As 2024 wound down and many of us enjoyed a well-deserved summer break to welcome the start of 2025, the College’s advocacy efforts continued unabated. As we transition into autumn, I wish to reflect on some of the progress we have made since the last edition of O&G Magazine, especially as the expected federal election in Australia rapidly approaches.

Ending the year with a rush of external consultations

The College contributes to a high volume of external requests for expert consultation, and the end of the calendar year often generates a rush of requests from government departments, research institutions, other medical colleges, and our fellow women’s health collaborators. Some interesting submissions we have made include:

• Interim Western Australian Abortion Care Clinical Guidelines produced by the Western Australia Department of Health
• Victoria Department of Health on Amendments to the Assisted Reproductive Treatment Regulations 2019 as well as new Proposed Amendments to Australasian Health Facility Guidelines
• Australian and New Zealand College of Anesthetists (ANZCA) on its PS15(PM) Statement on the Clinical Approach to Persistent Pelvic Pain including Endometriosis-associated Pain
• RANZCOG enacted its commitment to te Tiriti o Waitangi making a public statement in support of health equity and followed this up with a submission to the Aotearoa New Zealand Parliament

The College participated in well over 125 submissions in 2024, a significant number. I wish to recognise the time and expertise that contributing members, trainees and consumers volunteer to inform our submissions and the considerable effort our staff put into maintaining the College’s visibility across policy decisions that affect our specialty.

2025-26 pre-budget submissions and policy proposals ahead of the Federal Election

The end of January held the deadline to respond to the annual call for pre-budget submissions to the federal Department of Treasury. The College highlighted several areas for investment in women’s health in our submission, including:

• Access to sexual reproductive health: The College argued that the time has come to adopt a free contraception policy in Australia. In addition to the pre-budget consultation, the College has also written directly to the major party leaders and key independent MPs about the need to support this forward-thinking policy, especially as other comparable jurisdictions, such as Canada, adopt free contraception.
• Birth trauma: The College also submitted a budget request to expand training and education opportunities to better support the medical workforce in the prevention of birth trauma. Birth trauma was heavily discussed in 2024, and the College’s view is that it can only be prevented with better attention to truly multi-disciplinary model maternity care. Additional training opportunities must be provided to our collaborative maternity workforce to help make birth trauma a rare event.
• Training opportunities in sexual reproductive health: The College has also presented a proposal for funding to expand education and training for sexual and reproductive health services, to improve access to medical abortion and include requirements for training for GPOs and midwives.

With the budget expected in late March, we look forward to reviewing the government’s commitment to women’s health through its 2025-26 investment decisions.

In parallel to the pre-budget submission process, the College has also been working with the Department of Health and Aged Care to extend funding for Obstetrics and Gynaecology Education and Training (OGET), a program which aims to address the essential need for equitable delivery of health services in Australia. Data collected by RANZCOG highlights a significant maldistribution of the workforce with a shortage of obstetric and gynaecological services in country towns, and a need for training opportunities in rural, regional, and remote areas. OGET funding was also included in our pre-budget submission.

Roundtables advance

Actions stemming from the two College roundtables held in 2024 continue to advance. The College published the final report of the RANZCOG Roundtable on Preserving Women’s Choice and the Future of Private Obstetrics & Gynaecology that I reported on in my last editorial. Read more about the report.

Likewise, the College continues to pursue recommended actions from the RANZCOG Roundtable on Improving Access to Medications & Devices in Pregnancy and Women’s Health, specifically exploring several lines of opportunity to bring Nifedipine (immediate release) back to the Australian market, partnering with the National Aboriginal Community Controlled Health Organisation (NACCHO) to do so. The College has also continued to press the wider case of systemic shortages with political leaders, including the Honourable Mark Butler, Minister for Health and Aged Care, and has held meetings with the Pharmaceutical Benefits Scheme to ensure financial equity of access for medicines not already listed.

