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Accessing Healthcare as a Rural Australian

Living in regional or remote parts of Australia adds another layer of complexity for patients accessing healthcare. In today’s blog post, we discuss strategies to aid people from rural communities to feel that their needs are being addressed, whether that be for someone from a regional place having services transferred to a metropolitan hospital, or for someone from out bush seeking local care. All Australians have the right to access comprehensive health services, but due to geographical location in part, data demonstrates that regional and remote inhabitants have poorer access to primary healthcare (such as a GP), increased rates of hospitalisation, and increased rates of injury and death compared to city folk.1 Read on for how to utilise services to your advantage when you live a distance from a major health network.

Are there even sexual and reproductive health services in my area?

If you’re wanting to find contraception, pregnancy options, abortion or sexual health services in your area, contact us at 1800 My Options (phone line is open from 9am to 5pm Monday to Friday), or use our interactive map to search for a local practitioner who meets your needs.

There are currenlty 7 Women’s sexual and reproductive health hubs in regional Victoria, who can help you with information and support on all types of contraception, sexual health testing and treatment, medical abortion and referral for surgical abortion of pregnancy.

There are telehealth services offering phone/online consults for Medication Abortions, where your scripts will be sent to you after your consults. However, you will still need to attend a clinic in person where you can do your blood test/ultrasound scans.

If you’re after some basic STI testing, you can also use the TestMe service.
TESTme is a free service of Melbourne Sexual Health Centre (MSHC) for rural Victorians aged 25 years and younger, rural Victorian men who have sex with men and Aboriginal and Torres Strait Islander people. It offers self-testing kits for chlamydia and gonorrhea, which will be posted to you.

I’m unsure if I even need to go to the GP or hospital – should I just wait and see?

Generally speaking – no. If you are concerned enough to think you need to seek help, you should not delay. However, if you are seeking some advice, there are some services that you can access online or over the phone, if travel is challenging for you:

  • NURSE-ON-CALL: 1300 60 60 24 
    24/7
    Discuss your health concerns with a registered nurse

  • Healthdirect Symptom Checker
    If you have access to the internet, this symptom checker at can make some general recommendations, and you may be able to wait to see a local GP the next day.

  • Victorian Virtual Emergency Department (VVED)
    24/7
    A public health service for non-life-threatening emergencies – access emergency care from anywhere in Victoria.

  • 1300 MEDICINE: 1300 633 424 
    9am – 5pm, weekdays
    Talk to a registered pharmacist about medicine-related questions (including how to take medicines, possible side effects, and taking medicines during pregnancy or breastfeeding).

  • Pregnancy, Birth and Baby Line: 1800 882 436  
    7am – midnight, 7 days a week
    Talk to a Maternal Child Health Nurse for personal advice and guidance. They can direct you to local support services.

  • For other pregnancy concerns, many maternity units have a phone line you can call for questions about worries such as breaking the waters or early labour. This may be a valuable resource to help guide you regarding if/when you need to present to hospital.

As always, if you have major or persisting concerns, go to the hospital or call 000 if urgent.

Travelling to hospital for repeat appointments is time-consuming and expensive.

Whilst ongoing care from the hospital may be challenging if you live far away, continuing your follow-up after a medical issue can be critical in ensuring your recovery or making sure your long-term health is optimal. For outpatient appointments, many clinicians can conduct Telehealth appointments (either over the phone or by video chat), so ask your doctor if this would be appropriate for you. If it is important you are seen face-to-face, the Victorian Patient Transport Assistance Scheme (VPTAS) exists to provide financial assistance for Victorians who need to travel great distances for specialist medical care.5 Check your eligibility on the VPTAS website and then speak to your doctor about arrangements.

I feel culturally unsafe, or I’m not sure my culture will be understood or respected at hospital.

Unfortunately in Australia, First Nations people experience a burden of disease estimated to be 2.3 times greater for Indigenous people compared to non-Indigenous people.2 Whilst many influences play into this, an important factor is a lack of cultural understanding or sensitivity in interactions, and First Nations peoples’ understandable trepidation about engaging with a system that historically has been pejorative. In Victoria, the Improving Care for Aboriginal and Torres Strait Islander Patients (ICAP) program aims to provide culturally-safe care for First Nations people, and a crucial part of this is the role of Aboriginal hospital liaison officers who can provide linguistic and cultural support to patients.3 Victorian hospitals encourage people to identify themselves as First Nations so they can better meet the specific needs of this community; as such, please feel empowered to self-advocate and ask for Indigenous liaison services if you identify as Aboriginal or Torres Strait Islander. If you don’t feel comfortable asking for formal services, even bringing a support person to hospital (such as a family member or friend) can help. Furthermore, many maternity units offer Koori Maternity Services (KMS) which are geared towards supporting First Nations mums through their pregnancy journey.4

For migrants and people whose first language is not English, accessing healthcare can also be challenging. You can request a free interpreting service if you don’t understand what is being said – so please do not hesitate to ask for this from your medical professional.

