186. The National Women's Health Strategy outlines a national approach to improving health outcomes for all women and girls. The Strategy identifies 5 priority areas: maternal, sexual and reproductive health; healthy ageing; chronic conditions and preventive health; mental health; and health impacts of violence against women and girls.
187. The Government provides support for pregnancy termination services through Medicare Benefits Schedule rebates for relevant services, including telehealth consultations, subsidies for the cost of medicines under the Pharmaceutical Benefits Scheme and via the National Health Reform Agreement.³⁷ In 2023, the Government introduced changes to the dispensing and prescribing of a medical abortion drug, mifepristone and misoprostol (MS-2 Step©), reducing barriers to safe and affordable abortions, especially for women in rural and remote areas.
188. The Government is supporting awareness raising and access to sexual and reproductive health services, including:
     • $5.2 million over 3 years from 2024–25 to support health practitioners undertake training in long-acting reversible contraception (LARC) insertion and removal to improve access to effective, reversible forms of contraception;
     • $1.1 million over 4 years from 2024–25 for development of a virtual contraception decision-making tool for women and health practitioners;
     • $1.1 million over 4 years from 2023–24 for the Australian Contraception and Abortion Primary Care Practitioner Support Network to provide health professionals with support in delivering LARCs and medical termination of pregnancy.

Abortion services in Australian states and territories

189. Abortion is legal in every Australian state and territory, but legislation differs between jurisdictions.³⁸ States and territories have made progress via laws, policies and initiatives to make abortion more accessible, including state-wide abortion care helplines, online consumer information resources in multiple languages, and partnerships with non-government organisations to support access to high quality sexual and reproductive health services and information.
190. All Australian states and territories have legislation establishing safe access zones of 150 metres around the premises where abortion/termination services are provided, with the exception of the ACT. In the ACT safe access zones of an area no less than 50 metres can be declared by the Minister for Health based on community need (to date only one zone has been declared).³⁹
191. All Australian states and territories have legislation, or are in the process of legislating, an obligation requiring medical or health practitioners with a conscientious objection to performing pregnancy terminations, to make a referral to other health service providers who can provide advice.

Mental health

192. In 2020–22, the ABS found, one-in-4 women (24.6%) had a mental health disorder in the previous 12 months, compared with almost one-in-5 men (18.3%). In 2020, the Wiyi Yani U Thangani report,⁴⁰ commissioned by the AHRC, found 34% of First Nations women have been clinically diagnosed with a mental health condition. Transgender and gender-diverse Australians had higher rates of mental health disorders (33.1%) than cisgender Australians (21.3%).
193. Federally, mental health support is available to eligible Australians, regardless of gender, under the Better Access to Psychiatrists, Psychologists and General Practitioners initiative (Better Access). Better Access aims to improve outcomes for people with a clinically diagnosed mental health disorder through evidence-based treatment. Benefits are available for up to a maximum of 10 individual and 10 group mental health services per calendar year. Services can be provided by trained General Practitioners (GPs), psychologists (clinical/registered), eligible social workers and occupational therapists.
194. Additionally, the Government funds national free or low cost, digital mental health services, including crisis support, helplines and webchat, clinician-supported online therapies, self-directed education programs and tools, and moderated peer support forums.
195. The Government is providing $888.1 million over 8 years from 2024–25 to expand free mental health services available to all Australians, including women. From January 2026, every Australian will have free access to a new low-intensity digital service for people experiencing mild mental health systems, without a referral. The Government is investing over $80 million from 2019-20 to 2024‑25 to support universal perinatal mental health screening and working with states and territories to support data collection to enable new and expectant parents to access early support for perinatal mental health issues.
196. The Government, through the Indigenous Advancement Strategy is investing close to $13 million in 2024-25 to support mental health and suicide prevention for Indigenous people, including:
     • $5 million in support of suicide postvention and related supports, provided nationally;
     • $5 million for mental health first aid training, including accredited courses specific to youth and service provider staff supporting youth clients, provided nationally;
     • approximately $2.7 million for community-led youth and family support services in the Kimberley (WA) in support of suicide prevention.
197. In 2024-25, the Government committed $12.8 million from the Indigenous Advancement Strategy to continue the Indigenous Youth Connection to Culture program for a further 4 years in regional and remote Australia.
198. States and territories have their own mental health legislation, and diverse strategies to support the mental health of women. A non-exhaustive list of other initiatives include:
     • ACT: implementation of the Mental Health Workforce Strategy and Action Plan; Expanding Public Healthcare Services for Eating Disorders project; and improvements to perinatal mental health screening. The ACT Disability Health Strategy 2024‑2034, under development, aims to ensure people with disability have equitable and appropriate access to healthcare, including mental health services.
     • NT's bilateral agreement with the Government on Mental Health and Suicide Prevention (2022-26) supports expanding Headspace services and Head to Health centres in Katherine and Alice Springs, including a focus on First Nations children. The NT provides an effective territory-wide child and adolescent service and is improving services for children experiencing harmful sexual behaviours. The NT is improving access to specialised perinatal mental health services and enhancing screening during the perinatal period for women and families. The perinatal and infant mental health service improves equity of access, service delivery, and early identification and intervention for women and families in vulnerable situations.
     • NSW Health Perinatal and Infant Mental Health Services (PIMHS) provide perinatal women with serious mental illness with consultation liaison services or direct care, including assessment, intensive support and referrals to specialist mental health mother-baby-units or general inpatient units for acute care. PIMHS offers services within women's prisons and telehealth outreach to rural and remote areas. Programs support early parent-child relationships when parental mental ill-health affects attachment.
     • QLD released the Queensland Women and Girls Health Strategy 2032 which considers all aspects of women and girls' health, including mental health. The QLD Government funds programs supporting the mental health of women and girls, including eating disorder responses.
     • SA's Refugee Health Service is a specialist health service for newly arrived refugees and asylum seekers, focusing on new arrival families and individuals with complex health and psycho-social needs. It provides interventions to address acute and chronic physical/psychosocial consequences of torture, trauma and GBV.
     • TAS supports the mental health and wellbeing of Tasmanians under the Bilateral Schedule for Mental Health and Suicide Prevention between the Commonwealth and TAS governments (May 2022), including establishing an eating disorder service and universal aftercare services.
     • VIC is investing in supports for mothers experiencing acute mental health and wellbeing issues during the perinatal period and expanding the Perinatal Emotional Health Program.
     • WA provides funding to 11 community organisations under Proud and Connected Community Grants to increase connection and build resilience within the LGBTIQA+ community, aligning with outcomes in Western Australian Suicide Prevention Framework 2021-2025.

