The legal and non-legal barriers to abortion access in Australia: a review of the evidence.

OBJECTIVES: In Australia, about one in four pregnancies results in an induced abortion. The termination of a pregnancy is still, however, a criminal act in most jurisdictions, and access to abortion is not without barriers. This paper analyses existing access barriers and their implications. METHODS: Databases and the grey literature were searched for publications that examined any legal and/or non-legal abortion access barrier applicable to Australia (2000-2016). Only those barriers that had been demonstrated to be the most restrictive were included and categorised. RESULTS: From the initial 410 studies, only 20 publications were identified that matched the inclusion criteria. They indicated that access barriers do indeed exist in Australia. In many parts of Australia, abortion is only legal under strict conditions. Relatively strong evidence was found on the limited abortion access of rural women and of an imminent shortage in the provision of late abortions. For other barriers only limited research evidence existed, or merely opinions were expressed. Very few studies were undertaken to link barriers to outcomes. CONCLUSION: Although this review can form a base for the national improvement of abortion access, the gap found in Australian research demonstrates a need for additional studies.

A population-based study investigating the association between sexual and relationship satisfaction and psychological distress among heterosexuals.

This study examined whether sexual/relationship satisfaction are differentially associated with mental health issues. Using data from a population-based computer-assisted telephone survey, the authors included in this study 3,800 respondents who had a regular heterosexual partner. The authors used 2 methods of scoring the K6 to produce measures of moderate psychological distress and serious psychological distress. Overall, 8.8% of men and 12.1% of women were classified as having moderate psychological distress, whereas 1.6% of men and 3.2% of women were classified as currently experiencing serious psychological distress. The association between satisfaction and mental health was influenced by sex and the severity of the mental health issue but not by type of satisfaction. After adjusting for demographic differences in mental health, low ratings of sexual/relationship satisfaction were both consistently associated with higher levels of moderate psychological distress in men and women and higher proportions of serious psychological distress in men. Although women may be able to resolve their satisfaction issues during less severe stages of psychological distress, for men there was a strong association between low sexual/relationship satisfaction and serious psychological distress.

Incidence and persistence/recurrence of men's sexual difficulties: findings from the Australian Longitudinal Study of Health and Relationships.

This study presents data on the prevalence, incidence, and persistence/recurrence of 8 sexual difficulties among men. Participants were 3,157 Australian men who were administered 2 computer-assisted interviews approximately 12 months apart. Analyses were based on a weighted sample of 2,158 men who were 20-64 years of age, sexually active in the past 12 months, and in the same heterosexual relationship at both interviews. Upon recruitment, a third of men (34%) reported having 1 or more sexual difficulties. At follow-up, 21% reported a new sexual difficulty. The 2 highest incident difficulties were "lacking interest in having sex" (11%) and "reaching orgasm too quickly" (7%). In addition, 51% of men with 1 or more sexual difficulties at recruitment reported having at least 1 of these difficulties again at follow-up. While "trouble keeping an erection" had the highest persistence/recurrence (48%), "taking too long to orgasm" had the lowest (24%). Logistic regression modeling revealed a greater incidence of orgasmic difficulties among older and less educated men. There were few sociodemographic predictors of persistence/recurrence. These data should assist clinicians and other health service providers in identifying the potential challenges faced by men who experience sexual difficulties.

Incidence and persistence/recurrence of women's sexual difficulties: findings from the Australian Longitudinal Study of Health and Relationships.

This study presents data on the prevalence, incidence, and persistence/recurrence of 8 sexual difficulties among women. Australian women participated in 2 computer-assisted interviews approximately 12 months apart. Analyses were based on a weighted sample of 2,252 women who were 20-64 years of age, sexually active in the past 12 months, and in the same heterosexual relationship at both interviews. Upon recruitment, two-thirds of women (66%) reported having one or more sexual difficulties. At follow-up, 36% reported a new sexual difficulty. The two highest incident difficulties were "lacking interest in having sex" (26%) and "taking too long to orgasm" (11%). In addition, 68% of women with 1 or more sexual difficulties at recruitment reported having at least 1 of these again at follow-up. Lacking interest in having sex had the highest persistence/recurrence (65%). Logistic regression modeling revealed a lower incidence of sexual difficulties among women in their 40s. Age was also a predictor of the persistence/recurrence, with persistence/recurrence most likely among older women. Tobacco and alcohol use predicted the incidence, but not persistence/recurrence, of lacking interest in sex. Health professionals need to take note of the sociodemographic groups most prone to developing and having persistent/recurrent sexual difficulties.