I’m facing a challenge which is more likely to affect country folks.

While no matter where you live, staying healthy can be a challenge – living rurally can bring with it some significant barriers to good health.

  • For example, whilst motor vehicle accidents can occur anywhere in Australia, the rates of death from land transport accidents are nearly three times higher in remote areas, and nearly four times higher for very remote areas.1 Always make sure you are buckled up, your car is well-maintained, and never drive when tired.
  • Furthermore, occupational injuries and deaths are more common in rural areas due to practices like farming;6 visit the Safe Work Australia if you have concerns or are seeking workers’ compensation.
  • Rates of smoking and alcohol consumption are higher in the country generally,7 so stay aware and talk to your GP for advice on reducing your intake or quitting.
  • Rural folk face distinct stressors which can affect your mental health. Phone counselling services can support you remotely:
    • Lifeline — call 13 11 14 or chat online, for crisis support and suicide prevention services.
    • Yarning SafeNStrong (YSNS) – call 1800 959 563 for a free and confidential counselling service for Aboriginal and Torres Strait Islander Peoples.
  • For women living outside of major cities, the likelihood of experiencing intimate partner violence is 1.5 times higher.1 If you have concerns about your safety, some Victorian family violence organisations can be found here.
References
  1. Australian Institute of Health and Welfare (AIHW) 2023, Rural and remote health, viewed 30 March 2024, https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health
  2. Australian Institute of Health and Welfare (AIHW) 2022, Indigenous health and wellbeing, viewed 30 March 2024, https://www.aihw.gov.au/reports/australias-health/indigenous-health-and-wellbeing
  3. Victorian State Government Department of Health 2023, Access and continuing care, viewed 30 March 2024, https://www.health.vic.gov.au/health-strategies/access-and-continuing-care
  4. Victorian State Government Department of Health 2023, Aboriginal maternity services, viewed 30 March 2024, https://www.health.vic.gov.au/patient-care/aboriginal-maternity-services
  5. Victorian State Government Department of Health 2024, Victorian Patient Transport Assistance Scheme (VPTAS), viewed 30 March 2024, https://www.health.vic.gov.au/rural-health/victorian-patient-transport-assistance-scheme-vptas
  6. Australian Institute of Health and Welfare (AIHW) 2021, Geographical analysis of hospitalised injury and injury deaths data, 2017–18, viewed 30 March 2024, https://www.aihw.gov.au/reports/injury/geographical-analysis-injury-data
  7. Australian Institute of Health and Welfare (AIHW) 2024, Use of alcohol and other drugs in Major cities, regional areas, and remote areas, viewed 30 March 2024, https://www.aihw.gov.au/reports/rural-remote-australians/alcohol-drugs-geographic-areas

What is Reproductive Justice?

Reproductive justice has been defined as the complete physical, mental, spiritual, political, social and economic wellbeing of women and girls, based on the full achievement and protection of women’s human rights (Ross, 2007; Ross, Solinger, 2017). This definition of reproductive justice also broadens the concept away from ‘reproductive rights’, which had a heavy focus on individual legal rights and abortion.  Instead, reproductive justice looks to the broader structural determinants of sexual and reproductive health, including the socio-political context in which “choice” or “rights” can occur for many groups in society. Basically, this means considering how things like how much money you have, your visa status, disability status, marriage status, location, race, gender and sexual orientation might affect your sexual and reproductive health and the “choices” you make.

For example, population groups such as women, transgender and intersex women of colour, First Nations, queer communities, refugees, asylum seekers, and those with disabilities, have experienced historic and ongoing conditions where their reproductive and sexual autonomy have been monitored, surveilled, curtailed and regulated. Such practices include forced sterilisation, forced contraception, forced abortion and forced adoption. Other historical and contemporary practices might also include the prevention of access to contraception or abortion by the state either in an outright manner or in an exclusionary or highly regulated environment.

In their 2017 book ‘Reproductive Justice: An Introduction’, activist Loretta Ross & scholar Rickie Solinger defined the term reproductive justice as:

“…A contemporary framework for activism and for thinking about the experience of reproduction. It is also a political movement that splices reproductive rights with social justice to achieve reproductive justice.

The definition of reproductive justice goes beyond the pro-choice/pro-life debate and has three primary principles:
(1) the right not to have a child;
(2) the right to have a child; and
(3) the right to parent children in safe and healthy environments.