Transgender women

199. The Government recognises individuals may identify and be recognised within the community as a gender other than the sex they were assigned at birth or during infancy, or as a gender which is not exclusively male or female. The Sex Discrimination Act makes discrimination on the grounds of gender identity unlawful in key areas of public life. There is no requirement for any person to obtain legal recognition of their gender identity, however some people may wish to obtain legal recognition on their birth certificate.
200. Government Guidelines on the Recognition of Sex and Gender, released in 2013, apply to all Government departments and agencies maintaining personal records (including employee records), and/or collect sex and/or gender information. The Guidelines support departments to meet obligations under the Sex Discrimination Act, outlining a consistent standard of evidence required for people to change or establish their sex and gender information on personal records.
201. In 2021, the ABS released Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables 2020 (ABS Standard). The Standard states "gender is about social and cultural differences in identity, expression and experience as a man, woman or non-binary person. A person's gender may differ from their sex and may differ from what is indicated on their legal documents." The Standard guides policy and data collection across all Australian governments.
202. States and territories are responsible for laws associated with registering a change of gender.
     • ACT's Births, Deaths and Marriages Registration Act 1997 (ACT) removed criteria requiring a person to have gender re-assignment surgery before being eligible to alter their registered sex. In March 2024, further amendments mean a person can apply to alter their registered sex if the person believes their sex to be the sex nominated in their application. Clinical treatment, authorisation or verification from a medical practitioner is no longer required.
     • NSW Births, Deaths and Marriages Registration Act 1995 (NSW) provides a person who is 18 years or above and has undergone a sex affirmation procedure, may apply for an alteration of their birth certificate. NSW is considering reform to the requirements for sex markers on birth certificates.
     • NT's Births, Deaths and Marriages Registration Act 1996 (NT) allows for a change of sex or gender without medical treatment. A statement from a medical practitioner or psychologist must accompany an application, certifying the adult has received appropriate clinical treatment.
     • QLD's Births, Deaths and Marriages Registration Act 2023 (Qld) no longer requires transgender and gender-diverse people to undergo gender re-assignment surgery before obtaining legal recognition of their gender. The Act supports bodily integrity, autonomy and self‑determination. A person aged 16 years and over may apply to alter their record of sex through a declaration accompanied by a supporting statement from an adult who has known the applicant for at least 12 months. Parents of, or persons with legal parental responsibility for, a child under 16 years may apply to alter their record of sex with a report from a developmentally-informed-practitioner that confirms the child understands the legal implications of amending the record of sex.
     • SA's Births, Deaths and Marriages Registration Act 1996 (SA) allows a person 18 years or above to apply to record their new sex or gender identity if they have undergone required clinical treatment, which may include counselling and may not involve invasive medical treatment.
     • TAS's Births, Deaths and Marriages Registration Act 1999 (Tas) allows for registration of gender identity on the basis of self‑identification, without requirement for medical treatment. Birth certificates can be issued with a person's chosen gender or no gender at all.
     • VIC's Births, Deaths and Marriages Registration Act 1996 (Vic) no longer requires a person to undergo gender re-assignment surgery to apply to change their record of sex, reflected in published guidance to health services on inclusive collection and reporting of sex and gender data.
     • WA's Births, Deaths and Marriages Registration Amendment (Sex or Gender Changes) Act 2024 (WA) abolished the Gender Reassignment Board in April 2024, and introduced a streamlined administrative process for sex and gender recognition. There is no requirement to undergo medical or surgical re-assignment to change a person's sex or gender on their birth certificate. A statement from a medical practitioner or psychologist certifying the person has had appropriate clinical treatment, may include counselling, is sufficient.

