For over 30 years, Sexual Health and Family Planning Australia, SH & FPA, have been meeting the needs of Australians by providing advocacy, education and training around the issues of sexual health, family planning and cancer prevention through pap smears, vaccinations and information on contraception.
The innovations of SH&FPA; are far-reaching. Through their work with NGOs, government, and the private sector they have been able to influence the landscape of health policy in this country, providing health professionals with the training to deliver over a quarter of a million clinical services every year, ensuring that Australians can access some of the world's highest standards of sexual and reproductive health.
In my own state-and yours, Mr President-Family Planning Queensland, a member organisation of Sexual Health and Family Planning Australia, is working to bring sexual education and family planning services to all Queenslanders regardless of their geographical location, age, ability level, social disadvantage or ethnic group. In fact, their work concentrates on people who often have other forms of disadvantage. They have a range of programs particularly looking at people who have need in the migrant communities and Aboriginal and Islander communities across the state. Some of their work on bringing people into the wider community has been acknowledged, and they have won awards for their efforts.
Unfortunately, even with the best system, there is still a lack of access to the best information. One of the key issues is knowledge. Traditionally there has been a gap in organising good-quality evidence in health care and then making it available so it can be used in the most effective way. While literature and resources to improve sexual and reproductive health do exist, the diverse nature of the field means that not all of this literature is immediately and easily accessible for those who really need it. Currently evidence tends to be published and stored in different repositories and is described and indexed in different ways. A more integrated and robust framework is needed, and recent developments in knowledge translation have the potential to change this.
The problem of being able to find and use the expanding knowledge base for health is one that confronts so many people. For some fields of care, this problem is made more difficult because relevant evidence may come from many different fields and disciplines. It may also be needed by many different providers, not just a core set of specialists. Sexual health and family planning is one of these fields, and the challenges faced are not dissimilar to those faced by palliative care. Palliative care is informed by research and studies from many diverse disciplines, including medicine, nursing, psychology, social and community studies, pastoral care and allied health. Palliative care, as with sexual health and family planning, is practised in many different settings and by many different health professionals. It is an area of care that is fundamental to a life course approach and to population health approaches.
To deal with the challenges of managing a diffuse, complex and rapidly emerging evidence base, an online Australian resource in palliative care-CareSearch, developed by Flinders University-has provided a platform for generating, disseminating and facilitating access to that evidence base. Its success has been measured with over 1,000 hits a day and its impact on changing clinical practice for the better. This unique Australian resource uses knowledge translation principles and is a method for closing the gaps from knowledge to practice. It involves using high-quality knowledge in processes of decision making for professionals and for our community. It really provides equity in an area that has traditionally been hierarchical and privileged.
Recognising the contribution and benefits that this technology could bring to the sexual and reproductive health field, a partnership between Sexual Health and Family Planning Australia and Flinders University was established. The Flinders Filters researchers working in this specialist area of search filter development have worked with Sexual Health and Family Planning Australia to produce a pilot of three search filters on one key issue in sexual and reproductive health, and that is the area of contraception. The three specific search filters look at a general, all-inclusive contraception; long-acting, reversible contraception, commonly referred to as LARC; and emergency contraception. They have been generously made available for use by the community on the Flinders University website. They provide an example of how the evidence could be captured to inform practice, policy and planning in this field.
These search mechanisms enable sexual and reproductive health professionals and the community to carry out a quick search for information on these topic areas, confident that the search results provide reliable and valid information. Flinders undertook this work pro bono in order to demonstrate the value of ongoing automated knowledge translation for the sexual and reproductive health community. This is a beginning only, and gaps remain with the aim of building a fully functioning knowledge hub in sexual and reproductive health that captures all the functions of the proven work of CareSearch.
Indeed, the vision is to have an open-access, online network resource or knowledge hub that brings together in one place sexual and reproductive health information, evidence, tools and resources. The need for such a service lies in the growing literature and evidence base in sexual and reproductive health. This hub would not be merely a knowledge search, collection and dissemination tool but a means to build the capacity of the sexual and reproductive health sector and a tool to reduce duplication, create guidelines and inform policy decisions that are more in touch with the needs of the community, service providers and policymakers.
The current online automated search facility on contraception will provide an important tool for developing countries, where the sexual and reproductive health outcomes are poor compared with developed countries. Why do we need this in sexual and reproductive health? Many of us in Australia take our sexual and reproductive health for granted, and, without doubt, in comparison with many other developing countries it could be argued that, overall, Australia does quite well against the major sexual and reproductive health indicators. Nonetheless, there are many areas of sexual and reproductive health in Australia that still need to be addressed, as well as many notable disparities within the Australian population.
Groups that we all know are identified as being at higher risk of poorer sexual and reproductive health include Aboriginal and Torres Strait Islander peoples; young people; immigrants and refugees; people with disabilities; same-sex attracted people; bisexual people; transgender and intersex people; sex workers; homeless people, where the need is great and the effective services are now limited; those living in rural and remote areas; and people in the prison system. We already know some key statistics about areas of need.