In addition, reproductive justice demands sexual autonomy and gender freedom for every human being.”

What is the Disability Rights Movement?

The disability rights movement gained momentum in the 1960s alongside other civil and political rights movements of the time such as women’s rights and black rights movements. It was a movement led by people with disabilities and their allies, advocating for equal treatment and rights alongside social and political changes to the way disabilities were understood – moving from a medical model to a social model of understanding disability.

In a submission to a 2023 senate inquiry in relation to sexual and reproductive health, Women With Disabilities Australia notes that for women and gender diverse people with disabilities, reproductive justice is an important concept as there is often a limiting of critical access to information and resources that support their sexual and reproductive health, safety, and wellbeing of these groups. Without access to inclusive and intersectional sexual and reproductive health information and resources, these groups continue to frequently be denied the ability to make decisions about their own bodies, on the basis that they don’t have the knowledge or capacity to do so (WWDA p.8).

Histories of forced sterilisation, abortion & contraception

An Australian senate hearing in 2023 was told by disability and women’s groups that throughout history and even today, disabled Australian women face forced sterilisation, abortion and contraception, including ‘reproductive violence’, ‘coercion’ and ‘extreme’ violation of rights of women with disabilities.

The Victorian Women’s Health Services Network went on to advise the enquiry that there is no specific legislation that prohibits forced sterilisation in Australia and that other circumstances occur where women with disabilities are more likely to be vulnerable to family violence – including being forced to have abortions or use contraception. They also outlined how women with disabilities are more likely to be refused the right to consent to medical treatment including abortion are more likely to experience reproductive coercion that women without disabilities (see The Guardian, 27 April 2023).

Similarly, many First Nations women in Australia, as well as women of colour outside of Australia, report histories of forced sterilisation, contraception and abortion as part of colonial and eugenicist projects.

Ultimately, the aim of the reproductive justice movement is to ensure that everyone has access to the economic, social, and political power and resources needed to make decisions about our bodies, families and lives.

For more information on these issues see:

Interview with Melbourne Pregnancy Counsellors

It can be hard to find an independent, pro-choice Pregnancy Options Counsellor. Join us as we talk to Patricia Hayes, co-founder of Melbourne Pregnancy Counsellors!

Tell us a bit about yourself!

I am an accredited mental health social worker and counsellor working in private practice, specialising in pregnancy options and abortion counselling. I have worked in this sector in hospitals, private clinics, and private practice for the past 20 years. I am a committed intersectional feminist and activist and passionately believe in the power of collective change, especially in reproductive justice. Throughout my years of advocacy and action I was also a part of the many groups of women that contributed to the Victorian abortion law reform movement (which was super-inspiring to be a part of!).

I am also a co-owner of a fabulous not-for-profit vinyl record store with five of my feminist sisters & nonbinary mates called Feminista Vinyl, which specialises in showcasing women, non-binary & gender nonconforming artists. We have our vinyl record store in the shopfront and house our feminist counselling businesses at the back – how Portlandia is that!

Why did you start Melbourne Pregnancy Counsellors?

By 2017, I and three colleagues who had worked in abortion and unintended pregnancy counselling at hospitals and private clinics for over a decade were branching out into private practice counselling. We realised there was a real dearth of counselling services in Melbourne that were pro-choice, feminist and specialised in abortion and options counselling.

We wanted to make sure pregnant people got unbiased and nonjudgmental counselling, to counter the myths and misinformation about abortion peddled by many anti-choice ‘Pregnancy Helplines.’ Even in our own professions, there can be a lack of knowledge in this area. Together we decided to form Melbourne Pregnancy Counsellors (MPC) – a network of independently practicing social workers and counsellors who specialised in pro-choice counselling for women and pregnant people who are all at various stages of the reproductive continuum.

What exactly is Pregnancy Options Counselling?

Pregnancy Options counselling is a type of counselling that enables exploration of your values, goals,emotions, beliefs to support you to make the best decision you can regarding an unintended pregnancy. Most importantly, it situates you as the expert in your life, centering you as an autonomous being that can make the “most right” choice, once you have considered all your factors: psychological, social, cultural, physical, financial.

We know that women/pregnant people often come under pressure and judgments from a range of sources in relation to sexuality and pregnancy – family, partner,community, society – so we take care to validate in the counselling that there is nobody better placed to know what’s “most right” than you. We emphasise your autonomy; self-efficacy is a crucial factor amidst the numerous psychological and social pressures that often frame your choices as “selfish” no matter what you choose.

