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RUBY:

From Schwartz Media, I’m Ruby Jones, this is 7am

The decision of the US supreme court to overturn Roe v Wade, and the winding back of abortion rights in America has led to reflection on the rights and access that women have to healthcare. Here in Australia, the minister for women Katy Gallagher said it was a reminder to Australians to “remain vigilant because hard-fought-for wins before our parliaments can be taken away easily”. So are women treated equally in Australia’s healthcare system and what still needs to be fought for?

Today, writer and professor of public health at University of New South Wales Gemma Carey, on the gender gap in our healthcare system.

It’s Monday July 4.

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RUBY:

Gemma, in the week or so since the Roe versus Wade decision, I think there has been a lot of reflection on reproductive rights here, in Australia. I just wonder, when you think about that, what do you think the reality is of our situation when it comes to reproductive rights versus, I suppose, the widely held perception?

GEMMA:

This has been a very interesting and eye opening week on that front. I think, particularly in conversations with male friends and very progressive male friends who I would have thought had had a decent grasp on women's health, certainly at the very pointy end around abortion. So you know people would say and have said to me in the last week, well, that's not something we have to think about here, because women have… we have equal health care here. We have judgement-free health care here for women around abortion. And my actual response to that “you would only say that if you were male” because it is so far from the truth.

RUBY:

Well, it is true, I suppose, that women's right to abortion in Australia isn't under threat in the same way that it is in the U.S.. But that doesn't mean that it's necessarily an accessible procedure if everyone does, and it depends n on where you live. If you live remotely, it's more difficult. And it also depends on your financial position because it can cost hundreds and hundreds of dollars. But even the rights we do have, have been hard fought over a long time, haven’t they?

GEMMA:

My generation, I’m a millenial, certainly felt like abortion was not something we’d have to fight for, you know my mother's generation thought they had secured safe abortion, and yet I still marched in my twenties..

##Archival Tape – News Reporter
“Health Minister Tony Abbott says no case has been made to register the drug here…and he says for now the matter is closed.”

GEMMA:

In the early 2000’s, we saw a large debate over the drug RU486.

##Archival Tape – Tony Abbott
“I conclude that there is no reason, based on the report from the Chief Medical Officer, to change longstanding practice in regard to RU486.”

GEMMA:

That drug was the first drug that would enable women to have a home abortion or an abortion that didn't require medical interventions and much, much safer.

##Archival Tape – News Reporter
“The Australian Medical Association says the health department advice on RU486 that Tony Abbott released today is plain wrong…”

GEMMA:

And I marched against that. Thousands of women marched to get RU486 allowed into Australia.

##Archival Tape – News Reporter
“Women in support of abortion law reform have rallied outside Parliament House in Brisbane. “

##Archival Tape – Unidentified Protester
“We are tired of Queensland’s archaic abortion laws which have denied people the health care they need for far too long”

GEMMA:

So abortion was only decriminalised in Queensland in 2018 and that took years of protests.

##Archival Tape – Reporter
“As MP's arrive here today to debate this historic bill they are greeted by hundreds of protesters…”

GEMMA:

It was only decriminalized in New South Wales in 2019.

##Archival Tape – Unidentified MP
“The law surrounding terminations is no longer fit for purpose and needs to be modernized. I commend the bill to the House”

GEMMA:

So as I was saying, it sort of we think these things are in the past and we've won these battles. But if, you know… 2018, 2019, these are incredibly recent changes.

RUBY:

And in terms of where we're at now, not just access to reproductive health care, but I suppose to general health care. What would you say the situation is like for Australian women right now?

GEMMA:

I, I mean, I would… In particular areas I would call it poor. So some good examples of that is that we have in Australia, it's suspected that at least 1 in 9 women have endometriosis and it still takes seven years from the onset of symptoms to a diagnosis and treatment. And that's not even a hard diagnosis to make…that one. I would be very shocked if there was a condition that rendered men in agony, unable to work, unable to get out of bed on a monthly basis, seven years to be diagnosed and treated.

RUBY:

Mhm.

GEMMA:

Outside of reproductive health, you know, women die of heart attacks more often in Australia. The symptoms for heart attack look very different in women than they do in men. And that hasn't always been well taught in every med school. And so heart attacks in women get missed more. There was a study that came out in January this year that showed that women are 32% more likely to die if they have a male surgeon than a female surgeon. And they are 15% more likely to have a bad outcome from that surgery.

RUBY:

Mhm. Those statistics, they're disheartening and also pretty alarming, especially hearing them one after the other. Can you tell me a bit more, though, about what it's actually like to experience this kind of bias firsthand about trying to get health care and the ways in which you've been treated by the medical establishment as you've tried to do that.

GEMMA:

I think it's really important to note as well that I'm a very privileged person when it comes to navigating the health care system. So you know, I'm white, I'm middle class, I'm a professor in health. So you would think that if anyone was going to be able to navigate the healthcare system, perhaps outside of a doctor, that I would be one of the best placed women to do that. And yet I have quite an extensive list of bad experiences. The most extreme one that's happened to me was the one that nearly cost me my life.