An examination of the health and wellbeing of childless women: a cross-sectional exploratory study in Victoria, Australia.

BACKGROUND: Childlessness among Australian women is increasing. Despite this, little is known about the physical and mental health and wellbeing of childless women, particularly during the reproductive years. The aims of this exploratory study were to: 1) describe the physical and mental health and wellbeing and lifestyle behaviours of childless women who are currently within the latter part of their reproductive years (30 - 45 years of age); and 2) compare the physical and mental health and wellbeing and lifestyle behaviours of these childless women to Australian population norms. METHODS: A convenience sample of 50 women aged between 30 and 45 years were recruited to participate in a computer assisted telephone interview. The SF-36 Health Survey v2 and lifestyle indicators were collected in regards to women's health and wellbeing. Data were analysed using descriptive statistics, t-tests for independent sample means and 95% confidence intervals for the difference between two independent proportions. RESULTS: Childless women in this study reported statistically significant poorer general health, vitality, social functioning and mental health when compared to the adult female population of Australia. With the exception of vegetable consumption, lifestyle behaviours were similar for the childless sample compared to the adult female population in Australia. CONCLUSIONS: Childless women may be at a greater risk of experiencing poor physical and mental health when compared to the Australian population. A woman's health and wellbeing during her reproductive years may have longer term health consequences and as such the health and wellbeing of childless women requires further investigation to identify and address implications for the provision of health (and other social) services for this growing population group.

High prevalence of symptoms associated with ovarian cancer among Australian women.

BACKGROUND: Symptoms associated with ovarian cancer are often vague and non-specific, such as abdominal bloating and pain. Presently, nothing is known about the prevalence of these symptoms among women in the community. AIMS: To identify the prevalence and correlates of symptoms associated with ovarian cancer in a nationally representative sample of Australian women. METHODS: Women answered questions about symptoms associated with ovarian cancer via computer-assisted telephone interviews. Binomial regression was used to assess the association between reporting symptoms, demographic characteristics and sexual problems. RESULTS: Data on 2235 women aged 18-70 who had not had an oophorectomy or hysterectomy were analysed. Prevalences of symptoms were abdominal bloating 52%, abdominal pain 37%, increased abdominal size 30%, pelvic pain 29%, feeling full quickly 18% and unable to eat normally 15%. One-third of women (32%) reported three or more symptoms, 2% reported all six and 32% of women reported none. Severe symptoms were generally reported by <10% of women reporting symptoms, and symptoms usually persisted for 5 days or less a month. Older women were less likely to report symptoms, as were women who had been pregnant. There was an association between symptoms and sexual difficulties whereby women who reported multiple ovarian cancer symptoms were more likely to report sexual problems. CONCLUSIONS: There is a high prevalence of ovarian cancer symptoms in the Australian community. Because of this, awareness campaigns will likely impact a large number of women who do not have ovarian cancer.

National prevalence of urogenital pain and prostatitis-like symptoms in Australian men using the National Institutes of Health Chronic Prostatitis Symptoms Index.

STUDY TYPE: Prognosis (cohort). LEVEL OF EVIDENCE: 2a. OBJECTIVE: To provide a summary, using the National Institutes of Health Chronic Prostatitis Symptoms Index (NIH-CPSI), of the prevalence of prostatitis-like symptoms in a population-based sample of Australian men. SUBJECTS AND METHODS: Participants were Australian men aged 16-64 years recruited as part of the Australian Longitudinal Study of Health and Relationships: a nationally representative study. In all, 1346 men completed an extensive questionnaire which included the NIH-CPSI. The index identifies six types of urogenital pain, the presence of urinary problems, and effects on quality of life. Men who reported perineal and/or ejaculatory pain or discomfort and a total NIH-CPSI pain score of > or =4 were considered as having prostatitis-like symptoms. RESULTS: Based on a weighted population of 1373 men, some form of urogenital pain was reported by 105 (7.6%) men; with 2.8% of men reporting more than one type of urogenital pain. The mean (range) NIH-CPSI pain score for men reporting pain was 6.2 (5.6-6.8); for all men the mean score was 0.5 (0.4-0.6). About 20% of men (284) were considered to have urinary problems. The mean urinary symptom score for all men was 0.9 (0.9-1.0). The mean total NIH-CPSI score for men reporting pain was 13.3 (12.0-14.7) and for all men it was 2.6 (2.3-2.8). The estimated prevalence of prostatitis-like symptoms was approximately 2%. CONCLUSIONS: Using the NIH-CPSI the estimated prevalence for urogenital pain in Australian men is 8%; an estimated 3% of men experience pain from more than one urogenital location. The estimated prevalence of prostatitis-like symptoms in Australian men is 2%. Almost a third of Australian men experiencing urogenital pain or prostatitis-like symptoms would be less than satisfied if this was to be ongoing for the rest of their life.