Pro-choice pregnancy options counselling does not push you in a certain direction: towards abortion, continuing the pregnancy or adoption, but certainly sees and names abortion as a valid option given the stigma still attached to this option. Of course, abortion is not the right decision for everyone, just as continuing the pregnancy is not the right decision for everyone, so we make space to explore exactly how you feel about each option so you can make a decision that is most aligned with your heart and mind. We also provide post-abortion counselling to those who might experience difficult feelings post-abortion.

Who can come and see you?

Anyone who is pregnant and considering their options, or wish to explore their decision in relation to pregnancy and/or continuing the pregnancy/abortion/adoption. We can also see couples, but usually will try to see the woman/pregnant person first to ensure autonomy.

Are there any myths around the types of people who consider abortions?

So many! Where do I start? We often discuss and challenge the following internalised myths:

  • I’m old enough /materially well-offenough to have a baby – maybe that means I should have one
  • Only young women / single women / women who have been sexually assaulted get abortions
  • Mothers don’t have abortions
  • I’m selfish if I choose abortion
  • Abortion is rare and I don’t knowanyone else who would do this
  • I will have problems with fertility if I have the abortion
  • Taking “responsibility” means continuing the pregnancy
  • I’ll regret abortion/have mental health problems if I have abortion
  • I’m deficient/faulty/unworthy/shameful if I have an abortion

That’s why I think that the other critical component for pregnancy options counselling is education regarding abortion, to counteract the many myths that abound. We know from The Turnaway Study that most people who undertake abortion do not regret their decision and this evidence-based context is important to provide for decision-making.

What do clients worry about?

Like any life-crisis, an unintended pregnancy can challenge a person’s coping skills and also necessitate some soul-searching about the crossroads in life they find themselves in. Each session is so unique – related to individual factors – but these are some of the common themes that come up:

  • Will I be ok after the abortion?
  • Can I have a child of my own – if Ihave no family/ partner/community support?
  • Will my relationship survive if I am feeling pressured into my decision (either way)?
  • What if I choose abortion now but then can’t get pregnant again?
  • Am I selfish for choosing abortion/continuing the pregnancy?
  • Can I have another child in my current situation?
  • Am I making the right decision?

What do you find most challenging about the job?

After 20 years, I still find myself wishing I had a crystal ball sometimes to assist women to make a decision. I sometimes think this would be a most valuable counselling tool but then I think of how complex life is, and that the reality is that we never will 100% know what is around the corner – we just have to make the best decisions we can with the knowledge and awareness of what we know at the time. The trick, really, is to learn how to acknowledge the suffering we go through without adding to it – by being compassionate to ourselves about whatever we do. The other trick, in this area, is to also assist women/pregnant people to understand and navigate the systems of oppression they often encounter in their decision-making process. Understanding the personal is political can often help in this arena.

Witnessing the unnecessary suffering that women go through in this area – often related to intersecting structural oppressions impacting on their decisions such as gender, class, race, sexuality – still makes me angry after all these years. Abortions that are inaccessible and costly also make me see red – nobody should have to pay hundreds of dollars for a basic component of women’s health.

Your job sounds like it could be quite stressful at times! How do you relax?

  • Discovering new artists, buying vinyl, hosting open-mics and dancing at Feminista Vinyl with mates when the shop is closed!
  • My cat Totoro (both relaxation and stressor)
  • Yoga and meditation

What do you find most rewarding about the job?

The honour of witnessing women’s/pregnant people’s suffering, struggle, strength, and perseverance. Knowing that we, as humans, have the job of helping each other out. Feeling like I’ve contributed to progressive change in this area.

What would you say to someone considering options counselling?

If you are unsure, ambivalent, or clearin decision but unsettled, find a non-judgmental person to discuss with before you make any final decisions. It’s better to discuss before than after the decision. It does not have to be adiscussion with a counsellor, but it can be – particularly if you are feeling pressured, judged, or anxious about or by the opinions of those around you.

You can call 1800 My Options to find a non-biased counsellor who specialises in this area (not all counsellors are equal in this respect). Call 1800 696 874, use webchat or send an email to [email protected] on weekdays, 9:00am – 5:00pm.

Is syphilis still around today?

Syphilis “The Great Pretender”: Just Pretending to be Obsolete? 

The term ‘syphilis’ often conjures up images of afflicted artists and writers in Golden Age Paris, Columbus returning from the “New World”, or Al Capone’s release from Alcatraz due to advanced disease. Whilst once referred to as the “infinite malady” by Shakespeare, syphilis has been curable since the discovery of penicillin. Closer to home, we’ve also played a huge role in syphilis research and management. Did you know that the world’s first scientific collection of community-based syphilis data was done right here in Melbourne, in 19101?