Culturally-appropriate, gender-sensitive and non-discriminatory health-care services, and training for Indigenous health professionals

203. The Government has made cultural and gender-responsive health investments and reforms, including:
     • $3.5 million over 4 years from 2024–25 (and $0.4 million per year ongoing) will expand the Midwife Professional Indemnity Scheme to enable Birthing on Country⁴¹ programs to engage midwives who can provide culturally-safe, continuous midwifery care, in order to improve health outcomes for First Nations women and babies;
     • $12.5 million over 4 years to the National Aboriginal Community Controlled Health Organisation (NACCHO) to facilitate community-led distribution of menstrual products in regional and remote Indigenous communities where menstrual products are expensive and hard for First Nations women and girls to access.
204. The National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework and Implementation Plan 2021–2031 addresses structural, systemic, organisational and personal barriers to recruiting and retaining First Nations people across the health landscape.
205. The Government will grow the Indigenous health workforce across levels, roles, and locations to eliminate racism and build capacity to deliver culturally-safe, trauma-informed, appropriate health care to Indigenous peoples (including multicultural communities).
     • $54.3 million over 5 years (2022-23 to 2026-27) for NACCHO to deliver a First Nations Health Worker Traineeship Program to support up-to-500 Indigenous trainees to undertake qualifications enabling them to work in various health settings and deliver culturally-appropriate care to Indigenous peoples.
     • $52.9 million over 4 years (from 2022-23 to 2025-26) provided to First Nations Health Professional Organisations to support and develop the Indigenous health workforce.
     • $197.9 million to NACCHO to employ up-to-260 new positions in Indigenous community-controlled health services to deliver cancer treatment and other supports including health promotion activities, support for patients navigating cancer care post-diagnosis, and access to treatment and care on Country.
206. State and territory strategies and initiatives delivering culturally-appropriate, gender-sensitive and non-discriminatory health-care, and support to Indigenous health professionals, include:
     • NSW: funding to the Aboriginal Allied Health Cadetship since 2011, and to the Health Education and Training Institute, Training and Support Unit to provide culturally-responsive, evidence-based education and support to staff working in the Aboriginal Maternal and Infant Health Service and Building Strong Foundations teams;
     • TAS implements initiatives under Improving Aboriginal Cultural Respect Across Tasmania's Health System Action Plan 2020-2026, including increasing capacity of Aboriginal Health Liaison Officers and establishing an Aboriginal Health Worker traineeship pilot program.
     • WA established dedicated Indigenous health workforce officers within WA health service providers; the Aboriginal Cadetship Program offering Aboriginal University students opportunities for paid work experience in WA's health system; the Health Aboriginal Leadership Excellence and Development Program - prepares talented Indigenous leaders in WA's health system for senior management and executive positions.

National framework for the mental health and well-being of First Nations peoples

207. The Government actively participates in the Social and Emotional Wellbeing Policy Partnership aiming to improve social and emotional wellbeing and mental health, and reduce suicide rates in Indigenous communities.
     • On 3 August 2023, the Social and Emotional Wellbeing Policy Partnership established a working group to refresh the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples' Mental Health and Social and Emotional Wellbeing 2017-2023. The Government contributed funding to support the refresh and implementation planning process.
208. The National Plan and Aboriginal and Torres Strait Islander Action Plan recognises ongoing impacts of colonisation on Indigenous peoples, including intergenerational-trauma. The Aboriginal and Torres Strait Islander Action Plan's second reform area is 'Strength, resilience and therapeutic healing' - aiming for:
     • primary prevention, early intervention, response and recovery services to be trauma-informed, healing-focused, culturally-safe, place-based and kinship centred;
     • cultural knowledge and practices to be developed by and for Indigenous peoples to address impacts of intergenerational trauma;
     • health and wellbeing to be prioritised.
209. The Government is committed to Closing the Gap, and funds programs in partnership with communities to provide crucial opportunities for trauma recovery, including Healing for Familiesprogram which delivers culturally-based and trauma-informed healing support including counselling and therapy, financial support and advice. The program recognises the role First Nations women play in ensuring the strength and wellbeing of their families and communities, while working to address the disproportionately high rates of violence they experience.