Women’s health is shaped by decisions about what evidence informs policy, whose symptoms are investigated and who takes responsibility when care fails. We examine how public institutions exercise that authority, and what women should expect from them.
Women’s experiences of health care are often considered separately: heart disease, menstrual pain, thyroid disorders, recovery after birth, menopause or harm associated with a medical device. Each has its own clinical questions, specialists and treatment options. Across these areas, however, we can encounter similar difficulties: symptoms dismissed, referrals delayed, incomplete follow-up and uncertainty about who is responsible when care fails.
Women need health care that recognises our needs throughout our lives. Its quality depends on clinical knowledge and on the decisions public institutions make about research, funding, professional standards and access to services. When care is fragmented, delayed or unsafe, there must be clear responsibility for putting it right.
AAWAA’s submission to the Senate Select Committee on Women’s Health examined these connections through the public institutions established to serve us. We focused on accountability: what governments, departments, regulators and professional bodies must do to ensure that our needs are recognised and appropriate care follows.
Women’s experiences across institutional boundaries
Our approach examined how women’s experiences relate to the distribution of authority and resources. In health care, this includes whose account of pain is believed, which conditions receive research funding, what practitioners are taught and who decides that a complaint warrants further investigation.
When symptoms are dismissed, investigations delayed or recovery left without adequate follow-up, women bear the consequences in our bodies and daily lives. The effects can extend to paid work, caring responsibilities, relationships and financial security. Repeated appointments and referrals require time, money and persistence, with fewer options available to women who cannot afford private treatment or travel.
These experiences require scrutiny of the systems within which clinical decisions are made. Practitioner knowledge, appointment structures, referral pathways, service availability and funding influence the care we receive. Recurrent problems across different services warrant an institutional response, even where no single encounter explains the whole failure.
Why we took a broad approach
The inquiry provides scope for detailed evidence from clinicians, researchers and specialists in particular conditions. AAWAA’s contribution reflects the perspective of an affiliation of women’s advocacy organisations: we examine connections between areas of care and the responsibilities that can become unclear between them.
A woman with persistent pelvic pain may move between general practice, diagnostic services, specialists and pain clinics. After childbirth, maternity care may end while physical or psychological injury continues. During perimenopause, access to informed treatment depends on research reaching clinical guidance, practitioner education and ordinary appointments.
Our concern is what happens across these boundaries. Responsibility must remain clear as a woman moves between services, including for referrals, information transfer and follow-up. The organisation of health care should support our recovery and ongoing health, rather than require us to coordinate every part of it ourselves.
Standards and continuing care
Clinical standards establish what women should be able to expect. Their value depends on whether services have the staff, funding, referral arrangements and oversight needed to deliver that care.
The national standard for third and fourth degree perineal tears, for example, recognises the need for individualised continuity, follow-up and referral, including attention to physical, emotional, psychological and sexual health. That understanding of recovery should inform postpartum care more broadly.
Discharge from a service does not establish that a woman has recovered. Screening has limited value without access to assessment and treatment. Institutions must retain clear responsibility for communicating findings, arranging further care and checking whether identified needs have been addressed.
Continuity also requires attention to affordability. A pathway that relies on repeated private appointments or services unavailable locally can leave women with a formal referral but little practical access to care.
Regulators must recognise patterns
Women who raise concerns may encounter hospitals, complaints bodies, professional boards or the Therapeutic Goods Administration. These bodies have different powers, but women need an intelligible route through them.
Individual complaints require careful assessment and procedural fairness. Information from several complaints may also reveal a pattern that warrants broader investigation. Regulators need lawful arrangements for connecting concerns across practitioners, facilities, treatments and devices.
Women should not have to demonstrate a complete systemic failure before an institution considers whether one is emerging. Nor should we be expected to possess the technical knowledge needed to identify a device problem and navigate several agencies before our concerns receive attention.
Public accountability requires reasons for decisions, reasonable timeframes and a means of examining the regulator’s own performance. Where responsibility falls between agencies, that gap must be identified and addressed.
Women’s evidence and departmental responsibility
Independent women’s organisations bring a collective perspective to these questions. We can compare experiences across services and life stages, identify recurring concerns and challenge explanations that place responsibility back on individual women.
Our involvement must begin while institutions are defining the problem and considering their options. Consultation after a preferred approach has been developed limits our opportunity to influence decisions. Professional, institutional and commercial expertise must be considered alongside direct evidence from women and independent women’s organisations.
Departments shape women’s health through the evidence they use, the programs they design and the advice they provide to ministers. Responsibility begins with establishing that the information informing those decisions accurately describes women’s needs. Where evidence is incomplete, definitions are inconsistent or findings cannot be compared reliably, those limitations need to be assessed and made clear.
Biological sex must remain identifiable throughout the process, from collecting information to analysing results and using them in policy. This is necessary across health care, including for conditions affecting both sexes, so that differences in diagnosis, treatment and outcomes can be examined. A field labelled ‘sex’ does not, by itself, establish what information was collected. Institutions need to understand the definitions and collection rules behind the data they rely on, particularly when information moves between services, research bodies and government agencies.
The same care is needed in public communication. Descriptions of women, mothers, parents and families identify different groups and relationships. The wording chosen must preserve the meaning of the evidence and make clear whom advice or services are intended to reach. Changes should be assessed for accuracy and understanding, with women involved in that assessment.
Women’s accounts and population data provide different forms of evidence. Both require substantive consideration. Evidence that challenges an established approach deserves assessment and a reasoned response, including consideration of its implications for policy.
Assessing what changes
Women’s health strategies need named responsibilities, implementation deadlines and public evaluation. Announcing funding, publishing educational material or convening an advisory group records activity. Assessment must also establish whether women obtain earlier diagnoses, accessible treatment, sustained postpartum care and timely responses to safety concerns.
That is the basis of AAWAA’s approach. Public institutions exercise authority over standards, resources, professional practice and remedies. We expect that authority to be exercised transparently, with women involved in decisions and responsibility for the outcomes made clear.
Read our full submission, below.