However, syphilis is anything but a disease of the past. It is currently experiencing a massive surge in many Australian communities. Australian Government data indicates that, in 2022, rates of syphilis were double that of recorded cases in 2015.2 Let’s take a closer look at what syphilis looks like, and how it can affect your health.

What is syphilis?

Syphilis is caused by a bacterium called Treponema pallidum.

Syphilis infections have several hallmark features, including an initial painless sore (or ‘chancre’) which develops soon after exposure, and then a generalised body rash which occurs several weeks to months later. However, not everybody experiences these ‘classic’ symptoms, and syphilis has been nicknamed “the great pretender” because it can mimic many other diseases, making it hard to identify.

Eventually, if untreated, syphilis infection becomes largely silent for a variable period of time – sometimes for up to a decade, before long-term nervous system, psychological and cardiac symptoms may declare themselves. Because of syphilis’ vague early symptoms followed by a long asymptomatic period, many people with this particular sexually transmitted infection (STI) are not aware they have been infected.

However, it can be very dangerous for long-term health, and is a known cause of congenital disease for babies born by infected mothers. As such, syphilis awareness and testing is becoming a priority in Australia to manage our current outbreak and continue to keep our communities healthy.

Who is at risk?

Everyone who is sexually active is at risk of developing syphilis. However, certain groups are known to be higher risk of contracting the disease, including women of reproductive age, Aboriginal and Torres Strait Islander people (especially those in regional and remote areas with known outbreaks), and men who have sex with men (MSM).2 However, increasing rates of syphilis are also being discovered in the heterosexual community; in a study comparing rates of positive syphilis tests in people being screened at sexual health clinics in major Australian cities, 3 in 1000 tests for women were positive in 2019 (compared to 1.8 per 1000 tests in 2011), and 7.6 in 1000 tests for heterosexual men were positive in 2019 (from 6.1 per 1000 in 2011).3 Whilst these numbers seem only small, the Melbourne Sexual Health Centre has seen a 220% increase in syphilis cases amongst women over the past several years, according to The Age newspaper.4 Furthermore, as syphilis screening in the straight community is not as commonplace as that amongst the MSM community or for those involved in sex work, these numbers are likely under-representing the presence of syphilis in heterosexual networks.

How can I be screened for syphilis?

Luckily, syphilis screening is very straightforward and highly accessible. All it involves is a blood test, and this can be sought from your local GP or via a sexual health centre. Whilst testing for chlamydia and gonorrhoea can be done via urine or swab test, which is somewhat less invasive, syphilis testing does require a blood test, but this is also a good opportunity to screen for blood-borne viruses (BBVs) (given syphilis is known to increase the risk of acquiring HIV in high-risk populations,5 and many BBVs can infect people without symptoms). If you have a lesion on your genitals, anus, mouth or anywhere else that seems suspicious, this can also be swabbed by your doctor.

What does treatment involve?

Syphilis can be cured with penicillin, but the length of treatment depends heavily on how long a patient has had syphilis. If the duration of infection is less than two years, a once-off treatment of intramuscular penicillin is sufficient. If the infection has persisted for over two years, or the length of infection is unknown, it is safer to treat with weekly injections for three weeks to ensure clearance.6 Having regular screening for syphilis with general STI screens (recommended every 6-12 months if sexually active, or more frequently if you have new or multiple partners) can help guide your doctor about how long you may have had syphilis.

Any case of syphilis requires notification to the Department of Health, and ‘contact tracing’ (the process of contacting recent sexual partners to notify them they are at-risk) is performed so they can also be tested and treated. Anyone with syphilis must abstain from sexual activity for at least 7 days after treatment, or until all antibiotics are completed. Given the potential for re-infection, avoid sexual contact with partners from up to the past 12 months until they have been treated as necessary.5

How can I protect myself?

The only way to protect yourself from syphilis is through the consistent use of condoms for all types of sex (or dental dams if performing oral sex). Regular screening is useful to identify and treat syphilis as soon as possible if you do come into contact with it.

Can syphilis affect my pregnancy?

Syphilis screening is a routine test in early pregnancy, most commonly done by your GP when you are diagnosed as pregnant. However, it is possible to contract syphilis throughout pregnancy, so depending on your level of risk your pregnancy care team will decide if you need additional screening (which can be done at 28-32 weeks, at delivery, and at any other occasion if you are deemed at-risk or present with symptoms). Babies born to mothers with syphilis infection (even if appropriately-treated during pregnancy) require specialist follow-up.7 

‘Congenital syphilis’ (a condition seen in babies who are infected with syphilis whilst in the womb) can result in poor pregnancy outcomes such as organ damage or physical deformities for the baby, or potentially miscarriage or stillbirth. Since 2017, Victoria has seen 14 cases of congenital syphilis, including six cases of stillbirth, and this is a major public health emergency.7 To be vigilant about this important issue, syphilis screening across Australia is being stepped up in order to keep mums, babies and everyone safe.

