Reaching for health
The Australian women's health movement and public policy

Gray Jamieson, Gwendolyn

2012

ANU Press

The women’s health movement shocked and scandalised when it burst into Australian politics in the early 1970s. It cast the light of day onto taboo subjects such as sexual assault, abortion and domestic violence, provoking outrage and condemnation. Some of the services women created for themselves were subjected to police raids; sex education material was branded ‘indecent’. Moreover, women dared to criticise revered institutions, such as the medical system. Yet for all its perceived radicalism, the movement was part of a much broader and relatively conventional international health reform push, which included the ‘new’ public health movement, the community health centre movement and, in Australia, the Aboriginal health movement, all of which were critical of the way medical systems had been organised during the 20th century. The women who joined the movement came from diverse backgrounds and included immigrant and refugee women, Aboriginal women and Anglo women. Initially, groups worked separately for the most part but as time went on, they found ways to cooperate and collaborate. This book presents an account of the ideas, the diverse and shared efforts and the enduring hard work of women’s health activists, drawn together in one volume for the first time. This relentless activism gradually had an impact on public policy and slowly brought forth major attitudinal changes. The book also identifies the opportunities for health reform that were created along the way, opportunities which deserve to be more fully embraced.

australia; politics; women; women's health movement; healthcare; Domestic violence; Feminism

English

9781921862687

10.26530/OAPEN_459488

http://press.anu.edu.au/about/conditions-use

http://library.oapen.org/handle/20.500.12657/33641

Reaching for Health
The Australian women’s health movement and public policy

Reaching for Health
The Australian women’s health movement and public policy

Gwendolyn Gray Jamieson

Published by ANU E Press
The Australian National University
Canberra ACT 0200, Australia
Email: anuepress@anu.edu.au
This title is also available online at http://epress.anu.edu.au

National Library of Australia Cataloguing-in-Publication entry
Author:

Gray Jamieson, Gwendolyn.

Title:


Reaching for health [electronic resource] : the Australian women’s health
movement and public policy / Gwendolyn Gray Jamieson.

ISBN:

9781921862687 (ebook) 9781921862670 (pbk.)

Notes:

Includes bibliographical references.

Subjects:
Birth control--Australia--History.
Contraception--Australia--History.

Sex discrimination against women--Australia--History.

Women’s health services--Australia--History.

Women--Health and hygiene--Australia--History.

Women--Social conditions--History.
Dewey Number: 362.1982

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system
or transmitted in any form or by any means, electronic, mechanical, photocopying or otherwise,
without the prior permission of the publisher.
Cover design and layout by ANU E Press
Printed by Griffin Press
This edition © 2012 ANU E Press

Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1. Concepts, Concerns, Critiques . . . . . . . . . . . . . . . . . . . . . . . 23
2. With Only Their Bare Hands . . . . . . . . . . . . . . . . . . . . . . . . . 57
3. Infrastructure Expansion: 1980s onwards. . . . . . . . . . . . . . . . 89
4. Group Proliferation and Formal Networks . . . . . . . . . . . . . . . 127
5. Working Together for Health. . . . . . . . . . . . . . . . . . . . . . . . 155
6. Women’s Reproductive Rights: Confronting power . . . . . . . . 179
7. Policy Responses: States and Territories. . . . . . . . . . . . . . . . 215
8. Commonwealth Policy Responses. . . . . . . . . . . . . . . . . . . . 245
9. Explaining Australia’s Policy Responses . . . . . . . . . . . . . . . . 279
10. A Glass Half Full…. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Appendix 1: Time line of key events, 1960–2011. . . . . . . . . . . 327
Appendix 2: Women interviewed for this book . . . . . . . . . . . . . 341
Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389

v

Preface
In sifting through boxes and filing cabinets of material collected for this book,
I am struck by how much attitudes towards women, and attitudes of women
themselves, have changed since the 1970s. The argument that women are not
genetically equipped to participate in public-sector life is not often heard
today, for example. Where possible, therefore, I attempt to create a sense of
the atmosphere in which the women’s health movement emerged by including
selected anecdotes and quotations. The passion and commitment of early
Australian women’s health movement activists and the extraordinary efforts
they made to improve the circumstances of women’s lives and to fill gaps in
service provision can only be understood, I believe, in the context of the times.
The intensity of the critiques they developed was a product of their inferior
position, the scarcity of health information, the insensitivity of some health
professionals and the gaps in available health services, leaving many needs
unmet.
It is impossible within the pages of a single volume to document more than a
fraction of the work done by members of the movement. Similarly, only a brief
outline can be given of the influence of the movement on public policy in nine
jurisdictions over 40 years. Moreover, although I have interviewed scores of
women and collected mountains of documents, there is a wealth of experience
that I have been unable to record and there are parts of the story about which
little is now known.
Space also prevents me from naming the women and the handful of men who
have played important roles. The text necessarily contains reference to a few
women who carried out crucial work or held key positions. Such a mention
should not, however, suggest a more important role or a greater contribution
than women not mentioned at all. Indeed, so many women have been involved in
so many arenas that it would be impossible to calculate individual contribution.
All the women who were interviewed for this book either formally or informally
are listed in Appendix 2. Where no reference is provided, the information
presented derives from interviews or from personal involvement in the events
described.
One of the difficult decisions I have had to make in writing is whether to use
the past or the present tense when discussing the movement’s ideas and the
criticisms that developed. None of the problems that feminists identified in the
early 1970s has disappeared, although some are less pressing than they were.
For example, information about women’s bodies and women’s health is far
more readily available now and medical attitudes are less patronising. Serious
concerns remain, however, and the social health perspective that the movement
vii

Reaching for Health

has promoted since the early days is not yet central in mainstream debate. The
past tense, therefore, is often inappropriate. Mixed time frames are therefore
used but, try as I might to achieve stylistic elegance, even the casual reader will
notice an ungainly ‘wobbling’ between tenses.
At the outset, my involvement in the Australian women’s health movement
must be declared. Since the mid-1980s, I have been an active member, first, of
the ACT Women’s Health Network and then of the Australian Women’s Health
Network (AWHN). I represented the ACT Women’s Health Network on the
Australian Capital Territory’s Women’s Health Advisory Committee (WHAC)
from 1989 until 1996. From the early 1990s until 2008, I was a member of the
Board and sometime President of Sexual Health and Family Planning ACT and
represented the Australian Capital Territory on the Board of Sexual Health and
Family Planning Australia (SH&FPA) from 2002 until 2008. I was a member
of the interim management committee of AWHN in the early 1990s when the
constitution was written and the organisation was incorporated, Convenor from
1995 to 1998, Deputy Convenor from 1998 until 2008 and Convenor again from
2008 onwards.

viii

Acknowledgments
There are many people to thank for their assistance, support and encouragement
during the production of this book—so many that I am afraid some will be
overlooked. First and foremost, I thank the scores of women in the Australian
women’s health movement and in political parties, trade unions and bureaucracies
who so generously gave their time to talk with me, formally and informally.
Those interviewed are listed in Appendix 2. Women supported my research in
many other ways as well. They provided me with contacts, made appointments
for me with key policymakers and activists in their regions, gathered local
women together to facilitate group discussion and, in some cases, even offered
me a bed for the night. As well as agreeing to be interviewed, women gave me
access to written materials and pointed me in the direction of relevant sources.
Many have been willing to talk to me on the telephone, and answer followup questions sent by email. These women include Esther Alvares, Morven
Andrews, Moira Carmody, Karin Cheyne, Cathy Crawford, Denele Crozier,
Glynis Flower, Vig Geddes, Robyn Gregory, Jocelyn Hanson, Maree Hawken,
Lekkie Hopkins, Judith Ion, Libby Lloyd, Toni Makkai, Lynnley McGrath,
Roxanne McMurray, Heather Nancarrow, Cathy North, Anne O’Byrne, Andrea
Shoebridge, Mandy Stringer, Tammy Vu, Veronica Wensing, Karen Willis and
Faye Worner. Researching the history of the movement has been a socially
rewarding experience. I have been privileged to meet many wonderful women
and make new friends.
Dorothy Broom, Helen Keleher and Marian Sawer read the full draft manuscript
and I thank all three for their invaluable comments and suggestions and for
their friendship and support. Marian Sawer has been a wellspring of ideas,
support and encouragement throughout the writing process. People who gave
me excellent feedback on parts of the manuscript include Morven Andrews,
Marilyn Beaumont, Justine Cairns, Denele Crozier, David Denham, Carolyn
Frohmader, Peter Howe, Lynnley McGrath, Adele Murdolo, Anne O’Byrne
and Kerreen Reiger. Kerreen Reiger gave me great assistance with the first
half of Chapter 6, including providing documents, some of which were still
in press at the time of writing. Marilyn Beaumont generously gave me a copy
of her extensive notes on the four-year process through which abortion was
decriminalised in Victoria.
My thanks go to those who helped me with photographs, including Tony
Adams, Dorothy Broom, Peter Howe, Gail Radford and Romaine Rutnam. Tracey
Wing, photographer extraordinaire, combed through her files, freely sharing
her women’s health collection with me. Ann Pettigrew, Genevieve Ebeck and
Bridget Gilmour-Walsh volunteered to edit the manuscript—acts of generosity
ix

Reaching for Health

well beyond the bounds of friendship and filial duty. Peter Howe fixed leaky
taps, regained control of errant formatting and supplied me with relevant press
clippings.
Staff at the Australian National Library cheerfully and efficiently helped me
find sources and locate obscure references. I thank Duncan Beard and the staff
of ANU E Press for their assistance and cooperation and the ANU Publications
Subsidy Committee for its grant. The book was written during my time as an
Adjunct Fellow in the School of Politics and International Relations, Research
School of Social Sciences, College of Arts and Social Sciences, at The Australian
National University. I thank the University for supporting my work and
providing congenial surroundings in which to write.

x

Abbreviations
ABS

Australian Bureau of Statistics

ABSP

Alternative Birthing Services Program

ACCHS

Aboriginal Community Controlled Health Service

ACM

Australian College of Midwives

ACON

AIDS Council of New South Wales

ACSSA

Australian Centre for the Study of Sexual Assault

ACT

Australian Capital Territory

ACTU

Australian Council of Trade Unions

ACTWHN

ACT Women’s Health Network

AD

Australian Democrats

AHMAC

Australian Health Ministers Advisory Council

AH&MRC

Aboriginal Health and Medical Research Council of New
South Wales

AIHW

Australian Institute of Health and Welfare

ALMA

Australian Lesbian Medical Association

ALP

Australian Labor Party

ALRA

Association for the Legal Right to Abortion

AMA

Australian Medical Association

AMS

Aboriginal Medical Service

ANF

Australian Nursing Federation

ARHA

Australian Reproductive Health Alliance

ATSIC

Aboriginal and Torres Strait Islander Commission

AVO

apprehended violence order

AWHN

Australian Women’s Health Network

BCNA

Breast Cancer Network Australia
xi

Reaching for Health

C by C

Children by Choice

CAAC

Central Australian Aboriginal Congress

CASA

Centres Against Sexual Assault

CEDAW

Convention on the Elimination of All Forms of
Discrimination against Women

CEP

Community Employment Program

COAG

Council of Australian Governments

COAL

Coalition of Activist Lesbians

COCAITH

Coalition on Criminal Assault in the Home

CR

consciousness raising

CWA

Country Women’s Association

DES diethylstilboestrol

xii

DOHA

Department of Health and Ageing

DPIA

Disabled Peoples International Australia

DVCS

Domestic Violence Crisis Service

DVRCV

Domestic Violence Resource Centre Victoria

FaHCSIA

Department of Families, Housing, Community Services and
Indigenous Affairs

FORWAARD

Foundation of Rehabilitation with Aboriginal Alcohol
Related Difficulties

FVIP

Family Violence Intervention Program

FVPLS

Family Violence Prevention Legal Service

FVPP

Family Violence Partnership Program

FVRAP

Family Violence Regional Activities Program

EMSN

Extended Medicare Safety Net

GLBT

gay, lesbian, bisexual and transgender

GLBTIQ

gay, lesbian, bisexual, transgender, intersex and queer

Abbreviations

HCC

Hospitals and Charities Commission

HHSC

Health and Hospitals Services Commission

HRT

hormone replacement therapy

HRWWC

Hunter Region Women’s Working Centre

IUD

intrauterine device

IWD

International Women’s Day

IWDVS

Immigrant Women’s Domestic Violence Service

IWHS

Immigrant Women’s Health Service

IWOT

Independent Women’s Organisations of Tasmania

LPA

Liberal Party of Australia

LWCHC

Leichhardt Women’s Community Health Centre

MC

Maternity Coalition

MCWH

Multicultural Centre for Women’s Health

MGPs

Midwifery Group Practices

MWSAS

Migrant Women’s Support and Accommodation Service

NACCHO

National Aboriginal Community Controlled Health
Organisation

NAIHO

National Aboriginal and Islander Health Organisation

NASASV

National Association of Services against Sexual Violence

NECB

non-English cultural background

NESB

non-English-speaking background

NESBWHS

Non-English Speaking Background Women’s Health
Strategy

NGO

non-governmental organisation

NHHRC

National Health and Hospitals Reform Commission

NHMRC

National Health and Medical Research Council

NHS

National Health Service
xiii

Reaching for Health

xiv

NWH Program

National Women’s Health Program

NWHP

National Women’s Health Policy

NIFVGP

National Indigenous Family Violence Grants Program

NMA

Nursing Mothers Association

NOHSC

National Occupational Health and Safety Commission

NPY

Ngaanyatjarra Pitjantjatjara Yankunytjatjara

NQDVRS

North Queensland Domestic Violence Resource Service

NT

Northern Territory

OATSIH

Office of Aboriginal and Torres Strait Islander Health

OECD

Organisation for Economic Cooperation and Development

OHS

occupational health and safety

OSW

Office of the Status of Women

OWN

Older Women’s Network

PADV

Partnerships Against Domestic Violence

PANDA

Post and Antenatal Depression Association

PANDSI

Post and Antenatal Depression Support and Information

PCP

Primary Care Partnership

PGPD

Parliamentary Group on Population and Development

PHOFA

Public Health Outcomes Funding Agreement

PND

postnatal depression

PNDSA

Postnatal Depression Support Association

PTSD

post-traumatic stress disorder

QWHN

Queensland Women’s Health Network

RACOG

Royal Australian College of Obstetricians and
Gynaecologists

RANZCOG

Royal Australian and New Zealand College of
Gynaecologists

Abbreviations

RCA

Reproductive Choice Australia

REWP

Refuge Ethnic Workers Program

RHS

Reproductive Health Service

RSI

repetitive strain injury

SA

South Australia

SAAP

Supported Accommodation Assistance Program

SACS

Social and Community Services

SANDS

Stillbirth and Neonatal Death Support

SARC

Sexual Assault Resource Centre

SASS

Sexual Assault Support Service

SH&FPA

Sexual Health and Family Planning Australia

SHFPACT

Sexual Health and Family Planning ACT

SIDS

sudden infant death syndrome

TGA

Therapeutic Goods Administration

TUTA

Trade Union Training Authority

UN

United Nations

VAW Strategy

Violence Against Women Strategy

VicHealth

Victorian Health Promotion Foundation

VLRC

Victorian Law Reform Commission

WA

Western Australia

WAAC

Women’s Abortion Action Campaign

WARS

Women’s Addiction and Recovery Service

WAWHO

Western Australian Women’s Health Organisation

WCAG

Women’s Centre Action Group

WEL

Women’s Electoral Lobby

WESNET

Women’s Emergency Services Network
xv

Reaching for Health

xvi

WESP

Women’s Emergency Services Program

WHAC

Women’s Health Advisory Committee

WHAM

Women in Health around Melbourne

WHAV

Women’s Health Association of Victoria

WHIRCCA

Women’s Health and Information Resource and Crisis
Centres Association

WHO

World Health Organisation

WHSU

Women’s Health Strategy Unit

WHV

Women’s Health Victoria

WICH

Women in Industry Contraception and Health

WISN

Women’s Incest and Survivors Network

WL

women’s liberation

WODEB

Women of Different Ethnic Backgrounds

WWDA

Women with Disabilities Australia

WWDACT

Women with Disabilities ACT

Introduction
Once upon a time, before the feminists carried their banners emblazoned
with the women’s sign and the inscription ‘Women’s Liberation’, there
was a luxury tax on the contraceptive pill. (Stevens 1995:13)
When the women’s health movement burst onto the Australian political scene as
part of the resurgent women’s movement, resentment about social arrangements
was intense. Women knew how it felt to be trivialised, disbelieved and dismissed.
They had experienced frustration, indignity and stigmatisation in their daily
lives. For many, encounters with the health system were unsatisfactory and
often humiliating and traumatising. In the early 1970s, the gatherings organised
by mobilising feminists provided an opportunity for women to ventilate their
concerns, often for the first time. The gender order would never be quite the
same again.
At a packed public ‘speak-out’ organised by Melbourne feminists in early 1973,
poor health care and lack of relevant information emerged as the dominant
concerns. Women told stories that shocked those listening, stories that were
confirmed by the doctors, nurses and healthcare workers who were present.
Women’s health care was condemned as too often ‘demeaning, discriminatory,
judgemental and of poor quality’ (Hull 1986:14). Sydney women reached a
similar verdict at another gathering a few weeks later. Unmarried women told
of lectures that implied immorality and promiscuity when they requested
contraceptives, which were often denied them, and married women talked
about the difficulties and the humiliation of requesting an abortion. Older
women reported being unable to get information about menopause and of being
summarily dismissed or referred to a psychiatrist. All women shared the distress
they felt at being made to feel ‘dirty, shameful, unbalanced, neurotic, stupid
and guilty’. Out of these meetings, the first dedicated women’s health groups
were formed. The intention was to set up centres where skilled medical care
would be available, where women could speak openly about their lives and share
their experiences ‘in an atmosphere of warmth, acceptance and understanding’
(Cooper and Spencer 1978:149).
Feminists, as well as feeling anger about their encounters with the health system,
objected strongly to the entrenched gender order. From the ‘best’ clubs to
local pubs, women were frequently excluded from sporting and social venues.
The bar obliging married women to resign from permanent jobs in the Public
Service had been lifted in 1966 but women were still largely absent from publicsector life. Domestic violence, rape and child sexual abuse were not discussed
openly. A feminist-produced sex education pamphlet for young women was
branded ‘obscene’ by major newspapers in 1971 and abortion-squad detectives
1

Reaching for Health

carried out investigations at Sydney girls’ schools, even though the brochure
had been approved by parents’ and citizens’ associations (Stevens 1995:14–15).
Sanitary pads were wrapped in brown paper and hidden under pharmacy
counters and women’s sexuality was still depicted in Australian obstetrical and
gynaecological textbooks from a heterosexual perspective with women’s natural
aspirations portrayed as marriage and mothering (Koutroulis 1990).
There were few publicly funded support services for women or anyone else who
needed them. After more than 20 years of conservative national government,
the Australian welfare system was in a primordial state, having missed out on
most of the expansion that had taken place in comparable countries after World
War II (Gray 2003; Jones 1990:29–48). The hospital and medical system was
sorely in need of reform; financial barriers to access were high and the range
of services was narrow (Gray 1984, 1991; Sax 1984). Aboriginal communities
and Aboriginal health were ravaged by the combined impacts of colonisation,
racism and government policies. Despite high immigration rates in the 1950s and
1960s, services for newly arrived people were scarce. It was extremely difficult
to find an interpreter, for example, even in the largest hospitals in the country.
There was no public income support for single parents, and about 80 per cent
of court orders for family maintenance were never honoured. Only the wealthy
could afford child care. Some lone mothers, who needed paid work to survive,
took small children with them to early morning cleaning jobs. Others left them
at home to take themselves to school, sometimes hours before the starting bell.
It was in this context that the embryonic women’s health movement made its
first faltering efforts to respond to the calls for help that were being made. As
one participant remembers the early situation: ‘the phone calls and letters were
coming in from women everywhere…They desperately needed information
on abortion, contraception, and many other things that were affecting their
health so badly. And we didn’t know the answers!’ (Zelda D’Aprano, quoted in
Robertson n.d.:Ch. 16).
With few resources and, in many cases, very little knowledge about politics or
medical care, small groups of women set out not only to provide health services
but also to achieve fundamental social change and public policy transformation.
From the beginning, they knew that many of the circumstances of women’s
lives, not least their second-class status, had a detrimental impact on their
health and needed to be changed. They articulated the problems arising from
gender roles, identified domestic violence as a serious women’s health issue and
broke the silence surrounding sexual assault. Where they found glaring gaps in
the services available they tried to fill them by establishing services themselves:
health centres, sexual assault services and refuges for women and children who
had nowhere to go were set up on precarious foundations. They set up telephone
help lines to provide information and support. They took to the streets to fight
2

Introduction

for a woman’s right to choose a safe abortion and they campaigned on factory
floors and within the union movement to modernise occupational health and
safety regimes. Mothers’ groups agitated for women’s control of childbirth and
to achieve maternity-care reform. Feminist-inspired training modules for the
police, the judiciary and other relevant professions were developed, so that sexual
assault and violence services might be delivered more appropriately. Healthcare
providers were trained and educated about feminist health perspectives. The
underlying philosophy was to provide services and support ‘by women, for
women’. Critiques of the social, political and economic organisation of society
were developed, along with strategies for how to promote change. In carrying
out this work, women faced huge obstacles, particularly a shortage of resources
of all kinds.
As time went on, it became increasingly clear that the structural forces supporting
the existing system were not going to be dislodged easily. In health, the power
of organised medicine was brought to bear against every reform proposal, while
pharmaceutical giants continued to peddle their wares. Bureaucracies—not
accustomed to being challenged and comfortable with longstanding structures
and practices—resisted new ideas, especially the notion that there should be
separate women’s services. In the cultural sphere, ideas proved to be durable,
especially discourses around domestic violence and rape. And when women
suggested changes that would improve their economic position, the power of
business and its acolytes mobilised against them. Whether it was communitybased child care, national superannuation or paid maternity leave, the
arguments against were that markets do a better job and are cheaper for the
public purse. The political environment of the very early years was, however, a
rare moment—one that was unusually favourable for the articulation of radical
change proposals.

Radical Reform on the Radar: The context of
the early women’s health movement
In public policy terms, the context in which proposals are developed has a strong
impact on outcomes. Some political contexts facilitate change while others retard
it. The environment in which the Australian women’s health movement emerged
presented perhaps a ‘once in a lifetime’ policy opportunity. Internationally,
change was in the air as radical challenges to the status quo were mounted in
all Organisation for Economic Cooperation and Development (OECD) countries.
Equality-seeking social movements—interested in such issues as civil rights,

3

Reaching for Health

peace, sexuality, the environment, self-help, and consumer, student, worker
and women’s issues—were generating proposals for root-and-branch reform of
existing power relations.
In Australia, the health system was highly controversial. The publicly subsidised
private health insurance system was inequitable, unpopular, complicated and
expensive. Approximately 20 per cent of Australians had no health insurance
coverage and hundreds of thousands had inadequate coverage. Frustration was
widespread because the Liberal Coalition Government1—in power for more than
20 years—had failed to countenance reform except within the parameters of a
private insurance regime. Competition between the major parties was intense
as the Australian Labor Party (ALP), in opposition, developed a series of reform
proposals that generated fierce public debates. Inside the ALP, opinions were
divided between those who supported traditional Labor approaches to health,
including a national, community-based medical service, staffed by salaried
doctors, and those who supported the newer idea of universal health insurance.
The former group opposed the entrenchment of the private fee-for-service
medical practice that would come with national insurance because they thought
it inimical to good health care. Many within the party, therefore, viewed health
insurance as a transitional measure, a step along the way to a comprehensive
public health service, which would have strong primary health care as its
foundation (Gray 2003:274–5). Meanwhile, as well as women and other lowincome groups, Aboriginal people found that the existing system failed to meet
their needs for many reasons, not least of which was widely experienced racism.
An Aboriginal health movement developed that led the way in establishing
community-controlled primary healthcare centres, based on a social view of
health. A social health perspective recognises the impact of political, social,
economic, environmental and cultural factors on health outcomes. It points
out that the full circumstances of people’s lives need to be taken into account
when considering healthcare options. Because life circumstances can be altered,
strategies to achieve that change need to be developed. Income security, housing
security, physical security and the like are essential components of improved
population health. Moreover, disease-prevention strategies are fundamental
elements of a health system, alongside treatment services. A social view of
health is part of the cultural heritage of Aboriginal people. The women’s health
movement and the ‘new’ public health movement had to develop and articulate
this perspective for themselves in the 1960s and 1970s.
1  While several parties are usually represented in the national Parliament, in practice, Australia has a
two-party system. The Liberal Party of Australia (LPA) is the major party of the ‘right’ and, when in office
nationally, it forms a coalition with the small, rural-based party, The Nationals. The ALP is the major party on
the ‘left’. The historical distance between the two parties on health and social policy has, however, gradually
narrowed. Indeed, in 2011, analysts point to the centrism of both. There are two significant minor parties:
the Australian Democrats (AD) and the Australian Greens. After 30 years of success, however, the electoral
fortunes of the AD are presently in decline.
4

Introduction

The Limits to Medicine
Internationally, health reform and healthy public policy movements were
developing. Analyses of the limitations of modern, scientific medicine had
been developing since the 1950s and provided a theoretical underpinning for
structural change proposals. Twentieth-century advances in medical science,
such as improvements in anaesthetics and blood transfusion, had helped to
legitimise a focus on scientific medicine; however, epidemiological research
suggested the need for a broader approach. Health experts began to argue
that hospital and medical systems placed too much emphasis on treatment and
high-tech cures and too little emphasis on prevention and support services.
An individual explanation of the causes of health and illness was challenged
by a social determinants approach, grounded in social, economic and political
structures.
On the basis of work done in the United States, René Dubos drew early attention
to the now well-known idea that medical science was not responsible for the
nineteenth-century decline in mortality from infectious diseases. Rather,
improvements came about as a result of public health measures, including
improvements in water, air and sewage disposal (cited in Conrad 2004:6). This
work was followed by that of McKeown and colleagues, who, in the 1950s,
1960s and 1970s, showed that declines in mortality in England and Wales in the
nineteenth century were the result of social determinants: rising standards of
living, including a healthier diet, improvements in housing and water quality
and better sewerage and waste-disposal systems, accompanied by favourable
trends in the relationship between some micro-organisms and human beings.
Biomedical interventions had made little contribution (McKeown et al. 1975:391).
Other work produced similar findings for Sweden, France, Ireland, Hungary
and the United States (McKinlay and McKinlay 2004:8). Victor Fuchs’ (1974)
well-known work in the United States found that the very different health
outcomes in the neighbouring States of Nevada and Utah were attributable
to social determinants and lifestyle factors, rather than biomedical causes or
health system differences.2 The twentieth century probably presents a more
mixed picture in that lifestyle factors, such as smoking cessation, and medical
interventions have helped to improve population health.
The body of evidence about the importance of the social determinants has not
been well accepted in scientific medical circles. As McKinlay and McKinlay
(2004) report, the notion that modern medical care is not responsible for
improvements in population health (as distinct from improving the outcomes
2  Thirty years later, major differences remain between health outcomes in the two States (Rodwin and CroceGalis 2004).
5

Reaching for Health

of individual episodes of disease), is seen as ‘heresy’. Lack of acceptance by the
most powerful political group in the health landscape is the main reason that
public investment in health services—beyond those produced in hospitals and
doctors’ offices—is low.

Community Health Movements and the ‘New’
Public Health
On the basis of emerging evidence, proposals to change health system structures
were gradually developed. It is often argued that the internationally influential
Lalonde Report, released in Canada in 1974, marks the birth of what is loosely
called the ‘new’ public health. As in public policy generally, however, radical
proposals are invariably built upon previous experience and action. From the
early 1960s onwards, Canadian health experts developed a critique that was
sceptical of excessive reliance on hospital and medical services. They argued for
the establishment of community-based, community-controlled health centres
where care would be provided by teams of health professionals, including allied
health professionals. A full range of preventive and support programs would be
delivered alongside treatment services.
The community-health movement in western Canada has its foundation in the
strong cooperative movement that emerged in the Prairie Provinces about the
beginning of the twentieth century. A municipal doctor scheme was instituted
in the town of Sarnia, Saskatchewan, in 1914. The scheme expanded steadily,
operating in hundreds of towns and villages by 1948 with some services
established in neighbouring Provinces. A network of between 30 and 40
community health centres was set up in Saskatchewan by the early 1960s, where
doctors who wished to accept a salary could practice (Taylor 1979:319). In
terms of the ideas of the day, Canadian health system thinking was radical. The
benefits of community participation in health decision making were endorsed
by the Minister for National Health and Welfare, the Honourable John Monro,
in 1969. In a statement that the Australian women’s health movement would
endorse, Munro argued that ‘the key is contact, the place is the community,
the concept is preventative…group practice, community health centres,
mobile outpatient clinics, increased case findings through home visitation,
greater availability of local alternative institutions, better home care, increased
teamwork with community social agencies’ (Munro 1969, quoted in Donner and
Pederson 2004:5).
The Province of Quebec put many of these ideas into action. On the basis
of recommendations in the Castonguay Report, released in 1967, a Provincewide network of community-controlled health centres was established from
6

Introduction

1971 onwards (Government of Quebec 1970). The best centres provided
comprehensive, holistic care and worked on an outreach model, making contact
with the individuals for whom they were responsible in their catchment
areas. In the same year, the health ministers of Canada set up an inquiry into
community health centres, which reported in 1972 and recommended adoption
by provincial governments (Health and Welfare Canada 1972). Community
participation was stressed in the Manitoba Government’s White Paper on
Health Policy, released in 1972. The Foulkes Report (1973) in British Columbia
recommended that health and social services be integrated, that investment be
made in preventive services and that care be coordinated, with patients assisted
to traverse their way through the system. The Ontario Health Planning Task
Force in its 1974 report argued that primary health care should be the centre of
the health system and that services should be comprehensive, continuous and
delivered by teams of health professionals.
Thus, when the Lalonde Report, A New Perspective on the Health of Canadians,
was published, it built upon Saskatchewan tradition, Quebec innovations and
a decade and a half of discussion about how to achieve a more comprehensive
health system. It argued for broad reforms, including the establishment of
networks of community health centres.
By the late 1960s, community health and new public health movements began
to appear outside Canada. A resurgent community health centre movement
emerged in the United States3 as the healthcare arm of the civil rights movement.
An Aboriginal health movement and a community health movement developed
alongside the women’s health movement in Australia. In turn, by the time the
World Health Organisation (WHO) produced the Alma Ata declaration in 1978,
there was Canadian and Australian experience on which to draw. A social view
of health, preventive primary health care, and improved environments for
health, community participation and inter-sectoral action were all central to the
WHO strategy of ‘Health for All’ by the year 2000.

The Aboriginal Health Movement
The Australian Aboriginal health movement arose in part from intense
dissatisfaction with mainstream hospital and medical care, where a ‘cultural
chasm’ separated Aboriginal people and mainstream service providers
(Palmer and Short 1989:235; Saggers and Gray 1991:144, 147). In addition
to discrimination and racism, user charges prevented low-income earners
from accessing services. Recent research shows that health spaces need to be
3  There was a previous mobilisation in the 1920s.
7

Reaching for Health

‘Aboriginal friendly’, especially Aboriginal-women friendly, to allow people to
feel welcome and comfortable. Where everything in the space pertains to the
dominant culture, colonial stereotypes are ‘reinscribed’ (Fredericks 2009:41). In
order to provide culturally appropriate and accessible services, the Aboriginal
Medical Service (AMS) was set up in 1971 at Redfern, Sydney, by a community
group that included Shirley Smith and Gordon Briscoe. Within a year, the
Aboriginal population of Sydney had increased from a couple of thousand to 32
000 people as a result of freedom from confinement on reserves and subsequent
congregation in cities in search of a means of survival (Foley 1984:112). Like early
women’s health centres, Redfern AMS opened in extremely humble premises
and relied on donations and volunteer staff. Also as in women’s health, it
gradually secured precarious funding after extensive lobbying and submissions
and, over the years, was able to expand. By 1974, Redfern was ‘a free first-class
medical service, created by Aborigines for Aborigines in the Redfern area, with
similar facilities at the La Perouse settlement and with medical teams, headed by
Aborigines, visiting country settlements’ (Briscoe 1974:169).
Redfern AMS, the first community-controlled health service in Australia,
was ahead of its time (Palmer and Short 1989:235) and it inspired Aboriginal
communities across the country to set up their own health services. The Central
Australian Aboriginal Congress Health Centre in Alice Springs, the Fitzroy
Aboriginal Health Service in Melbourne and Derbarl Yerrigan Health Service
in Perth were all established in 1973. In 1974, at a national AMS meeting in
Albury, New South Wales, it was proposed that a national health organisation be
established. The National Aboriginal and Islander Health Organisation (NAIHO)
came into being in 1976—its first meeting funded by Redfern AMS. An office was
established in Melbourne and the organisation survived on donations for nine
years until it received its first government funds in 1985. In 1992, its name was
changed to the National Aboriginal Community Controlled Health Organisation
(NACCHO), and in 1997 it was funded to establish a secretariat in Canberra—a
location that facilitates access to policymakers. Similar peak organisations have
been established at the State and Territory levels (NACCHO web site).
The Aboriginal health movement takes a social health perspective, focusing
on support, empowerment and community control through elected boards of
management, local participation, disease prevention and provision of care by
multidisciplinary teams. Aboriginal health is defined by NACCHO as
not just the physical wellbeing of an individual but the social, emotional
and cultural wellbeing of the whole community in which each individual
is able to achieve their full potential, thereby bringing about the total
wellbeing of their community. It is a whole-of-life view and includes the
cyclical concept of life-death-life. (NACCHO web site)
8

Introduction

From the beginning, Aboriginal Community Controlled Health Services (ACCHSs)
aimed to deliver holistic, comprehensive and culturally appropriate care, with
a preventive and health education focus. The Central Australian Aboriginal
Congress (CAAC), in a submission applying for Commonwealth funding in 1974,
argued that the new centre being proposed should have ‘both a preventive and
[a] curative approach’, should be oriented towards the community and should
provide appropriate training for Aboriginal health workers (Perkins 1975:32).
The emphasis on community participation and community control was partly
based on awareness that such structures can readily respond to changing
needs—a bottom-up rather than a top-down approach (Bartlett and Boffa
2001). In the view of the congress, health cannot be considered separately from
people’s access to other resources, such as housing, education, employment, land
rights, food, recreation facilities and community development (Rosewarne et al.
2007:10). The new centre was to have a good relationship with secondary and
tertiary services to provide what, in present-day language, is called ‘continuity
of care’.
The origins of a holistic health perspective among Aboriginal people appear
to be embedded in the importance placed on each member of the community.
When Grace Kong, an Aboriginal women’s health nurse practitioner in New
South Wales, was asked whether her family was proud of her achievements,
she replied: ‘I think that with Koories our outlook on life is very different from
yours. Every single person that belongs to a Koori community is important,
regardless of what their role is, so that the fact of what I have achieved is nice
but so what?’ (Kong quoted in Smith 1992:27).
Moreover, it appears that there is no word meaning ‘health’ in Aboriginal
languages. Words that might mean something like the English word suggest
an approach to wellbeing that encompasses all aspects of life, including food,
housing and family—a truly social perspective. The Redfern AMS founders
thought that a health service should be able to meet the day-to-day needs of
consumers (Briscoe 1974:170). A CAAC submission in 1974 recognised that the
curative services provided by European medical systems ‘did not and could not’
meet Aboriginal needs. By 1976, it was being argued that ‘healthy living cannot
be developed without total community development under total community
control’ (Rosewarne et al. 2007:10).4
The Aboriginal concept of community health is exemplified in the rationale for
women’s stress-free days organised by Aboriginal health workers in La Perouse,
New South Wales, in 2001. The primary concern in this case was not for women
4  This conclusion was reached by Aboriginal people in Australia prior to and independently of the WHO’s
adoption of a social view of health at the end of the 1970s. The WHO’s own revision of thinking was strongly
influenced by the failure to improve population health in developing countries through the provision of
conventional medical services (Cueto 2004).
9

Reaching for Health

but for local youth. The reasoning is that the best way to empower young people
is to empower their mothers, who benefit from the support networks formed as
they come together (Aboriginal and Islander Health Worker Journal 2001a:14).
About the same time that Aboriginal people were setting up their first
community-controlled health services, health system restructuring plans were
being developed in the States, particularly in New South Wales. Communitybased services were being proposed, including aged care and mental health
services. A few limited-scale community health centres were set up in New
South Wales, providing child health services, dental and mental health care and
rehabilitation, domiciliary nursing and home-care services. Health education
outreach teams worked from some centres. In 1972, the Health Commission Act
was passed, which was informed by social health principles and provided for
the representation of consumer interests. Ideas from New South Wales spread
to other States through a body of Commonwealth and State officials known as
the Hospitals and Allied Services Advisory Council, set up to advise Australian
health ministers (Sax 1980; Shea 1970). Other States gradually enacted similar
legislation but the capacity of Australia’s sub-national jurisdictions to advance
policy reform was severely constrained by the financial centralisation of the
Australian federation. In other words, spare cash was, and still is, in short
supply in State and Territory coffers.
The reforms being developed in the Australian States were in line with historical
ALP support for locally based medical services. The new ideas found their way
into ALP policy partly through the office of the leader, Gough Whitlam, who
was keenly interested in the problems of the rapidly expanding, under-serviced,
outer-metropolitan areas of Sydney and Melbourne. Members of Whitlam’s
electoral office were in regular contact with officials in the Health Department of
New South Wales. They were supplied with research papers and detailed policy
proposals.5 By 1971, the ALP had developed plans for comprehensive health
system reform, including regionalised, community-based services, community
health centres, refurbished hospitals and national health insurance. ‘Preventive,
occupational and rehabilitation services’ were to be ‘key elements’ of the health
system (Sax 1984:100–3).
The women’s health movement in Australia, then, emerged at a time when ideas
about the social causes of ill health were beginning to run hot. The movement
drew upon these ideas, endorsed them and contributed to their development and
expansion. Together with the Aboriginal and community health movements, it
played a pioneering role in taking health and health care out of the personal
5  Information about health policy developments in New South Wales and other Australian States and about
contact between the New South Wales Health Department and Whitlam’s office was provided by the late Dr
Sidney Sax, Director of Health Research and Planning in New South Wales in the 1960s and early 1970s and
Chairman of the Hospitals and Health Services Commission, 1973–78.
10

Introduction

sphere and into the public domain, understanding that good health for all is
impossible without social and economic changes (Donner and Pederson 2004:2).
As commentators have argued, the principles underpinning women’s health
services are ‘almost identical’ to those of the new public health and community
health (Auer et al 1987:2; Dwyer 1992a:212). In Table 1, the similarities between
approaches are readily apparent.
Table 1
OLD PUBLIC
HEALTH

NEW PUBLIC
HEALTH

FEMINIST
HEALTH

ABORIGINAL
HEALTH

Focus on
improving physical
infrastructure to
provide adequate
housing, clean water
and sanitation.

Focus on physical
infrastructure,
but also on social
support, behaviour
and lifestyle.

Focus on physical
infrastructure,
but also on social
support and
empowerment,
especially through
information provision
and respectful
interactions.

Focus on
improving physical
infrastructure to
provide adequate
housing, clean
water, sanitation and
so on, but equally
on social support
and empowerment
through community
development.

Legislation the key
policy mechanism
especially in the
nineteenth century.

Legislation and
policy rediscovered
as crucial tools for
public health.

Legislation and
policy seen as crucial
tools for women’s
health, especially in
relation to the social
determinants of
health.

Not much expected
from legislation and
policy in view of past
experiences. Some
emphasis on lobbying
to change the shape
of healthcare delivery
system.

Medical profession
has a central place.

Recognition of intersectoral action as
crucial. Medicine
only one of the
many professions
contributing.

Recognition of intersectoral action as
crucial. Medicine
only one of many
professions and
service providers
contributing.

Recognition of intersectoral action as
crucial. Medicine,
including traditional
medicine, only one
of many professions
and service providers
contributing.

In nineteenth
century, public health
was one of a series
of social movements
that worked to
improve living
conditions. Primarily
expert driven but
some legitimation
of community
movement.
Progressively more
expert dominated in
twentieth century.

Philosophy places
strong emphasis
on community
participation, but,
in practice, this is
not often achieved,
despite some real
successes.

Philosophy places
strong emphasis
on women’s
participation
and community
participation. Often
achieved at the local
level. Consumers
and professionals
considered to be
equals.

Philosophy places
strong emphasis on
community control
and community
participation the sine
qua non. Consumers
and professionals
considered to be
equals.