RUBY:

We'll be back after this.

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RUBY:

Gemma, can you tell me more about your experience, about what’s happened to you when you’ve sought medical treatment?

GEMMA:

So I presented to an emergency department in a major New South Wales hospital with pain at a level where I couldn't breathe and I was assigned a junior male doctor. He did a few tests. While I waited for them, I was in so much pain I had to have lots of shots of fentanyl and he came back still at the end of that and said, I think this is a cramp and you should go home. It was actually a ruptured artery and the pain was coming from that. I was full of internal bleeding. The only reason I'm alive is because I refused to leave the hospital until they did an ultrasound, because I knew that it wasn’t a cramp. And by the time I got to having surgery I'd lost 60% of my blood and I had multiple blood transfusions.

That is my most extreme negative experience with the healthcare system. As a restorative justice process that this hospital ran, I had the chance to speak as much as I wanted to the head of that emergency department. He actually wasn't aware that women don't get their pain treated or taken as seriously as men. Women also tend to under-rate their pain compared to men as well. If you've ever been in hospital, they ask you that question. You know, what's your pain between one and ten? Women tend to rate it lower. And he didn't know that women's heart attacks are more likely to be missed than men's because of the difference in how they present. I was pretty shocked that somebody who ran a major emergency department in a major, major hospital wouldn't know that health care was gendered. He's definitely across it now, but it was illuminating in terms of just how ingrained that inequality and lack of knowledge around the inequality is.

RUBY:

Mhm. And it sounds like this was the, I mean, this was the life threatening experience you had, but it wasn't isolated in terms of other ways and other conversations that you've had with doctors over your lifetime, right?

GEMMA:

No, not at all. I've had nine miscarriages, so miscarriages and abortion if they require surgical intervention, it's the same procedure essentially. And even if you don't have surgery and you deal with it through drugs, it's the same medications that you take.

RUBY:

Hmm

GEMMA:

Some of the experiences that I had are quite graphic and shocking, I think. So in the major city that I live in, um, I lost a child at 12 weeks who had a major chromosomal disorder. That meant he was very disfigured. I was asked by the hospital to go home, take the drugs, have the miscarriage at home, and then bring the foetus back to the hospital in Tupperware so they could do an autopsy. Can you possibly imagine the trauma of going through that, let alone the pain, but the trauma of having to witness that? Again, the only reason that that didn't happen is that I refused to leave the hospital, which goes back to privilege in being able to feel like I can and will say, no, that's not good enough. That's not good enough treatment for women. We will not be doing that. That's that's some… I think that isn't what we would ever expect would happen in Australian hospitals.

RUBY:

And hearing all of those stories, I think the thing that strikes me is that they all have in common is this, I suppose, extreme disregard for what it's like for you as the patient in the middle of this.

GEMMA:

Yes. And I think what's really interesting about that was the contrast between when people thought my potential child was alive and when people realized that my potential child had passed away. When the potential child was alive, I was given amazing care and made a priority in every hospital that I presented in. But every time I lost the child, I sort of dropped to the bottom of the list, as did my suffering, my mental health, you know, all the things that sit around having a miscarriage as well. I think that tells us a lot about how we think about or prioritise women over - you know, going back to the abortion fight - over potential humans. I mean, it's not a human yet. It is a potential human.

RUBY:

Can you tell me a bit more about why that kind of treatment happens? Having to advocate for yourself in hospitals like this and perhaps not being believed – When you say that, you know, this pain isn't cramps, and not being trusted, I suppose to know what's happening in your own body. What is behind that lack of trust?

GEMMA:

I think what sits at the core of that to me is that it's not just that women aren't receiving treatment, it's that women aren't seen as worthy of having treatment or worthy of having good treatment. And the example of being treated well while carrying a five week old baby, but being treated very dismissively once that baby was six weeks and no longer alive really speaks to that point. You know, Are women worthy of good treatment outside of their reproductive potential?

I think what a lot of people and even doctors don't always reflect on is the fact that medicine and society are enmeshed. So society reinforces our medical views and in turn, medicine reinforces our societal views of women. I think medicine gets held up as something that is objective, scientific, because we want to need it to be. But actually, it is always a cultural product. It always reflects the norms and values of our time.

RUBY:

Gemma, thank you so much for your time.

GEMMA:

My pleasure.

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RUBY:

Also in the news today…

In NSW - Major flooding has hit areas around Newcastle, the central coast, south coast and Sydney – with evacuation orders given on Sunday for some low-lying areas in Sydney’s south-west. It is the third major flood event in the region since March.

And yesterday, Australia recorded its 10,000th death from Covid – two and a half years after the virus first began to spread. More than half of those 10,000 deaths have come in the last six months

I am Ruby Jones, this is 7am. See you tomorrow.

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