References
  1. Temple-Smith, M 2019, ‘The birth of syphilis surveillance in Melbourne’, The Conversation, viewed 5 April 2024, https://www.themandarin.com.au/106816-the-birth-of-syphilis-surveillance-in-melbourne/  
  2. Australian Government Department of Health and Aged Care 2024, National response to syphilis, viewed 1 April 2024, https://www.health.gov.au/our-work/national-response-to-syphilis. 
  3. Carter, A; McManus, H; Ward, JS; Vickers, T et al. 2023, ‘Infectious syphilis in women and heterosexual men in major Australian cities: sentinel surveillance data, 2011-2019’, Medical Journal of Australia, vol. 218, no. 5, pp. 223-228, viewed 1 April 2024, https://www.mja.com.au/journal/2023/218/5/infectious-syphilis-women-and-heterosexual-men-major-australian-cities-sentinel#1. 
  4. Cunningham, M 2021, ‘Syphilis epidemic in Melbourne suburbs: scientists use genomic sequencing to track STD’, The Age, 17 May, viewed 1 April 2024, https://www.theage.com.au/national/victoria/syphilis-epidemic-in-melbourne-suburbs-scientists-use-genomic-sequencing-to-track-std-20210511-p57qqv.html. 
  5. Wu, MY; Gong, HZ; Hu, KR; Zheng, H et al. 2021, ‘Effect of syphilis infection on HIV acquisition: a systematic review and meta-analysis’, Sexually Transmitted Infections, vol. 97, no. 7, pp. 525-533, viewed 1 April 2024, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8543214/. 
  6. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) 2021, Syphilis, Australian STI Management Guidelines for Use in Primary Care, viewed 1 April 2024, http://sti.guidelines.org.au/sexually-transmissible-infections/syphilis/. 
  7. Victorian State Government Department of Health 2023, Congenital syphilis in Victoria, viewed 1 April 2024, https://www.health.vic.gov.au/health-advisories/congenital-syphilis-in-victoria. 

3 ways to prevent contraception FAILS

Contraceptive failure is one of the biggest causes of unplanned pregnancy.1 It’s estimated that over half of all Australians requesting an abortion were using some form of contraception at the time.2  So what causes contraception to fail, and what can we do about it?

“Perfect” vs “Typical” use

There are many different types of contraception, and each have different levels of efficacy. Unfortunately, no contraception is 100% effective all the time. However, there is also a difference between their level of efficacy given “perfect” use (when used correctly all the time), and “typical” use (what happens in real life), as seen in the chart below:

Basically, “typical” use can be much less effective than “perfect” use. This is mainly due to human error – or external factors, such as:

  • Condoms worn incorrectly, breaking or slipping off
  • Forgetting to take a pill
  • Other medications impacting on the pill
  • Not getting an injection on time
  • Incorrect insertion of devices, such as vaginal rings, diaphragms, IUDs or implants
  • Mistimed withdrawal by your partner
  • Inaccurate tracking of your cycle
  • Somebody else sabotaging your contraception (eg. throwing away your pills or damaging your condoms).

Practice makes perfect

One way you can reduce your risk of contraceptive failure is to try to address any areas for human error. For example, you could:

  • Set a phone alarm to remind yourself to take the pill every day
  • Set up an arrangement with your GP and pharmacy so they send you an automated text when you’re due for another prescription/injection
  • Practice using condoms and diaphragms correctly
  • Stock up on plenty of lube

Two is better than one

Another way you can improve your chances of preventing unwanted pregnancies would be to use 2 different methods of contraception – a hormonal method with a non-hormonal method. For example, this could look like:

  • The pill and condoms
  • Vaginal ring and withdrawal method
  • Implant and diaphragm

LARCs – typically perfect!

