Dignity and choice

Sam Wilde Advocacy, Equity and access

On Wednesday 9th May, while Australia continued to dissect what the 2018 Federal budget meant for each of us, US-based research and policy body, The Guttmacher Institute and one of the world’s leading medical journals, The Lancet, released a comprehensive report on the progress of sexual and reproductive health and rights worldwide.

The report contains staggering statistics; almost 4.3 billion people of reproductive age on this planet will experience inadequate sexual and reproductive health services over the course of their lives.  

You could easily dismiss the Guttmacher-Lancet report as yet another assessment of the Global South, or non-OECD nations (I refuse to use the term ‘developing’ ). However this is a global report and it is relevant to every nation and every person on this planet.

The report, for the first time, brings together a holistic picture of the state of sexual and reproductive health and rights across the board. It highlights the key issues that we face globally and the common barriers that block access to all of us attaining good sexual and reproductive health.

Most prominently the report highlights the issue of infertility, its wide-spread occurrence (up to 180 million couples are impacted worldwide) and its costly treatment. It mentions cervical cancer, an entirely preventable disease that claims the lives of 266,000 women each year. It highlights the need for greater responses to STIs other than HIV. It also broaches the issue of prostate cancer that kills 310,000 men a year.

Laws, policies, the economy and social norms are all, according to the report, key barriers to responding adequately.  These issues and barriers to their resolution are just as relevant to Australia as they are to other nations.

The beauty of this report is that it clearly recommends what countries should support in order to provide adequate sexual and reproductive health and rights to its citizens. It recommends that governments focus on the traditional areas of sexual and reproductive health; contraception, maternal and new born care, and prevention and treatment of HIV/AIDs. However it also recommends that governments provide universal access to care for STIs other than HIV; comprehensive sexuality education; safe abortion care; prevention, detection, and counselling for gender-based violence; prevention, detection, and treatment of infertility and cervical cancer; and counselling and care for sexual health and wellbeing.

In Australia we have made great strides in the provision of the HPV vaccination program. We have also invested heavily and necessarily in HIV and Hepatitis C prevention and treatment. However, when it comes to most of the recommendations in the Guttmacher-Lancet report, investment has been rather patchy and, in some areas woefully inadequate.

The released budget perpetuates this pattern.

There are two issues at play here. We as a nation, like many other nations, are stymied from having a frank and fearless conversation about sexual and reproductive health and rights because of social norms and prevailing ideologies (particularly religious ones). We really need to get over this because we need to talk maturely and level-headedly when it comes to all forms of health.

The second issue, and the one that is most pertinent to budget time, is that we are viewing funding of sexual and reproductive health and rights as a cost. It’s not. It’s an investment that will pay future dividends in the form of improved health and wellbeing for all generations particularly the future generations, gender equality, productivity and increased household income and economic participation. And as anyone who works in public health knows, prevention and early intervention cost less to the economy than treatment.

What we have seen in this 2018 Federal budget has scratched the surface in some areas. It is pleasing that endometriosis has been provided with an additional $1 million bringing the government’s investment to $3.5 million over three years.  It was also heartening to see investment in infant and maternal health services and more funding to access to HIV prevention pill, PrEP. However, as a country we are only delivering sexual and reproductive health commitments in a piecemeal way.

In his budget speech on Tuesday night, Scott Morrison said “just because you are getting older, it doesn’t mean you should surrender your dignity or your choices”.  We have an aging population, and this budget certainly confirms the need to support the population in aged care services. However, what this assumes is that dignity and choice only diminishes with age. That’s not necessarily the case. Our dignity and choice also diminishes as we suffer poor sexual and reproductive health. 

It’s time that we have a national conversation about sexual and reproductive health and how we will ensure that our 24 million citizens have access to adequate services now and in the future. By doing so, we will ensure that we can age with dignity.

Michelle Thompson is CEO of Marie Stopes Australia, a national not-for-profit provider of abortions and contraception