Having a baby in Australia: Women's business, risky business, or big business?

Abstract

The political economy of childbirth services supply in Australia is an emerging space worthy of critical consideration by scholars, policy makers and economists. The interests served by current arrangements is a neglected area of scholarship and received perfunctory attention in the federal government review and report, Improving Maternity Services in Australia (DOHA, 2009) and the national framework for implementing primary maternity services (AHMAC, 2008). Recent government initiatives include a $120.5 million maternity reform package announced in the 2009-10 Budget and passage of three Acts encompassing new legislative arrangements for midwives (DOHA, 2010). These entail provision of a Commonwealth professional indemnification scheme and access to the Medicare Benefits Schedule and Pharmaceutical Benefits Schedule for eligible midwives working in collaboration with medical providers (Wilkes, Teakle and Gamble, 2009; NHMRC, 2010). Other key elements include commitment to a National Maternity Services Plan (Australian Health Ministers, 2010), expansion of the Medical Specialist Outreach Assistance Program to rural and remote communities, training support for doctors and midwives and expanding the National Pregnancy Telephone Counselling Helpline (DOHA, 2010). The government claims this reform agenda will improve choice for Australian women seeking high-quality, safe maternity care. However, absence of both equity considerations and economic analysis leaves this open to question. Data linkage including analysis of health outcomes and cost of services delivery on which to base future policy and sustainable health reform would seem prudent.