11

Reaching for Health

OLD PUBLIC
HEALTH

NEW PUBLIC
HEALTH

FEMINIST
HEALTH

ABORIGINAL
HEALTH

Epidemiology
legitimate research
method.

Many methodologies
recognised as
legitimate.

Many methodologies
legitimate. Validation
of women’s
experiences.

Many methodologies
recognised as
legitimate. Validation
of people’s own
experiences.

Focus on disease
prevention. Health is
seen as absence of
illness.

Focus on disease
prevention, health
promotion and a
positive definition of
health.

Focus on disease
prevention and
health promotion,
with emphasis on
group sessions,
support and
education services
and community
development. A
positive definition of
health.

Focus on disease
prevention, with
strong emphasis
on culturally
appropriate,
integrated, holistic
care. A positive,
holistic definition of
health.

Primary concern
was the prevention
of infectious and
contagious threats to
human health.

Concern with all
threats to health
(including chronic
disease and mental
health issues) but
also growing concern
with sustainability
and viability of
the physical
environment.

Concern with all
threats to health,
including neglected
issues, such as
mental health.
Concern with
avoidable health
inequalities. Focus
on the social
determinants of
health, especially
economic, social,
political and
cultural threats to
health. Concern
with sustainability
and viability
of the physical
environment.

Concern with all
threats to health,
including seriously
neglected issues.
Concern with
avoidable health
inequalities. Focus
on the social
determinants of
health especially
racist, economic,
social and political
threats. Concern
with preservation
of the physical
environment and
access to land.

In Table 1, feminist and Aboriginal health principles have been added to Fran
Baum’s (2007) comparison of the main elements of the old public health and the
new public health. The parallels are clear, especially between the Aboriginal
health movement and the women’s health movement, as Jenny Baker (1998)
has noted. In her view, non-Aboriginal women’s struggles for control over
their bodies are similar to Aboriginal struggles for the rights of freedom and
control over their own lives against Aborigines Protection Acts and other acts
of ‘confinement and segregation’. She points out that collectives were set up
and celebrated in both movements. Moreover, both movements, she argues,
‘fundamentally challenge the Australian health system to pursue primary
health care and community development, based on community management,
input and ownership’ (Baker 1998:92).

12

Introduction

The harmony between the principles of the three movements was an important
factor facilitating policy implementation in the early 1970s. Policymakers at the
Hospitals and Health Services Commission (HHSC) had developed plans for a
national community health scheme and women’s and Aboriginal health centres
fitted comfortably into the framework. Officers of the commission helped, as far
as possible, to overcome the obstacles put in place by sub-national bureaucracies
and by antagonistic vested interests. Dr Sidney Sax, Chairman of the HHSC, had
a strong background in primary health care. Along with Dr Gwen Greenman, his
wife, he had provided medical services for poor people in South Africa. The two
had set up a large community health centre in Alexandra Township, a violent,
overcrowded settlement on the edge of Johannesburg (Royal Australasian
College of Physicians web site). After arriving in Australia, Dr Sax participated
in work to develop community health services for New South Wales, and, in his
senior health policy position for the Whitlam Government, he was well placed
to support strong primary health care, including separate women’s health
centres. This policy direction was also championed by some members of the
Labor Government. The reform ideas being articulated posed a major challenge
to both health system structures and society’s wider institutions.
When the Whitlam Government lost office, there were six funded women’s health
centres and 21 refuges approved for funding. The first national women’s health
conference had been held in Brisbane in 1975 and was opened by the Prime
Minister. The first Commonwealth funding had been provided for Aboriginalcontrolled health centres and a network of community health centres had been
set up. The period of the Fraser Commonwealth Government (1975–83), however,
brought severe cuts in community health program funding under which most
women’s health centres were supported. The centres were forced to turn to State
governments for funding—a long process but one that eventually bore fruit.
Despite the unfavourable political climate at the Commonwealth level after 1975,
the women’s health movement continued to expand and to campaign for policy
reform on a number of fronts. Several State and Territory governments took
positive action in the 1980s, developing women’s health policies and strategies.
The movement staged a second national women’s health conference in Adelaide
in 1985. Work at the grassroots level slowly percolated upwards, creating
another policy opportunity when a second Commonwealth government willing
to support women’s health came to power. The Hawke Labor Government,
elected in 1983, found that women’s health, including maternity-care reform
and occupational health and safety (OHS), was a major concern when it held
consultations for its National Agenda for Women. Policy action was announced,
a consultation and policy development process was undertaken and, in 1989,
Australia became the first and only country to implement a national policy on
women’s health.
13

Reaching for Health

Australia’s First National Women’s Health
Policy
The 1989 National Women’s Health Policy (NWHP) is the high point of policy
achievement for the movement. Indeed, the 1980s can be seen as the golden
years of policy achievement. The NWHP identified six underpinning principles:
a social view of health; a lifespan approach without undue focus on the
reproductive years; participation by women in decision making as consumers
and providers; women’s rights as healthcare consumers, including privacy,
confidentiality, informed consent and the right to be treated with dignity; the
right to accessible information in order to make informed decisions; and the
need for accurate data and research, including women’s views about health.
The seven priority issues selected were reproductive health and sexuality, the
health of ageing women, emotional and mental health, violence against women,
occupational health and safety, the health needs of carers and the health
effects of sex-role stereotyping. The five key actions developed to advance
the priorities were improvements in health services for women, provision of
health information, research and data collection on women’s health, women’s
participation in health decision making and the training of healthcare providers
(Commonwealth of Australia 1989:78–81).
The development of affordable, acceptable, accessible and appropriate health
services was to take place through a ‘dual strategy’. A separate women’s
health sector would examine new issues and develop new models of practice
in participation with women on a day-to-day basis in a ‘comprehensive and
accessible’ network of primary healthcare services. Practice in the separate
sector would lead by example, influencing the way the mainstream operated
(Commonwealth of Australia 1989:82). During the consultations, women
expressed strong support for separate women’s services that would be low
cost, multidisciplinary, holistic, located in one place and would provide illnessprevention information and advice. Women said they wanted to participate
in decisions about health and treatment and they looked forward to being
able to choose services that had been tailored to meet their needs. A separate
women’s health sector was essential to the improvement of mainstream services
(Commonwealth of Australia 1989:60–1; Dwyer 1992a:213).
By the early 1990s, experience showed that changes had already been wrought.
Feminist criticisms of inappropriate minor tranquilliser use, for example, had
become respectable and were acknowledged in the mainstream after a decade
of lobbying. Another example was that the work done in rape crisis centres
had become a model for more appropriate policies and practices in mainstream

14

Introduction

services. In two decades, the ‘movement had extended the territory’ of what
could be discussed ‘in mainstream debates about how to care for women’ (Dwyer
1992b:26).
The National Women’s Health Policy and Program continued to advance
women’s health for years after its launch. Having the ideas and concerns of
Australian women written in black and white in a national policy document
not only increased their currency but also bestowed legitimacy. Policymakers
and activists alike could refer to the principles enunciated and the evidence
presented. The separate women’s health sector was enlarged and a wide
assortment of projects and programs was supported, creating a strong basis for
innovation and political action.
The election of the neo-liberal Howard Commonwealth Government in 1996,
however, ushered in more than a decade of antipathy towards the women’s
movement. In 1997, responsibility for the provision of women’s health services
was handed over to the States and Territories, although the national share of
funding was maintained. Shortly after the Howard Government was elected,
a delegation from the Australian Women’s Health Network (AWHN) arranged
a meeting with the Minister Assisting the Prime Minister for the Status of
Women. Members of the delegation were taken aback when the minister opened
the conversation by asking, ‘Well, girls, is there anything left to achieve in
women’s health?’
In 2004, the Commonwealth made an unsuccessful attempt to exclude women’s
health services from the funding flowing through public health financing
channels. During this period, the States and Territories, for their part, all
maintained existing services, although no conditions requiring them to do so
were attached to Commonwealth funding. Although the Commonwealth policy
environment was hostile, at the sub-national level, women in government and
outside were able to use the policy to support their arguments and claims.
From 1995 onwards, the women’s health movement consistently called for
revision and updating of the NWHP and for a resumption of Commonwealth
responsibility but there was no policy response. A change in direction took
place in 2007, however, when the ALP heard the message and committed itself
to a new NWHP should it win the next national election. This was the only
women-specific policy that the major parties took to the election—an indication
of changing attitudes to women’s issues and the importance of women’s vote
since the 1970s.

15

Reaching for Health

The Relevance of the 1970s for Present-Day
Health Reform
The structural proposals developed in the 1970s have lost none of their
relevance. Indeed, they might be even more relevant in the twenty-first century
as lifestyle factors such as obesity increasingly undermine health at the same
time as increasing the cost of hospital and medical services. Without structural
change, a destructive spiral is created: more people suffer from more serious
and chronic illnesses, the costs of treatment continue to climb, rendering
the prospect of significant investment in primary health care and prevention
increasingly unlikely.
Nor have women’s health priorities lost their relevance. Violence, sexual assault
and sexual and reproductive health problems persist. Preventive health and
support services are still in short supply. Mental health—long the Cinderella
of health issues and a major concern for women, as the NWHP pointed out—
is at last receiving more policy attention but huge shortcomings remain. The
community-based primary healthcare sector is small and fragile, after many
years of neglect. Financial barriers to hospital and medical services are not as
high as they were in the pre-Medicare 1970s but steadily increasing user charges
are preventing people, especially low-income earners, from using services.
Geographical access remains a serious problem: all services are scarce outside
the cities, while access to culturally appropriate care is still a priority for nonAnglo-Australian women.
All the while, the international health research community, including the WHO,
continues to produce evidence endorsing a social health perspective. The WHO
released an influential report in 2008 that argues that daily living conditions—
including a healthy environment, the availability of fairly paid work, economic
security, a fair distribution of resources and power and access to a comprehensive
range of services—are essential for decent health. Recommendations include
political empowerment for the marginalised, gender equity6 and greater equity
in all public policies, including taxation. The report points to serious, avoidable
health inequalities, not only between countries but also between different
groups within single countries. It presents the astonishing example of a 28year discrepancy in life expectancy between men living in different suburbs of
Glasgow (WHO 2008a:32).
In keeping with this evidence, the social determinants of health are now more
widely acknowledged in Australian policymaking circles. All the major policy
6  Gender, in contrast with biological sex, has been described as ‘the array of socially and culturally
constructed roles, personality traits, attitudes, behaviours, values, relative power, and influence that society
ascribes to the two sexes on a differential basis’ (Canadian Institutes of Health Research 2000).
16

Introduction

documents of recent years recognise the structural causes of ill health, including
acknowledgment of gender as an important determinant. A gender perspective,
like a diversity perspective, recognises that differently placed people—in this
case, men and women—experience health and illness differently and that
different expectations and norms influence experience and behaviour. Similarly,
it is recognised that socially and culturally determined roles and expectations
influence outcomes for people, including those with disabilities and those from
different income and ethnic groups. Moreover, discussion documents argue that
preventable health inequalities can—and should—be reduced.
So why is it, then, that although the need for structural reform through
investment in preventive primary health care is recognised, so little action
is taken? The answer lies chiefly in the immense political power of opposing
interests. In the first place, there are the vested interests of providers, who
benefit financially from the system as it stands. As the biggest single industry
in OECD countries, the health sector provides high incomes and profits and
prestigious positions for large numbers of service and technology producers. In
Australia, system arrangements directly augment incomes and profits through
hefty public subsidies. Change is vehemently resisted when it threatens to
disturb existing distributions of income and status (see, for example, Alford
1975; Evans 1998; Sax 1984). Another barrier, as mentioned, is the increasing
cost to the public purse of expensive hospital and medical services. A related
factor is that business-sector interests are a less direct but nevertheless powerful
set of opposing forces. By promoting the value of balanced budgets, low taxation
and a market distribution of goods and services, they make it politically difficult
for governments to find new money for investment in areas such as primary
health care.
Under the Rudd and Gillard Commonwealth Governments, a small window
of opportunity for reform was opened. The Commonwealth has claimed
health reform as a priority since 2007 and incremental responses based on
the recommendations of recent inquiries are beginning to be introduced.
Action includes a commitment to ‘closing the gap’ between Aboriginal and
non-Aboriginal health outcomes, for which some funding has been allocated.
Ironically, it is under the top-down Northern Territory Emergency Response
that Aboriginal-controlled health services are being expanded. While it is too
early to assess the impact of the changes, the Rudd and Gillard health reforms
are discussed further in the concluding chapter.

17

Reaching for Health

About this Volume
This account of the history and politics of the Australian women’s health
movement traces its presence as an integral part of the wider reform movements
of the 1970s, particularly the health reform movements. It provides a record
of some of the work women have done and locates actions and events in the
context of general political and social forces, including the opposing forces
that have impeded the path to reform. It looks also at the way windows of
opportunity for policy advancement opened in different jurisdictions at certain
times, and offers an explanation of the reasons for this, with particular attention
to the impact of feminist activism. Those readers who are primarily interested
in the movement and its activism might wish to focus on the first six chapters.
Those more interested in public policy and the influences that shape it will find
this discussion from Chapter 7 onwards.
The story told here is only one among many possible accounts of the Australian
women’s health movement and its impact on public policy. It draws upon a
rich tapestry of experiences, which is open to interpretation from a variety
of perspectives. I anticipate that some readers will disagree with some of my
arguments and with the emphasis placed on some events and issues rather
than others. This is unavoidable given that the movement encompassed
diverse perspectives from the beginning. Some women might wish to focus on
the uniqueness of the movement’s ideas. I have chosen to draw attention to
the strong concordance between the principles of women’s health and other
sets of reform ideas, including those that predated the movement, those that
were at the cutting edge in the 1970s and those that are on international
and Australian political agendas in 2011. In making these connections, the
overlap between the principles of women’s health and those of the community
health/new public health movements and the Aboriginal health movement is
clear. What all these approaches have in common is a structural view of the
causes of health and illness. Hence, they focus on improving the health of
whole populations, especially those groups most at risk, through investment
in community-based, preventive approaches, which would complement the
system for treating individual episodes of disease. Persuading policymakers to
adopt this comprehensive approach to the health system has been one of the
major objectives of the women’s health movement.
The health centre movement, the movements against violence and sexual assault,
the maternity-care reform movement and the movement for reproductive rights
have been selected for discussion. Activism to achieve women’s reproductive

18

Introduction

rights7 has been part of the work of all feminist groups. Initially, the women
who set up centres and services were all feminists. Indeed, the movement ‘has
its ideological base in feminism’ (Shuttleworth 1992:17). But as time went on,
women who do not necessarily so describe themselves have promoted women’s
health. Because of space constraints, however, discussion will focus mainly on
feminist work and action—the driving forces of the movement, especially in
terms of advocacy for structural change.
From the late 1970s onwards, there was a remarkable proliferation of women’s
health groups—an indication of the strength of the movement. To name just a
few in no particular order, groups for women with eating disorders, postnatal
depression, HIV/AIDS and mental health problems have been established,
alongside others focusing on lesbian health, maternity care, cancer support and
the wellbeing of older women carers. Some work within an overtly feminist
framework; others do not. While all are part of the modern women’s health
movement, it is clearly beyond the scope of a single volume to examine them all.
One important grouping that I have left to one side is Australia’s network of
Family Planning Associations, which have made a strong contribution to
women’s health. Family Planning Associations have, however, never branded
themselves as part of the women’s movement and they predate the second-wave
movement.8 In 1960, the Racial Hygiene Association changed its name to the
Family Planning Association of Australia and in 1961 it opened its first clinic
in Melbourne. Men, as well as women, have always been part of the active
membership (Siedlecky and Wyndham 1990). Space constraints prevent even a
cursory glance at this movement’s multifaceted activities. The YWCA is another
group whose work is not covered, despite having made a significant contribution.
It works to facilitate community development and to provide support for young
women and young families. Indeed, its focus on the many aspects of life that
impact on wellbeing is consistent with a social health perspective. Moreover,
the ‘Y’ has frequently worked with sections of the women’s health movement on
specific projects. Other women’s groups that have worked to advance women’s
health include the Country Women’s Association (CWA), the Catholic Women’s
League and the National Council of Women of Australia. These organisations do
not, however, always support feminist goals and are not primarily concerned
with health.
A focus on ‘feminist’ women’s health groups raises the question of what I mean
by the term in this book. There has never been a single feminism in Australia, as
examination of serious disagreements in the following pages will show. Moreover,
7  Many Aboriginal and Torres Strait Islander women see reproductive rights differently—discussed further
below.
8  For the purposes of this account, the ‘second-wave’ women’s movement is the surge of feminist activism
that took place in most OECD countries from the late 1960s onwards.
19

Reaching for Health

from the 1980s onwards, the existence of many ‘feminisms’ was recognised.
Some versions have lost support and new perspectives have emerged, so that
any definition has to be flexible and inclusive. I favour the kind of portrayal
developed by the editors of the Oxford Companion to Australian Feminism,
because it seems able to account for multiple strands of thought. ‘Feminism’, the
editors propose, ‘involves a sense of and concern with women’s oppression, an
interest and engagement in addressing, altering, or reforming it and a concern
about women’s claims to full citizenship and to recognise their social economic,
cultural and political participation’ (Caine et al. 1998:x). A feminist approach in
women’s health has been described as one where there is an
emphasis on ‘empowering’ women rather than ‘helping’ them, of
‘engaging’ women in their own health care management, rather than
‘fixing’ them, and providing information so that women make their
own informed decisions…the feminist/women-centred health model
provides an active and equitable exchange where the health professional
is recognised for her skill and expertise but the woman is recognised to
be the expert in her own life and circumstances. (Cameron and Velthuys
2005)
What follows is a policy study, set in historical perspective, which seeks to
answer major questions. Why is Australia the only country to have enacted
two national women’s health policies? Why is it also the only country to have
attempted to establish a national network of community health centres? Why is
it a leader, internationally, in developing public responses to domestic violence?
What are the conditions that have come together at different times to create
windows of opportunity for structural health reform? And what are the major
obstacles? Why, despite the evidence, the hard work of so many groups of
citizens and acknowledgment by policymakers, do the structures of the health
system in 2011 remain much as they were 40 years ago?
The organisation of the book is as follows. The first chapter examines the
women’s health movement, the ideas that influenced it and that it developed
further. It reviews feminist critiques of the conditions of women’s lives and of
the conventional medical system. The unique Australian debate about whether
or not to accept government funding to help run services is examined, along
with criticisms that the Australian women’s movement is Anglocentric. Chapter
2 provides a glimpse of pioneering women in action at the grassroots level, as
they organised, set up separate services and attempted to put women’s health
on policy agendas. Chapter 3 examines the consolidation phase, when more
health centres were established and women moved to work in funded services
alongside their grassroots sisters. Chapter 4 looks at the growth and strength of
the movement as groups within it proliferated and traces the networks, formal
and informal, that women formed. The extensive collaborations between groups,
20

Introduction

including inter-organisational action to advance occupational health and safety,
are examined in Chapter 5. The struggle for reproductive rights, including
maternity rights, is discussed in Chapter 6. State and Territory government
responses to women’s advocacy are examined in Chapter 7, and Chapter 8
traces Commonwealth policy responses, including the development of the two
national policies. The ninth chapter is an analysis of broad policy determinants
that have shaped responses to the movement. An evaluation of the social change
and policy reform achieved is presented in the concluding chapter.

21

1. Concepts, Concerns, Critiques
The driving ideas and principles underpinning the Australian women’s health
movement have remained remarkably stable over time, which is counterintuitive
given that the movement has always included women with a range of
perspectives. As Stevens (1995:26) has argued, the context of the early years
was not ‘quiet conformity to an overarching ideology’ but rather a time of ‘great
turbulence in the development of new ideas, forms of organisation and in the
ways in which women related to each other’. Ideas were developed, changed and
reformulated in line with experience and changing circumstances. For example,
among those setting up early centres and services the question of whether to
accept government funding was contentious. While opinions were strong and
feelings ran high, the issue was resolved relatively quickly because agencies
could not survive without financial support. Similarly, aspects of the feminist
critique of conventional medicine lost some of their relevance as appropriate
responses were put in place. Other parts of the critique, such as questions of
unnecessary medicalisation and criticising the inadequacy of pharmaceutical
safety evaluation, are as relevant as they ever were.
Priorities sometimes differed even when agreement was strong. Among AngloAustralian women, there was general agreement on a number of central issues,
including the harmful effects of Western gender roles, the shortcomings of
conventional hospital and medical services, the gaps in available services, the
need for information to make informed decisions about health and treatment
and women’s reproductive-health rights. In setting out to achieve change where
it was vital, movement members were initially unaware that their concerns
were not shared by all Australian women and that for some, racism and cultural
insensitivity were higher priorities. Differences between women from divergent
backgrounds gave rise to animosities and tensions, some of which remain but
in working to improve women’s health through multiple avenues many groups
have nevertheless developed successful collaborations.
The unifying set of ideas around which the movement revolves is that which
underpins a social view of health. The social perspective developed early
and took deep root, creating common ground between women from diverse
backgrounds. There is wide agreement among feminists with its underlying
principles, which include social justice, holism, respect, empowerment and
participation. Immigrant women applied these principles in the services they
established and Aboriginal women seem always to have known about the social
determinants of health.

23

Reaching for Health

Women and Healthcare Provision through the
Ages
Legislators, priests, philosophers, writers, and scientists have striven to
show that the subordinate position of women is willed in heaven and
advantageous on earth. (de Beauvoir 1972:22)
Second-wave women’s health activism, in Australia and elsewhere, was cast
by many as radical in the early years. Throughout history, however, women
have struggled to gain and retain a respected voice in healthcare decision
making. Direct action in support of women’s health rights is recorded as early
as the third century BC when Agnodice was arrested and tried for practising
gynaecology and obstetrics, allegedly without formal training—a forerunner to
modern accusations that some women’s health workers are not properly trained.
The leading men of Athens found her guilty but her patients demonstrated
in her support, forcing men to change the law and allow women to train and
practice.1 Since then, women have struggled against repeated attempts made
on religious and other grounds by churches, governments and male members
of medical professions to exclude them from medical education and to preclude
independent midwifery practice.
Women have provided health care for their families and community members
as nurses, unlicensed doctors, pharmacists, herbalists, abortionists, counsellors
and midwives since ancient times (Ehrenreich and English 1973:3; Willis
1983:94). Records have it that a midwife was present at the birth of the prophet
Mohammed in 570 (Giladi 2010:190). Khaldun, a Muslim historiographer who
died in 1406, dedicated a chapter of a large history to midwifery, arguing that
midwives were better acquainted with obstetrics than others and better able
to treat children’s ailments than male physicians (Giladi 2010:185). In Europe
and the Middle East, women continued to practice both as midwives and as
obstetricians, despite opposition and sometimes in contravention of the law.
In England, the term ‘man-midwife’ first appeared in the seventeenth century
but, until the twentieth century, childbirth was almost exclusively women’s
business (Willis 1983:94–6).
Aboriginal women played an important role in Australian history as midwives
in their own communities and for non-Aboriginal women in country areas.
They also played a role in caring for non-Aboriginal women when they were ill.
Women from the Wiradjuri tribe, whose country is central New South Wales,
are reported to have delivered as many white babies as black babies (Gaff-Smith
1  Whether Agnodice was a historical figure has been questioned; however, even if she were not, the
recorded struggle was clearly part of ancient experience. The story is eerily similar to modern attempts to
keep women out of medicine.
24

1. Concepts, Concerns, Critiques

2003:20). A settler’s wife has told an illuminating story of being called to assist
at a premature birth. The distressed husband read from a medical book outside
the room and shouted orders, while the Aboriginal midwife, Fanny, ignored him
and the settler’s wife and quietly did what needed to be done. A premature baby
girl ‘so tiny she would have fitted into a pint jug’ was safely born (Holthouse
1973:85–6). Childbirth is still women’s business for many Aboriginal women,
with mothers passing knowledge from generation to generation and assisting
daughters during birthing (Webb 1986:1–3). Similarly, a century ago in rural
New South Wales, my own great-grandmother was midwife at my mother’s birth
and the births of my uncles and aunts. She was midwife also for extended family
members and anyone in surrounding communities who chose to call for her. I
am not aware that she had any formal training, nor are there written records of
her work; Australian midwives left very few accounts of what they did (Willis
1983:94).

Women’s Health Reform Movements
In the United States, Weisman (1998) has identified what she calls a women’s
health ‘megamovement’ over the past two centuries, comprising several
‘episodes of intense public attention to women’s health’. Women were prominent
in the social health movement of the 1830s and 1840s, which advocated what
is now called primary health care2 and set up training and information sessions
(Baldry 1992). Women physicians and social reformers took leading roles in a
subsequent wave of women’s health action in the concluding decades of the
nineteenth century—a struggle partly about reproductive rights. This period
coincided with the women’s suffrage movement in North America and Europe,
Australia and New Zealand. A later women’s health activity phase, between 1900
and the 1920s, focused on maternal and child health, sex education and birthcontrol rights. Margaret Sanger, a public health nurse and reproductive-rights
activist, founded the American Birth Control League in 1921, after witnessing
shocking loss of young life for want of appropriate information and care.
The organisation became the Planned Parenthood Federation of America in
1942. It played a major role in the struggle for medical abortion in the United
States, which was legalised in September 2000. The fourth stage of the women’s
health ‘megamovement’ is the grassroots movement that began in the late 1960s
(Weisman 1998:37–92).
2  There is a distinct difference between primary health care and primary medical care. Whereas primary
health care focuses on the provision of a comprehensive range of community-based services, including
prevention, primary medical care is mainly concerned with the delivery of conventional treatment services to
individuals. The distinction is important because, as Keleher (2001:57) argues, primary health care can make
a difference to health inequalities in the population as a whole whereas primary medical care treats individual
episodes of disease.
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Reaching for Health

Australia, too, has seen several waves of women’s health activism. A women’s
movement, at least partly concerned with health, has been present since the
nineteenth century. Marilyn Lake (1999) has shown that the women’s movement
did not disappear after that ‘first wave’ but that women remained active through
the twentieth century, struggling for a range of rights and freedoms, including
equal pay, reproductive rights and sex education. At the end of the nineteenth
century, Australian women agitated for special women’s health services. Womenonly hospitals run by and for women were established in capital cities. Demand
for these services was overwhelming. For example, women are reported to have
come ‘in droves from all over Victoria’ to the Victoria Hospital for Women,
which was opened in a small church hall in 1896 (Robertson n.d.). In an early
example of Australian women taking a social health perspective, the Women’s
Progressive League, founded in 1900, initiated discussion groups and courses
on matters that included health and diet, and they lobbied for reform of factory,
health and prison legislation (Baldry 1992).
The contraception and abortion-rights movement developed late in Australia,
however, hampered by elite concern about declining birth rates in an empty
continent. Following a drop in the birth rate after 1890, a royal commission was
established in New South Wales in 1903. Its report is said to have influenced
Australian policy for half a century. It regarded the use of contraceptives as
a national problem caused by the growing selfishness of women and a love
of luxury and social pleasures. In the years that followed, all States extended
their laws restricting the availability of contraceptives (Browne 1979:24–8). The
birth rate fell again between 1928 and 1935, provoking another round of official
concern and ‘invocation of the twin spectres of physical decline and national
powerlessness’ (Hicks 1978:158). As Pringle (1973:19) has argued, the ideology
that was imposed on everyone displayed ‘total contempt for actual attitudes
and behaviour or for the rights of women to seek fulfilment outside narrowly
defined roles’. Under these circumstances, family planning organisations were
not formed until the 1930s and abortion-rights groups became active only after
World War II (Siedlecky and Wyndham 1990:9–31).
The most recent wave of women’s health activism emerged at roughly the same
time in the United States, Australia, Britain, Canada and New Zealand and a little
later in Ireland and South Africa. These are, of course, the major English-speaking
industrial countries. There were, however, no comparable mobilisations in nonEnglish-speaking capitalist democracies. Feminists in Norway, for example, were
intrigued when I inquired about a Norwegian women’s health movement in the
1990s. They answered that they saw no need for a specific focus on women’s
health, as the mainstream system could be influenced to respond appropriately.
The reasons women’s health movements were formed in one set of countries and
not in others are touched on in Chapter 7 but thorough analysis must wait for
another study.
26

1. Concepts, Concerns, Critiques

The Modern Women’s Health Movement in
Australia
The second-wave women’s movement in Australia—at first called women’s
liberation (WL)—emerged as feminist groups formed in capital cities and quickly
proliferated. Sydney WL began in January 1970 and within a year groups had
formed in every major town. Melbourne alone had 34 different groups by
1971 (Kaplan 1996:32). Although originating in ‘new left’ politics, WL groups
encompassed a range of perspectives. At first, there was reliance on material
heavily imbued with socialist ideas, primarily from the United States and Britain.
In some States, the movement was initially a people’s liberation movement. In
South Australia, for example, men participated in women’s meetings for the first
several years (Kinder 1980:30–54). In other States, however, the movement was
partly ‘a revolt against New Left men’ who, while concerned about imperialism,
oppression in the Third World and against minority groups, were nevertheless
happy to dominate and exploit new left women (Curthoys 1984:162). Groups
in different parts of the country quickly communicated with each other which
brought a level of consensus. As time went on, theoretical analyses of women’s
oppression were developed. New left ties meant that socialist ideas were strong
so that women’s oppression was often explained as a product of capitalism and
patriarchy (Curthoys 1984:162).
Health, especially reproductive health, was a major issue from the beginning.
Sex-role stereotyping and media exploitation of women were other early
concerns (Kinder 1980:30–54). The more centrist Women’s Electoral Lobby
(WEL) was formed in 1972. Initially, an uneasy tension characterised relations
between the two: whereas WEL focused on working within state institutions (an
approach called liberal or ‘reformist’ feminism), WL aimed to achieve a radically
restructured society—a project some women thought would be scuttled
by working through existing structures (Kinder 1980:104–8). Despite the
differences, the two groups cooperated and marched together on International
Women’s Day (IWD). In some settings, including Western Australia and the
Australian Capital Territory, collaboration appeared to come easily and some
women participated in both groups.
Initially, WEL adopted the six demands that WL had formulated: equal pay,
equal employment opportunity, equal access to education, free contraception,
abortion on demand and free twenty-four-hour child care. This list expanded to
include other policy areas and soon recommendations were being made about
taxation, the structure of work, paid maternity and parental leave, access to

27

Reaching for Health

justice and the public–private dichotomy. The notion that particular issues
were women’s issues was abandoned and most Australian feminists soon argued
that all areas of public and private life were important to women.3
By 1973, groups whose primary interest was health began to form. In Melbourne,
for example, the Women’s Health Collective and Women against Rape were set
up. In Adelaide, all segments of the women’s movement were concerned with
aspects of health. A group called The Body Politic, largely comprising nurses
and trainee doctors, was formed in 1972, absorbing an existing abortionrights group. It was concerned with a wide range of women’s health issues and
emphasised the need for sex education, producing an information sheet called
‘How not to get pregnant, how to find out if you are and what to do about it’,
which was distributed widely and became the subject of vice-squad inquiries. A
member of the group subsequently graduated in medicine and became one of the
founders of Adelaide’s first women’s health centre. Even within feminist health
reform groups, however, rape as a health issue was rarely mentioned (Kinder
1980:88–9), indicating the strong taboos around the subject. Sydney women
celebrated IWD in 1973 by holding a commission over a weekend at which
women shared their experiences. Health, especially the inadequacy of hospital
and medical services, emerged as the main topic. At follow-up meetings, groups
were formed to work on various issues and one was to focus on health services
for women (Cooper 2003). Similar developments took place in Melbourne.

The Struggle for Health Information
Simone de Beauvoir helped to lay the philosophical foundations for modern
women’s health activism when she argued in The Second Sex (first published
in 1949) that women had limited control over their bodies, their minds, their
lives and their destinies. ‘Woman is determined not by her hormones or by
mysterious instincts’, she argued, ‘but by the manner in which her body and
her relations to the world are modified through the action of others than herself’
(de Beauvoir 1972:734). While professionals monopolised health information,
women could not participate equally in treatment and care decisions or attempt
to control their own bodies.
The quest for knowledge and information emerged as a key issue in the
consciousness-raising (CR) groups of the 1960s in the United States. Members of
the pioneering Boston Women’s Health Collective, for example, realised in 1969
that they knew very little about how their bodies worked. They undertook to
research topics, found they could understand medical and scientific writing and
3  Separatist feminists, whose ideas include the view that women need to live separately from men, do not
necessarily share this opinion.
28

1. Concepts, Concerns, Critiques

decided to put together an information course for women. These efforts resulted
in the book Our Bodies, Ourselves, first published in 1971, later translated into a
dozen languages, adapted to suit different countries and now in its sixth edition.
From the late 1960s onwards, a feminist information-dissemination effort took
place in the United States, particularly in the cities (Lipnack 1980; Ruzek 1978).
At the same time, in Britain, a feminist health education movement emerged,
in which women produced information materials and other resources, together
with lists of speakers, to facilitate knowledge dissemination (Doyal 1983:22).
Information was a central issue at the first Australian national women’s health
conference, held in 1975. One major recommendation from the gathering
was that ‘a federal commission be set up to investigate all aspects of health
education’ (Commonwealth Department of Health 1978:3). Women reported
finding it extremely difficult to get the information they needed from medical
practitioners, particularly if there were additional obstacles, such as language
barriers. For example, in the late 1970s, widespread misinformation was found
among immigrant women in Melbourne by Women in Industry, Contraception
and Health (WICH), a newly formed grassroots non-governmental organisation
(NGO). WICH discovered women who were taking the contraceptive pill
without knowing it was a contraceptive and others who had had intrauterine
devices (IUDs) fitted that had not been changed for years (Caddick and Small
1982). Even where there were no language barriers, women often found it hard
to find out what they wanted to know. A young woman, Susan Waide, told me
about her unsuccessful efforts to extract information from her doctor during her
first pregnancy in the 1970s. ‘Y’know how it is’, she told me, ‘Pat you on the
head and kick you out the door’.
The early women’s health centres aimed to fill some of these gaps, both inside and
outside their walls. Activities included discussion sessions, coffee gatherings
and self-help meetings. As in the CR movement, group meetings were recognised
as valuable mechanisms for exchanging information, ideas and experiences.
Women aimed to ‘get to know themselves, reinterpret their biological function,
question their role in society’ and ‘regain control over their bodies. And their
lives’ (Sandall 1974:89). Feelings of frustration and powerlessness associated
with inadequate information were closely related to dissatisfaction with
conventional hospital and medical services.

The Feminist Critique of Conventional Medical
Care
At one end of a spectrum were straightforward expressions of anger about the
attitudes of medical practitioners and the inappropriateness of many treatments.
29

Reaching for Health

At the other end, sociological and political analyses of modern medical care
drew on social theory and the ‘limits to medicine’ perspective discussed above.
As Dorothy Broom (1991:43) explains, women were dissatisfied with medical
services, critical of many of the professionals who delivered them and had a
vision of a radically different society, in which women would be no longer
subordinate, would be proud of their bodies and would enjoy life conditions
that would enable them to be responsible for their own health and health care.
Social institutions are a product of their time and place and, in medicine in
the 1960s and 1970s, women were seen primarily as wives and mothers, rather
fragile creatures (nevertheless capable of long hours of unpaid work, without
recreation, and sick or weekend leave), who spent most of their lives in the
recesses of the private sector taking care of others. Founding members of the
Boston Women’s Health Collective identified four prevailing cultural notions of
femininity that they found restrictive: woman as inferior, woman as passive,
woman as beautiful object and woman as exclusively wife and mother (Boston
Women’s Health Book Collective 1976:18). Such ideas were conveyed to medical
students in gynaecology texts, which adhered tenaciously to views of women
as frigid and sexually unresponsive, long after contrary scientific evidence was
available (Broom 1991:38–9; Scully and Bart 1973). An Australian bureaucrat’s
view of single, middle-aged women, as expressed in a Commonwealth Minute
Paper in the 1960s, captures a perspective not uncommon at the time: ‘A spinster
lady can, and very often does, turn into something of a battle axe with the
passing years. A man usually mellows’ (Commonwealth of Australia 1963).

The Subordination of Women in Health Care
At a fundamental level, many women have a strong sense that health care
really is women’s business, given the long history of involvement, and many
were dissatisfied with a system in which women constituted the bulk of health
professionals but medical system decision making was heavily dominated by
men. In Australia, organised medicine had long worked to marginalise women
providers. It had campaigned against the introduction of any service, such as
baby health centres and school health services staffed by nurses, which might
be a threat to the size of private medical markets. By the middle of the twentieth
century, these campaigns had successfully sidelined female professionals,
leaving hospital and medical systems dominated by men, with doctors filling
most key positions (Gray 1991:60–2; Willis 1983; Wyndham 1983:28–30). The
division of labour resembled that in wider society: women did the low-status,
low-paid caring and support work while men in high-status, well-paid positions
made the all-important decisions. Pringle and Game (1983:94) argue that ‘in no
other workplace are power relations as highly sexualised as they are in hospitals.
30

1. Concepts, Concerns, Critiques

Bureaucratic domination is directly reinforced by sexual power structures.’
They also found that increases in the number of male nurses and female doctors
had not changed basic power relations. A similar situation prevailed in Britain
(Doyal 1983:27).
Women still make up a majority of the health workforce in Australia. More
than 90 per cent of nurses were women in 2006 (AIHW 2009:31). Although
women constitute an increasing proportion of doctors, at 33.7 per cent, only
21.6 per cent of specialists are women (AIHW 2006:8, 16). Male dominance in
health system decision making has many untoward consequences. For example,
unpaid care giving is rarely recognised as a women’s health issue. Primarily
a cost-cutting exercise, policies promoting shorter acute hospital stays and
de-institutionalisation in the mental health, disability and aged-care sectors
have transferred responsibility to predominantly female carers, significantly
increasing the burden of unpaid work and undermining women’s capacities to
achieve economic and other forms of independence (Armstrong et al. 2002).

Medicine’s Role in the Subordination of
Women
The male-dominated medical system of the 1970s, it was argued, not only reflected
the views about women held in wider society but also played ‘a particularly
strategic role in actively creating these stereotypes and in controlling women
who may deviate from them’ (Doyal 1983:26). The views about women presented
in medical textbooks, for example, masqueraded as scientific fact when, in fact,
they were (male) socio-cultural interpretations. Feminists claim that unscientific
medical discourse of this kind is really social and political action that helps
to sustain the status quo (Braun 2003:5–10). In this and other versions of the
narrative, medical personnel operate as agents of the establishment (reviewed in
Broom 1991:44–7), constructing ‘deviance’ through interpretation and labelling
processes and controlling it through medicalisation and other avenues, such
as population policies. Men become experts on women’s bodies and medicine
is involved in the construction of a particular view of the ‘nature’ of women,
labelling and treating ‘normal’ and ‘abnormal’ femininities. Broom (1991:53–
7) suggests that the word femininity itself conjures up notions of illness and
disease because women and sick people share characteristics, such as weakness,
passivity and dependency.4
4  Similarly, some semiologists argue that the word ‘woman’ is infused with inerasable meanings of weakness
and subordination or even that it simply means reproductive capacity. Simone de Beauvoir (1972:35) wrote:
‘Woman? Very simple say the fanciers of simple formulas: she is a womb, an ovary; she is female—this word
is sufficient to define her.’
31

Reaching for Health

Feminists argue that these influences are particularly apparent in mental health
systems, where therapeutic models perpetuate gender stereotypes, pathologise
women’s anger and maintain their lack of power (Ussher 1991:209). From the
beginning, women’s emotional health and wellbeing were major issues in
women’s health centres (Schofield 1998:1–9). The view that women suffer more
mental ill health than men because they are subjugated, distressed and unhappy
was put forward in the early years. On entering the psychiatric system, women
are confronted with a view of mental health that is inherently sexist: women’s
distress is pathologised rather than validated. The impact of violence and
trauma is not given full weight, the social conditions of women’s lives are not
examined and women’s control is further undermined because information
about treatment choices is not readily available. Research on women’s mental
health remains sparse and there is insufficient recognition that women and
men might experience conditions, such as stress, differently. An interactionist
model, it is argued, needs to be developed, which examines social conditions
and psychical factors as they occur together. In this view, the traditional therapy
model of dominant professional and submissive client must be replaced with an
egalitarian approach (Hodges 1997:22–30).