Hysterectomy trends in Australia--between 2000/01 and 2004/05.

BACKGROUND: Hysterectomy is a major and common surgical procedure that has the potential to provide relief from ongoing gynaecological problems, but is often associated with negative impacts on health and wellbeing. Research indicates that hysterectomy rates and trends vary widely between and within countries; yet little is known about patterns in Australia. AIMS: This research aimed to describe hysterectomy rates and trends in Australia between 2000/01 and 2004/05. METHODS: This repeat cross-sectional study used routinely collected data from all hospitals in Australia. Data on all women admitted to hospital for a hysterectomy were obtained from the National Hospital Morbidity Database (2000/01-2004/05). Data were analysed by calculating population rates for each type of hysterectomy. Incidence rate ratios were calculated to assess changes over time. RESULTS: Hysterectomy rates in Australia declined from 34.8 per 10 000 women in 2000/01 to 31.2 per 10 000 women in 2004/05. A decline in the incidence rate for abdominal hysterectomy (from 18.7 to 15.1 per 10 000 women) and the incidence rate for concurrent oophorectomy (from 12.4 to 11.3 per 10 000 women) were also observed during this time period. At each point in time, the highest incidence rates for hysterectomy were for women aged 45-54 years. CONCLUSIONS: Hysterectomy rates in Australia are declining over time and currently appear to be lower than most other countries. More hysterectomies are performed vaginally than in Canada, the USA, the UK and Finland and the rate of concurrent oophorectomy is less than that reported in the USA and the UK.

Is gender inequity a risk factor for men reporting poorer self-rated health in the United States?

Theoretical approaches suggest that gender inequity increases men's health risks. Previous findings from the United States support this contention, however only a small number of health outcomes have been explored. This study extends the range of health outcomes examined by using a cross-sectional, multilevel analysis to investigate whether measures of state-level gender inequity are predictors of men's self-rated health. Data were derived primarily from the Behavioral Risk Factor Surveillance System and the full-case data set included 116,594 individuals nested within 50 states. Gender inequity was measured with nine variables: higher education, women's reproductive rights, abortion provider access, elected office, management, business ownership, labour force participation, earnings and relative poverty. Covariates at the individual level were age, income, education, race/ethnicity, marital status and employment status. Covariates at the state level were income inequality and gross domestic product per capita. In fully adjusted models for all-age men the reproductive rights (OR 1.06 95% CI 1.01-1.11), abortion provider access (OR 1.11 95% CI 1.05-1.16) and earnings (OR 1.06 95% CI 1.02-1.12) measures all predicted an increased risk of men reporting poorer self-rated health for each 1 standard deviation increase in the gender inequity z-score. The most consistent effect was seen for the 65+ age group where the reproductive rights (OR 1.09 95% CI 1.03-1.16), abortion provider access (OR 1.15 95% CI 1.09-1.21), elected office (OR 1.06 95% CI 1.01-1.11) and earnings (OR 1.10 95% CI 1.04-1.16) measures all showed a significant effect. These findings provide evidence that some aspects of gender inequity increase the risk of poorer self-rated health in men. The study contributes to a growing body of literature implicating gender inequity in men's health patterns.

The Australian longitudinal study of health and relationships.

