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From Maternity Coalition 27th July 2010

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PostPosted: Mon Aug 09, 2010 10:01 am    Post subject: From Maternity Coalition 27th July 2010  Reply with quote

Hon Nicola Roxon MP,
Minister for Health and Ageing
House of Representatives

Tuesday 27 July 2010,      
Dear Minister Roxon

RE: National Health (Collaborative arrangements for midwives) Determination 2010 - National Health Act 1953.

Maternity Coalition is dismayed at the introduction of the regulations defining collaborative arrangements for midwives that were signed into law by the Governor General on 16 July. Under these regulations there are extremely limited prospects for Australian women to gain the improved choice and access which have been the focus of your maternity reform package. Each of the four options for “collaborative arrangements” make women’s access to MBS rebates for midwifery care subject to approval from a specified medical practitioner. The much feared medical veto on women’s access to MBS-funded midwifery care has been delivered.

The definition of “collaborative arrangements” leads to a range of problems, including:

Control of care is taken out of the hands of women, and given to doctors.
Defacto “parallel regulation” of the midwifery profession, with doctors setting conditions for Medicare-funded midwifery practice.
Anti-competitive influence on the health care market, giving one group of providers control over consumer access to another group of providers of the same health care service.
"Collaborative arrangements” cannot be made with hospitals, even though most private midwives consult and refer to hospitals rather than individual doctors.
The requirements do not improve “safety”, “access” or “continuity” for Australian mothers.

These risks were comprehensively outlined in the Senate Review in December 2009, and have been reinforced by events since then. We note that State Governments have made no apparent progress toward enabling collaborative arrangements between eligible midwives and public hospitals.

Women have clearly communicated their concerns about this issue. They have attended numerous meetings and briefings, sent hundreds of letters, many attended the 3000-strong rally outside Parliament House and submitted a record number of submissions to Senate inquiries. Despite this, women’s interests appear to have been ignored in favour of doctor’s. The Government must recognise that women are the key decision makers in their maternity care - not clinicians.

Maternity Coalition is extremely disappointed that the reforms which promised so much for women appear likely to deliver so little. It appears that the only workable models under these reforms will be for women with private health insurance to be able to access some midwifery care from a midwife employed by an obstetrician, and the public hospitals costshifting maternity care to MBS through the gradual development of midwifery models.

Maternity Coalition requests the Government demonstrates commitment to real maternity reform by guaranteeing they will address the following issues:

that the requirements for permission from a doctor be removed from the Medicare for midwives legislation (Collaborative arrangements for midwives), thus ensuring that women’s choices are protected;
that women's rights to informed consent (including right of refusal) are expressly recognised in all codes, guidelines and frameworks relating to midwifery practice;
that a long-term solution be sought for women to continue to have access to midwife-attended homebirth;
that the Federal Government provide strong leadership to ensure jurisdictions provide mechanisms for visiting rights for midwives in public hospitals.

Maternity Coalition appeals for urgent action to be taken so that there is some chance of the reforms meeting the stated aim “to increase access and affordability of midwifery services” for Australian women. It is simply not possible for the reforms to deliver for women while a medical veto over access to midwifery care remains in place. The definition of collaborative arrangements must recognise women’s right to reproductive self-determination.

We seek a response to this letter by 2 August 2010.

Yours faithfully

Lisa Metcalfe
National President Maternity Coalition

cc Julia Gillard Prime Minister
Tanya Pilbersek Minister for Housing & the Minister for the Status of Women.

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