Superior–Subordinate Relations
The Women’s Commission was told in Sydney in 1973 that doctors’ attitudes
towards women were often experienced as patronising and judgmental and
sometimes as degrading and humiliating. The commission was a two-day
gathering of some 500 women organised by WL as part of the 1973 IWD
activities. Patronising doctor–patient interactions could occur in any setting:
in the 1980s, a newly retired State Minister for Health, needing minor surgery,
asked a question about the procedure, to which her doctor replied, not with an
answer, but with the admonition: ‘Now you are going to be a good girl, aren’t
you?’
Women reported especially distressing experiences when seeking abortion
services. Jean Taylor (2003) remembers the concerns expressed in the early 1970s
during her volunteer work with a new Melbourne WL information service:
Many women were looking for a sympathetic doctor so they could have
an abortion and the Women’s Abortion Action Campaign (WAAC) was
set up in 1972 to campaign for the repeal of anti-abortion laws…We
encouraged women to let us know what their experiences had been…
so we could have a resource file of doctors who could do abortions or
other medical procedures or consultations in a sympathetic way. In the
same way we also had a file on doctors who were less than sympathetic
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1. Concepts, Concerns, Critiques

or downright incompetent and dangerous. We were challenging sexist
attitudes and ways of looking at the world. Doctors and other professionals
were often quite sexist and wouldn’t give women information, so we
were encouraging women to ask their doctor questions and find out
what was happening about treatment. From this, women started to be
involved in their own health care.
Women also identified a lack of sympathy for victims of violence and a lack
of concern about what women themselves wanted and needed (Siedlecky
1977:30). Many felt unable to discuss problems with their doctors. The tragic
consequences that can result from ineffective communication and inadequate
training to deal with issues such as domestic violence are illustrated in the
case of Heather Osland, who was convicted for her part in the murder of her
violent husband. Osland had attended her doctor regularly for 10 years prior
to the killing, with recurrent cystitis, and vaginal and pelvic infection and
inflammation, resulting from marital vaginal and anal rape. She had taken her
children, who displayed serious behavioural problems and sometimes physical
injuries, to the same doctor. Her husband also attended the practice. Osland was
treated with antidepressants, tranquillisers and antibiotics and although there
were discussions with her doctor about marriage problems, these discussions
were not included in her records nor were the problems connected with her
medical conditions (Taft 1999:64). This might be an extreme case, in terms of
both the oversight and its consequences, but it illustrates the way non-medical
and even medical problems, major and minor, can slip through the net in the
absence of information and training.
Another major issue for 1970s women was that their health problems were
frequently trivialised, regarded as exaggerations, not believed and/or passed off
as emotional reactions or overreactions. Endometriosis, for example—a painful
condition—often went undiagnosed for years. Women felt that menstrual
problems, pelvic infections and the like were not given appropriate attention
and were meant to be ‘suffered in silence’ (Broom 1991:37). Indeed, as late as
1990, the menstrual cycle had not been studied in depth (Doyal 1995:17). Chest
pain, long-term chronic pain, headache and dizziness were other conditions
women felt were often not taken seriously. Moreover, research shows the same
symptoms were taken more seriously in men, who received quite different
treatments. For example, chronic pain might be treated with painkilling drugs
in men but with tranquillisers or even shock treatment in women. Other studies
showed female prisoners were far less likely to receive conventional medical
treatment, and women with heart disease were treated differently from men
with the same condition (Wyndham 1983:29).

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Unnecessary Medicalisation
Women complained and continue to complain about the unnecessary
medicalisation of life events, such as menstruation, pregnancy, childbirth,
menopause and mental ill health. Social and emotional problems, in particular,
are often treated medically. The women’s health movement quickly identified
the heavy prescribing of tranquillisers as highly inappropriate. In 1984–85, 70
per cent of the six million prescriptions written in Australia for benzodiazepines
were for women. Estimates were that between 30 and 40 per cent of these women
would become addicted both physically and psychologically. Women from
non-English-speaking backgrounds were particularly likely to be prescribed
tranquillisers (Crawford and Elliott 1994:143). The safety of many treatments
was questioned. The untoward effects of drugs, such as Depo-Provera, and of
devices such as the Dalkon Shield, were discovered and publicised. The use
of the contraceptive pill came to be seen as a massive experiment on women:
dosage levels were the subject of trial and error and use became widespread
before longer-term effects could be known.
More recently, the use of hormones has become highly controversial (Boston
Women’s Health Collective 2006). After millions of women had been prescribed
hormone replacement therapy (HRT), evidence appeared that implicated it
in either causing or exacerbating a range of cancers, including lung cancer,
leading one researcher to question its use in medicine in any form (Ganti
2009:1218). Researchers argue that the HRT experience reaffirms the importance
of mandatory randomised trials. Recent work to develop a ‘female Viagra’ for
women with supposedly low libidos is seen as an attempt to create a new disease,
called ‘female sexual dysfunction’, and so establish a new and potentially
lucrative market. The work has been strongly criticised by feminists and others
(Moynahan 2003).

Gender Bias in Medical Research and Practice
The priorities and methods of medical research have attracted criticism since
the early 1980s. Even within the biomedical model, research on women was
the exception rather than the rule. Until the 1970s, ‘women’s health’ was
thought of as comprising reproductive issues and gynaecological diseases but
even these were seriously under-researched (Doyal 1995:17–18). Women were
heavily under-represented in clinical studies, which primarily studied men and
then applied the findings to both sexes (Keville 1994). In Australia, funding
for women’s health research constituted a ‘tiny fraction’ of the total until 1990
(Broom 1991:38). Inquiries of the National Health and Medical Research Council
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1. Concepts, Concerns, Critiques

(NHMRC) and the Australian Institute of Health and Welfare (AIHW) in 2010
failed to establish what proportion of total health research was specifically
devoted to women. The NHMRC collects data only on the research it funds
itself, not on the total Australian research effort. In 2010, however, $82.3 million
of a total of $730.1 million, or approximately 11 per cent, was identified as being
for ‘women’s health’ (NHMRC Research Funding Dataset 2000-2010). Inquiries
of the AIHW were less satisfactory. In reply to my questions5 and follow-up
questions, I received the following reply by email: ‘I passed your enquiry
around to colleagues specialising in areas that your questions were around. The
general consensus was that we are unable to answer the questions, this is due
largely to [the fact] that we try not to differentiate between sexes in our reports.’
Given that the importance of collecting sex disaggregated data and the need for
gender analysis has been acknowledged for many years, it is astonishing AIHW
staff seem unaware of the arguments.
By the 1990s, it was acknowledged in overseas medical research circles that
clinical trials on diseases that affect both men and women should include both
men and women as subjects (Cohen and Sinding 1996; Keville 1994). US responses
include the establishment by the Institutes of Medicine of a committee to
consider ethical and legal issues surrounding the inclusion of women in clinical
studies, which recommended that women be included ‘wherever possible’
(Mastroianni et al 1994). The US Congress passed legislation in 1993 stipulating
that women must be included in clinical trials in sufficient numbers to obtain
‘a valid analysis’ of differences in the way women and men respond to drugs,
therapies and treatments. Later research, however, suggested that companies
were disregarding aspects of the legislation (Pear 2000).
Similarly, the Medical Research Council of Canada issued a paper in 1994 drawing
attention to the need for gender balance in research. In Australia, the NHMRC’s
National Statement on Ethical Conduct in Human Research (2007) does not reflect
these concerns, referring only to ‘women who are pregnant’. Its recently revised
National Ethics Application Form, however, which researchers must use to apply
for ethics clearance, asks applicants about the ratio of males to females that will
be recruited and whether the ratio accurately reflects the distribution of the
disease, issue or condition within the general community. Research published
in a high-profile international journal in 2010 showed continuing gender bias
and prompted leading women’s health NGO Women’s Health Victoria (WHV)

5  The questions asked were: 1) What proportion of total Australian health research funding is devoted
to studying women’s health? 2) What proportion of women’s health research is devoted to areas other than
reproductive and sexual health? 3) What are the rules about the inclusion of women in clinical trials for
diseases that affect both men and women, such as cardiac disease? 4) What proportion of research on cardiac
disease is conducted specifically on women?
35

Reaching for Health

to issue a media release calling on the Australian Government to develop and
enforce a set of national guidelines to ensure that medical research takes account
of gender differences (WHV 2010).
Biased research results in biased approaches to care. Until recently at least,
drug and alcohol rehabilitation policies and services in Australia centred on
the needs of men with little recognition that these differed from the needs of
women. Almost all the research that had been undertaken investigated men’s
experiences (Morgain 1994:175–6). There were few women-only alcohol and
substance-abuse centres where women who, because of past experiences, were
afraid to use mixed-sex services could go, and there was virtually no provision
for women with children. Similarly, few professionals were trained to deal with
the effects of abuse and violence on women and children. Moreover, awareness
of the need for cultural sensitivity was low.

Gender Bias in Treatment
Biased medical research leads to biased treatment, with women less likely to
receive ‘accurate diagnosis and appropriate treatment’ (Bönte et al. 2008; Keville
1994:129). We do not know whether inappropriate treatment is less common
than it once was but we do know that serious problems remain. Rosenberg and
Allard (2007) found ‘a pattern of overestimation of benefit and underestimation
of harm’ for women being prescribed statin therapy. A large study in the United
States found that women are 30 per cent less likely than men to receive the kind
of stroke care that limits brain damage (RedOrbit News 2009). A number of
studies show that women with cardiac disease are treated less appropriately than
men, even after accurate diagnosis and hospitalisation. For example, research
in Germany, the United Kingdom and the United States found that ‘primary
care doctors’ behaviour differed by patients’ gender in all three countries’. In
Australia, recent research by the AIHW found that although cardiovascular
diseases (CVDs) are a major health threat for Australian women, awareness of
this threat is low. Both the severity and the number of episodes per woman can
be reduced, the report argues. An ‘enormous potential’ exists, according to the
AIHW ‘to improve the risk profile of Australian women and therefore reduce
the numbers of women and families affected by CVD’ (AIHW 2010b).
To summarise the feminist critique, in the male-dominated medical system,
men are not only experts on women’s bodies, they are also experts on women’s
healthcare needs and make crucial decisions on services and treatments. Women
have been subordinated as health professionals and, in many other respects,
medical practice perpetuates the inferior status of women. Unnecessary
medicalisation and gender bias in research and practice result in suboptimal
36

1. Concepts, Concerns, Critiques

health outcomes. From the social health perspective, a wide range of primary
health and community services is seriously undersupplied. Like Aboriginal
Medical Service (AMS) workers, women identify the need for more holistic,
preventive, community-based services.

The Integrity of Medical Research
Concerns have emerged about the scientific integrity of medical research,
following changes in the way it is funded. Whereas in the 1960s most research
was publicly funded, by 2006 approximately three-quarters was funded
privately. Moreover, until the 1990s, most drug company-funded research was
undertaken in universities; however, research has moved to for-profit locations,
where fewer checks and balances operate. Pharmaceutical companies can now
select the research designs most likely to produce the results they want, they
can terminate studies if the findings contravene their interests and they can fail
to publish results altogether. The fear is that private research is ‘far more likely
to produce results that support the sponsor’s interests’ (Boston Women’s Health
Collective 2006). Three Australian oncologists caused something of a stir in 2010
when they pointed out that 27 of 32 authors of research published in The Lancet
had declared financial links to the drug company that had funded the research.
The authors, it was argued, had a potential conflict of interest (Medew 2011).
In recent years, the pharmaceutical company practice of employing ghost writers
to write reports for medical journals has raised concerns about skewed findings.
Experience validates such concerns. A study of court documents in the United
States, for example, showed that 26 medical journal articles between 1998 and
2005 ‘emphasised the benefits and deemphasised the risks’ of HRT. All had
been drafted by a medical communications firm paid by a major pharmaceutical
company (Singer 2009:A1). Allegations have also been made about biased
reports on antidepressants and diet drugs and, more recently, about cancer
and haematology drugs. A recent analysis of reviews of a new drug for typetwo diabetes found that experts who were paid by the drug’s manufacturer
were more likely to report favourably on efficacy and safety. Investigation was
prompted by sharply conflicting conclusions in published scientific work, some
of which had warned about significant risks (Bakalar 2010). Medical journals
have been forced to abandon the honour system of disclosure and introduce
‘ghostbusting’ measures in an effort to reduce industry-financed writing
assistance (Singer and Wilson 2009:B1).

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A Social View of Health
A person’s physical health is like a frozen moment taken from the social
and economic environment.
— Stephanie Bell, 2001, Director, Central Australian Aboriginal Congress
Australian women did not need epidemiologists to tell them that the conditions
of their lives had important ramifications for their health. According to Laurie
Gilbert, Director of the Women’s Health Unit in the then Commonwealth
Department of Health in the 1980s, Australian women understood and subscribed
to a social view of health before they had heard the term. Laurie Gilbert was a
member of the team, headed by Liza Newby, which consulted with women about
their health needs for the 1989 NWHP. As the NWHP argues, a ‘major reason
for the acceptance by so many women of the social health perspective is their
understanding, often from personal experience, of the links between poverty,
type of employment, education, access to housing, and health’ (Commonwealth
of Australia 1989:10).
Another reason so many women take a social view, it has been suggested, is
that they are more likely to use, or want to use, the health system for health
reasons, whereas men use it mostly for illness. Aboriginal women have been
keenly aware that life conditions affect health outcomes for a very long time.
And although Aboriginal, immigrant and Anglo women often had different
priorities, they were in agreement on most aspects of the social perspective.
As Broom (2001:98) argues, ‘women of all racial and ethnic backgrounds were
united…in their call for a voice in personal health care decisions and in the
formulation of health policy’.
A social health perspective is an extension of the feminist critique of conventional
medicine in the sense that it argues that a treatment focus is narrow and misses
a great deal that is crucial for human health. When women talk about gaps in
services, some of the things they are noticing are the paucity of prevention
advice, counselling and support.
In a social view of health, the focus is on population rather than individual
health. It is concerned with ‘the causes of the causes’. Outcomes emerge from
complex interactions between social, economic, cultural, environmental and
biomedical factors rather than arising from biological determinants alone.
Furthermore, feminists argue that biology is not given and unchangeable, as it
tends to be in the medical scientific view, but is influenced by multiple factors.
Therefore, biomedical processes cannot be understood out of context. In this
view, as Hammarstrom (1999:243) argues, ‘there is a close interplay between
social and biological factors, which means that biology must be problematised’.
38

1. Concepts, Concerns, Critiques

There is no clearer association in the epidemiological evidence than that between
poverty and inferior health outcomes; however, the poor are not the only ones
who are affected. There is a definite social gradient in health, which shows that
everyone’s health is less robust than it might be, perhaps affecting even those
at the top of the socioeconomic scale. Health outcomes consistently improve as
socioeconomic status improves, with the biggest differences obviously found
between those at the top and those at the bottom. It follows therefore that
comfortable, middle-income people, for example, have poorer health outcomes
than they might have (WHO 2003:10–11). Recent research suggests that levels
of inequality, material and social, can explain the social gradient. Countries
with the largest gaps between rich and poor experience more mental illness,
more drug and alcohol-related problems, more obesity, higher rates of teenage
pregnancy, poorer educational performance and literacy scores and higher rates
of homicide (Wilkinson and Pickett 2009).
Inequality works to undermine health, it is suggested, by increasing stress
right across society. Stress, medical research shows, produces a range of diseases
and behavioural problems. In heavily unequal societies, the rich fear the poor
and the poor suffer from status anxiety and shame, making everyone’s health
poorer than it might be. In more equal societies there are higher levels of trust
and lower levels of stress. Low status, low levels of respect and feelings of low
self-esteem, rather than material deprivation per se, contribute most to poor
health and help explain the social gradient (Wilkinson and Pickett 2009). Such
arguments fit with the findings of earlier studies. For example, Kawachi et al.
(1999) studied men and women across the 50 American States and found that
both smaller wage gaps between the sexes and higher levels of women’s political
participation were ‘strikingly correlated’ with lower female and male morbidity
and mortality. Status, the authors conclude, reflects ‘more general underlying
structural processes associated with material deprivation and income inequality’.
Such findings corroborate the arguments of Aboriginal people who point to the
devastating health consequences of colonisation and racism.
Returning to the health of the most disadvantaged, the close association between
poverty and very poor health outcomes holds both between countries—some
rich, some poor—and within countries, whether they are OECD countries or
those that are less well off (WHO 2008a). Women are everywhere over-represented
amongst the poor.6 Australia’s gender pay gap, for example, contributes to
economic insecurity, increasing the number of low-income families, especially
female-headed families, with a negative impact on health, including that of

6  This is not generally the case for Aboriginal women, who point out that they often have better jobs and
higher education levels than Aboriginal men.
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Reaching for Health

children. It also contributes to financial vulnerability for women, especially
women in retirement. The effects of the pay gap are exacerbated by socially
prescribed caring responsibilities.
Violence is another major ‘cause of the causes’ of poor health. While the
underpinnings of violence are complex, there is wide agreement that intimate
partner violence, in particular, is firmly embedded in gender inequality. Violence
is detrimental to women’s health in many ways. A major WHO study found
that violence had a negative impact on women’s physical, sexual, reproductive,
psychological and behavioural health, as well as having fatal consequences in
cases of AIDS-related mortality, maternal mortality, homicide and suicide (Krug
et al. 2002).
Post-traumatic stress disorder (PTSD) is more prevalent among women who
have experienced violence, along with neurological disorders as a result of head
injuries and attempted strangulation. Women who have experienced violence
have more sexually transmitted and urinary tract infections, more migraine
headaches, more chronic pain and poorer reproductive health outcomes (Coker
2005:1; Taft et al. 2003). Moreover, studies show that the health consequences
of abuse can persist for years and that the more severe the abuse, the greater is
the detrimental impact on health, with multiple episodes having a cumulative
impact.
Workplace conditions can give rise, directly and indirectly, to poor health
outcomes. Discrimination or harassment in the workplace, for example, might
lead to anxiety, depression and other mental health problems and economic
insecurity—all closely associated with reduced life chances and poorer health.
The Canadian Women’s Health Strategy (Health Canada 1999) identified 12 key
social determinants of women’s health: income and social status; employment
status; education; social environment, including social support and social
exclusion; physical environment, including access to food, housing, transport,
clean air and the like; healthy child development; personal health practices and
coping skills; access to health services; social support networks; biology and
genetic endowment; gender; and culture. Indeed, each of these categories is an
umbrella for more specific determinants.
A biomedical perspective of health, in contrast, is narrower. It focuses on the
immediate or direct causes of ill health, which are seen as located in individual
bodies in interaction with outside causal factors, such as germs, toxins and
injuries. The human body is seen as a set of interdependent but contained
systems, and ill health is treated as a failure of one of the parts. Disease unfolds
within individuals. Day-to-day interactions with broader social and physical
environments are outside the scope of inquiry (Doyal 1995:15–16).
40

1. Concepts, Concerns, Critiques

Very different views of appropriate public policies flow from these distinct
perspectives. If the causes of ill health are predominantly biomedical and largely
outside human control, the role of public policy is limited. In an ‘old’ public
health framework (as discussed in the Introduction), the range of responsibilities
is relatively narrow but includes provision of clean water, sewage disposal
and health regulations. Public authorities might also provide relevant health
information and enact legislation to restrict the activities of commercial
enterprises if health concerns are at stake. Importantly, people in wealthy
countries now agree that good-quality hospital and medical services should be
made accessible to citizens, and public policies are required to regulate access.
In contrast, where a social determinants view of health is taken, extensive
public intervention is the rational response, both inside and outside health
systems. If the ‘causes of the causes’ can be known and understood, it follows
that health and public policy should focus on prevention as well as cure. A
social determinants perspective requires substantial investment in primary,
community-based health care to complement medical and hospital services, as
well as investment in economic security, physical security, affordable housing,
accessible education, food security and so on.
While the women’s health movement has championed a social view of health and
illness, this is equally relevant to men’s health. Gender, which is one of the social
determinants, helps shape the conditions of men’s lives, just as it does those of
women. Male gender roles might work to undermine health by encouraging
physical risk taking and, perhaps, the denial of emotions, physical discomfort
and pain. The expectations held about what is required of breadwinners might
induce men to work in stressful, dangerous occupations or to work unhealthily
long hours. Risk-taking behaviour can have untoward effects on the health of
both men and women, particularly in relation to sexual activity. We might not
be able to tell for sure whether women suffer more morbidity than men (Broom
1991:47–52), but a social health perspective tells us for certain that many men
and women suffer high levels of avoidable ill health as a consequence of the
constraints and requirements of masculine and feminine gender roles.

A Peculiarly Australian Debate: To accept or
reject state funding?
The question of whether women should collaborate with ‘the state’ (or
government) was a strongly contested issue in the early Australian women’s
health movement. The problem arose when the movement established its own
services and public funding support was a real possibility. Conflict and bitter
disagreements ensued and in some cases permanent ruptures followed.
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Reaching for Health

Demand for the services women’s health centres provided was strong and placed
a heavy load on volunteer and low-paid service providers. Some workers felt
frustrated, wishing to devote more of their time to broader, change-seeking
action, but often found their energies consumed by day-to-day service provision
(Broom 1991:120–2). Thus, some found the prospect of financial support
attractive. Whereas social liberal (social democratic) feminists were generally
comfortable working through government institutions, women oriented towards
socialist, anarchist, radical, cultural and lesbian-separatist feminist perspectives
generally held reservations. Divergent perspectives are nicely illustrated in a
letter written by Beatrice Faust, the founder of Melbourne WEL, to Biff Ward,
convenor of Canberra WL in 1972. ‘Does Canberra Women’s Lib plan to establish
a second branch of WEL?’ Beatrice asked. She went on to suggest: ‘If you believe
the democratic process is useless, perhaps you could pass this on to someone
who still has hopes of it’ (reproduced in McCarron Benson 1991).
In the 1960s and 1970s, many feminists were preoccupied with analysing the
nature of ‘the state’, which was a reflection of the strength of socialist feminist
thinking at that time. In the Marxist tradition, the institutional apparatus—
which includes government, the economic system, the legal system, the education
system, the military, the police and so on—is referred to as ‘the state’. The state
is regarded as an instrument of oppression, used by the ruling class to prevent
a revolution from below that would benefit the more numerous working class.
Socialist feminists, therefore, work within a tradition that is highly suspicious
of the state. Distrust of public-sector institutions also emanated from women’s
lived experiences. Because there was relatively low female participation in the
public sphere, the state could be seen as male in character, with institutional
arrangements, practices and processes that were alien to women.
Another strand of thinking analysed the state as male dominated or patriarchal.
In Kate Millett’s view, for example, patriarchy is a universal phenomenon and
patriarchal government is an institution under which ‘half of the populace which
is female is controlled by that half which is male’ (Millett 1977:25). Patriarchy
is deeply entrenched and runs through all the political, social and economic
institutions of all societies. In this perspective, as Randall (1988:10–11) argues,
‘the state has remained a bastion of male power’, controlling women’s freedom,
restricting creativeness, denying autonomy and ‘withholding from women large
areas of society’s knowledge, power, opportunity and resources’. Government,
some feminists suggested, was conducted as if men’s interests were the only
ones that counted (Pringle and Watson 1992:57).
Theorists also developed critiques of government bureaucracy—an arm of
the state—which went beyond conventional complaints about red tape, goal
displacement and empire building. Whereas behaviour, attitudes, structures
and processes are seen as gender neutral in conventional organisation theory,
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1. Concepts, Concerns, Critiques

feminist theorists argue that masculine values and assumptions underpin and
reinforce the systems of sex stratification typically found in organisations.
According to Ferguson (1984:4), the bureaucratic organisation of public life
directly controls the work of most women employed outside the home. Further,
because of its hierarchical nature, bureaucracy affects the entire society in a way
that is antithetical to the goals of feminist theory and practice and antithetical to
democracy. Clearly, such structures are not appropriate channels through which
to pursue the liberation of women.
With these ideas in mind, some women searched for new ways of working,
inspired by visions of a society based on empowerment rather than domination.
In alternative structures, it is argued, women can work towards their own
emancipation through processes in which they support and value each other
and where the conditions for empowerment and skill development are present.
In Australia, as elsewhere, feminist collectives were set up and were the chosen
management form for many health centres, rape crisis, domestic violence,
sexual assault and abortion counselling services (Outhwaite 1989:203–5).
Non-hierarchical power structures in women’s health were felt to benefit both
workers and clients. In keeping with a radical democratic focus, Jocelyn Auer
(2003:7) argues that hierarchical decision making in women’s health reduces the
power and information that workers have and this deficit is felt by clients.
As it developed in Australia, feminist theorising about the state produced
different positions, with some accounts suggesting the possibility of meaningful
improvement in the status of women through collaboration (see, for example,
Allen 1990; Yeatman 1994). One strand of the ‘reformist’ view was that while
seeking equality through the state might offer only limited prospects, the
alternative of purchasing equality in the marketplace offered even less cause
for optimism (Dowse 1984:143). Women were aware that accepting government
funding would involve, at the very least, keeping records, writing reports and
possibly complying with unacceptable conditions, such as restrictions on modes
of operation and/or on the selection of clients. In practice, such restrictions
quickly became reality. Marian Sawer (1990:50) notes the tensions created when
women’s health-sector workers became ‘caught up in bureaucratic procedures’,
requiring them to produce business plans, job descriptions, policies and
procedures. Collective-management models had to be modified and sometimes
abandoned.
Controversy over state funding appears to have been stronger in the women’s
health movement than in the mainstream women’s movement. It has been
argued that there was scarcely a debate in the wider women’s movement (Dowse
1984:146). An alternative view is put by Dorothy Broom (1991), who documents
vigorous and sometimes bitter debates and irreconcilable conflicts. For example,
differences between radicals and reformists in Brisbane’s Women’s House
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Health Centre ‘broke out into open warfare’ in the mid-1970s, resulting in the
centre losing its funding (Broom 1991:16). According to Broom’s central thesis,
working with the state in women’s health involves women in a fundamental
contradiction—the contradiction of ‘using the system to change the system’. In
this view, very briefly, both medicine and the state are patriarchal institutions
that prop up a social order that makes women sick. These institutions must be
reformed if the underlying social conditions that give rise to avoidable illness
amongst women are to be eliminated. The dilemma was expressed very clearly
by the Women’s Liberation Halfway House Collective just after accepting
government funding in 1975:
Whether we can threaten the relations of power and control that form
the basis of this society while being financed by the system which
maintains them, and how far we can use government funding to develop
the potential of the Halfway House as a political weapon are the most
important questions. (Quoted in Alley et al. 1980:10)
The movement has always been very clear that the relations of power and control
need to be changed, both inside and outside the health system; disagreement
centred upon the best way forward. Both Broom’s work and my own research
for this book suggest that opposition to cooperation with the state was much
stronger among women’s health advocates than in the mainstream women’s
movement. In interviewing activists from the 1970s and 1980s in the 1990s,
I more than once heard the view that the kinds of policy changes that women
were pursuing were insufficient to make even a dent in power relations.
Two points might help to explain the divergence between the women’s health
movement and the women’s movement more broadly. First, it has been argued
that radical feminists, rather than liberal or reformist feminists, have been a
particularly important force in the women’s health movement (Kenway 1992:111;
Outhwaite 1989:202). Radical feminists are especially concerned about sexual
subordination and violence against women and have been highly active in the
refuge movement. A second point of explanation is that in keeping with the
feminist critique of medicine, the state is heavily implicated in supporting the
mainstream medical system. Therefore many activists thought that collaboration
would ineluctably lead to being asked to work within the conventional medical
framework, with the accompanying displacement of goals. At Hindmarsh, in
Adelaide, for example, the area providing medical services was organisationally
cordoned off from the rest of the centre because feminists feared contagion from
a medical hierarchy in their midst.
Whatever the reasons, diametrically opposed attitudes to cooperation with the
state were a reality and a destructive force in several women’s health centres.
In a number of settings, the issue was not resolved, even if compromises were
44

1. Concepts, Concerns, Critiques

found. Joyce Stevens (1995:17) describes differing perspectives at the Leichhardt
Women’s Community Health Centre (LWCHC), Australia’s first women’s health
centre:
[S]ome thought that they should take advantage of the more favourable
situation to try to build some permanent outposts for women, such
as women’s services controlled by women. Others thought that the
movement needed to maintain its radical and oppositional stance
without the support of government funding or interference. The tensions
between these positions were not resolved and they often coexisted in
a type of unhappy marriage within projects, including LWCHC, where
defiance and acquiescence were twin progeny.
In South Australia, tensions over how far to go in engaging with the state
continued into the 1980s, along with concerns about losing touch with the
grassroots feminist movement (Auer 2003:8). Most groups providing services,
however, wherever they were located, accepted government funding from
necessity, which created very real difficulties for many movement members
interviewed for this book. Women reported that relationships with the state
were ‘always fraught’. Many thought that a level of separation was necessary
to retain critical independence and pursue feminist goals; securing survival
through the state risked submerging the reform agenda.
With the passage of time, the ‘revolution–reform dilemma’ that Broom
(1991:128) noted became less apparent. Today, women’s health workers are far
more likely to be concerned about the sufficiency, indexation and security of
public funding. Awareness of threats to independence is still keen, however, and
radical health reform is still a major objective. In the early days, the decision to
accept government funding undoubtedly weakened the movement by costing it
members. Sarah Maddison has argued that an ‘unintended consequence of state
engagement’ was the exclusion of many radical, socialist and anarchist feminists
from the women’s movement, with a subsequent decline in energy and activity
(Maddison 2001). State engagement certainly alienated many radical feminists
who distanced themselves from reformist activity. Moreover, antagonisms were
such that continued cooperation would have been very nearly impossible. The
decision of some to accept public funding, however, did not prevent radical,
socialist and anarchist feminists from continuing their own preferred forms of
activism and there is no clear causal link between engagement with the state
and the decline of the women’s movement as a whole.

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An Anglocentric Women’s Movement
The Australian women’s movement, like sister movements elsewhere, has been
described as centred upon the dominant group, or, in the Australian case,
centred upon Anglo-Australian women. It has also been criticised consistently
by women with disabilities for neglecting their issues. Early second-wave
feminism is said to have taken a ‘coherent, fixed, singular and unitary’ view
of the position of women. In this reading, women are everywhere subjugated
to patriarchy—a condition that gives rise to similar experiences for all women
everywhere. An all-inclusive feminism of this kind, as postmodern analyses
point out, ignores differences between and within groups of women and ignores
differences in preferences and priorities. By ignoring differences, positions
outside the mainstream are marginalised: a unitary, single-perspective feminism
cannot take into account the experiences of black women, immigrant women,
refugee women, women with disabilities or lesbian women, to name just a
few. Second-wave feminism, critics argue, is dominated by white, middle-class
women, whose focus on their own issues marginalises the concerns of ‘others’
(Larbalestier 1998:150).
This is not the place to discuss Australian feminist discourses (see, for example,
Bulbeck 1997; Larbalestier 1998), but portrayal as fixed and singular overstates
the case. A diversity of views was always present, acknowledging a variety of
‘feminisms’ and cultural differences. Mary Kalantzis (1990:40–1), for example,
has described Sydney meetings of an ethnic women’s network, which included
women as different from each other as Muslim women in purdah who wished
to reform working conditions to allow traditional prayer sessions, and women
from South American backgrounds who saw Australian women’s organisations
as politically backward.
While single-perspective feminism never existed, the theoretical position that
dominated in the early years did not take account of the perspectives of all
women, including Aboriginal, Torres Strait Islander, immigrant and refugee
women. Goodall and Huggins (1992), for example, identify key differences
between Aboriginal and non-Aboriginal women. They point out that, in
many ways, Aboriginal women are in a better position than Aboriginal men,
holding positions of power within their own communities—the reverse of the
general situation for Anglo-Australian women. Moreover, Aboriginal women
are generally better educated than Aboriginal men and often have higher-status
jobs. Whereas Anglo-Australian women were demanding rights to abortion and
contraception, Aboriginal women were fighting against unwanted sterilisation
and the loss of children to various agencies. Thus, many of the demands of
non-Aboriginal women were irrelevant to Aboriginal women and some were
contrary to their wishes (Burgmann 1984:37). The major issue for Aboriginal
46

1. Concepts, Concerns, Critiques

women has been the white feminist movement’s refusal to acknowledge the
extent and depth of racism and the priority many Aboriginal women give to
supporting Aboriginal men and to building healthy families and communities.
Without recognising ‘the full horror of racism in Australia’, ‘white women
simply invited Aboriginal women to join the movement’ (Goodall and Huggins
1992:401–2).
Feminists have also been guilty of attempting to speak ‘for’ Aboriginal women,
rather than inviting Aboriginal women to speak for themselves. Perera (1985)
recounts the story of a women’s housing conference where Anglo women told
Aboriginal women about their housing needs. The Aboriginal women present
walked out in protest, giving rise to consternation and feelings of guilt. In the
process of ‘reconciliation’ that followed, Anglo women learned something about
the requirements of effective consultation and inclusion. Bronwyn Fredericks
(2010) discusses the many barriers that still preclude effective cooperation
between Aboriginal and non-Aboriginal Australian women.
Immigrant women, too, have charged the movement with racism and with
relegating immigrant women’s activism to the sidelines (Larbalestier 1998:148–
58; Murdolo 1996). As with Aboriginal women, here, the main issues are often
different and include problems of racism, poverty, language barriers, isolation,
discrimination by supervisors at work, unfamiliarity with workplace rights and
cultural disadvantage. Also, even though refugee women often find themselves
with ‘the dirtiest and most dangerous jobs on the factory floor’ (Fraser 2008),
unions have been slow to recognise their problems. As Kaplan (1996:125) argues,
‘the right of participation was questioned even in the workplace’. Access
to services was also fraught with problems. For example, immigrant women
returned to violent relationships more frequently than Anglo women, leading
refuge workers to believe this pattern constituted a safety risk for workers
and other residents. According to Fraser (2008), the predominantly AngloAustralian workers lacked ‘the knowledge—or sometimes the desire—to help
women from other cultures’. Another obstacle to identifying with the AngloAustralian feminist movement was ‘a pervasive stereotype’ of immigrant women
as ‘uneducated, unskilled, under the thumb of a dominating father or husband,
and uncomplaining’ (Fraser 2008).
Immigrant and Aboriginal women have pointed out that they were politically
aware, active in campaigns and active in setting up organisations and services to
meet the problems they experienced. As Burgmann argued in 1982, ‘there is a
black women’s movement—it is just that white women know virtually nothing
about it’ (1982:37, original emphasis). There is also an Aboriginal women’s health
movement, as the activism described in the following chapters demonstrates.

47

Reaching for Health

Consequently, the work of Aboriginal and immigrant and refugee women has
often been left out of ‘mainstream’ accounts of what is erroneously labelled ‘the’
Australian women’s movement (Murdolo 1996). Despite limited opportunities
and heavy oppression, Aboriginal, Torres Strait Islander, refugee and immigrant
women have certainly been part of an Australian movement to improve the
conditions of women’s lives. Immigrant women set up a number of their own
associations and services from the 1970s onwards.7 For example, the Migrant
Women’s Association was set up in 1973 in Sydney and the Migrant Women’s
Refuge was established in Melbourne in 1978. The new centre could not meet
demand so a way around the problem was found by setting up the Refuge
Ethnic Workers Program (REWP) in 1981. This service provided language and
advocacy services for immigrant and refugee women in Anglo-Australian refuges
and became a model for service provision. In its current form as the Immigrant
Women’s Domestic Violence Service (IWDVS), it is funded by the Victorian
Government. It offers services in many languages and engages in prevention
work, training and community education (Fraser 2008; IWDVS web site).
At the same time, Aboriginal women were establishing their own separate
services. Aboriginal women’s work in the founding of community-based health
services has been mentioned and, in the early 1980s in Perth, a woman headed
the AMS. The Council for Aboriginal Women of South Australia was set up in
1966 and, while not focusing specifically on health issues, it was concerned with
women’s and children’s services, welfare and race issues (Grahame and Prichard
1996:37). The National Council of Aboriginal and Island Women was founded
in 1970, concerned with health, race, welfare, children’s issues and legal rights.
The Victorian Council of Aboriginal and Island Women was active in the 1970s
and the 1980s (Grahame and Prichard 1996:122). Among the council’s activities
was supporting the establishment of the Aboriginal Health Service, Fitzroy,
in 1973 and an Aboriginal girl’s hostel in Melbourne. Murawina Aboriginal
Preschool and Women’s Hostel was established in Chippendale, Sydney, in
1972. Mimbingal Violet (Vai) McGinness Stanton, of Kungarakany and Gurindji
descent, was one of the founders and later coordinator of the Foundation of
Rehabilitation with Aboriginal Alcohol Related Difficulties (FORWAARD) in
1976 (Grahame and Prichard 1996:42).
The Aboriginal Women’s Centre was set up in Darwin in the second half of
the 1970s and refuges were established in many places, including Melbourne
and Moree, New South Wales. The last provided services for non-Aboriginal
women as well. The founders of Cawarra Aboriginal Refuge, established in
7  According to Kaplan (1996:124–5), as well as experiencing racism, immigrant women were not helped
by ethnic organisations. She points out that the first national conference held by the Federation of Ethnic
Communities Councils of Australia in 1979 had one female delegate and no women on the executive. ‘Neither
ethnic community organisations nor the government gave enough weight to migrant women’s concerns’, she
argues. See also Sawer (1990:107–39).
48

1. Concepts, Concerns, Critiques

Sydney in 1979, had originally tried to locate it in the suburb of Penshurst but
lost council approval due to racist reaction. (Grahame and Prichard 1996:28).
The Western Women’s Council was formed in Wilcannia, New South Wales, in
1984, concerned with caring for the land ‘in the broadest sense’ and opposing
the establishment of an army base on ‘fragile desert land east of Wilcannia’.
Health was a concern, along with racism, imprisonment, police harassment and
violence. The Federation for Aboriginal Women was formed in Victoria in 1982,
with a number of aims including ‘consolidating and strengthening of Aboriginal
women’ and promoting ‘universal cooperation and friendship with all women’s
organisations’ (Grahame and Prichard 1996:45).

Early Cooperative Ventures
For all the understandable distrust that many Aboriginal, Torres Strait Islander,
refugee and immigrant women felt and still feel towards Anglo-Australian
women, there are examples of collaboration and evidence of a slow coming
together. A group called Joint Women’s Action began in Canberra in 1972. It
focused on ‘justice for blacks and whites’ and put together a leaflet dealing
with the interracial rape of Aboriginal women and girls, which was co-authored
by black and white women (Grahame and Prichard 1996:63). In Alice Springs,
WL helped to campaign to protect a women’s sacred site from being flooded
to create a recreational lake (Grahame and Prichard 1996:9). The Alice Springs
Women’s Centre—part refuge, part health centre—provided services for both
Aboriginal and non-Aboriginal women, and women from different backgrounds
participated in management.
Living in small communities seems to be conducive to breaking down barriers
between women of difference. Women in Broken Hill, New South Wales,
founded the Multicultural Women’s Resource Centre in 1986. Originally an
initiative of the Filipino Women’s Association, it received early funding from
the Commonwealth Department of Immigration and Ethnic Affairs. The centre
is managed by a committee of women from several ethnic groups, including
Aboriginal and Anglo-Australian women, and it provides services, including
health information and outreach, for all women in the area.
The cooperative effort that went into founding a women’s refuge at Bourke,
New South Wales, demonstrates that cultural differences do not necessarily
prevent women from different backgrounds working together. Over more than
a decade, work by Aboriginal, Anglo and Indian women, with the help of some
men, enabled a centre to become established without government funding. This
story of cooperation and perseverance has been summarised as follows: ‘In an
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Reaching for Health

otherwise racially divided community, we have managed to have Aboriginal and
non-Aboriginal women work together for the common good. Many women who
would have never met have come together and made friends’ (Alvares 1992:183).
A number of writers acknowledge the ‘well-meaning concern’ of many AngloAustralian feminists towards non-Anglo groups (Fraser 2008; Goodall and
Huggins 1992; Kalantzis 1990). Goodall and Huggins (1992:402) argue that the
Australian women’s movement learned about difference ‘slowly and somewhat
painfully’ over the first two decades. Tensions continued, however, because
both the way that ‘racism shapes sexism’ and the needs of Aboriginal women
to strengthen their communities were not sufficiently understood. Goodall
and Huggins note, however, that supportive and productive relationships did
sometimes develop.
In summary, Anglo-Australian concerns dominated the early women’s
movement but, gradually, feminists established links with women from different
cultural backgrounds and learned more about their issues. For their part, some
immigrant and refugee women, as well as some Aboriginal women, began to
find value in working with some Anglo-Australian women. The collaboration
that became possible is illustrated by the work of two immigrant women living
in Queensland in the 1980s. Raquel Aldunate and Gladys Revelo both worked
at the Brisbane Migrant Resource Centre but, as well, they belonged to the
Women’s Health Centre, the Community Health Association of Queensland, the
Migrant Women’s Network, the Australian Social Welfare Union, the Women in
Trade Unions Network, Radio 4EB, the Chile Solidarity Committee, the Latin
American Centre and others (Aldunate and Revelo 1987:40).