BACKGROUND: Ensuring the sexual and reproductive health of the population is essential for the wellbeing of a nation. At least three aspects of sexual and reproductive health are among the key policy issues for present Australian governments: maintaining and increasing the birth rate; reducing the abortion rate; and preventing and controlling Chlamydia infections. The overall aim of the Australian Longitudinal Study of Health and Relationships is to document the natural history of the sexual and reproductive health of the Australian adult population. METHODS/DESIGN: A nationally representative sample of Australian adults 16-64 years of age was selected in a two-phase process in 2004-2005. Eligible households were identified through random digit dialing. We used separate sampling frames for men and women; where there was more than one eligible person in a household the participant was selected randomly. Participants completed a computer-assisted telephone interview that typically took approximately 25 minutes to complete. The response rate was 56%. A total of 8,656 people were interviewed, of whom 95% (8243) agreed to be contacted again 12 months later. Of those, approximately 82% have been re-contacted and re-interviewed in 2006-07 (Wave Two), with 99% of those agreeing to be contacted again for Wave Three. DISCUSSION: ALSHR represents a significant advance for research on the linked topics of sexual and reproductive health. Its strengths include the large sample size, the inclusion of men as well as women, and the wide age range of the participants.

Does gender inequity increase men's mortality risk in the United States? A multilevel analysis of data from the National Longitudinal Mortality Study.

A number of theoretical approaches suggest that gender inequity may give rise to health risks for men. This study undertook a multilevel analysis to ascertain if state-level measures of gender inequity are predictors of men's mortality in the United States. Data for the analysis were taken primarily from the National Longitudinal Mortality Study, which is based on a random sample of the non-institutionalised population. The full data set included 174,703 individuals nested within 50 states and had a six-year follow-up for mortality. Gender inequity was measured by nine variables: higher education, reproductive rights, abortion provider access, elected office, management, business ownership, labour force participation, earnings and relative poverty. Covariates at the individual level were age, income, education, race/ethnicity, marital status and employment status. Covariates at the state level were income inequality and per capita gross domestic product. The results of logistic multilevel modelling showed a number of measures of state-level gender inequity were significantly associated with men's mortality. In all of these cases greater gender inequity was associated with an increased mortality risk. In fully adjusted models for all-age adult men the elected office (OR 1.05 95% CI 1.01-1.09), business ownership (OR 1.04 95% CI 1.01-1.08), earnings (OR 1.04 95% CI 1.01-1.08) and relative poverty (OR 1.07 95% CI 1.03-1.10) measures all showed statistically significant effects for each 1 standard deviation increase in the gender inequity z-score. Similar effects were seen for working-age men. In older men (65+ years) only the earnings and relative poverty measures were statistically significant. This study provides evidence that gender inequity may increase men's health risks. The effect sizes while small are large enough across the range of gender inequity identified to have important population health implications.

Travel undertaken by women accessing private Victorian pregnancy termination services.

OBJECTIVE: To investigate the extent and cost of travel undertaken by women accessing Victorian termination of pregnancy services. DESIGN, SETTING AND PARTICIPANTS: This was a multi-centre, cross-sectional observational study of women receiving privately funded pregnancy termination services, conducted between November 2002 and June 2003 at eight major pregnancy termination service providers in Victoria. MAIN OUTCOME MEASURES: Distance travelled, money and time expended undertaking travel, and reasons women chose particular clinics. RESULTS: Of the 1,244 Australian resident respondents who resided in Victoria, 9.3% travelled more than 100 km to access services. Teenagers were 2.5 times more likely than other respondents to travel further than 100 kilometres (km) (18.2% compared with 7.8%, OR = 2.5, 95% CI 1.5-4.2, p < 0.001). Women originated from all Australian States and Territories except South Australia and 13.7% were from Statistical Divisions other than Melbourne. More than one-third of respondents (41.3%) chose their clinic because they were referred by a doctor or general practitioner. CONCLUSION: Many pregnancy termination patients face substantial and immediate costs beyond the service fee, as well as the difficulties associated with poor continuity of care and significant time away from home. Patients and service providers should be consulted further to determine appropriate clinical services, support services and subsidy schemes for the sizeable proportion of patients who undertake long-distance travel to access pregnancy termination services.

Use of pregnancy counselling services in Australia 2007-2012.