Progress towards gender equity in the health system

Gender inequity embedded in the health system continues to be a barrier to progress. The College has been active in advocating for real progress in breaking down these deeply entrenched inequities. Examples include inequitable rebates provided by the Medicare Benefits Schedule (MBS) for services for men that are broadly compatible to equivalent services for women such as in pelvic ultrasound, inadequate MBS rebates for services for women such as care for endometriosis, and insufficient Pharmaceutical Benefits coverage for medications for menopause and sexual reproductive health.

The College has regularly brought these arguments to elected leaders and department staff, and we are seeing results. New MBS items for endometriosis care were funded in last year’s budget and are getting closer to coming into effect. Very recently, the federal government announced a significant $573.3 million funding package for women’s health. Many initiatives are already in place, such as the listing of new oral contraceptive medications and new hormonal therapies for menopause on the PBS. The rest will be taken to the federal election as a Labor Party campaign commitment. Importantly, the Coalition has pledged to implement this package as well, if elected. We have passed along our sincere thanks to the Minister for Health and Aged Care, the Hon Mark Butler MP and the Assistant Minister for Health and Aged Care the Hon Ged Kearney MP for their leadership in securing this funding package. We have also written to the Leader of the Opposition, the Hon Peter Dutton MP and the Shadow Minister for Health and Aged Care Senator the Hon Anne Ruston to commend them on committing to the same package. It is gratifying to see the recognition that women’s health is a priority across the political spectrum.

The College is tremendously proud of the central role we have played in keeping these issues on the agenda and pushing for solutions. We look forward to working with Members from across the political spectrum to advance women’s health priorities in the next Parliament, regardless of the outcome of the election.

Local advocacy initiatives

The College continued to support its members and trainees on jurisdictional issues. In December, we attended a meeting with the Minister for Health and Wellbeing for South Australia, the Honourable Chris Picton, to press the issue of better support for the GPO workforce, especially regarding rural sites. At issue was providing General Practice Obstetricians with indemnity insurance, which would allow these members to provide locum coverage in rural areas and provide some relief to the overstretched rural and regional workforce. We also discussed the need to improve access to abortion services in rural areas by enhancing training opportunities for rural GPOs. In February, we met with ACT Minister for Health, Rachel Stephen-Smith MLA urging the prioritisation of gynaecological surgeries and theatre time, citing long public wait times for those who do not have the means to access private health. Increasing operating lists would help enhance training opportunities and attract more consultants to Canberra.

In Aotearoa New Zealand, I was pleased to attend RANZCOG’s Urogynaecology Day in Auckland in December. This was the third time that the College held this event, bringing together members working in urogynaecology and responding to the challenge of the mandated pause in midurethral slings and the complexities of the ongoing credentialling process for urogynaecological procedures.  Te Kāhui Oranga ō Nuku continues to be very active in engaging with Te Whatu Ora Health New Zealand on a wide range of women’s health and professional areas, particularly calling for leadership in women’s health and a Gynaecology National Clinical Network to sit alongside the Maternity National Clinical Network.

I hope you’ve all had a promising start to 2025. The year ahead presents the College with many opportunities to support you all in the vital work we do in caring for the women in our charge. Our work at the College on behalf of our specialty cannot be done without the commitment of our dedicated members, for which you all have my sincere appreciation. Thank you all, and our very best wishes for a successful year ahead.

Finally, it is with great sadness that I acknowledge the passing of Kaumatua Luke Crawford (Ngāti Tūwharetoa, Ngāti Porou) on 13 December 2024. Luke was a valued member of our RANZCOG whānau, in particular as Kaumatua and member of He Hono Wāhine for the last eight years. I invite members to read the College’s celebration of Luke’s life. Truly, a mighty tōtara tree has fallen in Tāne’s great forest.

Kaumatua Luke Crawford (Ngāti Tūwharetoa, Ngāti Porou)