Women’s Health Services and the Needs of
Non-Anglo Women
This discussion of difference and exclusion would be incomplete without taking
into consideration the efforts made by women’s health centres, refuges and
sexual assault centres to meet the needs of the non-Anglo women who live in
surrounding communities. From the beginning, despite ignorance and racism,
many workers in women’s health centres sought to discover what local women
needed and wanted. They attempted to provide culturally appropriate services
and, where possible, assisted groups to set up their own services. Most women’s
health centres were deliberately established in areas of high need, where lowincome, immigrant, refugee and sometimes Aboriginal women lived (Auer et al.
1987:77; Broom 1991:3). They aimed to be accessible to disadvantaged women
and some focused specifically on the needs of migrant and/or Aboriginal women
(Broom 2001:101). The work of LWCHC serves as an example.
50

1. Concepts, Concerns, Critiques

LWCHC, like most sister centres, was located in the midst of a large workingclass and immigrant population. From the beginning, ‘before the concept of
multiculturalism had been invented’ (Stevens 1995:48),8 almost one-third of the
women using the centre were immigrants. Ways of delivering appropriate services
were explored and, within a year, information and services were being provided
in three languages. In the second year, bilingual and multilingual workers were
employed. Visits were arranged to factories and hostels and a publicity campaign
on immigrant radio and in the press elicited an ‘overwhelming response’. Italian
women became members of the collective.9
Throughout its 38 years, LWCHC has continued to provide services for
immigrant women, altering direction and focus in response to demographic
changes. The factory-visits program was expanded towards the end of the 1970s
and became an established Factory Project in the 1980s. Information brochures
were translated. In 1983, LWCHC and the similarly located Liverpool Women’s
Health Centre, which had been doing its own research into women’s industrial
health problems, set up the Health in the Workforce Factory Project, which
operated for more than a decade. The project employed women from Yugoslav,
Chilean, Greek, Turkish and Vietnamese backgrounds. Between them, members
of the group spoke 16 languages.
Outreach work uncovered the stressful lives of women working at home. In
addition, immigrant women, it was found, often had little information about their
health. Many had never had a pap smear and, as a group, they were frequently
prescribed tranquillisers. Outreach work in factories and shopping precincts
became a standard part of LWCHC’s work. By the mid-1980s, the managing
collective included South American, Italian, Thai, Turkish and Polish women.
Information brochures in Italian, Spanish, Polish, Turkish, Greek, Arabic and
Vietnamese were produced. In the early 1990s, Vietnamese and Chinese women
joined the staff, and services were developed for newly arriving Pacific Island
women. LWCHC continues to provide a range of services for the immigrant
women who live nearby.
Mary Dimech, writing in 1982, recognised the efforts that many Anglo feminists
had made to address the problems of immigrant women, pointing to the
activities of workers’ health centres, women’s health centres and some refuges.
She argued that women’s movement campaigns for equal pay, the right to work,

8  Stevens might be right about the timing of the introduction of the concept of multiculturalism. Certainly,
the term was not widely known or well understood in 1974. About this time, however, the Minister for
Immigration, Al Grassby, worked to win support for multiculturalism from the Australian community.
9  It soon emerged that there were significant cultural differences between women from different parts of
Italy.
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Reaching for Health

child care and abortion were all of benefit to immigrant women as were the
efforts of teachers’ unions to promote appropriate language-teaching services
for migrants, particularly women (Dimech 1982:16).
Working with and for women from different cultural backgrounds was not,
however, achieved without tensions and difficulties. LWCHC programs did
not (and probably could not) provide for the needs of all clients, leading some
immigrant women to feel ‘that they were outside the real experience and
discussions of the collective’ (Stevens 1995:53). Anglo women struggled to
understand the problems immigrant women faced and many wrestled with the
fact that some immigrant workers had little knowledge of feminism and were
not committed to its principles. For example, one worker is reported to have had
problems with the collective mode of organisation and with the propagation
of the ‘Women’s Libbers’ creed’. As Stevens (1995:53) has recorded, ‘it was
often difficult to decide how and if it was possible for feminism to incorporate
an understanding of all these experiences’. Most members of the collective,
however, were strongly committed to providing services for all women who
lived locally.
Many other women’s health centres made similar efforts. Loddon Campaspe
Women’s Health Service and North-East Women’s Health Service in Victoria
developed factory projects soon after opening in the 1980s. Although the
board was Anglo-Australian, women from non-English-speaking backgrounds
were employed at the Hindmarsh Women’s Health Centre, Adelaide, from the
early days. The staff of Liverpool Women’s Health Centre came from diverse
cultural backgrounds, including three Aboriginal staff members employed in
1984. Funding limitations, however, prevented Liverpool from reaching all
the groups that were known to have needs (Edwards 1984:22). In 2008, staff
members of Women’s Health Care House, Perth, spoke 14 different languages
and arrangements were in place for interpreters in other languages to be present
at appointments or to speak with clients on the phone. In some centres, lesbianfocused programs have been developed (Cameron and Velthuys 2005). This list
is far from exhaustive.
In summary, racism, ignorance and lack of understanding, along with a heavy
focus on the priorities of Anglo-Australian women, were, and possibly still are,
part of the women’s health movement experience. Some successful joint ventures
have, however, been developed and women’s health movement workers, within
the resources available to them, have made efforts to respond to diverse health
needs. The value of collaboration, where it proved possible, was recognised by
Raquel Aldunate and Gladys Revelo, when, at a community and environmental
health conference in 1986, they acknowledged ‘the support of our friends,

52

1. Concepts, Concerns, Critiques

companeras, mainly Anglos, who cared enough to get beyond their guilt, and
or ignorance, and therefore beyond their own racism’ (Aldunate and Revelo
1987:41).

Conclusion
Women with divergent views and from many cultural backgrounds have been
part of the Australian women’s health movement and while there have been
disagreements and differing priorities, a core set of ideas, around which there is
considerable agreement, serves as a guide for action. The question of whether
community-based service-providing groups should accept public funding has
long been settled, not to everyone’s satisfaction, and for many years the task has
been to acquire sufficient resources to be able to respond to women’s expressed
needs and pay workers decent wages. A great deal of learning has taken place
as Anglo-Australian movement members realised that not all women shared
their concerns, priorities and ways of doing things. While it is as misleading to
talk about the Anglo-Australian women’s health movement as one homogenous
whole as it is to talk about ‘all Aboriginal women’ or ‘all immigrant women’,
understanding has been developed between these different groupings and
collaborative and fulfilling working partnerships have been formed.
The critique of curative medicine, developed in Australia and other Englishspeaking countries, was a crystallising force in the early years and continues
to be relevant. Unsatisfactory encounters with the medical system were
common enough for large numbers of women to identify with the critique.
Some modification of medical practice has taken place, particularly in relation
to the provision of information as a basis for effective informed consent. Serious
concerns remain, however, including continuing medicalisation, gender bias in
medical research and treatment, questions about the safety and appropriateness
of pharmaceuticals and the paucity of prevention advice and support services.
The social view of health, which is an elaboration of feminist criticism of the
undue focus on treatment in conventional medical care, takes into account the
impact of life circumstances on health outcomes. Developed from everyday
experience in a context of support for structural health reform, it forms the
centrepiece of the movement’s ideas. Outside the movement, the concept has
gained legitimacy, as supporting evidence of its validity accrues. Within the
movement and in the public health and Aboriginal health movements, it is
strongly endorsed. Achieving structural change in the health system and in
the unequal conditions of people’s lives is the task that the Australian women’s
health movement set for itself.
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Reaching for Health

Canberra Women’s Liberation presenting street theatre, International
Women’s Day, 1972.
Photo: Property of WEL History Project

Opening Warrina Women’s Refuge, Coffs Harbour, New South Wales, July
1978. From left: Salvation Army Capt. Gail Rogers, Betty Craft, Director,
Jan Ireland, Mary Curran, Joan Dunkley, Bel Weise, Patricia Degens,
Shirley Jones, Valerie Furniss.
Photo: Pat Degens
54

1. Concepts, Concerns, Critiques

WEL-NSW members marching against the ‘Lusher Motion’,
a Bill moved by MP Stephen Lusher in the House of Representatives to
restrict the payment of medical benefits for termination of pregnancy,
International Women’s Day, 1979.
Photo: The Search Foundation, Mitchell Library of New South Wales

ACT Women’s Health Network members enjoy lunch at Romaine Rutnam’s
home, 1995. From left: Dorothy Broom (obscured), Mary Sexton, Ann
Smith, Karen Nienaber, Charlotte Palmer, Gwen Gray, Romaine Rutnam
(obscured).
Photo: Manoa Renwick

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The National Women’s Health Policy, 1989.

56

2. With Only Their Bare Hands
We had no one on our side, no political parties, no governments, no
armies, no police, no trade unions and no religions. All we had were
ourselves—women.
— Zelda D’Aprano (in Robertson n.d.:Ch. 16)
The Australian women’s health movement embarked on a journey of discovery
in the early 1970s, knowing little more than that the existing system was causing
deep pain and was not meeting women’s needs. Members had scarcely any
money and often knew little about health, the health system or how government
worked. However, as they listened to each other’s experiences and formulated
their critiques, they developed two aims: first, they wanted to change the power
relations of society that placed women in a vulnerable, subordinate position,
and second, they wanted to support the women they were hearing from, many
of whom were desperate to find compassionate medical services. In order to
politicise the problems they saw, they needed to articulate a set of concerns.
This task was not an easy one, not only because it was virgin territory but
also because criticism of science, medical science and the medical profession
was uncommon at the time and practically unheard of from women! Moreover,
they had to speak out in public about unmentionable topics that opened them
to portrayal as extremists—easy targets for ridicule. Rape and incest were
completely taboo subjects and even domestic violence was hardly mentioned at
the time, even within the counselling community.
Initially, women’s attention focused on reproductive health issues where the
gaps were glaring; however, a broader approach, a social view of health, soon
developed from the stories and experiences that were shared. In the process of
working for the structural reforms that follow from a social perspective, women
faced formidable opposition: from the medical profession, from the religious
right and its institutions, from bureaucracies bent on doing things the way they
had always been done, and from governments that had no feeling for holistic
health perspectives and often lacked the political will to confront powerful
opposition.
This chapter presents a sketch of the political and service-providing activities
of the early years. Because Broom (1991) has provided a detailed account of
the establishment of Australia’s first dozen ‘founder’ women’s health centres,
only a summary is presented here. The second part of the chapter examines the
establishment of the first refuges and services for women who had experienced
sexual assault. Setting up separate services was radical action, especially for
women without resources, and is a distinctive feature of Australian activism.
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In other countries with strong women’s health movements, relatively few such
services were established and even fewer have endured. The separate women’s
health sector is testimony to the strength of the Australian movement and to the
dedication of its members.

Women’s Health Centres and Services
The 1970s was a ‘period of ferment and hope that the world could be a better place’
(Auer 2003:3). As in the United States, women in Australia met in consciousnessraising (CR) groups in the late 1960s where one of the aims was to unlock
the silence about women’s personal experiences and to draw out the political
implications. Women also found these processes therapeutic (Orr 1994:209).
Issues were discussed and evaluated in small groups, with a particular focus on
the effects of traditional female roles, such as responsibility for caring. Women
acted as each other’s sounding boards; ‘old inhibitions and superstitions about
women’s physiology and psychological natural impediments were realised for
the crap it was’ (Melbourne University Consciousness-Raising Group 1974:46).
The disruption of conventional views about the female role and the development
of new norms about what constitutes femininity emerged from these processes.
Many groups attempted to work systematically and to devise new practices to
replace the old, especially in relation to households, sexual relationships, raising
children and participation in public life (Connell 1987:30–1).
Jean Taylor (2003) describes her CR/WL experience in Melbourne as follows:
From the moment I joined the Brunswick CR group, I was completely
involved. The Women’s Liberation Centre was set up, with a telephone
for information and support and also as a meeting place for unfunded
activist groups. I started doing roster there. The centre was basically a
large meeting space at 16 Little Latrobe Street. So women could either
drop in, if they were in the city, and pick up the latest position paper…
or subscribe to the Women’s Liberation Newsletter…so much was being
published and written about and women were ringing in about all sorts
of things. Domestic violence was rife and by the mid-1970s referrals to
refuges became crucially important.
CR and WL groups were being established at the same time. Mass gatherings
were held in an atmosphere that was peaceful but often radically confrontational.
For example, thousands of women, with their children and dogs, attended the
1972 International Women’s Day (IWD) march in Sydney, playing havoc with
traffic. They carried flags and banners, sang and chanted. There were Hyde
Park picnics, concerts and street theatre depicting the stages of women’s lives.
A few women removed their T-shirts in protest against double standards and
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2. With Only Their Bare Hands

were protected by others when police tried to move in. A man from the New
Theatre, wearing a bearskin, was arrested for wheeling a model of a giant penis
through the streets in a barrow—a send-up of prevailing masculinist views.
IWD Sydney made a profit from the day, which was used to rent the first WL
House in the city (Stevens 1985).
In CR and WL groups, health emerged as an urgent issue but activists initially
had no idea how to respond. As Zelda D’Aprano (in Robertson n.d.) describes
the situation:
Answers had to be found and found fast, for many of these women were
desperate. Quickly we had to gather information and pass it on. Off we
went to find sympathetic doctors; to talk to nurses we knew; and to read
everything we could find. Off to seminars, conferences, into courses to
find out how the healthcare system worked; into jobs within the system;
calling public meetings to see if what seemed wrong, really was. We
found it was much worse.
The wish to support women who needed services that were unavailable is easy
to account for but the determination with which women set about establishing
their own health centres and crisis-support services with so few resources
is not so easily explained. Not only were women short of money, they were
also inexperienced politically. They knew little about lobbying, conducting
advocacy or dealing with bureaucracy. As Lyn McKenzie (1979), a founding
member of the Melbourne Women’s Health Collective, recounts, few members
of the collective had any experience in writing submissions or seeking funding
and few had ‘access to the manner in which the bureaucratic maze could be
successfully tackled’ (McKenzie 1979:40).
Reproductive health and, to a lesser extent, mental health issues were early
priorities. Adelaide WL recognised the need for easily understood information
about contraception and in 1970 planned a pamphlet called What Every Girl
Should Know about Contraception. Run off in early 1971 and reprinted several
times, it was distributed widely to schoolgirls, working women and university
students, among others (Kinder 1980:49–51).1 In its 1971 manifesto, Adelaide
WL declared that women had the right to control their own bodies and called
for publicly funded birth-control education, the abolition of the 27.5 per cent
sales tax on contraceptives and the establishment of community-based birthcontrol centres.2 It argued that local health centres should provide services for
1  The pamphlet inspired the highly controversial Sydney publication What Every Woman Should Know, first
printed in July 1971 (Stevens 1995:15).
2  While WL took action on reproductive health issues, including contraception, from 1970 onwards, the
newly formed WEL was directly responsible for having the luxury tax removed. WEL made a submission in
the middle of 1972 to the tariff review being undertaken by the Tariff Board. As a result, the ALP promised
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Reaching for Health

psychological disorders and that free abortion on demand should be available.
Mental health issues and ‘dealing with doctors and psychiatrists’ were priorities
when the Adelaide Women’s Health Group formed in 1973. By the time planning
for the Hindmarsh Women’s Health Centre was under way in 1975, a social view
of health was being articulated. The new centre was to ‘provide a coordinated
community-based service which would cover the physical, psychological and
social aspects of women’s health care’. Preventive primary health care and
health education would be made available and women’s health research and
community action would be promoted (Radoslovich 1994:14–17). Such a broad
agenda was at the cutting edge of ideas at the time. The following list provides
a summary of the main services established in the 1970s.

Selected Women’s Health Centres and Services
Established in the 1970s
1972
• Children by Choice, Brisbane, family planning and abortion information
service.
1974
•
•
•
•
•
•
•
•
•
•
•

Adelaide Women’s Shelter, also known as Naomi Women’s Shelter.
Bonnie Women's Shelter, Sydney.
Collingwood Women’s Health Centre, Melbourne.
Elsie Women’s Refuge, Sydney.
Hobart Women’s Shelter.
Leichhardt Women’s Community Health Centre, Sydney.
Nardine Women’s Shelter, Perth.
Rape Crisis Centre, Melbourne.
Sydney Rape Crisis Centre.
Women’s Health and Community Centre, Perth.
Women’s Liberation Halfway House, Melbourne.

1975
• Alice Springs Women’s Centre, primarily a refuge, Northern Territory.
• Blacktown Community Cottage, Sydney.
to remove the luxury tax on contraceptives, make the contraceptive pill free through the Pharmaceutical
Benefits Scheme and support the development of family planning networks. Action on all areas was taken as
soon as the Whitlam Government gained office (Sawer 2008b:37–8).
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2. With Only Their Bare Hands

•
•
•
•
•
•
•
•

•
•

Bringa Women’s Refuge, Dee Why, Sydney.
Brisbane Rape Crisis Centre.
Canberra Women’s Refuge.
Darwin Women’s Health Centre.
Hindmarsh Women’s Health Centre, Adelaide.
Hunter Region Working Women’s Centre, now Hunter Women’s Centre, New
South Wales.
Launceston Women’s Shelter, Tasmania.
Liverpool Women’s Health Centre (which later participated in establishing
Sunshine Cottage, a local childcare service, Amberley Single Women’s Refuge,
Rosebank Sexual Assault Service, Dympna House, an incest counselling
service, Campbelltown Women’s Health Centre and Jilimi Aboriginal
Women’s Health Centre, now Waminda), Sydney.
Women’s House Health Centre, Brisbane.
Women’s Health and Community Centre Rape Crisis Centre, Perth.

1976
•
•
•
•
•

Adelaide Rape Crisis Centre.
Central Coast Women’s Health Centre, Gosford, New South Wales.
Christies Beach Women’s Shelter, South Australia.
Marrickville Women’s Refuge, Sydney.
Marty House, Woolloomooloo, Sydney, for women with substance-abuse
issues.
• Sexual Assault Resource Centre, Perth.
1977
•
•
•
•
•

Bankstown Women’s Health Centre, Sydney.
Bessie Smyth Feminist Abortion Clinic, Sydney.
Cawarra Women’s Refuge Aboriginal Corporation.
Women’s Health Care House, Perth.
Women in Industry, Contraception and Health (now Multicultural Centre for
Women’s Health), Melbourne.

1978
• Anne Women’s Shelter, South Australia.
• Geelong Rape Crisis Centre, Victoria.
• Warrina Women’s Refuge, Coffs Harbour, New South Wales.
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Reaching for Health

1979
• Elizabeth Hoffman House, emergency accommodation and support for
Aboriginal women and their children, Melbourne.
• Sexual Assault Service, Queen Victoria Medical Centre, Melbourne.
• Wagga Wagga Women’s Health and Support Centre, New South Wales.
• Working Women’s Centre, Adelaide.

New South Wales
Australia’s first women’s health centre was established in Leichhardt, Sydney, in
January 1974. The preparatory work was done by members of Control, a grassroots
abortion referral service. The need for the centre was amply demonstrated when
the first client arrived before the furniture and, within six months, a 10-day
wait for an appointment developed (Broom 1991:4). Women came from all over
Sydney—17 per cent travelling from the outer western suburbs—which alerted
staff to serious unmet need. It was decided to apply for funding to establish
another centre in Parramatta. In the meantime, a group of women had begun
to meet in Green Valley. They wanted a multipurpose women’s centre and a
refuge. They learned that Leichhardt had plans for a western Sydney centre
and successfully petitioned to have it located in Liverpool (Liverpool Women’s
Health Centre web site).
Liverpool Community Women’s Health Centre was opened in April 1975,
the premises having been painted and prepared by the women themselves.
Leichhardt Women’s Community Health Centre (LWCHC) also established the
Bessie Smyth feminist information, counselling and abortion facility (Broom
1991:1–14). Following a community-development approach, these centres
helped to establish more agencies, including Sunshine Cottage, a local childcare
service; Amberley Single Women’s Refuge; WILMA, a women’s health centre
in Campbelltown; Rosebank Sexual Assault Service; Jilimi, now Waminda,
Aboriginal Women’s Health Centre on the South Coast of New South Wales; and
Dympna House, an incest counselling service. The Leichhardt centre was also
involved in the establishment of the Workers’ Health Centre in Lidcombe, by
way of its interest in occupational health and safety (OHS) issues. Both Liverpool
and Leichhardt were inundated with inquiries from groups wishing to set up
their own centres, demonstrating the urgency of the need being expressed. Staff
supported initiatives in Bathurst, Wagga Wagga, Bowral and Nowra.
The Bessie Smyth Foundation provided supportive, holistic, non-judgmental
services, delivered in a setting intended to be homely rather than clinical.
Clients were able to bring their children if they had no-one else to care for
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2. With Only Their Bare Hands

them. A charge was necessary to make operations viable but it was recognised
that even a small charge was beyond the capacity of some women. Bessie Smyth
staff therefore set up the Powell Street Clinic in Homebush in 1977 to provide
information and counselling support on the basis that no woman should be
turned away because of inability to pay a user fee.3 Information was provided in
13 languages plus English, both over the phone and face-to-face.
After 25 years, Powell Street became financially unviable and was sold to Marie
Stopes International in 2002.4 As well as providing 42 000 safe, affordable
abortions and countless counselling and support services, Bessie Smyth
provided training for health professionals and student placements. Clients came
from all walks of life and included marginalised and disadvantaged women,
‘illegal’ migrants, sex workers, women in prison, women leaving prison and
women with drug and alcohol-related problems. With the funds from the sale
of the Powell Street Clinic, the foundation continued to provide counselling,
referral, information and support services for destitute women. Repeated efforts
were made to secure funding for the establishment of a State-wide information
service, similar to Queensland’s Children by Choice (of which more below).
In 2008, operations ceased, although the foundation was retained, in case a
‘window of opportunity’ should emerge for the establishment of a new women’s
reproductive health service.
Another early New South Wales centre is the Working Women’s Centre, near
Newcastle, set up in 1975, as a multipurpose centre, providing health, legal
aid, counselling, information, employment and childcare services. An enormous
amount of work was involved in setting up and maintenance because funding
had to be secured from a variety of separate sources (Broom 1991:15–16)—a
situation that continues in 2010! The centre, now the Hunter Women’s Centre,
has been unable to obtain the services of a doctor since 2003. It provides short,
medium and long-term counselling, undertakes casework and outreach where
resources allow and runs support groups and health-related activities, including
dancing, Tai Chi, massage and meditation.

3  A user fee, charge, co-payment or out-of-pocket expense—terms used interchangeably in Australia—
comes about when there is a gap between the Medicare rebate and the fee charged by the provider. User
charges constitute a serious financial barrier to the use of medical services.
4  For the same reason, Sexual Health and Family Planning ACT transferred its abortion service, Reproductive
Health Services, to Marie Stopes in 2004.
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Reaching for Health

Victoria
The concept of worker control and the principle of collectivity was
alien to the members of the HCC [Hospitals and Charities Commission].
(McKenzie 1979:41)
Two issues dominated the overflowing speak-out organised by WL, the Union of
Australian Women and the YWCA in Melbourne in 1973: poor health care and
lack of information. Women gave testimonies about poor-quality services and
about services they could not find or could not afford. The Melbourne Women’s
Health Collective was formed after the meeting, supported by a donation of
$490 from an abortion trust fund that had recently closed. Premises were rented
for the Collingwood Women’s Health Centre and furnished from donations
and small grants. Within a few months, the centre had five doctors, several
nursing sisters, a naturopath and a dietician. Service provision was voluntary,
although after Medibank, the Commonwealth’s new national health insurance
scheme, came into operation, medical services could be bulk billed. Demand
was heavy, as in New South Wales, and evening sessions often lasted until
midnight (Hull 1986). Dorothy Broom (1991:12–14) has described the funding
difficulties experienced as a result of federal processes and State-level political
intransigence but, briefly, Commonwealth funding was to have been channelled
through the Victorian Hospitals and Charities Commission (HCC) in 1975.
The commission, however, imposed conditions that were unacceptable to the
collective, including that services be provided for both men and women, that
men be allowed to join the collective and that doctors be paid by fee-for-service
rather than salary or other means. Compliance was unthinkable. The Melbourne
Women’s Health Collective closed its doors for clinical services at the end of
1975 and requested that the grant money be returned to the Commonwealth
(Hull 1986; McKenzie 1979).

South Australia
The health bureaucracy appears to have had an unfavourable view of
the women’s health centre from the start. (Quoted in Auer 2003:5)
As in Victoria, in South Australia, the health bureaucracy strongly opposed
separate women’s health centres. Opened in 1976 after operating from the house
of one of its doctors, the Hindmarsh Women’s Health Centre was the first in South
Australia. The founding collective hired an old building and renovated it, assisted
by volunteers, male and female. Expectations were high: a comprehensive,
women-centred, child-friendly service would provide comprehensive services
including relationship support and would help women to reach their potential
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2. With Only Their Bare Hands

(Radoslovich 1994:15–16). Commonwealth funding was temporarily blocked
in the Health Department but Hindmarsh became established and operated
successfully for four years. In 1980, however, disagreement broke out between
women who thought the centre had lost its independence and vision through its
close alignment with government and those of a more moderate persuasion. An
unsympathetic government lost no time in withdrawing funding and appointing
an administrator. The Women’s Adviser to the Department of Premier and
Cabinet was a key player in trying to salvage something from the ashes, and the
Health Minister, Jennifer Adamson, was supportive. In response to vigorous
grassroots lobbying, the minister was able to preserve the funding for another
centre. Shortly afterwards, Adelaide Women’s Community Health Centre was
established in North Adelaide and most of the Hindmarsh staff moved to
work there. The original collective, however, decided to continue operations,
providing some medical services, workshops, herbal treatments and massages
(Broom 1991:19–21, 93–101; Radoslovich 1994:19–21).

Western Australia
In Perth, women formed the Women’s Centre Action Group, which met weekly
at the WEL premises from October 1972 onwards. Establishing a refuge was
chosen as the top priority. Preparatory work proceeded through 1973 and
the Nardine women’s refuge was opened in July 1974. Shortly afterwards, the
Women’s Health and Community Centre at Glendower Street began operating on a
voluntary basis and was officially opened in 1975 after it received Commonwealth
funding. The focus was on providing services for all women on the grounds that
women from all income groups suffered discrimination and stereotyping in the
medical mainstream. A split between radicals and moderates—described to me
as ‘an implosion’—led to the withdrawal of funding in 1976. Again, the money
was preserved for another centre, and Women’s Health Care House opened in
1977 (Broom 1991:14–15). The small premises led workers to feel they were
operating from ‘a resurrected sardine tin’ but the centre was able to move to
its present location at 100 Aberdeen Street in 1989 (Stroud 1989:3). Medical,
counselling, information and postnatal depression services are provided along
with support and advocacy for women suffering mental health problems and
women experiencing domestic violence. Community-development projects and
workshops are held, child care is available for clients and development and
training are provided for health and social welfare professionals.

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Reaching for Health

Queensland
At a time when State politicians were telling women that everything they
could possibly need was being provided in hospitals, grassroots women set up
Women’s House Health Centre in Brisbane in 1975, as part of a multipurpose
centre. Participants remember it as ‘a hotbed of dispute’ between women with
different feminist orientations. Differences were not just between radicals
and reformists but also between women of different sexual persuasions. Early
management committees did not keep accurate records so the auditor was
unable to produce an audited set of accounts and the centre lost its funding
after less than two years. A variety of fundraising activities was used to survive.
Some services, mainly refuge services, continued on a voluntary basis but the
centre had to move to save money. The second set of premises was in poor repair
but was nevertheless full to overflowing with women needing shelter. At this
time, Premier, Joh Bjelke-Petersen, said there were no homeless young people
in Queensland and returned $14 million to the Commonwealth Department of
Housing.
The centre was eventually funded under the National Women’s Health Policy
(NWHP) in 1990 (Broom 1991:16–17). Among the ‘memorable moments’ of the
early years was the arrest of Women’s House workers for singing Lest We Forget
for women raped in war.

Northern Territory
In Darwin, local WEL women, supported by general practitioner Lyn Reid,
wrote a health centre funding proposal to the Health and Hospitals Services
Commission (HHSC) in 1974. Darwin Women’s Health Centre, a combined health
centre and refuge, was opened in 1975, having been delayed for six months,
this time not by the local bureaucracy but by Cyclone Tracy. Divisions among
members and identification with radical elements gave the NT Government an
opportunity to withdraw funding in 1980. In Alice Springs, too, WEL women
were behind the establishment of a women’s centre, which was primarily a refuge
and was opened on a volunteer basis in an old house in 1975. It provided crisis
counselling, referrals and emergency accommodation, but it too lost funding in
1980, and although volunteer workers tried to continue, the service was closed
and the house bulldozed (Broom 1991:21–2). Local women, however, worked
to re-establish a centre and 14 months later Women’s Community House was
opened as a refuge in an old building which was intended to be temporary.
It took a further nine years to arrange for specific-purpose accommodation
and a renamed Alice Springs Women’s Shelter opened in 1991. The service has
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2. With Only Their Bare Hands

expanded, gaining a children’s support worker, an outreach worker, a domestic
violence counsellor and a community-development and training worker. An
outreach service for women and children who do not want to stay at the shelter
and transitional housing arrangements operate at other locations. The service,
which is jointly funded by the NT and Commonwealth governments through
the Supported Accommodation Assistance Program (SAAP), is open to women
from all cultural backgrounds.

Refuges, Shelters and Houses5
The needs of women and children escaping domestic violence are as
complex and varied as the many kinds of violence that are being escaped
from. (Pateras 1997:4)
The Australian refuge movement has been a major force in having violence
recognised and accepted as a serious women’s health issue. The political pressure
generated at the local level slowly percolated upwards, in due course finding
expression in national policies. Violence against women has deep historical
roots. In eighteenth-century Britain, the law still allowed men to beat their
wives, and nineteenth-century English and Australian laws regulated violence
rather than outlawing it. It was a major issue for first-wave feminists: Louisa
Lawson wrote with outrage about it in The Dawn in 1891 (Spinney n.d.:1; Weeks
and Gilmore 1996:141). Despite more than a century of activism, however,
the National Council to Reduce Violence against Women and their Children
(hereinafter referred to as the National Council) (Commonwealth of Australia
2009a:20) found that one in three Australian women still experience violence
at some time in their lives. The majority of perpetrators are men, and women
are mostly assaulted in their own homes, often repeatedly, by men they know.
Violence is a major cause of homelessness for women and children. In 2003–04,
the Australian Institute of Health and Welfare (AIHW 2005a) found that 33 per
cent of women in SAAP-funded services were escaping violence, along with 66
per cent of accompanying children.
Violence is a major cause of ill health: intimate partner violence was the leading
contributor to death, disability and illness for Victorian women aged between
fifteen and forty-four years in 2004, ahead of well-recognised risk factors such as
high blood pressure, smoking and obesity. Intimate partner violence contributed
8 per cent of the total disease burden for Victorian women aged between fifteen
and forty-four years and 3 per cent of the burden for all Victorian women in
5  ‘Refuge’ is the term generally used in Victoria, New South Wales and Western Australia, while ‘house’
or ‘shelter’ is more common in Tasmania, South Australia, Queensland and the Northern Territory (Weeks
1994:44).
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Reaching for Health

that year (VicHealth 2004). Violent relationship experiences are associated with
allergies and breathing problems, pain and fatigue, bowel problems, vaginal
discharges, eyesight and hearing problems, asthma, bronchitis, emphysema and
cervical cancer (Loxton et al. 2006). This major health risk factor is not easily or
effectively addressed in the conventional medical system.
The magnitude of the problem emerged early in CR groups and phone-ins (Smith
1985:26; Weeks and Gilmore 1996:143). Women sought refuge from violence and
sometimes because their children were being sexually abused (Geddes 2007:2).
With almost nowhere for women to go, collective members often provided
accommodation in their own homes; however, the problem was too big to be
solved in this way and feminists knew that prevention required that the issue be
taken out of the private sector where it was invisible and debated publicly (Orr
1994:9–10). Elimination would require fundamental changes in societal values,
in public policy, in the conduct of relationships and in the status and economic
independence of women. Sustained political action would be necessary.
Feminist refuges were established to provide immediate support and to lobby
on key issues, such as public housing, income support, employment, education
and child care. Refuges also supported women after they moved on, where
necessary (Orr 1994:210). One of the first attempts to establish a refuge ‘by
women for women’ was in 1971 when Joyce Johnson and Elizabeth Hoffman
set up a facility for Aboriginal women and their accompanying children in
Melbourne. Both women worked at the Aborigines Advancement League,
where women who needed crisis accommodation often presented. ‘Aunty
Joyce’ and ‘Aunty Liz’ also took women into their own homes. The original
attempt failed and the facility was taken over by a hostel (Smith 1979) but the
two women continued to work towards a refuge. In 1979, under the auspices
of the Aborigines Advancement League, they established a service that later
became Elizabeth Hoffman House. A community-controlled organisation, with
a management committee and elected office bearers, the house was incorporated
in 1984, when it secured independence from the League. The underpinning
philosophy is that Aboriginal people have a right to self-determination and selfmanagement and that each community is best able to identify its own needs and
develop and monitor its own programs. It provides emergency accommodation
for Aboriginal women and children, counselling and support services (Elizabeth
Hoffman House web site).
In 1974, non-Aboriginal women established refuges in Sydney, Melbourne,
Adelaide, Perth and Hobart. The story of the way Elsie, the first permanent
1970s refuge, was set up and maintained in Sydney has been told in detail by
one of the founders, Anne Summers (1999:315–26). Briefly, a refuge working
group of the Sydney Women’s Commission, looking around for appropriate
premises, noticed that the Church of England held unused buildings in Glebe.
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2. With Only Their Bare Hands

The group wrote to the church, hoping to negotiate to rent a house for a modest
sum but the church refused to meet with them. Outraged, the group decided to
squat in one of the houses. Having let themselves in by forcing a window, they
found that the house next door was also vacant and shared the large backyard.
They then contacted television networks and announced that Australia’s first
feminist refuge had opened.
Premises are one thing. Operational money is another. The rundown houses
were soon crowded, women and children often had only the clothes they stood
in and there was no money for food and electricity. Summers relates the struggle
to obtain government funding, the compassion of women who came to help, the
generosity of local Glebe merchants, who often gave what was needed, and the
lengths that were taken to survive. She recounts the determination to continue
political action as well as provide a service for women. Elsie survives today, one
of 83 refuges for women and children in New South Wales.
In Melbourne, more than 100 WL members became part of the Halfway House
Collective formed in April 1974. The group met for months, writing letters,
funding submissions and a manifesto and attempting to gain media coverage.
Following Elsie, they considered squatting, since public authorities, churches
and private developers all owned empty houses. The idea was rejected,
however, on grounds that stability was needed for women and children already
in precarious circumstances. Instead, efforts were made to persuade owners to
allow empty houses to be used (Women’s Liberation Halfway House Collective
1977:13).
Eventually, a community woman offered the use of a house for a year and WL
Halfway House opened in September. The collective had a flat decision-making
structure, with both service users and workers involved in planning strategies
and running of the house. A roster was organised in four-hour shifts, with one
woman remaining overnight, along with transport and babysitting rosters. Jean
Taylor (2003) describes her experience:
I became involved in roster work…That was amazing…I had no idea,
really, what I was doing. I went along because some of the Brunswick
CR group volunteered at a public meeting to become members of the
committee…it was very difficult to get funding because the government
wasn’t funding refuges…We just kept putting in submissions.
Within two months, the centre was running out of space and money. It survived
on donations and proceeds from fundraising events, such as jumble sales. WEL
assisted by setting up a trust fund to pay for electricity, rates and phone. Besides
running costs, residents needed money to set up new accommodation in order to
move on. In early 1975, modest Commonwealth funding was obtained and the
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collective was able to pay its workers. The first employees were a diverse group,
including ‘a mother of six, a counter-culture freak, a Toorak lady, a heavily
feminist dyke, a dedicated resident intent on bringing fun to the Women’s
Movement, a trained statistician that never was and one that defies all attempt
at description’ (Women’s Liberation Halfway House Collective 1977:113).
Working conditions were onerous and a division threatened to open up
between paid workers and the rest of the collective. One ex-worker has left a
record of her feelings: it helped in the job to have ‘no heart’ to avoid emotional
involvement, to enjoy being a hermit because there was no time for social life,
to be able to function well on minimal sleep and to own a truck to carry around
‘all the necessary papers, speeches, cards, articles and files’ (Women’s Liberation
Halfway House Collective 1977:115).
When the original house was sold, another round of letter writing, lobbying,
speaking to the media and searching for premises began. The HHSC grant
included only $50 a week for rent. A former private hospital was located on the
outskirts of the city. After the move in April 1975, however, it transpired that
the lease was not renewable because the building was earmarked for demolition.
Another frustrating search began; no-one was prepared to consider letting to
a feminist women’s refuge. Suitable premises were eventually found and the
house moved for the third time in 20 months.
Another problem was conflict with the Victorian Government about
confidentiality of location. Collective members insisted on secrecy in order
to protect women from angry partners. After a protracted struggle involving
media debate and direct action, a compromise was reached: selected government
women, who visited at least once a year and reported on operations, became
address holders (Orr 1994:217; Women’s Liberation Halfway House Collective
1977:32–3, 69).
Political action focused on housing shortages, income-support requirements and
police handling of domestic violence. Direct action included a demonstration
outside the Victorian office of the Commonwealth Department of Social Security
in May 1975, which drew attention to the inadequacy and uncertainty of the
pensions available to women who had no other means of support. Later that year,
a campaign to increase the availability of low-cost housing included squatting
in unoccupied Housing Commission flats. In the same year, the collective
wrote a submission to a police inquiry on behalf of women who had used the
house. It argued that women experiencing domestic violence found the police
unsympathetic and unreliable and that distrust was common. A number of
recommendations were made, including suggestions for police training, but the
collective was told that the submission did not fall within the terms of reference
of the inquiry.
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2. With Only Their Bare Hands

In the 15 months until the end of 1975, Halfway House received accommodation
requests from 907 women and 1949 children but only 202 women and 304
children could be accommodated. Places were found for 38 women and 52
children in private homes, leaving 667 women and 1593 children who had to
be turned away. The collective estimated that the voluntary time devoted to
Halfway House during the period was equivalent to that of 25 full-time workers
(Women’s Liberation Halfway House Collective 1977:5, 85).
The first Adelaide women’s shelter was set up in June 1974 in response to phone
calls from women who had nowhere to go. A small group squatted in a vacant
house belonging to the Highways Department, then informed welfare agencies
of their existence and called for donations of furniture and volunteer support.
The group had already established contact with the local Bowden/Brompton
Community Development Group and was hoping for ongoing support. The
condition of the house, however, was poor: ‘there was no laundry, the roof
leaked, a wall was falling down, there was only an outside toilet and the yard
was not closed off’ (Otto and Haley 1975:11). Feminist activist Sylvia Kinder
(1980:150) has described the project as a ‘desperate attempt to alleviate a
pressing need’.
Unforeseen problems quickly emerged. First, establishing trusting relationships
with women staying temporarily was sometimes difficult. Second, housingmarket obstacles often prevented residents from moving on so conditions
became overcrowded, dirty and fraught with disagreement, instability and
lack of privacy. Third, some clients were simply homeless rather than escaping
violence and some had drug, alcohol and mental health problems. Providing
support required skills and resources beyond the means of the group, members
of which were on a steep learning curve trying to obtain information about
welfare benefits, legal rights, hospital services, housing availability and the
like. Fourth, residents had varying attitudes and needs, creating friction and
difficulties. Some wanted their partners to be able to attend the shelter to
facilitate negotiations; others felt the need for sanctuary from men. Since the
address was not secret, men sometimes turned up looking for women to date!
As in other feminist establishments, at the Adelaide Women’s Shelter, the
founders did not have a uniform view on principles. Most favoured cooperative,
non-hierarchical management structures but one, it appears, did not, and saw
herself as matron/landlady. Within the first month, heated arguments broke out
and after less than six months a serious rift developed (Otto and Haley 1975:12–
16). Members of the Highways Department were drawn into the dispute but
the compromises put forward were unacceptable to collective members, who
eventually withdrew (Smith 1985:28).