However, you can see above that there are some methods of contraception (aside from permanent sterilisation) where the “typical” use rate is nearly the same as the “perfect” use rate. These contraception methods are known as LARCs – Long Acting Reversible Contraception.
Once they are correctly installed, LARCs are not affected by user error. They last a very long time, and because they are so low maintenance, are often described as “set and forget” methods.
LARCs available in Victoria include:

  • The Implant 
    99.95% effective
    A small, short rod inserted under the upper arm
    Lasts up to 3 years
  • The hormonal IUD
    99.8% effective
    A small, plastic device inserted in the uterus
    Lasts up to 5 years
  • The copper IUD
    99.2% effective
    A small, copper device inserted in the uterus
    Lasts up to 10 years

LARCs are the most efficient way to prevent pregnancy. For information about LARC services near you, or all contraception and pregnancy options services – please contact 1800 My Options on 1800 696 784 (weekdays, 10am – 4pm) or email [email protected]

REFERENCES
Trussell J. Understanding contraceptive failure. Best Pract Res Clin Obstet Gynaecol. 2009;23(2):199-209. doi:10.1016/j.bpobgyn.2008.11.008
Marie Stopes International. Real Choices: Women, Contraception and Unp

Can I get the abortion pill without a script?

Medication abortion can be a convenient option to end an early pregnancy as it allows you to have the abortion in the privacy of your own home. However, the process for accessing the medication (MS2STEP) is not quite as simple as many people believe it to be – there are a few steps to the process.

Steps for a medication abortion

Most doctors will require you to have both a blood test and an ultrasound dating scan before they will prescribe the medication needed for a home abortion. These tests are needed to confirm how many weeks pregnant you are (gestation) and to check for an ectopic pregnancy (this is when the pregnancy is developing outside the uterus).

Where can I go for a medication abortion in Victoria?

If you live in the Melbourne metropolitan area you can attend a private abortion clinic where they can do the blood test, ultrasound and give you the medication all in the one visit.

Alternatively, you could see a GP that prescribes the medication. In Victoria only 10% of GPs provide medication abortion so they can be tricky to find. This is where 1800 My Options comes in. We can help you find your nearest medication abortion provider that best suits your needs.

If you are going through a GP, it will require two separate visits – first visit to request referrals for a blood test and ultrasound dating scan and second visit (after you’ve got your test results back) to receive the prescription for the medication.

Some public hospitals also provide medication abortion, but as with GPs, you would need to have the blood test and ultrasound done beforehand.

How long does this all take?

Having a medication abortion generally takes a lot longer than most people expect. Firstly, you need to take into consideration the time it may take to get appointments with services. Availability for appointments is often more limited in rural areas where there are less health services.

How long it takes, can also depend on the gestation of the pregnancy (how many weeks you are). While blood tests can be done from anytime you return a positive pregnancy test, ultrasounds are not normally done until at least 6 weeks of pregnancy (as they cannot get a clear enough image before 6 weeks).

Once you have the medication, the actual abortion process takes several days as it involves taking two separate lots of medication, taken 36-48 hours apart.

So, with all these factors, a medication abortion can take some time.

For more information about medication abortion and services please call us or talk to us over webchat. We’re here Monday – Friday, 9am-5pm – call1800 696 784, email [email protected] or message us on web chat!

5 Cervical Screening Myths

Whilst most people with a cervix are generally familiar with cervical screening, confusion about the difference between Pap smears and Cervical Screening tests is still quite common. Some myths about cervical screening also continue to persist which we know can dissuade people from having regular testing.

So, let’s take a look at some of these myths:

  • Myth #1: You can’t have a CST if you are pregnant, or on your period.

Cervical screening can be performed at any time, including during pregnancy or at any time during your menstrual cycle.

It is perfectly safe to have a CST while you are pregnant.

  • Myth #2: Getting a CST is always painful

While a CST isn’t typically painful, some people can experience some discomfort from the use of the speculum.

If you’re concerned about your CST being painful, you can now ask your doctor for self-collection which does not require the use of a speculum.

  • Myth #3: You don’t need to get a CST after menopause

CSTs are recommended every 5 years from the age of 25 -74, unless your doctor advises otherwise. The risk of getting cervical cancer is the same even after menopause, so it is important to keep having CSTS every 5 years.

  • Myth #4: Pap smears and CSTs are the same thing

While both tests involve taking a sample from your cervix or vagina, they actually test for two different things.

A Pap smear looks for early signs of cervical cancer, while the new CST tests for HPV – human papillomavirus – the major cause of cervical cancer.

  • Myth #5: If you’ve had the HPV vaccine you don’t need to have CSTs

There are many strains of HPV. While the HPV vaccine prevents over 95% of cancer-causing HPV strains, it does not prevent all HPV strains. So even with the vaccine, it is important to get screened every 5 years.

 

Now we’ve got that that’s sorted, if you’re aged between 25-74, have a cervix, are sexually active and it’s been 5 years since your last CST (or pap smear) – make a booking for a CST today!

You should have the test every 5 years if you are aged 25 to 74 years old, have a cervix and have ever been sexually active.

If you need help finding a GP or sexual health clinic that can organise a CST for you, contact us on webchat or 1800 696 784 (weekdays, 9am – 5pm).