We know that there has been great discussion around the area of teenage pregnancy. Whilst we do not have the highest rate or concern in the world, it is something that needs to be considered. The Australian teenage pregnancy rate of approximately 16 per 1,000 population remains significantly higher than countries such as Denmark and Sweden, where there are on average six births per 1,000 women, and Singapore, where there are five births per 1,000 women. Teenage pregnancies are also higher in rural and remote regions of Australia. The evidence on this is clear. The most disadvantaged areas of Australia are in the Aboriginal and Torres Strait Islander areas, where there are 76 births per 1,000 women. This applies also in areas where there is limited knowledge.
We also have the issue of infant mortality-again, a knowledge base we have, and we need to maintain this and learn from the experience. In 2011, the overall Australian infant mortality rate was 3.8 deaths per 1,000 births; however, to our shame the rate for Aboriginal and Torres Strait Islander people was higher, at 7.2 deaths per 1,000 births. Rates were also higher for mothers whose countries of birth were Oceania, the Middle East, Africa or Southern Asia.
In the areas of infertility and assisted reproductive technology, where there have been great advances in Australia, we know that infertility may affect as many as one in six couples in Australia. That is an astounding statistic when you think about the number of couples who are seeking to have the joy of birth: one in six could have trouble and need support in this area. Despite the increase in the proportion of births resulting from assisted reproductive technology, public perception about the true success rate of ART, combined with a lack of knowledge of the effects of age on fertility, may have resulted in a 'biased perception and overestimation of the effectiveness of ART in treating infertility'. Further work is therefore needed to 'ensure that women are fully aware of the strengths and limitations of infertility treatment when they choose to delay childbirth'. Indeed, in 2008, only 'approximately 23 per cent of ART cycles resulted in a clinical pregnancy and 17 per cent in a live birth'. The need for information on the process in Flinders is to make sure that the knowledge is known, the research is up to date and people can access this knowledge easily and not be fearful or worried when they go to practitioners who may not have the knowledge at hand.
One of the issues that Sexual Health and Family Planning are looking at is the issue of bullying in schools. The third national study on the sexual health and wellbeing of same-sex attracted and gender-questioning young people reported that:
61per cent of same sex attracted young people reported verbal abuse because of homophobia/transphobia;
And:
Twice the number of young people who suffered verbal abuse, had attempted suicide, compared to those who reported no abuse;
And:
4.5 times the number of young people who had been physically assaulted, had attempted suicide, compared to those who reported no abuse …
The fact that this information is collected is something of which Australia can be proud: the fact that we do have the data. But we need to know where it goes and what is done with it and how we can learn by having effective studies in the area.
The causes of sexual and reproductive health issues in Australia are varied and complex and there are so many stakeholders. Two of the major barriers to improving sexual and reproductive health outcomes and developing an integrated approach in this field in Australia are the lack of policy coordination at the national level and the difficulty for the many stakeholders in gaining access to quality information and knowledge. The online search mechanism and future knowledge hub has great potential to address the second point raised-that is, access to quality, reliable evidence to inform policy, practice and service delivery. In order to improve sexual and reproductive health outcomes we need to ensure that researchers, policymakers, clinicians, nurses, politicians and the general public all have access to high-quality and reliable information and resources. Indeed, it is well known that, globally, health systems fail to use evidence optimally and the community has limited access to what they need. The result is inefficiency and a reduction in both quantity and quality of life.
It is important that we acknowledge the work that has been done by Sexual Health and Family Planning Australia and Flinders University in working on this initiative. One of the core issues, of course, is the ongoing future and the effect of funding in this area. We know that across many of our state governments reductions in funding have occurred for sexual and reproductive health areas. That will have an impact on the services that can be provided to the people who need it most.
Innovative programs, such as the one we are seeing at Flinders, need to have effective funding into the future. We know that it is a difficult area and we know that there are different views in this area about what is appropriate work for government here and what is not. But we have the need. It has been identified in the statistics.
We know that one of the other areas that is most important is that of sexually transmitted diseases. The problem is that we know the statistics. We know from the gathering of data that one in five Australians will contact SDI at some stage during their lives, with young people, homosexually active men and Aboriginal and Torres Strait Islanders experiencing the highest rates. There is no debate about this. The fact is there.
In 2011, chlamydia was the most commonly reported STI, with an infection rate of 354 per 100,000 population. It shows an increasing trend, with rates more than tripling in the past 10 years. The HIV stats continue to confound us and the data is there that the problem exists. One of the core issues, as I pointed out, is access to effective knowledge so that everybody who is concerned will feel confident that they have the information on which they can base treatment and programs into the future.
It is an incredibly important area. Governments at all levels need to combine to look at how they can best use these resources. Then we will not be relying exclusively on NGOs to ensure that we have this information into our future. It is something that we need to consider because the need is great.