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Another Adelaide shelter, Christies Beach Women’s Shelter, was established in
1976 by a group of women who had met in the women’s studies department at
Flinders University. Initially, one of the women opened a drop-in centre at her
shop, to which a steady stream of women trying to escape violence presented
themselves. Soon the chairs were replaced with mattresses. Clearly a shelter was
needed and lobbying began. The Housing Trust was eventually persuaded to
provide a house but women had to raise money to pay the rent. The St Vincent de
Paul Society helped with furniture and provided food vouchers in emergencies.
In 1977, ongoing funding was obtained from the State Government.
As mentioned, the Perth Women’s Centre Action Group (WCAG), comprising
WL, WEL and others, decided to give priority to a refuge because the three
existing centres for homeless women in the city were overflowing. In July
1974, Nardine Women’s Refuge was opened in a three-bedroom house, without
public funding. A mixed group of more than 40 WCAG-trained community
women provided a 24-hour service. Operations were financed from donations.
The principles were feminist and included the provision of respectful support
and empowerment through self-help and collectivity. As in other pioneering
refuges, at Nardine, the floors were soon covered with extra mattresses and
overflow families were accommodated in private homes. Even then, in the first
year up to four families each day were turned away (Murray 2002:21–31).
In 1975, the refuge moved to much larger premises, by which time it had secured
State Health Department funding; however, the new house soon overflowed as
well. The adjoining property was taken over and in the late 1970s a third house
was acquired nearby. Collective members lobbied ministers and bureaucrats,
staged rallies, attended forums, presented papers and wrote submissions. Direct
action included accompanying a group of women and children to a departmental
office and refusing to leave until something was done. The political climate in
the second half of the 1970s was unsympathetic and feminist refuges were seen
as politically embarrassing. The Premier, Charles Court, said on radio that the
recipe for a successful marriage was a tolerant and patient wife. The police
responded to a call for help from Nardine in the case of a violent incident by
raiding the place instead, in the belief that the women were drug-taking hippies
(Murray 2002:31–45).
Initially, Nardine workers were largely from Anglo-Australian backgrounds,
with little understanding of the lives of Aboriginal and immigrant women. As
experience grew, however, the refuge began to facilitate cultural sensitivity
training and it gradually gained a reputation among Aboriginal women as a safe
and accepting establishment. Nardine also implemented a policy of affirmative
action in the employment of Aboriginal workers. Over the years, half or more
of Nardine’s residents have been Aboriginal women and their children who,
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because of the difficulties of securing appropriate, affordable housing, sometimes
remained at the refuge for long periods. The refuge worked politically to raise
awareness of housing shortages (Murray 2002:46).
Nardine continues to operate as a feminist refuge, funded by State and
Commonwealth grants and short-term project money. As well as operating a
residential service, it provides outreach, counselling and advocacy services. It
is managed by a small committee, supported by a broader collective. Political
activism to achieve social change is still central to its work, along with education
projects that promote zero tolerance of violence against women and children.
In Hobart, the Women’s Action Group, which had a sister group in Launceston,
was formed in 1972. In 1974, the Hobart Women’s Shelter was opened, followed
by the Launceston Women’s Shelter in November 1975 (Magnolia Place Team
2007; Murphy 2006). Both centres were overcrowded, under-funded and
subject to opposition and criticism from the beginning. As in other places,
in Launceston, committee members disagreed about management principles.
Stress was further increased because fundraising was a constant necessity. For
example, in 1977, when the Launceston shelter needed larger premises, the
Tasmanian Government agreed to provide 50 per cent of the money, leaving the
committee to somehow raise the other 50 per cent. It succeeded.
The Canberra Women’s Refuge Committee was formed in 1974 and the Canberra
Women’s Refuge was opened in a suburban house on IWD, 1975. Committee
members visited both Elsie and the Adelaide shelter and talked with Melbourne
feminists, seeking advice and information. As in other places, in Canberra,
the guiding principles were feminist. The house, owned by the Department
of the Capital Territory (the Australian Capital Territory had not yet gained
independence from the Commonwealth), had sleeping accommodation for 16
women plus three cots—and one wardrobe! The lounge room was used as an
office, relaxation room, play room and bedroom (Canberra Women’s Refuge
Collective 1976).
The Canberra committee undertook groundbreaking political work. In 1976,
two major discussion papers were written, the first on women, violence and the
law and the second, on women, violence and housing. These documents were
distributed widely to local and national politicians and relevant others. The
law paper argued that women and children had a right to live in the marital
home and that consideration should be given to evicting violent partners.
Police should inform women of their rights and refer them to legal aid, it was
suggested, and interpreters should be employed, as necessary. The group met
with the Registrar and other officers of the Family Law Court, talked with police

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and met with the Assistant Police Commissioner. Public attention was drawn
to the fact that non-molestation orders were often flouted and the police were
asked to provide better protection for women.
The discussion paper on urgent housing needs argued that if refuges were to
be able to take new clients, there must be a reasonable turnover of women and
accompanying children. Because interim housing was so scarce, bottlenecks
were forming. It pointed to the absurdity that women who were joint owners of a
marital home were ineligible for emergency public housing. Interim housing was
necessary to cover the period between separation and the settlement of financial
and custody matters. Nor were woman eligible for alternative accommodation
if the home they had lived in was publicly provided. The paper also pointed
out that two women, who might meet at a refuge and might want to split costs
and help protect each other, were not eligible to share a government house.
Moreover, single women with children were considered high-risk tenants in
the private sector and rental bonds were out of reach of those surviving on
public benefits. This paper was circulated to politicians, housing officials, the
Real Estate Agent’s Institute and other key groups. The committee met with the
Commonwealth minister responsible for housing and gained certain concessions.
The Canberra group also undertook direct action. For example, members ‘sat in’
a government house with a woman and her children who were threatened with
eviction, after a bungle between departments in relation to rent. The eviction
was averted. The group also formed a coordination team for ACT and New South
Wales refuges in 1977, as part of a campaign to secure stable refuge funding
from the Commonwealth (Canberra Women’s Refuge Collective 1977).
In New South Wales, Bonnie Women’s Shelter was opened in 1974 and the
Blacktown Community Cottage was opened in 1975, along with Bringa Women’s
Refuge, Dee Why, which was set up by a feminist collective with help from
unions, the Salvation Army and community groups. It works according to the
principle of ‘women helping women’ and still operates. Marrickville Women’s
Refuge was established in 1976 after a funding struggle and a battle with the
local council over premises. Marty House, Woolloomooloo, was founded in 1976
for women trying to recover from substance abuse in a house supplied free by
the Sydney City Council.
The quest for Commonwealth funding for refuges is a complicated and protracted
story, involving disagreement and confusion about which bureaucratic portfolio
should be responsible. There were debates about whether funding should come
from homelessness agencies or whether it should be provided by the social
security or health departments. After interaction between feminists inside and
outside government, the Women’s Affairs Section of the Department of Prime
Minister and Cabinet put a proposal to the Prime Minister that refuges be
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funded under the Community Health Program, which was accepted in June
1975. At that time, 11 refuges were ready to be funded (Dowse 1984:139–49;
Sawer 1990:12–13). As discussed, however, the Fraser Government slashed
Commonwealth funding, resulting in protracted funding insecurity. The next
phase of refuge development is discussed in Chapter 3.

Sexual Assault Services
Feminists in the 1970s were intent on extricating sexual assault from the recesses
of the private domain and placing it on public agendas—an unenviable task.
They politicised the varieties of sexual violence prevalent in Western countries
and argued that it was a systemic problem rather than a problem arising from
the behaviour of aberrant individuals. For centuries, the attitudes and practices
of the dominant culture had kept it ‘marginalised, secretive, pervasive and
ignored’ (Doyle 1996:44). Whereas the anti-violence movement gained political
support and early policy prominence, the same level of attention was not paid to
sexual assault (Carmody 1990:303). In contrast, rape had become a major issue
in the United States by the early 1970s.6
One of the reasons that feminist analyses of rape were slow to gain acceptance
appears to be the strength of longstanding myths and stereotypes. Rationalisations
that condone or trivialise rape and place blame on women and sometimes children
have been identified in most countries and can be traced back to ancient times
(Yarrow Place web site). In Australia, justifications are said to be deeply embedded
as a result of the country’s ‘strange beginning’, when women were imported to
provide sexual and other services. There is also a strand of thinking that sees
Aboriginal women as ‘sexually available’ (Broom 2001:96). Sexual assault has
been ‘woven through our landscape’ from the time of white settlement (Simmons
2009). As Shoebridge and Shoebridge (2002:1) argue:
Australia, perhaps more than most, is a masculine country…whose
European settlement was by British and Irish, mainly male, convicts
whose presence was supplemented later by boatloads of women,
brought to civilise disruptive unruliness and begin building families…
The masculine norm continued, through the mythology built up by
participation in several wars, dominant industries such as mining and
stock farming, and cultural obeisance to the romance of ‘the bush’—nonmetropolitan Australia where men are men and women are incidental.

6  Despite early attention, however, the fictions around rape remain. ‘Few crimes in the United States today
elicit as much scepticism and victim blaming as do allegations of rape and sexual assault’ (Weiss 2009:810).
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That Australia is the country with ‘the highest incidence of recorded gang rape
in the world’ (McFerran 1990:193) lends support to such analysis. In 2005, more
than 950 000 Australian women reported being sexually abused before the age
of fifteen—a horrifying statistic (Commonwealth of Australia 2009a:19). The
2005 Australian Bureau of Statistics Personal Safety Survey showed that 19 per
cent of women over the age of fifteen had experienced sexual violence and that
about one in three who were physically assaulted by partners were also raped
(Commonwealth of Australia 2009a:19). A 17-country study in 2000 found that
Australia was one of four countries with the highest risk of sexual assault (van
Kesteren et al. 2000:4, 35–6).
Historically, women have been held responsible for preventing rape. Apart from
not talking to strangers, they have been told not to dress ‘provocatively’, to
travel in groups, to always carry money for a taxi and to stay home after dark.
Elder (2007:133) records a recent case where a girl raped on a school trip was
questioned in court about the length of the skirts she wore. The idea that rape
is a woman’s fault is so deeply ingrained in Australian culture that women’s
services have had to stress, regularly and repeatedly, that this is not so.
The National Council to Prevent Violence against Women and Their Children
argues that ‘sexual violence by male intimate partners remains one of the
least recognised, underreported and consequently, least prosecuted crimes’
(Commonwealth of Australia 2009a:19). The feminist argument that there is
more danger from family members, friends, work colleagues and other known
persons than from strangers is borne out by evidence: less than 10 per cent of
attacks on young women are made by strangers. Sexual assault is more prevalent
in rural and remote areas and among younger women, Aboriginal women and
women with disabilities. Estimates are that less than 20 per cent of sexual assault
crimes are ever reported. Of the small number that come to trial, less than 20
per cent result in the accused pleading or being found guilty (Commonwealth
of Australia 2009a:17–20).
Feminists argue that sexual violence is a structural problem: men who commit
sexual assault are tacitly supported by an unequal, male-dominated society in
which women have inferior status. As in the case of domestic violence, feminists
challenge power structures and argue that attitudes must change. The myths to
be subverted include that women ‘ask for’ and enjoy rape, that children can be
‘seductive’, that only ‘loose’ women are raped, that women and children often
lie about rape, that only bad, deranged or stressed men commit sexual assault
and that men have uncontrollable sexual urges (Cook et al. 2001:1).
As in the health centre and anti-violence movements, the movement against
sexual assault set about the twin tasks of providing support services and
developing strategies to promote social change. The Sydney Rape Crisis Centre
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formally opened in 1974. A group of volunteer women had been travelling ‘all
over Sydney’ picking up women who had been assaulted and bringing them to
the centre for counselling and medical services. The centre was funded by the
Commonwealth in 1974, allowing workers to be paid. Currently known as the
NSW Rape Crisis Centre, it is funded by the NSW Department of Health and
adheres to feminist goals. It is not-for-profit and community controlled and its
overarching purpose is ‘upholding the rights of women to live in a socially just
and equitable society and the rights of all people to live free of violence’ (NSW
Rape Crisis Centre web site). It provides 24-hour, seven-day-a-week telephone
counselling and support, regardless of when the assault occurred. Support and
information are provided about safety, emotional impact, possible actions and
the availability of long-term services.
In Brisbane, Women’s House established the Brisbane Rape Crisis Centre in April
1975, followed by a refuge the following month. As discussed, Women’s House
lost its funding after operating for less than two years but women continued
to provide services on a voluntary basis. On condition that it raise $2500 of its
own, the management group received $10 000 from the Commonwealth for a
refuge in 1978. Not until 1983 did it receive funding for the Rape Crisis Centre.
Adelaide feminists established a rape crisis centre in an old house in 1976.
As well as services, the centre established a forum for discussing the multiple
issues surrounding rape, including legal issues. The centre also operated as a
safe drop-in place, where women could share their experiences, chat and read.
Self-defence classes were offered and training modules for nurses, teachers and
other professionals were developed.
A rape-crisis group was formed within Melbourne WL in 1973. It set about
gaining information on key medical, legal and statistical issues. Some members
found the issues too confronting, however, and the size of the group shrank.
The following August, another group was called together by WEL, which
included women from the original group. A 24-hour rape-crisis service was
established and the name Women against Rape was chosen. Prevention was
a priority. After meetings with police, and medical and legal professionals to
disseminate information and suggest referral, the Rape Crisis Centre was opened
in November 1974, operating from the premises of the Melbourne Women’s
Health Collective in Collingwood and funded by donations. Its establishment
drew considerable media attention and women who had been raped were soon
seeking services.
There followed a long and unsuccessful struggle to gain public funding.
Because the centre was a long-term project, it was ineligible for International
Women's Year funds. The Commonwealth Department of Health authorised
funding in 1975 but in another instance of bureaucratic obstruction, the money
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was blocked by the Victorian HCC on grounds that the organisation’s aims were
unacceptable: it was a women-only collective that did not depend entirely on
professionals. It was decided to give up the quest for funding in 1976 because
it sapped too much time and energy, and to operate independently. Collective
members turned their hands to fundraising and pledged their own money on
a weekly basis (Hewitt and Worth n.d.; Women against Rape Collective n.d.).
Political action was continued until the late 1970s from WL Centre in Little
Lonsdale Street, including campaigns for legislative reform and reform of court,
police and hospital practices.
The Women against Rape Collective established the Geelong Rape Centre in
1978, following the poor treatment of a woman who had been raped. It ran on
voluntarism and donations from workers, but, in 1984, it succeeded in gaining
funding from the Victorian Health Department. In 1995–96, it was offering
therapy groups for children, young women who were incest survivors, mothers
of sexually abused children and adult women who had experienced incest. It also
ran a men’s group. A community-development worker coordinated community
education in schools and for professionals. Campaigns included a week of action
against domestic and sexual violence and a child-protection week (Geelong
Rape Crisis Centre 1995–96). In 1999, it was one of seven organisations funded
under the national Partnerships against Domestic Violence (PADV) to develop
a model of best practice for working with children affected by family violence
(Hunder 1999:iii).
In its early days, WEL formed the Rape Study Group in Melbourne to work
for law reform and better services. Its advocacy resulted in the Victorian Rape
Study Committee being established in the Department of Premier in 1977, which
recommended the establishment of a government-funded 24-hour counselling
service. The Queen Victoria Medical Centre set up a sexual assault service in
1979—the first public sexual assault service in the State. Another Melbourne
group, the Campaign against Causes of Rape, was formed in response to a double
rape-murder.
In Western Australia, the Women’s Health and Community Centre had set up a
rape-crisis service at Glendower Street in 1975 but it did not survive. A new
centre was opened at Sir Charles Gairdner Hospital in 1976 in response to
feminist concern about the treatment of women who wished to report a crime
(Deller et al. 1979:771). The women who set up the second service prepared for
it by holding consultations with the police, the Office of the Under Secretary
for Law, the Women’s Health and Community Centre, a panel of women doctors,
officials from the Sir Charles Gairdner Hospital and forensic experts. The main
aims were to provide comprehensive support services for victims of sexual
violence, to promote greater community understanding and awareness, to
establish appropriate education for medical, legal, police and health personnel
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and to support and encourage research (Deller et al. 1979). When the original
women’s health centre reopened in 1977, it housed the local branch of the
Australian Women against Rape group until 1985.
The operation of the Sexual Assault Resource Centre (SARC) became controversial
in the early days as women’s health activists expressed concern that a hospital
setting might not be conducive to women-centred care. A compromise position
was reached whereby the service remained part of the public hospital but was
managed by an independent board. During its first 2 years, the centre saw more
than 200 clients. SARC is now located at the King Edward Memorial Hospital.
Nationally, Australian Women against Rape, which had State-based branches,
was established at the National Conference of Rape Crisis Centres in Sydney in
1976. The main objectives were raising public awareness of misogynist ideas,
and law reform. The organisation argued for legal recognition of rape within
marriage, for corroboration requirements to be dropped in rape cases, for the
previous sexual history of victims to be inadmissible and for the legal definition
of rape to be extended to cover oral and anal penetration and attempted
penetration. In 1976, it organised a national demonstration in support of a
Brisbane woman accused of making a false rape complaint and drafted model
rape legislation (Grahame and Prichard 1996:16).

Other Early Women’s Health Agencies
Women in Industry Contraception and Health (WICH), as it was known for
many years, is a Melbourne service with a long and successful history, set up
by a grassroots group of women. In response to a dire lack of information about
contraception and related matters among immigrant women working in factories,
a well-attended public forum was held, which resolved that family planning
education should be taken out of the medical context and located within the
workplace and the community. Two doctoral students, with a small group of
immigrant workers and advocates, established Action for Family Planning in
1977. The founders developed a multilingual factory-visiting program, which
took reproductive health education to women where they worked. Financial
support came from the technical and further education (TAFE) sector and the
Commonwealth, allowing multilingual workers to be trained. Another round of
advocacy and lobbying in 1980, when funding was running out, brought support
from the Victorian Health Department and the Department of Immigration. In
1982, the name was changed to WICH, reflecting decisions to move beyond
reproductive issues towards women’s health in its social context. Information
dissemination and advocacy continued and regular newsletters were produced.
The Factory Visits Program was expanded to include OHS, mental health and,
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in the recession of the early 1990s, work, retrenchment and stress issues. At that
time, a funding boost was received from the NWH Program and work was able
to expand again, targeting a wider range of cultural and language groups.
In the second half of the 1990s, however, State funding was reduced, requiring
the organisation to contract but it continued to respond to the needs of newly
arriving groups. In 2000, the name was changed again, to Working Women’s
Health—again reflecting changing priorities. Bilingual health educators were
trained in increasing numbers of languages, as resources permitted, and health
education was extended to community settings, some of them rural, and to
prisons. A library and resource collection was put together, including 10 000
health information items in 96 languages.
In 2006, the name was changed yet again, to the Multicultural Centre for
Women’s Health (MCWH), its present name, which reflects the ‘organisation’s
multifaceted and comprehensive approach to immigrant women’s health’.
Currently, health information is provided in 19 languages in diverse locations
(MCWH web site).
Another major 1970s initiative with a long and successful history is the Children
by Choice Association (C by C), formed in Brisbane in 1972 from what had been
the Queensland Abortion Law Reform Association. C by C was established as
a family planning and abortion information service. Like so many women’s
services, it was set up in an old house, sparking a blaze of publicity, during
which bricks were thrown through the windows. In Queensland at the time,
termination was deemed illegal, even in a case where a woman had contracted
rubella. Vasectomy was also illegal.
In this context, C by C made arrangements for women wanting an abortion to
be referred to Sydney hospitals and organised help with travel costs. It lobbied,
made submissions to public inquiries, picketed parliament, wrote letters and
presented petitions, calling for the repeal of the relevant sections of the Criminal
Code. The voluntary workers were trained and saw more than 300 clients per
month, referred to them by doctors. So controversial was the work in 1977–78
that more than 120 media news items were generated. C by C staff persisted
through a succession of crises in the 1970s and 1980s, which included attacks
on clinics. Partly as a result, Queensland legislation was modified in 1986 but
abortion was not removed from the Criminal Code.
Unable to gain government funding, the association nearly had to close because
of serious financial problems in 1987; however, a request for support to the
Planned Parenthood Federation of America, which normally funds only agencies
in Third-World countries, was successful. The association was then able to
expand its services, move into rural provision and offer some paid employment.
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After three years, the US donor had its own funding reduced and was forced
to discontinue support. Fortuitously, about the same time, the ALP was elected
to government in Queensland after more than 30 years in opposition. Public
funding was obtained in 1991, after which outreach, counselling, information,
education and library services were expanded.
These activities brought renewed opposition from anti-choice forces, in the
face of which the Goss Government shelved its election promise to remove
abortion from the Criminal Code. Indeed, when a ‘comprehensive’ review of the
Criminal Code was instigated in 1990, abortion laws were specifically excluded,
even though one of the aims of the exercise was to ensure that the criminal
law reflected contemporary attitudes. In response to a letter of objection from
a women’s group, the then Attorney-General replied that he would be acting
improperly if he were to allow abortion laws to be reviewed because the
Parliamentary Labor Party had unanimously decided that the subject ‘was not
on the agenda’ (McCormack 1992:40). On Labor’s defeat in 1996, the association
lost its funding. Services were continued by volunteers but the hours of opening
had to be reduced. Fundraising campaigns enabled the State-wide telephone
counselling line to stay open. Labor’s return to power in 1998, however, resulted
in funding from Queensland Health, which continues.
C by C has been built on untold hours of unpaid and low-paid women’s work and
has provided extensive support services. It has worked steadily to raise public
awareness about reproductive health issues and has lobbied and campaigned in
support of legislative change. After almost 40 years, however, abortion remains
in Queensland’s Criminal Code, so powerful are the forces of the religious right
and so reluctant are politicians to confront them.
Although it was not until the 1980s that women’s health groups proliferated,
a sprinkling of new groups formed in the 1970s to draw attention to needs in
particular areas. The Women Behind Bars group was set up in Sydney in 1975,
concerned with legal rights and women’s health inside prisons. In Brisbane,
the Women’s Community Aid Association was established, taking up health
and sexual violence issues and providing women with practical support. The
Women’s Health and Education Group was formed in Sydney in 1975 with
the aim of contacting women outside the movement, especially rural women,
young women and immigrant women (Grahame and Prichard 1996:154, 167).
The Women’s Information Centre Collective was formed in Townsville, which
focused on rape crisis, abortion and women’s services. Meanwhile, in far north
Queensland, an Aboriginal welfare officer at the Cairns hospital, Rose Richards,
became concerned that there was no halfway house for Aboriginal children
brought to Cairns for treatment or for pregnant women awaiting the births of

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their babies. In 1976, she began to care for people in her own home, assisted
by two other Aboriginal women, using their own money when necessary. This
grassroots initiative became a successful halfway house in the 1980s.
Another 1970s grassroots undertaking about which little seems to be known
was a second national women’s health conference, held in Newcastle in 1977,
organised by the Hunter Region Working Women’s Centre (HRWWC). More
than 100 women attended, along with half a dozen men. The main session
streams reflected a social view of health: ‘Becoming Healthy’, ‘Women at Work’,
‘Fertility and Sexuality’ and ‘Especially Disadvantaged Women’. A workshop
considered the possibility of an Australian version of Our Bodies, Ourselves.
Bridget Gilling, well-known feminist and campaigner, put forward a critique
of the overemphasis on curative medicine. Alice Day, a sociologist, presented
the now familiar argument that the nature of women’s work makes them sick,
particularly their inferior position in occupational hierarchies (Day 1977). Recent
epidemiological evidence supports Day’s analysis (Wilkinson and Pickett 2009).

Conclusion
It is evidence of both profound need and passionate commitment that women
set up so many separate services in the 1970s. Looking back, their achievements
are remarkable, given the minimal resources at their command and the strength
of the forces ranged against them. Working often in the face of criticism and
sometimes ridicule, women’s health problems were identified and articulated.
With little more than their bare hands, Anglo, Aboriginal and immigrant women
set up health centres, reproductive health agencies, factory visitation programs,
refuges and sexual assault centres to provide urgently needed services that were
scarcely available elsewhere. Many episodes of extraordinary effort and personal
generosity have undoubtedly been lost to history because women were too busy
campaigning and providing services to produce written records.
Women of the early years succeeded in their twin aims of working at both the
service provision and the political levels, supporting women and promoting
women’s health as a major political issue. A social health perspective, which has
provided the movement with a solid set of foundational principles for 40 years,
was worked out and voiced.
The new centres and services created an institutional foundation from which
political action could more easily be orchestrated, although, as Broom has
documented, the high demand for services always threatens to divert women
from advocacy and social change work (Broom 1991:120–2). Despite the
disagreements and implosions in Anglo-Australian women’s health centres,
activists were able to influence public policy when political circumstances were
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right. The campaigns around domestic violence and sexual assault brought
hidden crimes onto the public agenda and paved the way for the extensive
efforts of the 1980s and beyond. As Lynne Hunt (1994:390) has argued, the
women’s health movement worked outside the conventional health system,
‘moved around’ the medical profession and set up alternative services, creating
a space from which to lobby for health system and societal change.

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Movement members from all States and Territories gathered in Canberra
in February 1994 to develop and write the AWHN Constitution. From left:
Dorothy Broom (ACT), Manoa Renwick (ACT) and Sheryl Rainbird (Tas).
Photo: Julie McCarron Benson

Carol Low (Qld), Annette Burke, partly obscured, (NSW), Keren Howe
(Vic), Cate Mettam (SA), Nancy Peck (Vic) and Dorothy Broom listen to
constitutional deliberations, Canberra, February 1984.
Photo: Julie McCarron Benson
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2. With Only Their Bare Hands

Annette Coppaola and Deborah Gough from the Northern Territory put on
their best smiles at the AWHN Constitution meeting, February 1994.
Photo: Julie McCarron Benson

Annette Burke, Andrea Shoebridge (WA) and Keren Howe at the AWHN
constitution development meeting, February 1994. Jan Darlington (Qld),
Gwen Gray (ACT), Fiona Hillary (SA) and Marian Palandri from Port
Headland, WA (whose fare was paid by BHP) were also present.
Photo: Julie McCarron Benson
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Meeting to discuss the evaluation of the National Women’s Health
Program, Juliana House, Canberra, 1996. From left: Manoa Renwick,
Christine Purdon, Janette Gay, Barbara Gatler, Barbara Podger.
Photo: Manoa Renwick

Some of the members of the organising committee for the Third AWHN
National Women’s Health Conference, Canberra, 1995. From left:
Pam Neame, Roslyn Sackley, Romaine Rutnam, Debbi Cameron and
Jilpia Nappaljari Jones (then Marjorie Baldwin-Jones).
Photo: Tony Adams
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2. With Only Their Bare Hands

Tasmanian delegates at the Fifth AWHN National Women’s Health
Conference, Melbourne, 2005. Middle and back row from left to right:
Karen Price, Yvonne Hardefeldt, Sally Riley, Tracey Wing, Joan Barry,
Wendy Hartshorn. Front row: Morvan Andrews, Sue Moss.
Photo: Tracey Wing

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3. Infrastructure Expansion:
1980s onwards
We bring women together to support each other and strengthen their
sense of connection. Using a community development approach we
involve women in a range of short or long-term health promotion
activities within their own communities, including health festivals,
support groups, resource production and more. (Women’s Health West
web site)
The two decades after the fall of the Whitlam Government can be seen as the
high point of the women’s health movement. A momentum had been generated
that even unenthusiastic governments could not afford to ignore. The 1980s in
particular was a period of intense policy development as the political advocacy
of the previous decade began to bear fruit. Inquiries into women’s health were
held in most States and Territories and all produced women’s health policies,
plans or strategies. Similarly, in several jurisdictions, the first policies in relation
to domestic violence and sexual assault were formulated. All governments set
up women’s health policy machinery in their bureaucracies during this time, in
the form of either a women’s health unit or a special women’s health adviser. As
a result, channels of influence became more diverse. Grassroots activists were
able to interact more readily with women in the bureaucracy and opportunities
were created to serve on government advisory committees and inquiries. At
the Commonwealth level, the development and launch of the groundbreaking
National Women’s Health Policy (NWHP) was definitely the pinnacle of policy
achievement.
Yet the movement faced a mixed policy environment, or series of environments,
during the period. While no government after Whitlam’s would be as strongly
committed to structural reform of the health system, especially at the level of
community-based health care, policy opportunities did emerge. These were
all the more visible because they were interspersed with periods of resistance,
sometimes bordering on overt hostility. During these years, members of the
movement carried on their work in both the political and the service-provision
arenas. Women from diverse backgrounds continued to establish new services
to meet needs, sometimes in collaboration with each other, and although some
centres waited years, in almost all cases funding was eventually allocated by
one level of government or the other and sometimes by both. Staff in womenled services received training, often for the first time, and training packages
were developed for relevant professionals, such as the police and lawyers. For

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mobilised groups in some States and the Australian Capital Territory, the NWH
Program provided the funds with which to establish the health centres and
services they had been planning for years.
By the end of the period, the Australian women’s health infrastructure was
largely in place; very few new centres or services have been established since
the mid-1990s. Given the lack of Commonwealth policy interest since that time
(notwithstanding the introduction of a second national women’s health policy
in 2010), the locus of action has largely moved to the sub-national level and
sometimes involves local government as well. This chapter presents an overview
of the movement’s advocacy and infrastructure-building activities over the two
decades, which are summarised in the list below. The policy responses of the
period are examined in Chapters 7 and 8.

Selected Women’s Health Centres and Services
Established from 1980 Onwards
1980
• Adelaide Women’s Community Health Centre.
• Dawn House, providing accommodation and support services, Darwin.
• Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women’s Council, provider of
health and human services, South Australia.
1981
•
•
•
•

Blue Mountains Women’s Health Centre, New South Wales.
Wirraway Women’s Housing Co-operative, Moree, New South Wales.
Women’s Community House, Alice Springs, Northern Territory.
Women’s Place, for homeless or intoxicated women, Sydney.

1982
•
•
•
•
•

Brisbane Women’s Community Health Centre.
Coffs Harbour Women’s Health Centre, New South Wales.
Dympna House, Sydney.
Louisa Lawson House, Sydney.
Women’s Health Resource Collective, later Women’s Health Information
Resource Collective, Melbourne.
• Yinganeh Aboriginal Women’s Refuge, Lismore, New South Wales.

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1983
• Elizabeth Women’s Community Health Centre, South Australia.
• Esther Refuge Collective, Sydney.
• Mookai Rosie Bi-Bayan, Aunty Rosie’s Place, services for rural and remote
Aboriginal women and children, Cairns, Queensland.
• The Women’s Cottage, Hawkesbury District, Sydney.
• Toora Single Women’s Shelter, now Toora Women, Australian Capital Territory.
1984
•
•
•
•

Dale Street Women’s Community Health Centre, South Australia.
Illawarra Women’s Health Centre, New South Wales.
Immigrant Women’s Support Service, Brisbane.
Jilimi, now Waminda Aboriginal Women’s Health Centre, Nowra, New South
Wales.
• Migrant Women’s Lobby Group, Adelaide.
• Refuge Ethnic Workers Program, Victoria.
• Southern Women’s Health and Community Centre, South Australia.
1985
•
•
•
•
•
•

Darwin Counselling Group, providing sexual assault services.
Immigrant Women’s Resource Centre, Sydney.
Immigrant Women’s Speakout Association, Sydney.
Migrant Women’s Support and Accommodation Service, Adelaide.
Shoalhaven Women’s Health Centre, New South Wales.
Southwest Women’s Child Sexual Assault Resource Centre, later Rosebank,
Sydney.

1986
•
•
•
•
•
•
•
•
•

Albury–Wodonga Women’s Health Centre, Albury, New South Wales.
Central West Women’s Health Centre, Bathurst, New South Wales.
Dympna Accommodation Program, Sydney.
Goldfields Women’s Health Centre, Western Australia.
Migrant Women against Incest Network, New South Wales.
New South Wales Women’s Refuge Resource Centre.
Sexual Assault Support Service, Hobart.
Sexual Assault Referral Centre, Darwin.
Women’s Centre, providing sexual assault crisis services, Cairns, Queensland.
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1987
• Blacktown Women’s and Girls’ Health Centre, Sydney.
• Campbelltown Women’s Health Centre, also known as WILMA, Sydney.
• CASA House, Centre against Sexual Assault, Royal Women’s Hospital,
Melbourne.
• Congress Alukura, women’s health, maternal and child health centre, Alice
Springs, Northern Territory.
• Healthsharing Women, Victoria.
• Hobart Women’s Health Centre.
• Immigrant Women’s Health Service, Fairfield and Cabramatta, Sydney.
• Lismore and District Women’s Health Centre, New South Wales.
• Penrith Women’s Health Centre, Western Sydney.
• Ruby Gaea, providing sexual assault services, Darwin.
1988
•
•
•
•
•

Domestic Violence Resource Centre, Queensland.
Geraldton Sexual Assault Referral Centre, Western Australia.
Gloria Brennan ATSI Women’s Centre, East Perth.
Sexual Assault Counselling Service, Alice Springs, Northern Territory.
Waratah Support Centre, sexual assault and domestic violence services,
Bunbury, Western Australia.
• Women’s Health Service for the West, Victoria.
1989
• Laurel House, Launceston, Tasmania.
• Patricia Giles Centre, offering services for gay, lesbian, bisexual, transgender,
intersex and queer (GLBTIQ) people.
• Whitfords Women’s Health Centre, now Women’s Healthworks, Western
Australia.
1990
•
•
•
•

Canberra Women’s Health Centre, now Women’s Centre for Health Matters.
Cumberland Women’s Health Centre, Sydney.
Perth Women’s Centre.
Townsville Women’s Community Health Centre, Queensland.

1991
• Geraldton Women’s Health Centre, Western Australia.
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• Rockhampton Women’s Health Centre, Queensland.
• Wide Bay Women’s Health Centre, Queensland.
1992
• Edith Edwards Women’s Centre, accommodation and support services,
Bourke, New South Wales.
• Ipswich Women’s Health Service, Queensland.
• Logan Women’s Health Centre, Queensland.
• Mirrabooka Multicultural Women’s Health Centre, Western Australia.
• North-East Women’s Health Service, Victoria.
1993
•
•
•
•
•

Eastern Goldfields Sexual Assault Resource Centre, Western Australia.
Goulburn North-Eastern Victoria Women’s Health Service.
Hedland Women’s Health Service, Western Australia.
Rockingham Women’s Health Service, Western Australia.
Women’s Health Victoria, formed from amalgamation of Healthsharing
Women and the Women’s Health Information Resource Collective.
• Yarrow Place, incorporating the Adelaide Rape Crisis Centre.
• Yorgam Aboriginal Corporation, providing support services for people who
have experienced violence, East Perth.
1994
• Gladstone Women’s Health Centre, Queensland.
• Gosnells Women’s Health Service, Western Australia.
• Gympie and District Women’s Health Centre, Queensland.
1997
• Immigrant and Refugee Women’s Coalition Victoria.
2002
• Aboriginal Family Violence Prevention and Legal Service, Victoria.
2005
• Women’s Health Services, formed from amalgamation of Women’s Health
Care House and Women’s Health Services.

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The Context: Mixed political opportunity
structures
The 1980s and 1990s saw both high and low points for the women’s health
movement, fluctuations that can be explained largely by the advent of favourable
or unfavourable political opportunity structures. The defeat of the Whitlam
Government ushered in a period of ‘depleted political opportunity’ for women’s
health at the national level, which was the first of two inauspicious periods in
the life of the movement so far. Political opportunity structure is a term used
to denote the political context in which social movements try to influence
governments, and is held to be a key element in determining whether advocacy
succeeds or fails. Opportunity structures can help to explain the rise, fall and
transformation of social movements and can go some way to explaining different
outcomes at different times within one country or in different countries (Meyer
2004:125-131; Tarrow 1996:81–99). Political opportunity structure interacts
with other factors that influence policy, among which institutional arrangements
are considered important (Gray 2008:55).
During the years of the Fraser Commonwealth Government, from the end of
1975 until 1983, opportunities for policy expansion, which had been wide
open, all but closed. Moreover, most of Labor’s health system reforms, which
were of so much benefit to women and low-income earners, were steadily
dismantled. The Fraser Government came to power promising to retain both
the national health insurance scheme, Medibank, and the Community Health
Program. Within months, it set up an informal interdepartmental committee to
review the operation of national health insurance. No public consultation was
ever undertaken nor was any report published, but over the next five years
Medibank was steadily abolished.
In addition, Commonwealth funding for the Community Health Program,
through which women’s health centres and refuges were funded, was
progressively slashed each year. In 1981, community health centre funding
was completely absorbed into the general federal tax-sharing grants, absolving
the Commonwealth of all policy responsibility. The previous grant conditions
requiring that the remaining funds be used for the Community Health Program
were lifted and Commonwealth monitoring ceased. Funding for the Aboriginal
housing program was also drastically cut back (Dowse 1984:151). The one area
where funding was not reduced in total was refuges, of which more below.
On the other side of the coin, as often happens in federations, political
opportunities were relatively open in several sub-national jurisdictions.
While there was sporadic support for women’s health within the Liberal
Party, particularly among women members, it was almost entirely under
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Labor governments, national and sub-national, that significant reforms were
implemented. Under National-Liberal Coalition or National Party governments,
as in Queensland up to 1989, support for women’s health was entirely absent.
In jurisdictions where Labor had a significant share of office, reforms were
introduced earlier. The South Australian Dunstan Labor Government, for
example, passed Australia’s first legislation making rape within marriage a crime,
in 1976.1 In New South Wales, the Wran Labor Government, which supported
women’s health, came to power in 1976 and was not defeated until 1989. Labor
was elected in Victoria in 1982, re-elected in South Australia in the same year
and elected in Western Australia in 1983, after being out of office for 11 years.
In Tasmania, Labor lost power in 1982 and was not returned again until 1989,
after which policy development moved ahead.

Opposition—and some support
All governments operated in a context where opposition emanated from the key
player in health politics: the organised medical profession. The main doctor’s
union, the Australian Medical Association (AMA) has steadfastly opposed
separate women’s health services. Historically, it has taken a stand against all
publicly funded services, such as baby health centres and venereal disease
clinics in public hospitals because it feared such services might attract clients
away from the private medical market. The President of one State branch of the
AMA put the general case that separate women’s health services are ‘illogical’.
Women are a majority of the population and consume a majority of the services.
If they are not happy with the services, the services should be modified rather
than supplied separately. The solution, the President suggested—missing the
point that women would like more comprehensive services supplied by teams
of providers—is to increase remuneration for general practitioners so they can
afford longer consultations. Under the Medicare payment schedule, the 19-minute
consultation is an economic disaster for doctors, the President told me. Publicly
funded services are always unfair competition for the private sector,2 he argued,
especially in the face of what was seen as an oversupply of general practitioners
in the 1980s and 1990s. In some States, AMA members actively campaigned
against the establishment of separate women’s health services. In Western
Australia, where medical unions appear to be especially powerful, obstetricians
from the King Edward Memorial Hospital for Women threatened to go on strike if
the Government funded salaried midwives. For similar reasons, country general
1  Reform-minded governments are sometimes constrained by reform-resisting bureaucracies, as in South
Australia in the 1970s and 1980s. This is discussed further in Chapter 9.
2  The claim to be part of ‘the private sector’ ignores the fact that approximately 80 per cent of ‘private’
medical incomes is drawn directly from the Commonwealth Treasury. It also ignores the reality that without a
conduit to the public purse, the medical profession would be much smaller and its remuneration much lower.
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practitioners and radiologists resented the introduction of mobile screening
services. Indeed, Stefania Siedlecky, general practitioner, founding member of
family planning, adviser to the Leichhardt Women’s Community Health Centre
(LWCHC) Collective and later Commonwealth women’s health bureaucrat,
remembers that some of the bitterest opposition to women’s health centres came
from female doctors, who asked that funding be withdrawn.
At the level of practice, however, general practitioners, even those who were
initially suspicious, often found that there was little or no encroachment upon
their markets. Indeed, many found that the work of the centres complemented
their own. From the early days, LWCHC saw many women whose doctors had
been unable to help them. At the Liverpool centre, acceptance was such that
one gynaecologist developed the practice of having his female medical students
spend time at the centre (Edwards 1984:22).
Although organised medicine was strongly opposed, many individual women
doctors worked hard3 over long periods as part of the general women’s health
movement, providing services in many of the early centres, usually on a
voluntary basis. The contribution of Dr Janet Irwin from Brisbane is an example
of dedication and hard work. Irwin, a long-time human rights advocate,
campaigned strenuously on abortion issues, supporting C by C and early family
planning initiatives in Queensland. She was director of student health services
at the University of Queensland from 1974 to 1988, where she promoted
student health and identified sexual harassment as a women’s health issue. In
1982, the university was one of the first in Australia to establish procedures to
deal with sexual harassment complaints. In 1996, Janet Irwin was appointed
the university’s first Sexual Harassment Committee conciliator. Among many
other health-related activities, she served on the university’s Status of Women
Committee, where she fought for the rights of general staff members, almost all
of whom were women, especially on OHS issues. She was also active in medical
women’s groups and is co-author of two books on raising female daughters,
Mom, I Got a Tattoo and Parenting Girls. For her work in human rights and
women’s health, she was made a Member of the Order of Australia and awarded
a Centenary Medal. Many other women were similarly dedicated.
Opposition sometimes came from unexpected quarters: in Sydney, it was
suggested that a sexual assault counselling service should be set up at Rachel
Forster Hospital for Women but the board decided that such a service was
unnecessary. Another possibly unlikely opponent was the Parramatta Council,
which objected to the establishment of a local women’s health centre. In South
Australia, the hospitals, as well as organised medicine and the bureaucracy,
opposed both women’s health and community health centres. Across the country,
3  Perhaps some men did also, although I have not uncovered written records.
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general practitioner organisations opposed the appointment of women’s health
nurses. Finally, in some places, women opposed each other. In Tasmania, for
example, some women consider that opposing positions within the movement
in the 1980s and into the 1990s were at least as much of a problem as external
opposition.