What is stealthing, and why is it illegal?

What is stealthing?

Stealthing is the intentional non-use, removal or tampering of a condom without consent. In addition to violating consent, stealthing increases the risk of unwanted pregnancy and STI transmission. Like other forms of sexual assault, survivors can also experience psychological trauma.

Stealthing is also considered a form of reproduction coercion. Reproductive coercion is any behaviour that interferes with your right to make choices about your sexual and reproductive health. Reproductive coercion is a form of family violence and commonly happens in intimate partner relationships. Reproductive coercion can also occur in casual sexual relationships.

How common is stealthing?

There are no comprehensive estimates of how common stealthing is. Among some parts of the community, it may be quite common. A Monash University study in 2018 surveyed attendees of a sexual health clinic in Melbourne, finding 32% of women and 19% of men who have sex with men who responded to the survey had experienced stealthing. This study found that female sex workers are particularly at risk, almost three times more likely to have experienced stealthing than other women reporting to the sexual health clinic. Stealthing is largely unreported, only 1% of the Monash study respondents reported stealthing to police.

What are the laws around stealthing?

In July 2023, the Victorian government changed the existing laws around consent and adopted an affirmative consent model. Affirmative consent means if someone wants to engage in a sexual act with another person, they must actively gain consent, rather than rely on the other person to give their consent. This means if a sexual assault is alleged, the burden of proof of consent is the responsibility of the alleged perpetrator, not the alleged victim survivor.

Under these laws, sexual consent is NOT given if there is:

  • Force, fear, coercion, or harm of any kind
  • Abuse of a relationship, authority or trust
  • If a condom is not used when it is agreed it will be used
  • If a condom is removed or tampered with

What can you do if you experience stealthing?

As stealthing is a crime, you have the right to report the assault to police.  Sexual assault cases are investigated by specialised teams in Victoria Police: Sexual Offences and Child Abuse Investigation Teams or the Sex Crimes Squad.

Making the decision about whether to report sexual assault can feel overwhelming. Being fully informed about what to expect during the legal process will help you to make a decision about how to proceed.  Sexual Assault services can provide counselling, support and advocacy. You never need to feel that you will go through the legal process alone.

If you would like some information, support or advocacy from a sexual assault or family violence service, you can contact:

If you are concerned about STI transmission, you should speak to a medical professional about STI testing.

If you are concerned about an unintended pregnancy, you can access emergency contraception from a pharmacist without a prescription. Emergency contraception works best as soon as possible after unprotected sex. 1800 My Options can talk you through this.  Contact us on webchat or 1800 696 784 (weekdays, 9am – 5pm).

Am I old enough for sexual and reproductive healthcare?

If you are a young person and you are having sex, it is important that you know your health rights and the law. You can talk to someone older that you know and trust, or get information from your doctor, nurse, or counsellor.

What if I don’t want my parents to find out?

Confidentiality is a rule that says what you say to someone will not be told to others, unless you agree. This means that if you see a doctor, nurse, or counsellor about sex, contraception, STIs, or abortion they cannot tell anybody else without your permission. The only except to this might be if they suspect you are in danger; in this case, they will discuss with you about what they might need to do.

Am I too young to have contraception, abortion or screening tests?

There is no minimum age for getting contraception, screening for sexually transmitted infections, or having an abortion. Condoms can be purchased from a supermarket, petrol station, or chemist at any age. If you want other contraception options, your doctor can prescribe it or insert it for you. Your doctor or nurse can arrange screening for STIs as well. These tests are done by taking a blood sample, urine test, or swabs. If your tests are positive for infection the doctor will prescribe medications for treatment, and your sexual partner may also need treatment.

It is important that you know what your options are if you have an unplanned pregnancy. If you are under 16 years old and pregnant, you can have an abortion without your parents/ guardian permission. The doctor will make sure that you understand what is involved with having an abortion and get your consent before going ahead with the procedure. Consent means that you sign a document that says you understand and agree to an abortion.

If you want to keep the pregnancy and are under 16, a plan will be made with you about how to keep you safe, and how you are going to support yourself and a baby. You also have the option of fostering or adopting your baby to someone else.

A cervical screening test (CST) is recommended every 5 years for people with a cervix after they turn 25 years old.  This test checks for the human papilloma virus (HPV) that can cause changes to cervical cells, and after many years cause cancer.  Since June 2022, CSTs can be self-collected, meaning you use a swab and take a high vaginal sample yourself. In some circumstances, a doctor or nurse will take a CST using a speculum.  Testing might be more frequent than every 5 years if you have a positive result.

If you want more information about your rights as a young person, go to Victorian Legal Aid.