OBJECTIVE: To assess the uptake of Medicare Benefit payments for non-directive pregnancy support counselling which commenced in November 2006. METHODS: Counts of services for pregnancy counselling from 1 July 2007 to 30 June 2012, where a Medicare rebate was paid, were used to calculate age-, state- and provider-specific rates per 100,000 women aged 15-44 years, and rates per 100,000 births for each study year. RESULTS: Rates of Medicare rebates for pregnancy counselling were low, with a mean of 90.6 services per 100,000 women recorded over the study period. GP services were accessed most frequently, while services provided by allied health professionals averaged less than 5% of those for GPs. The overall rate of services fell in all jurisdictions except Victoria/Tasmania, although services provided by allied health professionals remained steady or rose in all jurisdictions over the study period. CONCLUSIONS: There has been a low uptake of pregnancy counselling covered by the Medicare Benefits Item numbers introduced in 2006, especially for services provided by allied health professionals. Due to a lack of available data, the impact on abortion rates is unknown. IMPLICATIONS: Provision of Medicare rebates for pregnancy counselling does not appear to be an effective way of assisting women with unintended pregnancies.

Intention to claim a Medicare rebate among women receiving private Victorian pregnancy termination services.

OBJECTIVES: To determine the proportion of women who have pregnancy terminations as private patients in Victoria who do not intend to claim a procedure fee rebate from Medicare, to compare characteristics of women who intend to submit a Medicare claim with those who do not and to compare the findings to the results from a similar study conducted in NSW in 1992. DESIGN, SETTING AND PARTICIPANTS: This was a cross-sectional observational study over a 12-week period. Women having a pregnancy termination service in eight large Victorian private clinics were invited to complete a brief written questionnaire. OUTCOME MEASURE: The proportion of women who did not have a Medicare card or who had a Medicare card but did not intend to use it to claim from Medicare. RESULTS: Of the 1,329 women who responded, 13.1% either did not have a Medicare card or did not intend to use their card to claim a Medicare rebate. A further 20.7% of respondents were not sure about whether they would submit a claim. Women who intended to claim a Medicare rebate were different from women who did not according to age, language spoken at home, residency, citizenship and distance travelled to the service. These results are very similar to the findings from the 1992 NSW study. CONCLUSION: Between 13.1% and 33.8% of private Victorian pregnancy terminations were estimated to not be recorded at the Health Insurance Commission. Health Insurance Commission records of Medicare rebate claims for pregnancy terminations are an incomplete and somewhat biased record of the services that are provided and are likely to have been so for some time.

Who's cheating? Agreements about sexual exclusivity and subsequent concurrent partnering in Australian heterosexual couples.

UNLABELLED: Background Concurrent relationships are a driver of generalised epidemics of sexually transmissible infections (STIs). In Australia, explicit negotiation of agreements about sex outside regular relationships has been recommended in health promotion for gay men but not for heterosexuals. OBJECTIVE: To ascertain the annual incidence of concurrency among people in ongoing male-female relationships according to their reported expectations of exclusivity. METHODS: In a national cohort recruited by household random digit dialling in 2004-05, people aged 16-64 years completed computer-assisted telephone interviews including questions about expectations of sexual exclusivity, discussion and agreements. A year later, those in ongoing sexual relationships (5323 people) were asked about sexual partner numbers in the past year. RESULTS: The huge majority (96%) expected sexual exclusivity of themselves and their partner. However, only 48% of men and 64% of women had discussed the matter and explicitly agreed. Older respondents were less likely to report discussion. Only 1% reported mutually nonexclusive ('open') relationships. A year later, 93% of respondents were still in the same relationship, among whom 4% of men and 2% of women had had sex outside the relationship. Those with agreements that one or both partners could have sex with others were more likely to do so, but the majority of respondents who had sex with someone else were in relationships that were explicitly or implicitly expected to be exclusive. CONCLUSIONS: Sexual health promotion should stress the importance of STI testing and establishing agreements about exclusivity before condoms are abandoned in new relationships.

Demographic predictors of consistency and change in heterosexuals' attitudes toward homosexual behavior over a two-year period.