Women’s Health Centres: Continuing
expansion
Despite the forces standing against them and the scarcity of resources, community
women continued to set up their own services. Aboriginal women worked
together and through Aboriginal community health centres and Aboriginal
resource centres, making their voices heard in a range of ways. Similarly,
immigrant and refugee women continued to respond to expressed need.

Aboriginal Women’s Initiatives
To us, health is about so much more than simply not being sick. It’s
about getting a balance between physical, mental, emotional, cultural
and spiritual health. Health and healing are interwoven.
— Dr Tamara Mackean, Australian Indigenous Doctors’ Association
A few examples of the various centres and services set up in different parts of
the country by Aboriginal women are presented here by way of illustration.
An impressive centre was established in Alice Springs under the auspices of
the Central Australian Aboriginal Congress (CAAC). The major focus of the
congress was health service provision from the beginning and the model
adopted was comprehensive and community controlled, in keeping with the
social health perspective. At the time, the NT Government was unsympathetic
so Commonwealth support was sought, which enabled a general health service
to be opened in 1974 (Rosewarne et al. 2007).
In the early 1980s, Central Australian Aboriginal women approached the
congress about the need to respect traditional birthing practices and other
concerns. As a result, the Birthright Research project was established in 1984
with financial support from the Commonwealth. The research team visited
60 communities and met with women from 11 language groups who were
spread over 78 000 sq km. The research was followed up with the Women’s
Birthrights Conference, where the aims and objectives of a proposed new centre
were worked out. A primary healthcare model was selected, to be based on
traditional grandmothers’ law, under which ‘law, languages and culture’ were
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to be incorporated into ‘a women’s health and birthing service’ (Carter et al.
1987; Stuart 1995). The conference established the Congress Alukura Women’s
Council, which set up the Alukura Women’s Health Program in 1985. Alukura
means ‘a woman’s camp’ in Arrernte, the language of the traditional owners of
the Alice Springs area. The women’s council is a subcommittee of the CAAC and
has representative, advisory and decision-making roles in relation to women’s
law and practices. It set about the task of obtaining funding and was eventually
successful. Congress Alukura opened as a pilot project with a midwife, a health
worker and a liaison worker in June 1987 (Carter et al. 1987).
Alukura provides a range of health services for the city and surrounding regions,
including comprehensive antenatal and postnatal care, shared maternity care,
gynaecological services, a well women’s clinic, sexual assault and domestic
violence counselling and examinations, health education, transportation, health
worker training and a bush mobile clinic. In 1994, Alukura was awarded a UN
Human Rights Award for the development of its community health and birthing
service. After 10 years of operation, the Acting Director was able to claim that
‘we are one of the most experienced organisations in the country in Aboriginal
women’s health, a national leader in primary health care and a strong political
voice for the health of our people’ (Stuart 1995:179).
In the 1990s, some women were able to give birth at Alukura. In 2002, however,
an agreement was signed under which Alukura midwives had visiting rights at
the Alice Springs Hospital. For three years, babies were delivered at the hospital
by Alukura midwives but in November 2005, due to staffing shortages and
other issues, birthing services were suspended. Some of the special projects
carried out by Alukura include a three-day Women’s Health Conference in
1997, attended by more than 700 women, the production of a grandmothers’
law video, which preserves cultural information, a cooperative research project
on antenatal health, the development of the Women’s Business Manual and the
Young Women’s Community Health Education Project (CAAC 2004–05, 2006–
07; Carter et al. 2004).
Concern about the lack of appropriate health services for Aboriginal women
and their families emerged on the South Coast of New South Wales in the early
1980s. There were financial barriers to accessing mainstream services, which,
in any case, could be insensitive to cultural needs. In 1984, the Aboriginal
Women’s Health Centre was set up under the auspices of Jilimi, the Shoalhaven
Women’s Health and Resource Corporation. A change of incorporation brought
into being the South Coast Women’s Health and Welfare Aboriginal Corporation
and a change of centre name to Waminda in 1990. Understanding and valuing
Aboriginal culture are fundamental at Waminda. Other principles are a holistic,
family and community-as-a-whole approach to health and respect for women’s
agency and participation in decision making. Primary healthcare programs
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include the Women’s Health Program, providing a health and sexual health
clinic, screening services, support groups for grief and loss, physical activity
groups, health promotion and information. A domestic violence support
program is responsible for education, awareness and community-development
projects, healing camps and court support. There is a drug and alcohol support
program and a Koori Girls School Program, which aims to empower girls and
young women and help them make informed, healthy lifestyle choices. A Koori
Women’s Playgroup supports mothers in relation to health, welfare, housing,
finances and social and emotional wellbeing. An early childhood nurse and
a dietician are employed, along with other children’s service providers. The
Family Support Program operates workshops for women and their children in
skill development and strength building and identifies family needs in relation
to housing, finances, social and emotional wellbeing and health. A parenting
program aims to build stronger families and the Aboriginal Women Artist
Cooperative promotes personal growth and empowerment through art and craft,
as well as the development of business and information technology (IT) skills.
Aboriginal women in Cairns set up a women’s and children’s health centre in
the early 1980s. An Aboriginal welfare worker from the Cairns Hospital, Rose
Richards, aware that Aboriginal children from rural and remote areas were
returned home before they had fully recovered because there was no appropriate
Cairns accommodation, began to take children to her own home. With help from
other women, including registered nurse and midwife Jilpia Nappaljari Jones,
she eventually obtained funding to set up a halfway house. Later relocated,
it became known as ‘Rosie’s Farm’. It was also apparent that transitional
accommodation was needed for women who came from remote locations before
the births of their babies. Secure funding was obtained and Rosie’s Farm
moved to its present location, where it is known as Mookai Rosie Bi-Bayan, or
Aunty Rosie’s Place. It provides services for women and children, including
accommodation, transport, recreational activities, health support and advocacy,
access to counselling, cultural and emotional support, reproductive health
care, pre and postnatal care, nutrition and environmental health education, a
playgroup and other educational activities. Anecdotal evidence from Mookai
Rosie health workers suggests a reduction in the number of children who
fail to thrive, an increase in breastfeeding, a drop in premature births and an
improvement in infant health (Mookai Rosie Bi-Bayan web site).
Another Aboriginal women’s centre, the Gloria Brennan Aboriginal and Torres
Strait Islander Women’s Centre, was established in 1988 by the Aboriginal and
Torres Strait Islander Women’s Congress of Western Australia to provide health
and childcare information. Located in eastern Perth, it is a multipurpose centre.
As well as health information, it provides assertiveness training and conducts
courses in problem solving, conflict resolution, letter writing, management
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and communication skills and meeting procedures. It runs cultural education
programs and provides support, counselling and referral services. Among its
political projects has been the ‘Stop the Abuse’ campaign against sexual assault
(Weeks 1994:86, 99).
The Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women’s Council, which
covers parts of Western Australia, South Australia and the Northern Territory,
was formed in 1980 when women felt that their needs were not being addressed
in relation to land rights. The council, incorporated in 1994, soon became a major
provider of human services, juggling advocacy work with casework. It takes a
holistic approach to issues such as domestic violence, aged care, emotional and
social wellbeing, nutrition and disability needs. The Cross Borders Domestic
Violence Service covers 350 000 sq km across the three jurisdictions (NPY
Women’s Council web site).
In other places, Aboriginal women work for health through local Aboriginal
Controlled Community Health Services (ACCHS), or in cooperation with
government-employed health workers. The Aboriginal and Islander Health
Worker Journal provides a record of multiple health-improvement projects
undertaken by Aboriginal women over three decades. For example, Lajamanu
women, who live in an outback area of the Northern Territory, participated in
a project designed to address alcohol and violence issues in their community in
the late 1990s. The women painted their stories on calico, which was made into
wall hangings and displayed in various public places, conveying their messages
to their community. A banner, in English on one side and Warlpiri on the other,
and a video were also made. The Lajamanu women insisted on involving men in
discussions. Evaluation showed that alcohol and violence issues and strategies
to overcome problems were more openly discussed in both family and women’s
groups. The principles on which the project was based demonstrate traditional
views about the importance of community:
Mobilising communities or even groups within communities has long
been acknowledged as the most successful method of empowering people
to take responsibility for their own health and well-being. Ensuring
that the client group has ownership and direction of the program, in
cooperation with an outside agency to support and help resource the
activities is a virtual guarantee of a positive outcome for the community.
(Clarence and McDonald 1998:2)
Storytelling has also been used by Aboriginal women as a method of health
promotion. Drawing on the tradition of oral narratives and on aunty/niece and
grandmother/granddaughter relationships, information about female sexual
and reproductive roles and practices has been disseminated in several Sydney
communities. In 1993, a group of Koori women elders, in cooperation with
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Aboriginal academics and other women, made video recordings, in which the
need for healthy lifestyles was stressed and information was provided about
cervical cancer and coronary heart disease—two of the big illness issues for
Aboriginal women. The Aboriginal women involved were empowered and
affirmed in their roles as carers and health-promotion information was made
available to be passed on to others (Newman et al. 1999:18). Other projects have
used art to help women dealing with social and emotional issues and mental
illness to feel safer and to bring women together for mutual support (Aboriginal
and Islander Health Worker Journal 2002:12). These examples serve to illustrate
the keen interest Aboriginal women take in improving the health of their
communities.

Immigrant and Refugee Women’s Initiatives
Similarly, immigrant and refugee women continued to set up their own centres
and services, within the limits of the resources available to them. Gradually,
collaboration with the Anglo-Australian women’s movement grew. In most
places, immigrant and refugee women sought to work with government
departments and to gain representation on relevant boards and committees.
Like the rest of the women’s movement, the immigrant women’s community
lost human resources to bureaucracies, as women moved into newly created
positions.
In most jurisdictions, from the early 1980s onwards, immigrant and refugee
women were active around issues of health, culturally appropriate services,
language barriers, isolation, the scarcity of interpreters and issues concerning
overseas qualifications. Activism was easier in some States than in others. In
Queensland, women had to work extremely hard to gain support for health
issues. They tried to get appointments with relevant ministers, attempted to get
representatives onto relevant advisory committees and tried to persuade the
government to take responsibility for interpreting services. Progress was slow,
however, under the National and National-Liberal governments that held power
through the 1980s.
Brisbane women established the Immigrant Women’s Support Service in 1984
with Commonwealth SAAP funding. The centre is multipurpose and community
based and adheres to feminist principles. In 2004, it was providing services for
women from 72 different countries through its two main programs, which focus
on domestic violence and sexual assault. The service is now funded jointly by
the Commonwealth and Queensland governments.
The Multicultural Women’s Health Centre was established in Fremantle, Western
Australia, by a group of women in 1985, spearheaded by the extraordinary
efforts of one woman, Ronelle Brossard (Broom 1991). As well as providing for
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the needs of immigrant women, the centre was soon also providing services for
local Aboriginal women. Also in Perth, the community-based Ishar Multicultural
Centre for Women’s Health, formerly the Mirrabooka Multicultural Women’s
Health Centre, began operation in 1992. Its philosophy is grounded in a
social model of health and, as well as core staff, it is supported by a band of
volunteers. In 2009, Ishar collaborated with a neighbouring women’s health
centre, Women’s Healthworks, supported by the Western Australia Department
for Communities, to consult with more than 100 women on their views about
issues of concern for the new national women’s health policy. The centres wrote
a combined submission to the Commonwealth.
In 1987, the Immigrant Women’s Health Service was established in western
Sydney, with centres in Fairfield and Cabramatta. It provides a comprehensive
range of preventive and clinical services and information and referral services
for women from diverse backgrounds and it adjusts its programs to changes
in cultural demography. Special events are staged regularly, including cooking
demonstrations, food sharing and well-known feast days.
Multipurpose immigrant women’s centres and associations generally feature
health as one of their priorities. The Immigrant Women’s Speakout Association,
community based and managed, was formed in New South Wales in 1985,
following a successful speak-out gathering in 1982. The NSW Immigrant
Women’s Resource Centre was established at the same time. The association’s
priorities include health, domestic violence, child care, education, and
workplace, legal and equity issues. It undertakes community-development
projects and is particularly concerned about the needs of disadvantaged women.
Speak-out gatherings were also organised in Brisbane and Adelaide in 1983.
The Migrant Women’s Lobby Group, established in Adelaide in 1984, is a peak
body for immigrant women’s groups. Health issues are a major focus. Another
such group is the Australian Vietnamese Women’s Association, formed in Victoria
in 1983. More recent groups include the Filipino Women’s Support Group, New
South Wales, formed in 1998, and the Victorian Immigrant and Refugee Women’s
Coalition, set up in 1997. The Migrant Women’s Support & Accommodation
Service (MWSAS) is a not-for-profit, community-based organisation, established
in 1985 in Adelaide. It is a specialist provider of emergency and short-term
accommodation and crisis and support services for women and children escaping
violence. It operates an outreach service and conducts community education
workshops. The organisation aims to promote the basic human rights of women
and children from non-English-speaking backgrounds ‘so they may live free of
domestic violence’ (MWSAS web site).

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Anglo-Australian Initiatives
The second half of the 1970s was a period of serious funding insecurity for
established women’s health centres, while there were few financial opportunities
for those that were trying to set themselves up. State and Territory governments
were being asked to shoulder the costs of the Community Health Program and
other programs as the Commonwealth withdrew its funding. Thus, even where
sub-national governments actively supported women’s health, money became
scarce as the Whitlam Government’s largesse came to an end. At the best of times,
Australian federalism is characterised by severe financial imbalance, as discussed.
This general situation was exacerbated by the balance-of-payments problems of
the late 1980s and the recession of the early 1990s. At that time, the Commonwealth
Labor Government drastically and unilaterally cut its grants to the States and
Territories in order to curtail public spending, resulting in straitened financial
circumstances at the sub-national level (Summers 2006:142–3).
In the late 1970s in New South Wales, where most of the women’s health centres
were located, women waged a time-consuming and discouraging battle for
several years to maintain funding. They were assisted by femocrats and women
in the ALP. Under the new arrangements, funding levels were reduced so that,
for example, the workers at LWCHC received no pay increases during the first
eight years.
Survival on minimal funding was one thing but the new centres that were trying
to establish themselves from the mid-1970s onwards had an even more difficult
time. Most opened and survived on a mix of volunteer labour, donations,
the proceeds of fundraising and small, short-term grants. The Central Coast
Women’s Health Centre in Gosford began in 1976, staffed by volunteers. After
two years, it succeeded in obtaining minimal funding but, until the mid-1980s,
it relied heavily on donations and volunteers (Broom 1991:18–19). In 2011 it has
satellite services in Woy Woy and Wyong. The establishment committee for the
Bankstown centre in south-western Sydney was involved in four years of intense
work before it received a small grant in 1978. The Wran State Government ‘firmly
refused’ to fund it fully, in what was believed to be a strategy to discourage
the formation of new centres (Smith 1984:5). Eventually, it received enough
funding to allow it to expand in the mid-1980s (Broom 1991:23).
The Wagga Women’s Health and Support Centre (New South Wales) was opened
in 1979 after a long period of activism. The centre enjoyed relatively high levels
of material support from the local community, despite the founders having
to endure a deal of disparagement (Roberts and Stewart 1999). The feminist,
community-based Women’s Community Health Centre in the Blue Mountains
was set up in 1982. In the Coffs Harbour area of New South Wales, the local
branch of WEL researched women’s health needs in 1973. Priorities were a
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refuge, opened in 1978, and family planning services. The Women’s Resources
Centre was opened in 1982, providing information and support and, later,
family planning services. When funded in 1986, it became the Coffs Harbour
Women’s Health Centre. At that time there were health fears about the use of
agricultural chemicals. Within hours of opening, appointments were booked
out for three months.
The Illawarra Women’s Health Centre (New South Wales), a feminist, communitybased organisation, was opened in 1984. It houses a lesbian safe place, the
Illawarra Lesbian Health Project, which provides health information and
services for lesbians. Shoalhaven Women’s Health Centre was opened in 1985.
Another organisation, The Women’s Cottage—not strictly a women’s health
centre—opened in the Hawkesbury district in 1983, funded by the Department
of Community Services to be a resource centre. The cottage now functions
primarily as a feminist women’s health centre, helping to address considerable
unmet need in its local area.
In 1985–86, women’s health centres in Wollongong, Wagga Wagga,
Campbelltown, Penrith and Blacktown received funding for the first time, as
a result of the recommendations of the NSW Women’s Health Policy Review
Committee. In Bathurst, the Central West Women’s Health Centre was opened
in 1986. A feminist, community-based organisation, funded by the NSW
Department of Health and the Department of Community Services, it aims to
make its community safer, fairer and more supportive for women and children.
Blacktown Women’s and Girls’ Health Centre was opened in 1987, after years
of lobbying by a group of feminists. Initially funded by the Commonwealth,
it works from a social determinants framework and is cognisant that many of
its clients have low incomes. In the same year, Penrith Women’s Health Centre
and Lismore and District Women’s Health Centre were opened. In 1990, the
feminist Cumberland Women’s Health Centre began to operate, with a particular
focus on combating violence against women. It employs complementary health
practitioners and an Aboriginal women’s health worker. The Women’s Health
Centre in Albury–Wodonga is very unusual in that, instead of having to work
long and hard for funding, it happened that money became available before
women had fully mobilised (Broom 1991:143–4).
Other States have fewer women’s health centres than New South Wales. Between
the closure of the Brisbane Women’s House Health Centre in 1977 and when
the next centre was funded in 1990, a group of volunteers struggled to provide
a rudimentary service. Over the years, hundreds of women belonged to the
group and many came, left and joined again. By the early 1980s, the volunteers
were despondent and their energies depleted. They had been unable to secure
meetings with Health Minister, Brian Austin, and, indeed, he is said to have
ridiculed and trivialised women’s issues in public statements. Only three of the
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original group remained committed and such funding as they had derived mainly
from a pledge system and from performing street theatre! A women’s health
centre group in Hervey Bay was mobilised and, in Rockhampton, a women’s
information centre was run by volunteers from donated premises in a shopping
centre. Despite efforts across the State, there were limits to the community effort
and interest that could be maintained in the face of a staunchly conservative
government.
In 1982, however, a new collective formed in Brisbane, which opened Brisbane
Women’s Community Health Centre in Woolloongabba in early 1983. The
centre was supported by project funding from the Commonwealth Community
Employment Program (CEP). At the end of 1983, enough money was raised
to employ Carol Low as a fundraiser and submission writer. Workgroups and
subcommittees were formed and fundraising included staging a women’s health
day. A submission to CEP in 1984 produced funds to employ seven full-time and
two part-time workers but when the funding finished, staff were reduced to three
and survival again became dependent on a pledge system and small amounts
of temporary funding. About this time, another group of women, sensitive to
trade union issues without being trade unionists, began to meet in the Union of
Australian Women offices. A Queensland branch of the Australian Community
Health Association was formed and energy for a women’s health centre was
mobilised again, supported by the newly established Workers Health Centre
and the Migrant Women’s Speakout. A way was found to have Commonwealth
money channelled through the Australian Community Health Association to
the Queensland branch and then to the Brisbane Women’s Health Centre, which
received Commonwealth funding in this way for three and a half years. Hard
work and strong commitment brought a modicum of success: Helen Abrahams,
then a participant, now a Brisbane City Councillor, is of the view that anything
that survived in Queensland during the years of government hostility is strong,
like a desert flower.
The Goss Government came to power in 1989 with a policy on women’s health
that it is said was written by a male party member. Jude Abbs, women’s health
activist, is credited with having brought women’s health to the Queensland
branch of the ALP and then into government when she became head of the new
Women’s Health Unit. From this time on, women’s health in Queensland received
more stable funding, jointly supplied by the Commonwealth and Queensland
under the NWH Program. In the next two years, six new community-based
centres were funded from the same source: Townsville in 1990, Rockhampton
and Wide Bay in 1991, Logan and Ipswich in 1992 and Gympie and District
Women’s Health Centre in 1994. Gladstone nurses had campaigned for a centre,
which was opened in 1994. In 2011, there are nine women’s health centres in

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Queensland, all women controlled and community based, except for the Ipswich
centre, now called West Moreton Women’s Health, which ran into financial
difficulties in 2003 and became part of Queensland Health in 2004.
The general situation in South Australia in the key early 1980s was one of
strong community and ministerial support for women’s health, on one hand,
and determined bureaucratic opposition on the other. The story of the closure
of Hindmarsh and its reopening as Adelaide Women’s Community Health Centre
has been discussed. Soon after, Labor replaced the Liberal Government and
the new Minister for Health, John Cornwall, was strongly interventionist. He
was persuaded to support a social determinants and community-development
approach to health and was aware that, despite Australia’s relatively good
average life expectancy, there were serious inequalities in health outcomes and
significant levels of preventable death, disease and injury, especially among
low-income groups (Cornwall 1989:157–62). Liz Furler was appointed Women’s
Adviser on Health at the beginning of 1984, with a brief to increase women’s
influence in health policy. During his tenure, Cornwall approved funding for
three new women’s health centres to complement Adelaide Women’s Community
Health Centre as a State-wide service.
The first was Elizabeth Women’s Health Centre (later Northern Women’s Primary
Health Care Centre), which began providing services in 1983 and officially
opened in 1984 after five years of lobbying and preparation by a sponsoring
group. In a clear instance of party difference, the centre had been approved
by the Labor Government in 1979 but was abandoned by the incoming Liberal
Government (Radoslovich 1994:31–7). In the southern part of Adelaide, women
mobilised in response to the enormous health and social problems and service
gaps that were evident in the area. A formal group was established in 1983 and,
supported by the local community health centre, it wrote a submission for a
women’s health centre. Approval to proceed was announced at the opening of
the Elizabeth centre, and Southern Women’s Health and Community Centre was
officially opened in September, 1984 (Radoslovich 1994:39–44).
Again in 1983, Minister Cornwall gave approval for a steering committee of local
women to investigate the feasibility of establishing a centre in the Port Adelaide
area. Dale Street Women’s Community Health Centre was opened for business
the following year. From the beginning, 180 people per month attended group
and other sessions and waiting times for appointments with doctors, counsellors
and nurses soon extended to several weeks (Radoslovich 1994:45–50).
In keeping with the longstanding bureaucratic preference for government (or
health department) control, the SA women’s health centres have now lost their
independence, although refuges have been allowed to maintain independent
management committees. An early amalgamation attempt in 1986–87 by the
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Health Commission was staved off by extensive grassroots action (Auer 2003:8).
In 1995, however, in a move with the stated aim of achieving ‘efficiencies’,
Adelaide Women’s Health Centre was de-incorporated and merged with the
Women’s and Children’s Hospital. A memorandum of understanding was
written that outlined the responsibilities of the two agencies and the name,
Adelaide Women’s, was changed to Women’s Health Statewide. The three other
women’s health centres were amalgamated into the community health services
of their regions. In 2004, the Women’s and Children’s Hospital and Women’s
Health Statewide were amalgamated to form the Children, Youth and Women’s
Health Service. According to Jocelyn Auer, a member of the movement from
the early days, the SA women’s health centres are now clearly part of the health
service and can no longer be said to be run ‘by women, for women’. They now
work for change within the health system (Auer 2003:8, 12).
Various groups interested in setting up a women’s health centre formed in
Hobart in 1974 but their efforts to get support were unsuccessful and they
finally disbanded. In 1984, another group, the Women’s Health Foundation,
was established. Members were especially concerned that low-income women
could not access abortion services because they could not afford to travel to
Melbourne. At this time it was estimated that between 75 and 90 per cent of
Tasmanian women wanting an abortion were forced to go interstate. Moreover,
virtually no counselling services were available in Tasmania. The foundation
raised some $33 000 over two years, with which they bought a building at
9 Pearce Street, Hobart. It was renovated and approved as a medical centre;
however, medical practitioners willing to do abortions and general practitioners
to provide back-up could not be found.
After this setback, it was decided that the house could be leased to the Hobart
Women’s Health Centre group, to be used as a women’s health centre; however,
operational funding was not available from the Tasmanian Government.
Eventually, 18 months’ funding was allocated by the Commonwealth and the
centre opened in 1987. A doctor who was able to bill Medicare for consultations
was found. Lobbying for expansion continued and, in 1989, in the lead-up
to the State election, the Labor Party promised that it would support three
women’s health centres. Once in government, however, it announced that there
was only enough money for one. And so it is that Tasmania, to this day, has one
(precariously funded) women’s health centre.
After the closure of Collingwood Women’s Health Centre in the late 1970s,
Victorian activists focused their attention on supporting women to care for their
own health and trying to influence mainstream services to be more responsive to
women’s needs. Information and community education resources were produced,
as a variety of health-focused groups began to form, such as an endometriosis
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self-help group and a DES4 action group. A Women’s Health Resource Collective
(later Women’s Health Information Resource Collective) was formed in 1982 by
a small group of women, some of whom had belonged to the original collective.
The group survived on bits and pieces of short-term funding. It focused on
information provision, community development, advocacy and lobbying and
the development of written health-promotion material. In its first five years, it
produced 14 information leaflets and booklets on a range of issues and printed,
in total, 95 300 copies. Workers collaborated with other community groups and
gave talks and addresses. The centre also operated as a drop-in place (Women’s
Health Information Resource Collective 1987).
The Ministerial Women’s Health Policy Working Party was established in 1985.
It reported in 1987, giving rise to a serious struggle that resulted in a period of
expansion for Victorian women’s health services. The report recommended that
at least one women’s health service be set up in each of the health regions and
that there should be two women’s health information services, one of which
would focus on the needs of immigrant women. A group called Healthsharing
Women was formed, which successfully tendered to run a State-wide information
service, opened in 1988. The Women’s Health Service for the West, the first
regional women’s health centre, was initiated by two groups, one a coalition
from the northern and the western suburbs and the other the Western Women’s
Health Network. Under the cost-shared NWH Program, women’s health centres
were set up in each of the regions between 1989 and 1992, following initiatives
by groups of community women, most of which had been mobilised for years.
In 1993, the Women’s Health Information Resource Collective and Healthsharing
Women amalgamated to form a single State-wide agency. The service changed its
name to Women’s Health Victoria (WHV) in 1996. It provides health promotion,
information and advocacy services, with a focus on informing and influencing
health policy and service delivery. Currently there are nine independent
regional services and three State-wide services funded under the Victorian
Women’s Health Program.
The political climate in Western Australia was not strongly conducive to the
establishment of separate women’s health services, although small windows of
political opportunity opened at different times. The network of women’s health
services that is in place, therefore, testifies to the dedication of grassroots groups
and the women in bureaucracies, political parties and other places who support
them. Grassroots action continued in the late 1970s and through the 1980s in
efforts to get State support for new centres. The establishment of the Goldfields
Women’s Health Centre resulted from action by community women and nurses
over a period of years, for example. Initially, the director of community nursing,
4  Diethylstilboestrol, which is discussed in Chapter 4.
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Margarita Paul, sent out a questionnaire asking women to identify the services
that were important to them. A public meeting was held and the Goldfields
Women’s Health Care Association formed, followed by fundraising drives and
lobbying. A group of volunteers began to provide skeleton services in 1986.
The following year, services were expanded, supported by donations and
more fundraising. The then Health Minister, Ian Taylor (minister from 1986 to
1988), was sympathetic but the women were required to prove they could run
a centre efficiently on a volunteer basis before government funding would be
considered. Money for a house was obtained from the Lotteries Commission in
1988 and funds were raised to employ a counsellor. Operational funding was
secured from the Health Department in 1989 but had to be supplemented with
other grants and community donations.
A similar process took place in the Geraldton area where a group wishing to
establish a centre had been organised for several years. A regional planning
study had been undertaken and submissions written. Despite supportive
government statements, only $5000 had been allocated by 1989, when Labor
promised support in its election campaign. Once in government, however, they
refused to provide further funding. The centre, initially called the Midwest
Women’s Health Resource Centre, was eventually funded under the NWH
Program in 1991.
Whitfords Women’s Health Centre, now Women’s Healthworks, was set up
under the auspices of the Women’s Health Care House in 1989, but the following
year it developed its own constitution and became independent. Mirrabooka
Multicultural Women’s Health Information Centre, now Ishar Multicultural
Centre for Women’s Health, opened in 1992. Rockingham Women’s Health Service
was established in 1993, funded by the NWH Program, along with Hedland Well
Women’s Centre. Gosnells Women’s Health Service opened in 1994. By 1997, 11
community-managed women’s health centres, metropolitan and regional, were
being jointly funded by the Commonwealth and WA governments under the
NWH Program (Commonwealth of Australia 1997:26).
Throughout this period, Perth’s original women’s health centre, Women’s
Health Care House, continued to operate and expand. At the end of the 1980s,
a decision was taken to try to better meet the needs of the significant numbers
of clients with alcohol and other drug problems. To this end, Perth Women’s
Centre was established a block away the following year. In 2005, Women’s Health
Care House and Perth Women’s Centre were amalgamated and now operate as
Women’s Health Services. The organisation manages numerous community and
outreach projects and provides services for more than 45 000 families each year
from more than 60 nationalities and from city, rural and remote areas of the
State.
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In the Australian Capital Territory, efforts to establish a women’s health centre
go back to 1974 when the first unsuccessful funding submission was made. The
ACT Women’s Health Network (ACTWHN) established a women’s health centre
working party in preparation for the NWHP in 1987. The ACT Department
of Health suggested a workshop in early 1990 to discuss the implications of
the NWHP for local services. The workshop was convened by Dorothy Broom,
then Convenor of ACTWHN. There was unanimous agreement that the NWH
Program money should be used to establish a women’s health centre. The draft
recommendations of the meeting were circulated for comment and a special
general meeting of the network was called to refine the draft proposals. A
subcommittee was formed to progress the decision. The ACT Government and
the Commonwealth accepted the recommendations and the Canberra Women’s
Health Centre, later renamed the Women’s Centre for Health Matters, was opened
in 1990. Networkers became members at the next ACTWHN meeting and stuck
gold stars on their foreheads to celebrate!

The Work of Women’s Health Centres
Women’s health centres provide a broad range of community-based services.
The service mix varies from centre to centre and from time to time, depending
on resources and local needs but whatever is offered is highly valued, judging
by the queues of women who line up to use them. As well as medical services
in some locations, counselling and preventive health advice might be on offer,
alongside referral, naturopathic and massage services, for example. Counselling
for emotional and mental health issues, sometimes related to abuse and domestic
violence, is nearly always in high demand. Centres provide information on
countless topics, often in many languages, facilitate the formation of support
and self-help groups and hold a variety of workshops and classes in response to
changing needs. Most centres provide outreach services. Service provision for
individuals and groups involves interaction and cooperation with a wide range
of local and State agencies, from individual health professionals to housing
departments.
The cluster of services provided is not readily available from primary medical care
facilities, such as general practitioners’ offices. Moreover, services are provided
in a sympathetic manner with time taken to listen, provide information and
consider a woman’s overall life situation. Waminda Aboriginal Women’s Health
Centre serves as an example. As well as conventional reproductive health and
screening services and childhood health programs, there are domestic violence
prevention and support programs, healing camps, grief and loss support systems,
social and emotional wellbeing projects and health-promotion activities.
Personal growth and empowerment are major goals. This work includes school
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programs for girls alongside parenting programs and family support workshops
for women and their children, involving the development of skills in relation
to everyday needs and activities, such as housing, finance, business and IT use.
Like other women’s health centres, Waminda aims to offer integrated, culturally
appropriate, holistic primary health care, with a focus on health promotion and
illness prevention.
Political advocacy is a major component of work. Women’s health workers write
letters and position papers, make submissions to inquiries, and lobby and liaise
with governments at all levels, including the local level. They lend their support
to other groups, such as unions, during campaigns for equal pay, for example.
Typically, a centre will be involved in a number of community-development
activities, which can range from sexuality education for young people to the
elimination of toxic waste. In facilitating participation in its decision making, a
centre contributes to the personal development, health and wellbeing of local
women (Broom 1998a:7). The bigger centres undertake research into local needs
and conditions and publish and disseminate the findings.
Women’s health centres have been able to influence the way things are done in
mainstream hospital and medical systems by expanding the scope of debate and
developing best-practice models of primary health care, although their influence
is less than activists would wish. Centres and the wider movement bring up
new issues and suggest new approaches and new ways of working that raise
mainstream awareness about what might be involved in women’s health care.
More opportunities are thereby created for mainstream innovation than would
have otherwise been possible (Dwyer 1992a:26–7). Centres influence both by
example and through training: staff members are regularly invited to contribute
to the education of medical students and centres provide training placements for
medical students and students from other disciplines, such as nursing and social
work (Broom 1998b:10–11). Information about women’s health, both hardcopy
and online, finds its way into the nooks and crannies of health systems. It also
contributes to the formation of bands of health consumers who expect to be
well informed and to participate in decisions about their health and health
care. And the day-to-day activities of centres support and reinforce political
activism. As Dwyer (1992b:25) has argued, the two arms of the dual strategy
reinforce each other: ‘the delivery of services legitimates the advocacy and the
advocacy disseminates the lessons learned from the people being served and
advances their interests.’
Women’s health centres are highly valued by the women who use them.
Research undertaken in the 1990s by Dorothy Broom probed the reasons. Broom
found that many women felt safer in an all-women environment and many were
more comfortable with a woman doctor and therefore more willing to discuss
problems. Women appreciated the sympathetic hearing they received, the time
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taken to provide explanations and information and the responsiveness to their
health, broadly defined, and their life situations. Women gained empowerment
through their participation in groups organised around a range of healing and
health-promoting activities, such as education, living skills development,
exercise and self-defence. When asked, women wanted other health agencies
to replicate features of women’s health centres: they wanted more informal
environments, more supportive staff, more information and counselling, the
availability of more groups, a more holistic approach to health and they wanted
more women’s health centres, closer to home (Broom 1996, 1998). In summary,
the appeal of women’s health centres was found to be based in best-practice
models of care, including the time taken to deal sympathetically and holistically
with complex problems and to provide information. Women felt empowered
by their participation in groups and by opportunities made available for health
development (Broom 1998b:5).

