause and everywhere in between,” she said.
“All of the screening and diagnostics for pregnant people are often relevant for non-pregnant people.
“We’re in the middle of a gender-based violence crisis … the screening midwives do for family and domestic violence, we’re already really good at that.”
In its submission, the Australian College of Midwives (ACM) wrote that a broader presence in primary care could allow them to deliver to their “full scope”.
The midwifery workforce is an “under-utilised resource that, if enabled, could play a crucial role in providing universal access to reproductive healthcare and women’s health underpinned by women’s choice and autonomous control”, the college wrote.
“Endorsed midwives are already living and working in the identified ‘abortion deserts’ of Australia.
“By undertaking the same credentialing and training required by medical practitioners (currently not available to midwives), these midwives will improve access and quality of care for women.”
The college described abortion deserts as places “where women are unable to access the limited number of medical practitioners qualified to perform abortions and/or pharmacists to prescribe medical abortion”. That leads to limited access and long wait times, increasing the chances of poor outcomes, while midwives are “ideally placed to provide prescriptions for those seeking medical abortion”.
The college also said the federal government should consider making the contraceptive pill, condoms and intrauterine devices free for those under 25 and allow midwives to prescribe contraceptives.
Of 36,000 registered midwives, only 908 are endorsed (after extra study and 5,000 hours practice) to prescribe contraceptives and even then only a limited number are on the PBS. According to the submission, midwives would particularly help in rural, remote and Aboriginal communities.
Midwives Australia, which represents midwives in private practice, said midwives worked in a range of settings including homes, communities and health units and provided a range of services including sexual health and education. It said women’s access to “termination of pregnancy services across regional, rural and remote areas” is “highly problematic and below the expected standards for a first world nation”.
In New Zealand, midwives play key roles not just in pregnancy, birth and post-birth, but also in medical abortions and the prescribing of contraception.
“Unfortunately, in Australia the role and potential of the midwife is not fully realised,” MA wrote, adding they were not seen as “essential in public health strategy”.
Midwives Australia called for a “whole of life approach”, for it to be easier for midwives to qualify to prescribe contraceptives and for legislative change so midwives could prescribe and provide medical terminations.
The Nursing and Midwifery Federation also called for the removal of barriers for both nurses and midwives, as well as support for measures including providing contraceptive implants, hormone replacement therapy, termination counselling, and STI testing.
MS Health, a non-profit pharmaceutical body that is part of MSI Australia, has applied to the Therapeutic Goods Administration to expand the number of eligible prescribers and therefore expand access. MS Health would like to see nurses, midwives, and Aboriginal and Torres Strait Islander healthcare workers able to prescribe medical abortions.
The assistant health minister, Ged Kearney, said everyone deserved access to “equitable and appropriate sexual and reproductive healthcare”.
“We know there are barriers to access for women seeking terminations or contraceptive options across Australia – be that geography, cost, lack of awareness for consumers or a lack of training or education among health practitioners,” she said.
The committee is due to report on 11 May.