This study investigated demographic predictors of consistency and change in heterosexual people's attitudes toward homosexual behavior. A nationally representative sample of Australian men and women were recruited via random digit dialling in 2004 through 2005. Participants completed annual computer-assisted telephone interviews over the next five years. Questions about attitudes toward male and female homosexual behavior were assessed at Wave 1 (2004-2005) and Wave 3 (2006-2007) of the study. The majority of the sample reported tolerance of both male and female homosexual behavior (with women slightly more tolerant than men). Multivariate analyses showed that those who regularly attended religious services were more likely to consistently disapprove of homosexual behavior and more likely to change from tolerant to disapproving. Among those who were initially tolerant, younger respondents and those with higher educations were less likely to become homophobic. The results of this study show that individual attitudes toward homosexual behavior are open to change, particularly toward a more tolerant position. Religiosity appears to be consistently associated with the development and reinforcement of homophobic tendencies.

Sexual practices and the duration of last heterosexual encounter: findings from the Australian longitudinal study of health and relationships.

This study investigated the association between sexual practices and duration of a sexual encounter. Using data from a population-based computer-assisted telephone survey of 8,656 Australians aged 16 to 64 years, four distinct patterns of sexual practices among respondents were found: "basic sexual encounter" (involving mainly kissing, cuddling, stroking one's partner and being stroked, and vaginal intercourse), "basic sexual encounter plus oral sex," "all assessed sexual practices" (all sexual behaviors included in the survey), and "mainly vaginal intercourse" (characterized by lower levels of kissing, cuddling, and stroking). For both men and women, respondents classified in the basic sexual encounter plus oral sex, and all assessed sexual practices clusters reported significantly longer durations than those in the basic sexual encounter group, whereas respondents in the mainly vaginal intercourse cluster reported shorter durations. These differences were found even after allowing for demographic differences in sexual duration-specifically, age and partner type of the most recent opposite-sex partner. These findings add to the understanding of what typically happens in a sexual encounter. Overall, longer sexual encounters appear to be associated with the inclusion of the least common sexual practices-namely, oral sex and self-stimulation.

Who gets tattoos? Demographic and behavioral correlates of ever being tattooed in a representative sample of men and women.

PURPOSE: Despite recent increases in the popularity of tattooing, little is known about the prevalence and characteristics of adults who have ever been tattooed. We investigated demographic and behavioral correlates of ever getting tattooed in an adult population. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 8656 men and women ages 16-64 years in Australia. RESULTS: A total of 14.5% of respondents had ever been tattooed, and 2.4% of respondents had been tattooed in the year before the interview. Men were more likely than women to report a tattoo, but the highest rates of tattooing were found among women in their 20s (29.4%). Men and women ages 20-39 were most likely to have been tattooed, as were men with lower levels of education, tradesmen, and women with live-out partners. Tattooing was also associated with risk-taking behaviours, including smoking, greater numbers of lifetime sexual partners, cannabis use (women only) and ever having depression (men only). CONCLUSIONS: Tattooing has increased in popularity during the past decade. Yet tattoos still appear to be a marker for risk-taking behavior in adults.

Association between sexual behavior and cervical cancer screening.

BACKGROUND: Not much is known about whether women who follow Pap testing recommendations report the same pattern of sexual behavior as women who do not. METHODS: Data come from part of a larger population-based computer-assisted telephone survey of 8656 Australians aged 16-64 years resident in Australian households with a fixed telephone line (Australian Longitudinal Study of Health and Relationships [ALSHR]). The main outcome measure in the current study was having had a Pap test in the past 2 years. RESULTS: Data on a weighted sample of 4052 women who reported sexual experience (ever had vaginal intercourse) were analyzed. Overall, 73% of women in the sample reported having a Pap test in the past 2 years. Variables individually associated with Pap testing behavior included age, education, occupation, cohabitation status, residential location, tobacco and alcohol use, body mass index (BMI), lifetime and recent number of opposite sex partners, sexually transmitted infection (STI) history, and condom reliance for contraception. In adjusted analyses, women in their 30s, those who lived with their partner, and nonsmokers were more likely to have had a recent Pap test. Those who drank alcohol at least weekly were more likely to have had a recent test than irregular drinkers or nondrinkers. Women with no sexual partners in the last year were less likely to have had a Pap test, and women who reported a previous STI diagnosis were more likely to have had a Pap test in the past 2 years. CONCLUSIONS: There are differences in Pap testing behavior among Australian women related to factors that may affect their risk of developing cervical abnormalities. Younger women and regular smokers were less likely to report a recent test. Screening programs should consider the need to focus recruitment strategies for these women.