Refuges, Shelters and Houses
The one women’s health issue that the Fraser Commonwealth Government
supported was shelter for women escaping domestic violence. At the time, new
refuges were being established by churches and welfare-oriented groups, as well
as by feminists. In 1975–76, 19 refuges were funded under the Community Health
Program and one under the Homeless Persons Assistance Program; however,
one year later, there were 40 refuges, with more than 100 in operation by 1979
(Dowse 1984:149–50). As discussed in Chapter 2, in the absence of agreement in
the Commonwealth bureaucracy about the appropriate locus of responsibility,
refuge funding had been provided through the Community Health Program
under the Whitlam Government. The Fraser Government continued to use the
same channel but it simultaneously slashed the funding, leaving the Community
Health Program to fight for its life (Dowse 1984:151). One result, among others,
was reduced refuge funding.
Prime Minister, Malcolm Fraser, seemingly supported refuges: he had personally
intervened to ensure that Queensland refuges were funded directly after Premier
Bjelke-Petersen refused to pass on Commonwealth money on the grounds
that ‘Marxist lesbians’ were involved in the Brisbane refuge. In 1977, it was
decided that the Commonwealth would put refuge financing on a secure basis
and the Minister for Social Security, Senator Margaret Guilfoyle, was requested
to prepare a submission for the budget that year. The minister was, however,
reluctant to take on the new responsibility and the budget approached without
a satisfactory proposal. Facing the possibility that funding would cease, the
Office of Women’s Affairs sent out an alert. Strong community action followed,
including a high-profile media campaign. In response, cabinet decided that
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existing arrangements should continue and that the money allocated would
be doubled to $2 million (Sawer 1990:38). At the same time, however, the
Commonwealth continued to cut funding for the Community Health Program
and called on the States and Territories to take up the slack (McFerran
1990:194). The outcome of this extraordinary situation was that while there was
more money for refuges, existing (that is, feminist) refuges, which by this time
comprised about one-third of the total, suffered funding cuts. Moreover, newly
established refuges received ‘only shoestring assistance’ (Dowse 1984:151–2).
The entry of private institutions and organisations into the field gave rise
to debates and disputes about the legitimacy of ‘feminist’ refuges. Workers
continued to endure poor wages and conditions in feminist establishments,
often donating their own money by splitting available salaries among a greater
number of workers. Conservative sub-national governments did not support the
refuge movement, at least initially, whereas reasonable support, albeit infused
with electoral expediency, came from Labor governments. Overall, ‘new refuges
were set up with ridiculously poor funding and funding for existing refuges
stagnated’ (McFerran 1990:194).
A funding crisis was created in 1981 when the Commonwealth passed
responsibility to the States and Territories for what remained of the Community
Health Program, women’s health centres, refuges and rape crisis centres. A
strong reaction followed from feminist organisations, supported by the National
Women’s Advisory Council, which issued a media release censuring the
Commonwealth for abrogating its responsibility to women and children. A tent
embassy was set up outside Parliament House but the decision stood (McFerran
1990:198–9; Sawer 1990:54–5). Refuges limped along on grossly inadequate
funding, unable to pay standard wages, until 1984, when a Commonwealth
Labor government set up the Women’s Emergency Services Program (WESP),
which brought with it funding increases. In 1985, WESP, jointly funded by the
Commonwealth, States and Territories, was incorporated into SAAP—a move
that was initially resisted by feminists on the grounds that refuges were not
about homelessness but about domestic violence. The advent of SAAP funding
brought a measure of stability, in the form of five-year funding agreements.
Perversely, perhaps, the end of the ‘annual scramble for bitterly contested
money’ rendered the refuges invisible in a political sense. No longer forced to
draw attention to themselves and to make their arguments public, there was
less debate about domestic violence and the homelessness it caused (McFerran
1990:200–2).
The proliferation of refuges did not solve women’s emergency accommodation
problems. For example, only 19 per cent of women seeking emergency shelter
were able to gain a place in Victoria in 1992 (Fredericks 1993). Thus, women
from different backgrounds continued to set up new services. For example,
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Cawarra Women’s Refuge Aboriginal Corporation was established in 1977 and
has provided services for Aboriginal and non-Aboriginal women since that
time. Wirraway Women’s Housing Co-Operative in Moree, New South Wales,
was established in the early 1980s to provide Aboriginal women with emergency
as well as permanent accommodation. More recently, the Aboriginal Family
Violence Prevention and Legal Service Victoria was established to assist people
affected by family violence and sexual assault. It has three branches in country
Victoria and among its activities are programs for young Koori women. The
Yinganeh Aboriginal women’s refuge was set up in Lismore, New South Wales,
in 2005.
Immigrant women in Victoria set up the feminist Refuge Ethnic Workers
Program (REWP) in 1984, which conducted education projects and worked to
challenge negative stereotypes, both inside and outside immigrant communities.
It adopted a new name and a new mission in 1994 as the Immigrant Women’s
Domestic Violence Service. Run by a community-based collective, it provides
an exceptionally comprehensive range of services. Women of Different Ethnic
Backgrounds (WODEB), a subgroup of Women in Health around Melbourne
(WHAM), was also formed to explore different ways of dealing with immigrant
and refugee health issues. In South Australia, a number of services for women
escaping violence were established, including the Non-English Speaking
Background Domestic Violence Action Group.
New Anglo-Australian feminist refuges include the Women’s Place for homeless
or intoxicated women without children, opened in Sydney in 1981 after
considerable difficulty finding suitable accommodation. Louisa Lawson House
was set up in Sydney in 1982, in response to concerns that women escaping
physical and sexual violence were becoming ‘mental health statistics’ for want
of appropriate services (Grahame and Prichard 1996:71). Its founders marched
on the Premier’s office to demand funding. Coffs Harbour Women’s Support
Group, formed in 1984, had a turbulent beginning, with serious disagreements
in the first year (Grahame and Prichard 1996:34). The Esther Refuge Collective
was formed in 1983 to establish a feminist refuge in the Hornsby–Ku-ring-gai
area of northern Sydney.
In South Australia, Anne Women’s Shelter, Elizabeth, opened in 1978 and Hope
Haven Women’s Shelter, Adelaide, Port Adelaide Women’s Shelter, Port Augusta
Women’s Shelter and Whyalla Women’s Shelter all operated in the 1970s and
1980s. Annie Kenney Young Women’s Refuge was set up in Hobart, Matilda
Women’s Refuge and Woorarra Women’s Refuge were established in Melbourne,
along with others in country Victoria. In the Australian Capital Territory, the
Single Women’s Shelter Collective was formed in 1981, in response to problems
that emerged when women with different needs were housed in the same place.
The group struggled to obtain funding for three years but Toora Single Women’s
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Shelter, now called Toora Women, opened its doors in August 1983. Demand
for services has always been high and, like so many others, it has survived
on minimal funding, and, on occasion, even that has been under threat. The
organisation has expanded and changed during its 28 years: there are now eight
separate Toora services, employing more than 50 women (Rosenman 2003). In
Western Australia by 1990, there were eight metropolitan refuges, five country
refuges, an immigrant women’s service and an Aboriginal women’s refuge. One
of these, the Patricia Giles Centre, which was opened in 1989 and expanded
in 2006, offers programs specifically tailored for Aboriginal women and gay,
lesbian, bisexual, transgender, intersex and queer (GLBTIQ) people.
The Women’s Health Network in the Northern Territory took the lead in
lobbying for a refuge and wrote several unsuccessful funding submissions.
Eventually, an application for Commonwealth SAAP funding succeeded and
Dawn House, which is about to celebrate its thirtieth birthday, was established.
The remarkable story of how a country refuge, Edith Edwards Women’s Centre,
in Bourke, New South Wales, was set up is worth recounting in detail because
it illustrates the extraordinary efforts women undertook to set up basic services
and demonstrates that women from different cultural backgrounds can work
together successfully. Its establishment took a series of community meetings,
stretching over a decade, and dedicated collaborative action by Aboriginal
women, non-Aboriginal women and other members of the Bourke community.
In response to high rates of violence, the first public meeting was held in the
early 1980s, followed by the formation of a committee, a succession of further
meetings and several unsuccessful funding submissions. In 1987–88, the
District Manager of the then Department of Youth and Community Services
supported the committee, making strong representations to her department and
documenting the need for a facility in this isolated town. Her efforts also failed
but the committee persevered.
In the meantime, Mygunyah Aboriginal Corporation, formed by Dubbo women,
had obtained funding for a number of domestic violence workers to be located
in western towns. The Commonwealth Department of Family and Community
Services proposed that a support worker be provided through Mygunyah.
Bourke women protested strongly because women and children would need to
be transported to the nearest refuge in Parkes, about 500 km away. A support
worker nevertheless arrived.
The Bourke committee continued to agitate for separate funding. It was assisted
by a nun from Cobar who had helped set up another country refuge. In 1991,
another public meeting was held. The result was an offer from the Historical
Buildings Cooperative of a heritage-listed ‘Grand Mansion’ with a large garden
in the centre of town, on condition that the group take responsibility for
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maintenance. An added attraction was that it was only half a block from the
police station. The group became incorporated, applied for charitable status and
decided to wait no longer for government funding.
A mammoth community fundraising effort ensued. The solicitor employed by
the Aboriginal Legal Service cooked curries to sell in the main street, helped
by others making salads and rice. A radio auction was organised, with donated
goods and services from surrounding towns. There were cake stalls, bingo
games and the like, a small bequest and a local businessman who, facing a court
appearance, donated $2000 to show he was of good character. The council agreed
to waive water, sewerage and land rates. During the preparatory phase, informal
community consultations were held, which included talking to older women
about expectations, needs and concerns. Given that renovations, building
maintenance and insurance had to be paid for, the committee was fortunate in
finding a qualified, highly respected Aboriginal woman who agreed to live in,
rent free, as unpaid manager.
The refuge opened on International Women’s Day, 1992. The first clients had
arrived two weeks beforehand and in the first month 100 bed nights were
occupied. Donations from religious organisations allowed the employment of
two casual employees; otherwise all work was voluntary. Fundraising continued:
donations included half a sheep a week from a fundamentalist Christian
community and a towel service supplied by the Country Women’s Association.
Aboriginal and non-Aboriginal women worked together and volunteers were
included in decision-making processes, fostering feelings of ownership. By
1992, the refuge was providing a 24-hour, seven-day-a-week service without
public financial support. In 2011, Edith Edwards Women’s Centre is a publicly
funded, community-controlled service, with the capacity to house three
families. Additional accommodation options are available in private homes, if
needed (Alvares 1992; Personal communication with refuge staff).
A variety of other services to support women experiencing domestic violence
has been set up over the years. To give just a few examples, the NSW Women’s
Refuge Resource Centre has operated since 1986 as a referral, information and
awareness-raising service. In Queensland, a State-wide domestic violence service
offered counselling, community education and produced resources until 2002,
after which it became an advocacy and outreach service. A domestic violence
crisis service was set up in the Australian Capital Territory in 1988 to provide
crisis intervention at the scene of the incident alongside the police and a 24-hour,
seven-day-a-week crisis telephone service. Aboriginal women have devised
various projects, using art and storytelling traditions for therapeutic purposes.
Community arts projects are also used in multicultural settings (Cazalet and
Lane 2000). In Townsville, in the late 1990s, a women’s collective established a
community garden in the grounds of the North Queensland Combined Women’s
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Services Centre, as a symbolic project to work for peace and against violence
(Lynn and Perkins 2000). Another creative project is the collection of stories
by workers in a north Queensland women’s shelter, published as Dragonfly
Whispers (Sera Women’s Shelter et al. 2006).
Like women’s health centres, refuges, shelters and houses operate with dual
aims: they try to meet the immediate support and accommodation needs of
women and children escaping violence while engaging in political action.
Intensive case-management services for diverse groups of women and children
are provided and some agencies have special programs for children. Refuges
advocate on behalf of clients, produce information and research and conduct
community education, aiming to generate awareness of domestic violence and
promote the rights of women who have suffered from it. Training packages are
developed for relevant professionals, along with a full range of information
production and dissemination activities.

Sexual Assault Services
Despite campaigns against sexual violence in the 1980s and 1990s, the issue
has been difficult to keep on political agendas. A couple of well-reported
pronouncements helped the cause. In South Australia, Supreme Court Judge
Justice Bollen said in 1993 that a husband may use ‘a measure of rougher than
usual handling’ to persuade a wife to consent to sex. In the same year, Justice
Bland told a Victorian County Court in a rape case that ‘no often subsequently
means yes’. Such statements prompted public debate and intensified feminist
campaigns.
As with domestic violence, in relation to rape and sexual assault the importance
of considering cultural factors gradually became more widely recognised. In
communities where shame was attached to victims and their families, sexual
crimes were rarely discussed (Yarrow Place web site). Despite the establishment
of services such as the Migrant Women against Incest Network in New South
Wales in 1986, immigrant and refugee women usually maintained silence about
sexual assault (Jung 2003). Regardless of these barriers, sexual assault became a
major issue in many multipurpose centres set up by immigrant women.
As far as I have been able to discover, only a few sexual assault services along
white feminist lines have been established by Aboriginal women.5 One such is
the Yorgam Aboriginal Corporation, set up in 1993 in East Perth to overcome the

5  Aboriginal women have their own ways of meeting community needs.
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problem that available services were inappropriate. Yorgam supports spiritual,
physical, emotional and mental health needs and provides a range of counselling
services to address violence and sexual abuse affecting Aboriginal people.
Anglo-Australian women set up many new services. In New South Wales, the
Dympna House incest service secured funding for the Dympna Accommodation
Program in 1986, which was incorporated as the Stepping Out Housing Program
in 1987. Dympna staff recognised that clients who were homeless would benefit
from more stability in their lives. The Stepping Out Housing Program provides
supported accommodation for women (with or without dependent children) who
have experienced childhood sexual abuse. Many such women fled to the streets
at a young age. Another New South Wales service is the Southwest Women’s
Child Sexual Assault Resource Centre, set up by women with CEP funding
in 1985. Later called Rosebank, the service struggled to locate appropriate
accommodation but, in 2006, premises were secured until 2011.
Women’s House, Brisbane, which began as a rape crisis centre in 1975, had to
wait until 1983 to receive temporary funding and until 1991 to obtain secure
funding. The following year, it added the word ‘incest’ to its title, to better
acknowledge the scale of sexual violence, becoming the Brisbane Rape and Incest
Survivors Support Centre. A multipurpose women’s centre was established in
Cairns in 1986, providing a sexual assault crisis service. Similar services have
been established on the Gold Coast and the Sunshine Coast.
In South Australia, the feminist Adelaide Rape Crisis Centre was still struggling
financially in the 1980s, although it received some government funding. In
1993, the Government decided to amalgamate the service with the sexual
assault service run by Queen Elizabeth Hospital. Feminists campaigned
against the ‘amalgamation’, which meant disestablishment of the management
collective, but the merger went ahead. The service, called Yarrow Place, has a
strong preventive focus. It challenges attitudes and beliefs and works towards
‘a society free of sexual violence’. Two Aboriginal health workers are employed.
The Women Against Rape group formed in Tasmania in the 1970s and worked
towards law reform but was hampered by internal divisions. Roughly, one
group of professional women favoured workers with professional qualifications
while another thought that experience was the most important qualification
and that cooperation with government would lead to cooption. Another issue
was whether the service would participate in police training. Complicating
matters was the position taken by male gynaecologists, who wanted a hospitalbased, medically oriented service. In the event, women were able to cooperate
sufficiently to set up a service in 1986.

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As mentioned in the previous chapter, the publicly funded Sexual Assault
Centre was established at the Queen Victoria Medical Centre, Melbourne, in
1977. The centre developed within a feminist framework and part of its early
work was to undertake community and professional education. In 1982, the Cain
State Labor Government was elected on a promise to establish a sexual assault
service in each of the State’s health regions. By 1985, six Centres Against Sexual
Assault (CASA) had been put in place. In response to the recommendations of
the inquiry into women’s health, which reported in 1986 (of which more below),
another seven centres were established by the end of the 1980s, followed by two
more in 1992 and 1995 respectively, completing a network of 15 services. The
centres have a variety of management models. Although government controlled
and funded, some are community based and some have mixed boards, which
include hospital administrators and community members—a structure designed
to facilitate community input and accountability. According to Hewitt and Worth
(n.d.), it is something of an open question whether CASA are an expression of
the feminist struggle against patriarchy or ‘whether they had been co-opted to
create a well serviced class of victims’.
Western Australia’s original Sexual Assault Resource Centre (SARC) was relocated
in a house close to the King Edward Memorial Hospital in 1985. The aim was
to provide a confidential, non-hospital environment, with hospital backup
nearby. Workers enjoyed a considerable degree of autonomy, were organised as
a collective and able to operate from a feminist perspective, although tensions
existed ‘vis-a-vis the bureaucracy of a large teaching hospital’ (Farr 1987).
A number of regional services also operate in Western Australia, including
Waratah Support Centre, in Bunbury, which is a combined sexual assault and
domestic violence service, set up in 1988. It runs the Mooditj Healing Program,
which originally provided healing services for Aboriginal women and children
but now also supports Aboriginal men. The Eastern Goldfields Sexual Assault
Resource Centre is a community-based, government-funded centre, with a
voluntary board of management, established in 1993 as part of the NWH
Program. New sexual assault resource centres were set up in Port Hedland and
Albany using NWH Program money.
In the Northern Territory, a group of women volunteers who saw an urgent need
for a feminist service set up the Darwin Counselling Group in 1985 to provide
support for women and children who had experienced sexual assault. The
women lobbied for funding and, after two years, were successful. Ruby Gaea
was opened in 1987 and is still managed by a collective today. Decision making
is done on the basis of consensus and women from a variety of ethnicities have
served on the collective.
In summary, what has emerged after almost 40 years is a variegated patchwork
of government and non-governmental sexual assault services across the States
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and Territories. All provide services as well as engaging in advocacy and other
political activities. Preventive programs are devised to challenge attitudes and
beliefs, along with training programs for police, lawyers, doctors, nurses, social
workers, youth workers and others. Two services, the NSW Rape Crisis Service
and the Canberra Rape Crisis Service, have a continuous history back to the
1970s. Both provide 24-hour, seven-day-a-week telephone or online access to
experienced counsellors. In Victoria, the services can be described as ‘arm’slength’ government services, as each of the 16 CASA has its own communitybased board and has been heavily influenced by feminist principles. In
Queensland there are 16 services, all of them non-governmental organisations
(NGOs). In Tasmania there are three services, one in each of the health regions,
and all three are NGOs. All States and Territories provide 24-hour services but
not all provide access to specialist counsellors. In some States, after-hours calls
are referred to nurses or mental health workers. In other locations, only recent
assaults are dealt with at the time of a call, with less recent assaults referred to
daytime services.

Direct Activism in Relation to Sexual Violence
Following Italy and the United Kingdom, in Australia the first ‘Reclaim the
Night’ marches were organised in 1978. The aim is to draw attention to sexual
violence against women and to protest against the virtual curfew imposed on
women because walking on the streets at night can be dangerous.
Direct action has included drawing attention to rape during war. One of the
most publicised activities of the early 1980s was women marching on Anzac Day
in memory of women who were raped in war. The Sydney Women Against Rape
Collective was formed in 1980. In 1981, approximately 300 women joined the
end of the Anzac Day march in Canberra, resulting in 65 arrests. The magistrate
who heard the case used the language of terrorism and mutiny and sentenced
three women to a month in jail for coming within 400 m of the march (Elder
2007:251). The Rape Action Group for Every Woman, established in Perth, was
involved in Anzac Day activism in 1983, which resulted in 168 women being
arrested when they marched, after having been refused a permit. The emphasis
was, nevertheless, on non-violent protest (Grahame and Prichard 1996:111).
Reclaim the Night marches are held annually in cities around Australia, as they
are overseas. These attempts to decentre the dominant narrative of military
heroism were met with outrage in many sections of society and they also sparked
controversy and debate within the women’s movement about appropriate
strategy (Howe 1984:22).

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In recent years, Reclaim the Night activism has been partly overshadowed by
the more male-oriented White Ribbon Campaign. Initiated by a small group of
Canadian men in the early 1990s, it was a response to the massacre of 14 young
women in Montreal. The United Nations followed up in 1999, declaring 25
November the International Day for the Elimination of Violence against Women,
to be symbolised by the White Ribbon. Generally led by prominent men acting
as White Ribbon Ambassadors, the international campaign asks men and boys
to speak out and take an oath, swearing never to commit, excuse or remain
silent about violence against women.

Conclusion
Members of the women’s health movement from a variety of backgrounds worked
tirelessly to build an institutional infrastructure that would provide urgently
needed services, giving generously of their time and energy and often their own
money. Most of the services that were set up are not available elsewhere and are
highly valued and strongly sought. The work of the movement has given rise to
significant opinion shifts: taboo subjects that were not spoken about in public
are now inscribed in government policies and many people now consider that
access to appropriate services is a basic right. Moreover, although considered
highly unconventional in the early years, separate women’s health services now
enjoy a level of legitimacy in most jurisdictions.
The network of centres and services across the country provides an institutional
base for the movement from which political action in all its forms can more
readily be undertaken. Since the 1980s, those women working in women’s centres
and services, both government and non-government, have constituted a core
network of women’s health advocates. Surrounded by a growing constellation
of funded and unfunded advocacy groups—some tiny, some large—a strong
foundation is in place for continuing work.
In keeping with these developments, advocacy work took on a steadier, more
predictable character from the 1980s onwards. After the heady days of the 1970s,
when direct action was common, new institutional structures, set up in response
to the earlier activism, created opportunities for new ways of working. A wider
range of avenues through which governments might be approached and policy
might be influenced was put in place. These included the channels opened
through women’s health policy machinery in all jurisdictions and the extensive
consultation processes that formed an important part of government inquiries
into women’s health and aspects of women’s health in the 1980s. Inquiries, task
forces and advisory bodies created representative roles and movement members
were able to serve in the new positions and present a feminist perspective.
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The possibility of working effectively through institutionalised structures is,
however, strongly influenced by the political orientation of the government
in power. Governments with no interest in women’s health have held power
both nationally and sub-nationally at different times. The commitment and
perseverance of movement members has been such, however, that advantage
has been taken of political opportunities as they became available. In some cases,
such as when Brisbane activists devised a means of having Commonwealth
money for their centre channelled through national and State community health
associations, women opened up opportunities for themselves. The institutional
base that the movement has built for itself is small but strong.

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Women with Disabilities Australia (WWDA) Management Committee and
staff, Hobart, 2010. Executive Director, Carolyn Frohmader, centre back;
Convenor of WWDACT, Sue Salthouse, far right.
Photo: Women with Disabilities Australia

Members of the AWHN management committee at the Women’s Health
Summit held at Parliament House, Canberra in 2007 to draw attention to
the need for a review and update of the National Women’s Health Policy.
From left: Vicki Lambert (WA), Denele Crozier (NSW), Cobi van der Es (Qld),
Marilyn Beaumont (Vic), Marian Hale (Tas), Morven Andrews (Tas),
Tracey Wing (Tas), Gwen Gray (ACT) Dot Henry (WA) and Celia Karfpen (SA).
Photo: Gill Wann

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Members of the Queensland Women’s Health Network voluntary
management committee facilitate Women’s Health Forums in the Torres
Strait Islands, 2010. Pictured: Dr Betty McLellan, Chair of Queensland
Women’s Health Network (centre), with local women and children on
Hammond Island.
Photo: Queensland Women’s Health Network

Hobart Women’s Health Centre.
Photo: Tracey Wing
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Unaccustomed to gathering in salubrious surroundings: the AWHN
management committee plans the Sixth AWHN National Women’s Health
Conference, Hobart, 2008. From left: Mandy Stringer, Megan Howitt,
Kelly Bannister, Cathy Crawford, Maree Hawken, Annie Flint,
Marian Edmondson, Daniel Crozier, Patti Kinnersley, Celia Karpfen,
Gwen Gray, Marilyn Beaumont, Cheryl Barker, Susie Reid.
Photo: Tracey Wing

Dorothy Broom, inaugural convener of the ACT Women’s Health Network,
who has written extensively on the Australian Movement, in front of the
AWHN stand at the Sixth National Women’s Health Conference. Dorothy
had attended all six national conferences, 1975-2010.
Photo: Tracey Wing
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Networks
There are hundreds of community-based groups of women organised
around particular health issues. (Dwyer 1992b:211)
Like the women’s movement, which has been described as ‘broad-based’ and
‘somewhat protean’, ‘loosely made up of many disparate parts’ (Dowse 1988:207),
the women’s health movement has always encompassed groups with different
views and priorities. From the 1980s onwards, however, it became even more
diverse as groups proliferated and the movement took on the appearance of a
variegated array of assemblages, some of them tiny. Most of the new health groups
were concerned with specific issues, such as maternity services or breast cancer
treatment, but some focused on the health of particular groups, such as women
with disabilities or sex workers. Immigrant and refugee women continued to
set up their own associations and services, as did Aboriginal women. Not all of
the new groups were feminist but most undertook advocacy, provided support
and facilitated information sharing and self-help. As new interests and needs
emerged, existing centres and services modified their activities in response.
In the academy, the proliferation of groups was reflected in feminist theory
building, where attention moved from a focus on similarities to the importance
of difference and different experiences, whereupon the notion of a ‘variety of
feminisms’ gained currency.
In the 1980s, women in the movement turned their minds to the problem of
how to improve the effectiveness of political action. One response was the
formation of generalist networks and associations that were established in most
jurisdictions, along with a national peak body: the Australian Women’s Health
Network (AWHN). Specialist associations and peak bodies were also set up in
the refuge and sexual assault sectors. Over time, most of the generalist State and
Territory networks have been replaced with associations of service providers
but AWHN and the Queensland Women’s Health Network (QWHN) continue.
Group proliferation can be seen as both a strength and a weakness. The formation
of multiple organisations is one of the criteria that has been used to assess the
strength of women’s movements: the more organisations and the more members,
the stronger is the movement (Weldon 2002:80). The creation of so many groups
demonstrates the importance that women attach to health and it facilitates the
articulation of a much broader range of issues. On the other hand, movement
members often no longer know each other, even at the local level. The capacity
of the movement to speak with a single voice is reduced. The list below and the
following survey of new groups are far from exhaustive.
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Selected Specialist Women’s Health Groups Formed
from the 1970s Onwards
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128

ACT Incest Centre
AIDS Council of New South Wales
Australian Lesbian Medical Association
Australian Women’s Health Nurse Practitioners Association
Australian Women’s Health Nurses Association
Bonnie Babes Foundation
Breast Cancer Network of Australia
Centre for Women’s Action on Eating Issues
Coalition against Depo-Provera
Coalition of Activist Lesbians
Collective of Australian Prostitutes
Continence and Women’s Health Physiotherapy
Council for the Single Mother and Her Child
DES Action
Eating Disorders Foundation of Victoria
Eating Issues Centre
Endometriosis Association of Victoria
Female Doctors Group (Gender and Medicine)
Feminist Therapists Group
Girl2girl
Incest Survivors’ Association of Western Australia
Jean Hailes Foundation
Medea
Migrant Women against Incest Network
National Breast Cancer Foundation
National Council for the Single Mother and Her Child
National Network against Trafficking in Women
National Rural Female GP Network Steering Committee
National Rural Women’s Coalition
Older Women’s Network
Older Women’s Network of New South Wales
Older Women’s Wellness Forum
Pelvic Instability Association of Victoria

4. Group Proliferation and Formal Networks

•
•
•
•
•
•
•
•
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•
•
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•
•
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•
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Pink Links
Polycystic Ovarian Syndrome Alliance
Polycystic Ovarian Syndrome Association of Australia
Positive Women
Post and Antenatal Depression Association
Post and Antenatal Support and Information Group
Postnatal Depression Support Association
Project Respect
Project without a Name
Real Rape Law Coalition
RSI Group Canberra
Scarlet Alliance
SIDS Council of Australia
Stillbirth and Neonatal Death Support
Sydney Incest Survivors Collective
Tenosynovitis Association
Victorian Women with Disabilities Network
Women against Incest
Women and Addiction Group
Women with Disabilities ACT
Women with Disabilities Australia
Women’s Addiction and Recovery Service
Women’s Healing Centre
Women’s Incest Survivors Network
Women’s RSI Support Team

A Proliferation of Groups
Specialist and single-issue women’s health groups had already begun to
emerge in the 1970s. One of the early specific concerns was use of the drug
diethylstilboestrol (DES). DES Action was initiated by the Union of Australian
Women in 1979 as a support and advocacy group for women exposed to synthetic
hormones, which can have cancerous and other adverse reproductive side effects
for mothers and daughters and possibly sons. Other groups followed in different
parts of the country. Initially, pharmaceutical companies, health authorities,
doctors and gynaecologists denied that the drug had been used in Australia but,
in 1983, after a long campaign, a DES clinic was opened at the Royal Women’s
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Hospital, Melbourne. Its existence, however, was not publicised and neither
doctors nor the Victorian Government knew of its existence. It was eventually
privatised (DES Action Australia web site). A coalition against another drug,
Depo-Provera, was arranged in Victoria in 1987, after a 10-year campaign by a
number of organisations (National Women’s Health Centres Newsletter 1988).
Groups began to form around women’s mental health issues from the late 1970s
onwards, partly in response to reluctance in the mainstream movement to address
serious mental health issues. The Feminist Therapists Group began in Adelaide
in 1981 to provide mental health care and facilitate the formation of support
groups. The Project without a Name was set up in Sydney in 1982, with mental
health among its several concerns. The Leichhardt Women’s Community Health
Centre (LWCHC) collaborated with feminist therapists and others to establish
Louisa Lawson House, which was opened in 1983, first to provide support for
women in severe emotional crisis and, later, when more public funding became
available, to provide emergency accommodation. In 1985, funding was received
to operate a women’s mental health and therapy centre, including provision
of counselling services and group programs. Later, a minor tranquilliser clinic
was established to offer education and mental illness prevention programs.
Obtaining funding was always a struggle (Shaw and Tilden 1990:94–5).
Meg Smith, one of the original workers at LWCHC, set up a mood-disorder
support group in 1982, which grew rapidly. Many similar self-help and support
groups were formed, some of which also undertook advocacy, concerned about
the poor state of mental health services and the shortcomings of mental health
legislation. Other issues were discrimination against people with mental illness
and lack of rehabilitation services for people in the recovery stages (Smith n.d.).
In the Australian Capital Territory, a group of friends who had experienced
mental illness themselves formed a collective in 1984 and opened Medea in 1986
when funding was obtained. Medea was a holistic alternative to the limited
mental illness management options that existed in the Territory at the time.
Workshops, open to any member of the community, were held three days a week
on issues such as anger release, unresolved childhood issues, child sexual abuse,
resolving conflict and the like (Australian Women’s Health Network 1988:2–4).
Feminists brought incest out of the shadows and publicly identified it as a
major, long-term women’s health issue. Women against Incest was formed in
Sydney in 1983, and worked to attract funding for a community-based centre.
Dympna House, Australia’s first feminist incest facility, was opened a year
later, to undertake counselling, research, training, community education and
accommodation provision. Its priorities were the protection of children, the
empowerment of women and girls and the creation of a referral network for
offenders. Women against Incest continued to work with Dympna House as a
policy advice and advocacy group. Originating at Women’s Health Care House,
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Perth, the Incest Survivors Association of Western Australia was incorporated
in 1984. It deals specifically with child sexual abuse and post-traumatic stress
disorder (PTSD) in later life, and produced a parenting manual in 2007. The
Migrant Women against Incest Network was established in 1986, which broke
new ground by conducting public awareness and education programs around
this previously taboo issue (Jung 2003:111). The Women’s Incest Survivors
Network Incorporated (WISN), which still operates, was formed in Sydney in
1992 after the First National Confest for women survivors of incest and child
sexual abuse, which was organised by the Sydney Incest Survivors Collective
(Martin 2000). Women in the Australian Capital Territory set up an incest centre
in the 1990s but it was forced to close when funding was withdrawn by a Liberal
Party government.
Recognised as a major women’s health issue in the 1980s, eating disorders became
a focus for program development work and research. A variety of communitybased associations and foundations was established to support sufferers and
undertake advocacy. Most were not women specific, which is perhaps surprising
given that women are the main sufferers. Only about 10 per cent of the young
adults diagnosed are males (Eating Disorders Foundation of Victoria web site).
The new organisations provide services for women, of course, and there are
one or two that are exclusively for women. Brisbane feminists set up the Centre
for Women’s Action on Eating Issues in the 1990s, changing its name to the
Eating Issues Centre in 2009. It provides services for women on Tuesdays and
Thursdays and for men, women, transgender and intersex people during the
rest of the week. The centre takes a holistic view and uses the term ‘eating
issues’ in preference to ‘eating disorders’ to denote a social view rather than a
medical, individual pathology perspective (Isis web site).
A number of specialist groups formed around issues related to pregnancy in
addition to maternity care reform and pro-choice groups. Postnatal depression
(PND), trauma and grief after miscarriage, stillbirth and neonatal death emerged
as important women’s health issues from the 1980s onwards. The Post and
Antenatal Depression Association (PANDA) is a Victorian community-based,
self-help organisation formed to provide support, including telephone support,
information and referral services, to women and their families. An average of
200 calls per month is received through the helpline. PANDA trains volunteers,
undertakes advocacy, supports the establishment of new support groups and
offers information, education and training seminars for professionals and
community groups. In 2003, it established a network of postnatal depression
group facilitators to bring health professionals and facilitators together. In the
Australian Capital Territory, the Post and Antenatal Depression Support and
Information group (PANDSI) and, in Perth, the Postnatal Depression Support
Association (PNDSA) provide a similar set of services. Groups that formed in
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the 1980s around miscarriage, stillbirth and neonatal death include Stillbirth
and Neonatal Death Support (SANDS Australia), which has branches in several
jurisdictions, and the National Sudden Infant Death Syndrome (SIDS) Council of
Australia, with branches in all jurisdictions and the Hunter region of New South
Wales. The Bonnie Babes Foundation, established in 1994, provides a range of
services, including counselling, in cases of infertility, miscarriage, stillbirth,
pregnancy loss, neonatal loss and premature birth.
Groups also sprang up around the ‘new’ malady repetitive strain injury (RSI)
in the 1970s and 1980s. The problem was new only in the sense of having been
recently brought to public attention: reports of its occurrence had appeared
in journals for 100 years. The Workers Health Centre in Lidcombe, Sydney,
ran support groups from 1979 onwards. Victorian women set up the Women’s
Repetitive Injury Support Team (WRIST) in 1982. In the same year, Adelaide
women set up RSI Campaign and in 1984 the Tenosynovitis Association was
formed in Sydney and the RSI Support Group in Canberra. Most groups
provided information in a number of languages. Doctors at Adelaide Women’s
Community Health Centre discovered that women prefer support groups rather
than individual counselling because it reassures them to know they are not
alone. Moreover, groups were found to be an efficient way of disseminating
information (Brown et al. 1986).
The advent of HIV/AIDS was the stimulus for the formation of yet another set
of issue-specific groups when women felt that their concerns were not being
fully recognised. By 1993, there were groups in most major cities providing
support and information and conducting advocacy. Positive Women was
established in Victoria in 1988, for example. The organisation obtained funding
to develop a resource kit for women with HIV/AIDS and for service providers.
It was also funded to facilitate support group formation and to develop a sense
of community. Women had expressed a strong need to meet other HIV/AIDSpositive women to break down the sense of isolation they felt. To help meet
these needs, a book and a video were produced.
There is a women’s health sub-movement around alcohol and other drugs but it
has always been small. Most community-based associations and public agencies
are mixed-sex services, and, in the early days, in particular, the focus was on
the needs of men. High relapse rates were attributed to the inability of services
to meet women’s needs. In 1989, an Australia-wide survey showed that there
were no arrangements in place in 44 per cent of agencies to meet the needs of
women with children. There were even fewer services for women with special
needs, such as migrant women, Aboriginal women and lesbians (Crawford and
Elliott 1994:143–53). The Royal Women’s Hospital, Melbourne, however, does

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provide a voluntary, State-wide women’s alcohol and drug service for pregnant
women with ongoing drug and alcohol issues, along with professional support
and education programs.
Otherwise, nearly all women-specific drug and alcohol programs originated
in women’s health centres. Most of the larger women’s health centres, such
as Leichhardt, employ drug and alcohol workers. The Women and Addiction
Group associated with the Leichhardt centre was formed in 1981. Women’s
Health and Family Services (formerly Women’s Health Care House), Perth, offers
a comprehensive set of services for women and those living with women who
are experiencing drug and alcohol problems. As well as a general program,
separate services have been fashioned for immigrant and refugee women, and
for pregnant and parenting women and their families, and the Singing Up
Project has been created for Aboriginal women and their families.
ACT initiatives include the establishment in 1985 of the feminist Women’s
Addiction Recovery Service (WARS) by the Toora Single Wimmin’s collective.
WARS was a community-based information, referral, education, training and
counselling service for women and children; however, the service had only
one paid worker and so could not provide effective support for more than a
few individual clients. It therefore set about developing a broader approach,
which included a critique of existing services. It attempted to counter negative
attitudes towards drug-dependent women, redefined women’s dependence and
developed new models to promote positive change. Experience showed that
it is impossible to separate women’s experience of drug dependence from the
conditions of their everyday lives, including past and present abuse, levels
of self-esteem and motherhood roles (Morgain 1994). Focusing on both licit
(pharmaceuticals, alcohol) and illicit drugs, a policy of resourcing communities
to respond to their own needs and experiences was developed.
The ACT Women’s Health Network, of which more below, established a
longstanding working group on alcohol and other drugs. One issue of concern
was the provision of safe injecting equipment for the local remand centre.
It successfully lobbied for a halfway house, opened in 1994, where women
recovering from addiction could be with their children.
The availability of information about breast cancer and its treatment became
a concern in the 1980s when survivors began to form support, advocacy and
exercise groups around the country. The Breast Cancer Network of Australia
(BCNA) was established in 1998, after public meetings in each State and Territory
had brought women together to discuss their concerns. The network is supported
by well-known people such as Olympian Raelene Boyle, a breast cancer survivor,
and by donors with significant capacity, such as Baker’s Delight. After only two
years, the organisation had 5100 members. At the time of writing, BCNA has
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33 000 individual members and 200 member groups. It aims to ensure that all
women diagnosed with breast cancer receive the best information, treatment,
care and support available. In the first decade, it conducted public awareness
campaigns, such as setting up (pink) ‘Fields of Women’ in various locations, and
lobbied extensively on breast cancer treatment issues. It has established a free
telephone information service, produces brochures and publishes a newsletter
four times a year (Breast Cancer Network of Australia web site). The non-profit
National Breast Cancer Foundation, which gathers support from both the
corporate and the community sectors, was formed in 1994 to raise money for
breast cancer research. In the Australian Capital Territory, Pink Links has been
formed as a support group for younger women with breast cancer. These groups
have lobbied successfully for improvements in treatment, gaining, among other
things, the provision of more information, more supportive care and, in 2001,
the establishment of a lymphoedema research network (Redman et al. 2003).
New groups continued to form around violence against women, especially in
response to notorious statements by members of the judiciary, mentioned above.
For example, the Justice for Women Action Collective was formed at Melbourne
University in response to comments by Justices Bollen and Bland in 1993. About
the same time, the Victorian Police Service conducted a sexual assault phone in,
called Operation Pegasus, which met with an overwhelming response. Ten extra
phone lines had to be installed to cope with calls and the police who took the
calls are reported to have wept openly. Another Victorian group, the Real Rape
Law Coalition, was active in the 1990s, along with the Brisbane Rape Crisis
Centre, which partnered with the Women’s Legal Service, the Domestic Violence
Resource Centre and the Brisbane Women’s Health Centre to produce a critique
of Queensland’s Criminal Code, entitled Rougher Than Usual Handling: Women
in the criminal justice system (Fredericks 1993).
A variety of other issue-specific groups, too numerous to list, includes the
Women’s Healing Centre, formed in Sydney in the early 1980s, which, like
dozens of others, was concerned with promoting alternative therapies, including
relaxation, meditation, acupuncture and herbal remedies. Menopause-awareness
groups sprang up in many places and the self-help Endometriosis Association
was formed in Victoria in 1984, following calls to the Women’s Health Resource
Collective from more than 200 women seeking information. The Polycystic
Ovary Association of Australia began in 1998 as an information-dissemination,
awareness-raising and support group. In 2008 it established an alliance with
the Jean Hailes Foundation and the Robinson Institute and in 2009 received
Commonwealth funding support. The alliance lobbied for the development
of a set of evidence-based guidelines for the assessment and management of
polycystic ovarian syndrome, which was released in 2011. The Pelvic Instability
Association was formed in Victoria in 2003. The Australian Physiotherapy
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Association set up a subgroup, Continence and Women’s Health Physio, which
provides information and resources about back and pelvic-floor health during
pregnancy. A national e-newsletter is produced four times a year and one of the
aims is to provide resources for rural and remote-area physiotherapists who do
not have access to specialist services (Australian Physiotherapy Association web
site).
As well as forming around specific health issues, women organised to promote
the health of particular groups. The need for a specific focus on women
prompted the formation of Women with Disabilities Australia (WWDA) as a
national peak body in 1995. Founding women felt that their issues were not
getting a full hearing either in the disability sector or in the women’s health
movement. The organisation evolved from a women’s network within Disabled
Peoples International Australia (DPIA), where it had operated as an unfunded
subgroup for some years. WWDA is managed by women with disabilities and
has a strong human rights focus. A large part of its work concentrates on health
issues, including activism around enforced sterilisation, the facilitation of access
to appropriate hospital and medical services and violence and sexual assault
issues. Affiliated groups include the Victorian Women with Disabilities Network
and an ACT group formed in 1995. Women with Disabilities ACT (WWDACT)
is a feminist collective that undertakes systematic advocacy on the impact of
disability across all areas. It was funded by Disability ACT in 2011, allowing
it to employ two part-time workers who are co-located with the local women’s
health centre, the Women’s Centre for Health Matters.
Health is a priority for many same-sex-attracted women who have experienced
having their sexuality overlooked in medical encounters. Homophobia, social
isolation and discrimination often lead to mental and physical health conditions,
which can result in other problems, such as substance misuse.1 Lesbians might
also have special needs, such as those arising from a disability, for example
(Women’s Health in the North 2009:6). While some Australian lesbians thought
that the women’s health movement was not fully cognisant of their issues, they
have, on the whole, been far less critical of it than their North American sisters,
probably because so many have been involved as members. Sylvia Azzopardi
(quoted in Robertson n.d.:Ch. 19) notes the importance of this contribution,
which resulted in many women’s health centres developing specialised services.
As well as working with multipurpose women’s health groups, lesbians have also
formed separate groups. In 1999, the Australian Lesbian Medical Association
(ALMA) was founded to offer support and mentoring for lesbian doctors,
medical students and their partners. It funds lesbian health research, lobbies
to have lesbian health included in medical curricula and fosters links with like1  For an excellent review of health problems faced by sexual-minority women, see McNair (2003, 2009).
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minded organisations. The voluntary committee runs an annual conference
and produces a newsletter. The Coalition of Activist Lesbians (COAL)2 is an
advocacy and lobbying association formed in 1994 to campaign for an end to
discrimination. It produced a major paper on lesbian health issues in 1997 (Myers
and Lavender 1997) along with research papers on violence against lesbians,
‘lesbophobia’ and lesbian domestic violence. Girl2girl is a web site providing
information for lesbians about safe sex and sexually transmitted infections. The
AIDS Council of New South Wales (ACON) is a community-based Sydney group
with 150 staff members and 700 volunteers that operates extensive programs to
promote the health and wellbeing of the gay, lesbian, bisexual and transgender
(GLBT) community and men and women with HIV. In Victoria, action by the gay
and lesbian communities led to the introduction of the Gay and Lesbian Health
Action Plan, announced by the Minister for Health in 2003. As part of the plan,
a health resource unit was established for gay, lesbian, bisexual, transgender
and intersex Victorians, which is jointly managed by the Australian Research
Centre in Sex, Health and Society, the Victorian AIDS Council/Gay Men’s Health
Centre and Women’s Health Victoria (WHV).
Many generalist women’s groups see health as one of their major concerns. Said
to be the first of its kind in the world, the Council for the Single Mother and
Her Child was formed in 1969 by a group of Victorian single and relinquishing
mothers who had experienced prejudice and discrimination. From the beginning,
the group worked within a self-help framework and its twin objectives were to
support single mothers and at the same time work for social change and legal
reform. The council aims to change practices and laws that have an adverse
effect on women’s health. Early concerns were social and institutional pressures
to relinquish babies for adoption, refusal of the right for mothers to see babies
prior to adoption and adoption processes that were shrouded in secrecy. There
was no reliable income support for single mothers at the time and such special
benefits as might be available were discretionary. ‘Illegitimate’ children and
their mothers were stigmatised and legally discriminated against in a variety
of ways. Similar organisations were set up in other States soon afterwards and
the National Council was established in 1973. The organisation has successfully
fought for and achieved a range of important reforms.
Health is a central concern for many immigrant women’s organisations such
as the Association of Non-English Speaking Background (NESB)3 Women
of Queensland, formed in the early 1990s as a lobby group. The YWCA has
advocated and worked for women’s health on its own and in collaboration
2  There is a group with the same name in the United States.
3  ‘Non-English-speaking background’, a term that appeared to be widely accepted in the 1980s and 1990s,
has largely fallen into disuse. It is sometimes replaced with ‘culturally and linguistically diverse’ (CALD), or,
more simply, immigrant and refugee women.
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with women’s health groups over many years. Older Women’s Network (OWN)
groups have been established across Australia, including an Australian peak
body, beginning with a group formed in New South Wales in 1985. Health has
always been a major issue for OWN members. Betty Johnson, the first Convenor
of OWN Australia, who regularly collaborates with AWHN and other women’s
groups, was appointed an Officer of the General Division of the Order of Australia
for her advocacy on aged care and health care. She serves on numerous health
committees in New South Wales.
OWN has developed a positive approach to older women’s wellbeing, based
on the social perspective. Women are encouraged to define their own needs
and to design and implement programs that will meet those needs. With public
funding support from health departments, local councils and other places, OWN
New South Wales supports groups that wish to establish wellness centres. The
Older Women’s Wellness Forum in 1999 resulted from collaboration between
OWN New South Wales, the Benevolent Society and the Departments of Health,
Women, Sport and Recreation and Ageing and Disability. There are currently
14 regional groups in New South Wales, which aim to provide an inclusive,
welcoming, drop-in environment for women from a diversity of cultures. At
the time of writing, there are OWN Wellness Centres in The Rocks, Bankstown,
Chatswood, Sutherland and in Coniston, in the Illawarra area.
Health is a major concern for women living in rural and remote areas where all
services are in short supply. Some areas have access only to the Royal Flying
Doctor Service and perhaps a clinic staffed by a remote-area nurse and an
occasional doctor on a flying visit. Such circumstances reduce the likelihood of
regular screening, for example, so it is not surprising that women in the bush
have higher morbidity rates from cervical cancer. Domestic violence is a serious
concern, partly because support services are few and partly because disclosure
can create socially difficult situations. Problems of isolation from family and
friends can be exacerbated because rural and remote mental health services are
under resourced (National Rural Women’s Coalition 2008; Whittle and Williams
2001).
A number of organisations have been established to promote rural health.
While only a few are women specific, all have women members. The National
Rural Health Alliance is a mixed-sex, Commonwealth-funded coalition, with
27 member organisations. It was set up in the early 1990s as an advocacy and
information-providing agency. The Rural Doctors Association of Australia
was formed in 1991 and has a women’s special-interest group, the Female
Doctors Group (Gender and Medicine), which keeps the organisation abreast
of current research. In 1992, a group of rural women in Victoria met to discuss
the possibility of a State-wide organisation, which resulted in the formation
of Australian Women in Agriculture the following year. The National Rural
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Women’s Coalition, whose member organisations are mostly mixed-sex groups, is
one of the six national women’s alliances funded by the Department of Families,
Housing, Community Services and Indigenous Affairs (FaHCSIA). It currently
focuses on women’s health issues, including family violence. On the basis of
extensive consultations, it produced a report on rural health infrastructure in
2008. The National Rural Female GP Network Steering Committee has also been
formed for the purpose of encouraging other organisations to value and support
female general practitioners.
Women set up groups in the 1980s to agitate for the rights, including the health
rights, of sex workers, with policy reform as a major goal. The Collective of
Australian Prostitutes was formed in Sydney in 1983, concerned with legal
rights, policing and health issues. In 1989, Scarlet Alliance was established
as the national body for State and Territory sex-worker associations with the
aim of achieving optimal OHS and legislative provisions (Scarlet Alliance web
site). One of the key aims of sex-worker organisations is to develop effective
responses to HIV. In 1998, a non-profit community-based organisation, Project
Respect, was formed to support women in the sex industry, including women
trafficked to Australia, and to prevent exploitation and enslavement. The
organisation conducts outreach support and advocacy work in relation to law
and policy reform. The National Network against Trafficking in Women has also
been formed.
Unlike their Canadian counterparts, Australian nursing organisations have not
mobilised strongly around access and equity issues in health, although a couple
of ‘Keep Medicare Healthy’ campaigns were run in the 1980s. Nurses have,
however, been active in relation to industrial issues, including remuneration,
occupational health and conditions of work. From the 1970s onwards, several
groups promoted the transfer of nursing education to the tertiary sector. An
extended strike over inadequate staffing levels and pay was staged by Victorian
nurses in 1986, following direct action in other jurisdictions (Ross 1987).
OHS issues have been a major concern for the Australian Nurses Federation
(ANF). The Australian Women’s Health Nurse Practitioner Association was
formed in 1988, first in New South Wales, where the first women’s health nurse
practitioners were trained. Its name was changed to the Australian Women’s
Health Nurse Association in 1999—a peak body for women’s health nurses
throughout Australia. The Community Health Nurses Association was formed
in Victoria and groups have been active on environmental health issues. A ‘lead
in the soil’ campaign, for example, was conducted in Port Pirie, South Australia,
a lead-smelting town where, among other problems, citizens had high bloodlead levels.
A different type of women’s health organisation is the non-profit Jean Hailes
Foundation, established in Victoria in 1992, in honour of the female doctor after
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whom it is named. The foundation is Commonwealth funded and focuses on
research and education. Meanwhile, partly in response to the fragmentation that
came with the movement’s expansion, women decided to established specialist
advocacy groups, generally called networks, in the mid-1980s.

Generalist Women’s Health Networks
Networking is a way of working that has been used extensively by women’s
groups in Australia and overseas. It has been found to be an effective way of
problem solving, exchanging views and information, building confidence,
morale and professionalism, sharing resources and improving skills. Networks
are also used to increase visibility, to access sponsors and mentors, to build
alliances with like-minded organisations and engage in collaborative projects
(Townsend 1994:12–13).
In the 1980s and 1990s, the women’s health movement established formal
networks with the aims of strengthening capacity and creating advocacy arms
that were independent of funded centres and services. During unfavourable
political times, established agencies were in danger of becoming ‘activists on
a leash’. In Victoria under the Kennett Government, for example, the threat of
being de-funded had a ‘gagging effect’ on women’s health services and tended
to subdue criticism of policy changes that were detrimental to the community
sector (Horsley 1994:10). Independent networks, it was therefore thought,
would allow women to speak out strongly. Moreover, women’s voices would
be more unified and advocacy work could be planned. Intelligence about
community perspectives was to be gained through the centres and services that
are in daily contact with clients and other community agencies. At its best, this
set of arrangements would work as a type of standing consultation process,
which, under the right conditions, could feed ideas into policy on a regular
basis. In addition to service providers, networks were open to all women who
agreed with the aims and objectives.

Establishing a National Women’s Health
Network
In the wake of momentum generated by the successful 1985 Adelaide women’s
health conference and the subsequent announcement by the Prime Minister
that a national women’s health policy would be developed, the Australian

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Women’s Health Network (AWHN)4 was formed by women attending the
inaugural Community Health Association Conference in September 1986.
About 50 women from different States and Territories, mindful of the need for a
feminist perspective to be represented in general health policy debates, agreed
to form a national network. The new association was announced at the final
conference plenary session, attended by Commonwealth Health Minister, Neal
Blewett, and was greeted with a spontaneous ovation. Yoland Wadsworth, a
sociologist, was the first convenor. Immediate expressions of interest and offers
of assistance came from officers of the Commonwealth Health Department (Abbs
1994; National Women’s Health Centres Newsletter 1987a).
Jude Abbs, long-standing women’s health activist, became interim national
convener in 1987. She and the State and Territory representatives of the new
organisation generated interest across the country, assisted by a Commonwealth
Women’s Health Development Program Grant. A funding submission for a
secretariat was written to the Commonwealth setting out the long-term goals,
proposed activities and a provisional organisational structure (Abbs 1987). Links
were established with the Consumers Health Forum and maintained with the
Australian Community Health Association. AWHN gained a place on the newly
formed Australian Health Ministers Advisory Council (AHMAC) Subcommittee
on Women and Health, a position that served the movement well (Abbs 1994:4–
5). It allowed women’s views to be fed into policy processes while facilitating
the dissemination of information about policy developments within government
to the wider movement.
The first national meeting of AWHN was funded by the Commonwealth
Department of Health and took place in the Board Room of the Royal Women’s
Hospital, Melbourne, in October 1987. Women worked strenuously for two days
to develop a set of aims and objectives and work out a structure. It was decided
the organisation would be feminist, with as broad a base as possible. The main
purpose was ‘to present a well-articulated set of demands to Commonwealth
and State Governments’ (Donovan 1987:9). Liza Newby, who headed the
consultation team for the first NWHP, attended, outlining the main issues that
would be canvassed in a forthcoming discussion paper. Participants reported
on the state of play in each jurisdiction, which varied considerably from place
to place. At the time, it was expected that AWHN would soon receive funding.
The plan was to become incorporated and ‘advertise for a national coordinator
as soon as possible’ (Donovan 1987:9). In the event, AWHN was to wait 25 years
for the funds to employ a coordinator.
At the same time, enthusiasm for connection prompted women’s health centres
to produce a newsletter—a process assisted by Senator Patricia Giles, Labor
4  It was at first called the National Women’s Health Association; the name was not settled for a year.
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Senator for Western Australia, a founder of WEL and women’s health activist. ‘At
last! A thousand welcomes, sisters; we’ve needed you so much’, wrote the Hunter
Region Working Women’s Centre in a letter to the editor of the first issue. Issue
2 came out in October and flagged that the newsletter might become a vehicle
for the distribution of information from AWHN, as the network became further
established (National Women’s Health Centres Newsletter 1987b). And so it was.
The decision was taken to rename the newsletter and to make its receipt an
AWHN membership benefit. Issue 4, produced in April 1988, became the first
Australian Women’s Health Network Newsletter. Two further newsletters were
produced before production ceased in early 1989. The 1987 funding application
had not succeeded. AWHN continued to participate in the work of the AHMAC
Subcommittee on Women and Health and that of the Consumers Health Forum
but, by 1990, it had not been incorporated, it no longer communicated with
members and was effectively in recess.
Three years later, ACTWHN, whose financial management system consisted
of collecting money in a polystyrene cup to cover meeting expenses, held a
women’s health festival outside Old Parliament House. The festival, organised
by a committee led by Jenny Lyons, made a profit! With a few hundred dollars
to spend, members decided to pay someone to write a funding application for
AWHN. At the time, Leanne Webster, the first coordinator of the Canberra
Women’s Health Centre, was on maternity leave and was available to do the
work. The 1993 application to the Commonwealth Department of Health was
successful and AWHN received seed funding of $61 180.
The Interim Steering Committee of ACTWHN members—Convenor, Manoa
Renwick, Dorothy Broom, Jenny Lyons and Gwen Gray—was formed. A project
officer, Julie McCarron Benson, was employed and the first (and so far the only)
AWHN office was established in Kingston, ACT, complete with office equipment,
including a computer and a photocopier. A teleconference of State network
representatives was called and arrangements made for a two-day face-to-face
meeting in February 1994. Representatives from all jurisdictions attended, the
aims and objectives were clarified and the structure and constitution agreed.
AWHN was incorporated in the Australian Capital Territory on 3 March 1994.
During the funded 12 months, strong communication channels were established
across the country, not only with AWHN members but also with like-minded
organisations. The 1994 submission for continued funding, however, was
not successful. The photocopier was sold, the national office disbanded and
newsletter production once again ceased.
During the years until the end of 1998, the position of convenor remained in the
Australian Capital Territory, with Gwen Gray filling the position. AWHN worked
closely with QWHN members, especially with Carol Low and Marybeth Sarran,
who took the role of secretary for several years. These were frustrating years
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of repeated, unsuccessful funding submissions. Communicating with members
was difficult, with fax the main method. Telephone calls and teleconferences
were expensive and mostly outside the capacity of the tiny budget. Nongovernmental sources of funding, such as foundations, were explored without
success. In 1994, AWHN was told that the Commonwealth Department of Health
would no longer provide operational funding. Henceforth, one-off project grants
would be all that were available—a development influenced by encroaching
neo-liberal ideas. A funding application was made to the National Agenda for
Women Grants Program in 1995, but it, too, failed. In 1996, however, AWHN
was chosen by the Office of the Status of Women (OSW) to be one of four
national organisations to be assisted by a consultancy firm to develop strategic
and business plans. The plans were duly developed but could not be used
effectively by an organisation that could scarcely afford a teleconference.
Undaunted, the 1996 AWHN AGM agreed that efforts to gain funding should be
the top priority in the next year. At the time, the network was fortunate to have
Carolyn Frohmader5 to assist with submission writing and other AWHN work.
An unsuccessful application was made to the Rural Health Education Support
and Training Grants Program ‘to improve access to women’s health information,
education, training and support in rural and remote areas’. In early 1997, officeholders met once more with officials in the Commonwealth Department of
Health and Family Services to consider possibilities. Extensive discussions took
place about an expanded role for AWHN, the outcome of which was another
major funding submission. After a protracted process, that application, too, was
eventually rejected.6 In June 1997, a repeat application to OSW for operational
funding resulted in a grant of $25 000. The organisation was able to develop
a web site, arrange for information and membership pamphlets to be printed,
pay for a post office box, hold teleconferences and continue to research and
write submissions to a range of grant programs and funding bodies. A third
submission to OSW for the 1998–99 year was turned down.
At the end of 1998, Helen Keleher was elected convenor and the centre of gravity
shifted to Victoria until 2005. During that period, the enormous job of organising
two successful national women’s health conferences, one in Adelaide and the
other in Melbourne, was undertaken. Small profits from the conferences allowed
the web site to be upgraded and maintained and regular newsletters produced.
In 1995, the position of convenor moved to South Australia under Anne-Marie
Hayes and, subsequently, Celia Karpfen. As the costs of communication fell, it
became possible to hold regular teleconferences and was easier to have office5  Carolyn Frohmader has been Executive Director of Women with Disabilities Australia (WWDA) since the
second half of the 1990s.
6  Rumours had it that when the proposal came to the notice of staff in the office of the Minister for Health,
it was swiftly conveyed to the ‘no’ tray.
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bearers located far from each other. In 2008, the position of convenor moved
back to the Australian Capital Territory, with the convenor, program convenor,
secretary and treasurer of the 2010 Sixth AWHN National Women’s Health
Conference Organising Committee all living in different States.
Since incorporation in 1994, AWHN has financed operations from membership
fees, small conference profits and a handful of small project grants. It has
responded to relevant political issues as they emerge, as resources allow. It
has participated in ‘Defend Medicare’ and right-to-choose/reproductive rights
campaigns. In 2002, it was one of seven original members of the National
Medicare Alliance—a group that met frequently by teleconference and lobbied
to try to persuade the Commonwealth to preserve the universality of Medicare,
on the grounds that universal access to hospital and medical services is essential
for women’s health. It is a member of the Australian Health Care Reform Alliance,
formed in 2003, a coalition of some 53 health organisations and associations
advocating structural health reform.
AWHN has written submissions to government commissions and inquiries.
It has written letters and otherwise lobbied on a range of issues, providing
support for State women’s health services when they seemed to be under threat.
It was instrumental in warding off a Commonwealth attempt to discontinue its
funding for women’s health centres through the Public Health Funding Outcome
Agreements (PHOFAs) in 2004. It campaigned for an update of the first NWHP
from 1995 onwards and influenced the Labor Party’s commitment to develop
a second national women’s health policy, launched in 2010. It has increased
its membership, communicates with them weekly, maintains a web site and
produces regular newsletters. Successful national women’s health conferences
have been staged every five years since 1995, when the Third National Women’s
Conference was organised jointly by ACTWHN and WEL ACT. Generous
Commonwealth subsidisation facilitated the participation of more than 160
Aboriginal women in the 1995 conference, which laid the foundation for the
later development of an Aboriginal women’s subgroup, the AWHN Talking
Circle, of which more below.
Between 2007 and 2011, efforts to secure operational funding were stepped up.
The matter was discussed with relevant departmental officers and ministerial
staff. Applications were written variously to the Women’s Development Grants
Program of the Commonwealth Office for Women, the Department of Health and
Ageing and to the office of Health Minister, Nicola Roxon. AWHN’s submission
to the new NWHP stressed the need for funding support if the organisation was
to be able to represent its membership and provide good policy advice to the
Commonwealth. In 2009, on the basis that it was already an alliance with 64
organisational members at that time, AWHN applied to become one of the six
National Women’s Alliances funded by FaHCSIA. In a review of the alliances
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the previous year, there had been strong support for a national alliance focusing
on women’s health. That application was also unsuccessful. Quite unexpectedly,
however, in September 2011, Minister Roxon endorsed a proposal that AWHN
had put to her office several months earlier and the organisation received
secretariat funding for 2011-2012 from the Community Sector Support Scheme.
At the time of writing, negotiations are taking place about the details of the
contract with officers from the Department of Health and Ageing.

State and Territory Networks
The first general State and Territory-based networks were formed in the mid1980s, as branches of the newly formed national network. Formal networks
operated in every State and Territory by 1988, most focusing on lobbying
for the development of sub-national women’s health policies and plans and
the establishment of more women’s health services, especially women’s health
centres. The Victorian network held bimonthly meetings and produced a
bimonthly newsletter, named Hot Goss, while the New South Wales network
aimed to link a large number of informal networks that had already been
established (Community Development in Health 1988:3–12). Several of the early
sub-national networks did not survive as the level of voluntary contribution
needed to keep them going was too heavy. Others fell into abeyance and were
revived from time to time.
Among the earliest and most active was the ACTWHN, which began with
informal meetings, followed by the establishment of a formal network in 1986,
at much the same time that AWHN was formed. It held well-attended monthly
meetings and carried out advocacy work for more than a decade. At the height
of its strength in the early 1990s, a number of standing working groups managed
their own meetings and their own agendas. The working parties included those
on reproductive technology, the health centre working party, alcohol and drugs,
information and resources, alternative therapies, the national women’s health
policy, assertiveness/self-esteem and a party working party (planning an endof-year celebration).
In 1991 and 1992, ACTWHN members, especially Dorothy Broom and the staff
of the Canberra Women’s Health Centre, which was still only in the planning
stages, were distracted by a challenge to the legality of the centre. Indeed, the
case, which was ‘full of outrages, ironies and contradictions’ (Broom 1992:62),
challenged the legality of all separate women’s health centres, including those
being established under the NWH Program. Three men, led by a Canberra
doctor, claimed that the centre breached the Sex Discrimination Act because it
excluded men from taxpayer-funded services. The case involved much that was
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abhorrent. During the hearings, women were asked to provide evidence that the
women’s health movement was not ‘special pleading by a lunatic fringe’ and that
women’s needs were real rather than merely perceived by women themselves.
The reality and integrity of the claims that the women’s health movement had
made over the previous 20 years were ‘distorted, demeaned and discarded’
(Broom 1992:63–4). In the event, the President of the Human Rights and Equal
Opportunity Commission, Sir Roland Wilson, decided that it is not unlawful
under the provisions of the Act to ensure that persons of a particular sex have
equal opportunities with other persons. He argued that because women are
disadvantaged, measures that promote equal opportunity between women and
men in the health field are lawful. Mounting a defence, however, which included
a not inconsiderable nationwide fundraising effort, was extremely stressful and
time consuming for the women involved.
Reviewing operations in May 1994, a meeting of ACTWHN listed among its
achievements the establishment of the Canberra Women’s Health Centre, a
birthing centre and a halfway house for women with alcohol and other drug
problems. It had organised the incorporation of AWHN, provided support for
key defendants in the Canberra Women’s Health Centre case, contributed to
surrogacy legislation, influenced alcohol and drug policy and participated in the
consultation processes for the NWHP. It had lobbied for the establishment of an
abortion service, which was opened the same year by Sexual Health and Family
Planning ACT, and lobbied against the Hawke Government’s ‘New Federalism’.
As mentioned, it had jointly with ACTWEL organised the 1995 AWHN National
Women’s Health Conference. This event was so popular that women had to be
turned away after 760 registrations were received because of the capacity of the
venue.
The AWHN Top End Branch, NT, was established in 1987, at the prompting of
Pip Duncan, a member of the Central Australian Aboriginal Congress (CAAC)
who had heard about AWHN. At first energy was low because women were
already overwhelmed with meetings in a small jurisdiction (the saying was that
the same five women often attended the same five meetings). Enthusiasm was
stimulated, however, by the news that there was to be a national women’s health
policy, and regular monthly meetings soon became the pattern. The first major
project was to plan a women’s health conference. An Alice Springs branch was
formed and the two groups kept in touch by exchanging minutes of meetings.
Both supported the establishment of the Alukura Birthing Centre (Australian
Women’s Health Network 1988:8–9). In April 1989, the first AWHN women’s
health conference was held in Darwin and was well attended by both Aboriginal
and non-Aboriginal women.
The Queensland Women’s Health Network (QWHN), the most enduring of
the sub-national bodies, was formed at a public meeting in 1986, after which
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volunteers worked at home to progress establishment. A State-wide survey
led to a publication, The Health Needs of Queensland Women. Without funds,
the network went into abeyance but was revived when the State Government
changed and the NWHP was launched in 1989. Funding submissions were
written and the first grant of $21 000 was received from Queensland Health in
1993 (QWHN 1995).
Once funded, the network was able to produce communication bulletins, organise
planning days and teleconferences, link groups in Brisbane with regional
centres, gather and disseminate information and increase its membership. The
management group met monthly by teleconference and a members’ gathering
was held every three months (QWHN 1995). The network carried out advocacy
in relation to the implementation of the NWH Program in Queensland and, later,
worked with Queensland Health’s Women’s Health Policy Unit. A longstanding
tradition is the organisation of regional women’s health forums (QWHN 2003).
A linked rural women’s health network operated for a time, as did local network
groups that worked with regional health authorities.
Queensland is currently the only jurisdiction with both a formal Women’s
Health Network and a providers’ alliance. In 2009, when funding insecurity
was restricting the work of women’s health centres, the coordinators gathered in
Gladstone to share ideas and discuss strategies. From the meeting, the Women’s
Health Services Alliance was formed. QWHN provides secretariat services,
acts as a contact point, assists with communication and correspondence and
provides a direct link with AWHN (QWHN 2009:7).
The South Australian Women’s Health Network was formed in the mid-1980s
and survived into the 1990s. It received funding support for two years from
the NWH Program, which enabled it to employ a part-time worker, and was
responsible, with Adelaide Women’s Community Health Centre, for the
newsletter Stating Women’s Health. Country women’s health service providers
joined, along with women from the community health movement. Members
served on a number of key women’s health committees. An application to the
South Australian Government for funding for a permanent part-time executive
officer, which had been promised at one time, was unsuccessful.
After a recess, a women’s health network was re-established in Tasmania in the
mid-1990s and a branch was formed in the north of the State in 1997. A web
site was developed that carried a comprehensive range of health information for
clients and providers. The Women’s Health Forum was staged in Launceston in
2002, along with a hysterectomy awareness forum. In the same year, a domestic
violence symposium was organised in Hobart. Neither branch, however, has
met since 2006. The Independent Women’s Organisations of Tasmania (IWOT),
which represented women’s services, including shelters, support and information
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services, was a peak body formed by the Hobart Women’s Health Centre and
others, to provide a stronger voice when negotiating with government. It, too,
lost momentum and has not met since 2006; however, the Women’s Emergency
Service Providers (WESP) group continues to meet.
Several network groups were formed in Victoria at different times, including
Women in Health around Melbourne (WHAM) and the Women’s Services
Coalition, developed with the assistance of the Victorian Council of Social
Services in 1991. The coalition’s membership included refuges, housing services,
domestic violence and rape crisis centres, drug and alcohol and women’s
information services. It was disbanded because the broad-based membership
could not agree on principles and objectives. According to one participant, a
‘heavy, restrictive feminism’ was embraced by some members but not others.
After a period of dormancy, the Victorian network reactivated in 1998 in
response to interest from women who were not service providers but wanted to
participate in the movement. It was incorporated the following year. It aimed to
enhance communication about women’s health, create a coalition of like-minded
organisations, provide a forum for debate and consultation and undertake
advocacy. It organised forums on the Victorian Women’s Health Plan, women’s
access to reproductive information and services and a rural forum. After a
couple of years, energy fell and the network again ceased to meet; however,
women’s health services and agencies are networked with each other through
the Women’s Health Association of Victoria (WHAV), the peak body, which has
nine regional and two State-wide member services. WHAV now encourages
organisations with compatible goals to join as associate members. It is a central
point of contact for policy consultations.
Network organisation has an uneven history of recess and revival in Western
Australia as well. The Australian Women’s Health Network (WA) was revived
in Perth in 1992 in response to threats to women’s health centres. At the time,
the centres, most of which were newly established, had had their counselling
positions abolished. The network made public statements and organised a media
campaign. At its peak, it had a membership of approximately 180 women, many
of whom had worked in women’s health centres, plus miscellaneous supporters,
including women from environmental and consumer groups. There have also
been various manifestations of a peak service provider body, including the
WA Women’s Health Organisation (WAWHO), which operated from 1998 until
2003. At the time of writing, however, only the managers of the women’s health
centres meet regularly.
In New South Wales, the original network did not survive, which is partly
explained by the prior formation of a strong service providers’ network. In
1981, when the Commonwealth was handing responsibility for the Community
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Health Program back to the States and Territories, the Women’s Health and
Information Resource and Crisis Centres Association (WHIRCCA) was formed.7
It aimed to support centres, create regular connections between them and to
advocate and lobby on behalf of communities trying to establish new centres.
The association met quarterly and developed a list of some 26 policy guidelines,
major and minor, in the early 1980s, which included establishment of a women’s
health service for each administrative region of NSW Health. Another priority
was the provision of broad preventive health care for the most economically
disadvantaged women. In the first half of the 1980s, it engaged in regular
consultative meetings with NSW Health.
Partial success came in 1985 when three new centres in the western suburbs
of Sydney—Blacktown, Penrith and Campbelltown—were opened, along with
others in rural areas. Funding, however, has always been seen as inadequate. In
2000, WHIRCCA changed its name to Women’s Health NSW and now represents
23 centres across the State. It assists members where appropriate, undertakes
advocacy and policy development work, develops training modules and other
resources, gathers and disseminates information, assists with infrastructure
and standards, organises State-wide meetings three times a year, provides
facilitation and mediation services and participates in the work of AWHN. The
management board is elected and is representative of the different services and
regions (Women’s Health NSW web site).

The AWHN Aboriginal Women’s Talking Circle
The major recommendations formulated by the Aboriginal contingent at the
Third National Conference and endorsed by the full conference were the
establishment of a National Indigenous Women’s Coalition, the staging of an
Indigenous women’s health conference and the development of a national
Aboriginal and Torres Strait Islander Women’s Health Policy. Within its limited
resources, AWHN attempted to further the recommendations. In 1997 the
organisation wrote to the Council for Aboriginal Reconciliation, informing it of
the resolutions. AWHN’s proposal was endorsed by the council and discussed in
its 1997 report (Australian Institute for Women’s Research and Policy 1997:20).
Subsequently, a delegation from AWHN attended a meeting with the then head
of OSW, Pru Goward, to discuss the proposals, but Commonwealth support was
not secured.

7  The original name of the association appears to have been Women’s Health and Information and Rape Crisis
Centres Association; however, Rape Crisis Centres resigned in 1985 when WHIRCCA agreed to be part of a
government working party to develop service guidelines for NGOs.
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In 2004, an Aboriginal woman from Perth, Dot Henry, joined the AWHN
committee. As one of AWHN’s representatives on Womenspeak,8 Henry was
able to use that forum to draw attention to Aboriginal women’s health problems.
AWHN obtained funding from the Office of Aboriginal and Torres Strait
Islander Health (OATSIH) in 1997 to bring Aboriginal women from each State
and Territory to Canberra for a national summit staged in September, of which
more below. The Aboriginal women met the day before, developed an initial
position paper and decided to form an Aboriginal women’s talking circle as a
subgroup of AWHN. A further grant was obtained from Womenspeak in 2008,
which enabled the group to meet again, in Adelaide in 2009. At approximately
the same time, AWHN obtained a grant from the Women’s Development Program
of FaHCSIA to manage a consultation process with Aboriginal women and
write a submission to the proposed new NWHP. The contract also required the
development of an Aboriginal women’s health strategy and the strengthening
of the Talking Circle. A working group to oversee the project was formed at the
Adelaide meeting.
Sandra Angus took leave from her position at Queensland Health to become
the project officer and undertake the consultations, which were held in every
jurisdiction. Unfortunately, time constraints prevented consultation with
women living in the Torres Strait Islands.9 The Talking Circle Working Group
met regularly by teleconference to steer the project and to comment on various
drafts of the submission, which was written by Sandra Angus and delivered
to the Commonwealth Department of Health and Ageing in September 2009.
The working group continued to meet by teleconference, with one face-to-face
meeting, to work on an Aboriginal women’s health strategy. The writing process
was ably assisted by Dr Bronwyn Fredericks and Dr Karen Adams, and the
strategy was launched at the Sixth AWHN National Women’s Health Conference
in 2010. It received considerable press attention. At the time of writing, advocacy
is continuing to try to progress implementation of the recommendations but the
political response is disappointing.

8  WomenSpeak was one of four National Women’s Alliances that were funded by the Commonwealth
Office for Women to undertake consultations on issues affecting women. The alliances were introduced
by the Howard Government and replaced the Hawke Government’s National Women’s Non-Government
Organisations’ Funding Program, under which operational funding had been made available to a number of
women’s NGOs. In 2009, the number of alliances was expanded to six.
9  Such work requires a long lead time, as women are scattered and transport between islands is often
infrequent.
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Domestic Violence and Sexual Assault
Networks
A variety of networks and coalitions has been set up in the domestic violence and
sexual assault sectors. As the number of refuges increased in New South Wales,
the need for unified action led to the formation of a State-wide organisation
in 1979. The feminist Women’s Refuge Movement Resource Centre, established
in 1986, is the central contact for the movement in the State, where there are
currently 57 member refuges. It aims to promote community awareness and
provides information, resources and advocacy. A longstanding commitment to
facilitating participation in decision making is maintained, and, to this end,
regional and State conferences where major policy decisions are made are held
quarterly. The NSW Women’s Refuge Working Party is a smaller management
body with authority to make decisions between conferences, in line with
endorsed policies and philosophies. Within the movement, Koori, immigrant
and lesbian women have formed their own support groups and there is also a
child-support group. The Stop Violence against Women Network has also been
established in New South Wales.
The incorporated Coalition of Women’s Domestic Violence Services was
established in South Australia in 2003. It works to raise the profile of violence
against women and children in the public domain and to broaden the focus
of discussion. It has explored the possibility of coordinated relationships with
sexual assault and women’s health services and, to this end, has developed
a multi-agency working party. It produces policy documents, collects and
analyses statistics, collaborates in awareness campaigns and writes submissions
to inquiries and consultations, drawing attention to a range of unmet needs,
particularly the health problems of children who have experienced violent
situations. Among such children, PTSD, developmental delays and behavioural
problems are more common.
A women’s refuge group was established and incorporated in Western Australia
in 1977. Now called the Women’s Council for Domestic and Family Violence
Services (WA), it is a peak organisation that operates within a feminist
framework, representing 54 refuges and other domestic and family violence
services. It makes referrals and carries out a range of capacity-development,
representation, advocacy, information dissemination, community education,
research and training functions. In 2009, it conducted a State-wide survey of
services, which found unacceptably low pay levels for workers and disparities
between services. It found that the non-governmental not-for-profit community
sector is underpaid by up to 30 per cent, compared with other sectors in the
State, creating serious staff and recruiting problems (Hartwig 2009).
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Nationally, the Women’s Emergency Services Network (WESNET) was
established in 1992, as a peak advocacy body for SAAP-funded women’s
services. The impetus for action was an identified need to bring representatives
from all jurisdictions together to address issues of common concern. Members at
early meetings unanimously agreed that the advancement and recognition of the
essential nature of the work required better organisation at the national level.
Funding was obtained to employ a consultant to develop a national structure and
gather information for incorporation. The first National Joint Forum of SAAPfunded organisations was held in Canberra in 1994 (Townsend 1994:9–11).
WESNET works within a feminist framework and recognises that women’s and
children’s experiences are shaped by their ethnicity, ability, age, sexuality and
class. It collaborates with member organisations to identify unmet needs and
emerging issues. Like other peak groups, it provides policy advice and lobbies
for legislative and program reform. At the time of writing, WESNET has almost
400 members across the country. It has developed a comprehensive domestic
violence policy, which includes recommendations for law reform. Changes
proposed include the strengthening of mechanisms to remove a violent partner
from the family home and the training, including cross-cultural training, of
police, court staff, legal representatives and magistrates. The full provision of
interpretative services, the compilation of comprehensive statistics in relation
to sole-occupancy and exclusion orders and the development of model domestic
violence and related legislation through Commonwealth, State, Territory and
community-sector collaboration are all objectives. WESNET facilitates national
debate, stages national conferences and sector forums and lobbies on all relevant
issues (WESNET web site).
The Victorian Centres against Sexual Assault Forum was formally established
in 1992 and was incorporated in 1994. It is a peak body for 15 sexual assault
services in the State and is committed to addressing all inequalities that result
from sexual violence against women, children and men. It takes the view that
the occurrence, consequences and elimination of sexual violence should be the
responsibility of the whole community and all tiers of government.
The National Association of Services against Sexual Violence (NASASV) has
been established nationally to facilitate information exchange, undertake policy
and advocacy work and promote the development of a national response to
sexual violence within a feminist framework. It aims to challenge and change
the attitudes that underpin the perpetuation of sexual violence and, eventually,
to see it eliminated. An initial meeting was held in Sydney in 1989, attended
by representatives from all States and the Australian Capital Territory. The
association was incorporated in 1997 with assistance from the Office of the Status
of Women but has no secure funding. NASASV coordinates information, skills
and resource sharing between services, lobbies and negotiates with governments,
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provides policy advice, promotes community awareness, undertakes research,
promotes quality training and skills development, monitors innovative service
models and organises national meetings, conferences and seminars. In 2002, it
released a major report, Cultural diversity and services against sexual violence
(Weeks 2002). The National Standards of Practice Manual has been produced and
work on the development of a national data set has been undertaken. In 2009,
Framing best practice: national standards for the primary prevention of sexual
assault through education was produced by a small research team in partnership
with other groups, including the Commonwealth and VicHealth.

Conclusion
The Australian women’s health movement expanded and grew more diverse as
groups multiplied from the early 1980s onwards. A decade later, there were
literally ‘hundreds of community-based groups of women organised around
particular health issues’ (Dwyer 1992:211). A panoply of networks and
associations was established that facilitated the articulation of women’s health
issues despite the restrictions imposed by unfunded operation in most cases. The
movement established a number of formal networks over the years but public
funding to support them was difficult to obtain and many fell into abeyance
or were dissolved. Clearly, the movement does not have the political clout that
other health provider groups enjoy.
It was thought in the 1980s that the political arms of the movement—the State,
Territory and national networks—needed to be one step removed from funded
services in order to protect funding and independence. And certainly there
have been unfavourable political times when this consideration was important.
In 2011, however, most service-provider organisations are independent but part
of the institutional apparatus. They work constructively with governments,
pressing strongly for the sector’s interests and for changes that will improve the
conditions of women’s lives. In most cases, they refrain from public criticism
of the government in power. This way of working demonstrates the significant
level of legitimacy that the movement has gained at the State and Territory level.
Growth and diversification within the movement seem to have had both costs
and benefits. Expansion is generally considered to be a sign of strength and it
certainly facilitated the public discussion of a broader range of women’s health
issues. In addition, it facilitated the generation and sharing of more and more
detailed health information. The capacity of the movement to lobby on specific
issues was increased and its ability to provide support to women was enhanced.
Self-help groups make a vital contribution to women’s health.
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But proliferation has contributed to a fragmentation of the movement, at least
since the very early days. As time passed, groups developed considerable
expertise in their own areas and tended to undertake advocacy separately. More
opportunities to address and articulate a wider range of issues have thus been
offset by an increasing lack of cohesion, undermining the extent to which the
movement can be seen, or can see itself, as a coherent entity. We will see in
Chapter 6, for example, that the maternity-care reform movement has tended
to work separately from other movement groups. In some areas, fragmentation
can be a very real problem. Multiple groups lobby on specific disability issues,
for example, and provide valuable support and information to their own client
groups. It can be, however, that no group is working at the level of the broad
picture where it is necessary to advocate for the general rights of all people with
disabilities.10
Other processes were at work at the same time that groups were proliferating.
Neo-liberalism and managerialism were gaining strength and these ideas
influenced the way governments responded to community organisations. Many
women who had previously worked at the grassroots level were taking paid
positions in the newly created services, in the bureaucracy and in other places.
According to Carmody (1990:307), these changes resulted in fewer opportunities
for advocacy and collective action and a diminution in the quality of feminist
political analysis, all of which was exacerbated by the demands of service
provision in poorly funded services. Compared with the 1970s, feminists were
becoming separated from each other in different spheres of activity, she argues.
Clearly, many forces were important in changing the way the 1970s women’s
health movement operated, including changing political opportunity structures.
Fragmentation seems to be an unavoidable consequence of expansion, which as
we have seen brought benefits as well. While it is hard to isolate the impact
of each of the impinging forces, the evidence suggests that the movement has
been able to make progress towards its goals, no matter what the changes, when
governments sympathetic to its objectives have held power.

10  I owe this insight to Sue Salthouse, Convenor of WWDACT.
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So much of what affects women also affects children and men, so many
agencies have responsibilities…and our agenda is so large, that we need
to work with and through others as much as possible. (Dwyer 1992a:25)
The value of a collaborative approach to health care, pioneered in the
community sector,1 is now widely accepted among public health experts.
Collaboration between team members and with outside services and agencies is
considered a foundational element of effective, comprehensive primary health
care. Collaborative ventures are undertaken between governments and nongovernmental agencies and between agencies in the health sector itself. Health
workers collaborate with local governments and social and community services,
including housing, income security, child services and services responsible
for safety from violence (Keleher 2001:59). Partnerships between government,
non-governmental agencies and communities are now considered indispensable
when addressing health promotion. Community-based partnerships are a means
through which local needs and capacities can be evaluated and appropriate
projects and programs designed. National, State and Territory partnerships of
various kinds are being put together in most jurisdictions.
Collaboration is an essential element of everyday work in women’s health centres
and services. Within a few months of opening in 1975, Liverpool Women’s
Health Centre was already working with local agencies. Referrals were coming
in from local doctors, invitations to speak to local groups and organisations had
been received and liaison with local agencies and government departments was
under way (Cooper and Spencer 1978:151). Collaboration is so extensive that
in South Australia a special project has been deemed necessary just to identify
and document the ‘myriad activities’ of the Central Northern Adelaide Health
Service’s Women’s Health and Safety Unit, which includes Dale Street Women’s
Primary Health Service, Northern Women’s Primary Health Care Service and
the Northern Violence Intervention Program (MacKenzie 2009:6).

1  Much of the pioneering community health centre infrastructure established in the 1970s has now been
disbanded. After the Fraser Government handed back responsibility, most State and Territory governments
have presided over a dismantling process, as part of an exercise to shift costs to the Commonwealth. Without
community health centres, citizens will primarily get their services from general practitioners in private
practice, subsidised by the Commonwealth through Medicare. Queensland never established a comprehensive
community health centre network, due mainly to the vehement opposition of organised medicine in
cooperation with the conservative government that held power there until 1989. Victoria has retained the
most extensive community health centre infrastructure, although centres have lost at least some of their
independence. The Aboriginal community-controlled health sector, however, has been maintained and has
managed to expand in some jurisdictions.
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At the most fundamental and perhaps most important level, according to one
of the principles of women’s health, health workers collaborate with clients and
families in arrangements where power is shared. The ‘health worker as expert’
model is supplanted with one that aims to empower and enhance the self-esteem
of those seeking advice and care. Both the expertise of professionals and the
expertise of individuals and family members are recognised. As Radoslovich
(1994:51) argues, ‘women’s health centres believe in empowering women to take
control of their health…To achieve this, the services have adopted particular
styles which differ from traditional service models’.
Women in centres and services support each other and work with agencies in the
wider community. In the early days, they provided strong support for groups
trying to establish new services. They share information and experiences, work
together to address service problems and act politically to influence public
policy. In collaborative partnerships, they produce a broad range of community
health, outreach and education services designed to meet multifaceted needs,
especially the multiple needs of disadvantaged groups. By working together at
the local level with other service providers and agencies, the resources of the
community are mobilised and appropriate community-development projects
are generated. The teams of health professionals employed by most women’s
health centres, including nurses, dieticians, counsellors and psychologists, for
example, are generally well equipped through their training and their approach
to health, to facilitate community participation and community development
(Baum and Keleher 2002:36). Ongoing collaboration has, however, always been
hampered by scarce resources and the pressure to respond to women’s immediate
needs (Broom 1990:121). For many centres and services, demand is so heavy that
the capacity to operate beyond day-to-day provision is limited. Nevertheless,
an amazing array of informal interactions and collaborations characterises the
work of the sector.
The move towards multi-agency cooperation and collaboration in health
mirrors changes that are taking place in the way Organisation for Economic
Cooperation and Development (OECD) countries are governed. Since World
War II, the complexity of policymaking processes and the interdependence of
the agencies have increased in Western countries in response to globalisation.
A large literature has emerged on what is called ‘collaborative’ or multilevel
governance (see, for example, Leo and Enns 2009; Sorensen 2004; Stein and
Turkewitsch 2008). Growing international interaction has increased the
number of intergovernmental actors and agencies involved in policy, as well
as expanding their roles. At the same time, there has been a proliferation of
NGOs, both national and international, so that governments now collaborate
in decision making with a variety of agencies, public and private, including
corporations, unions, NGOs, members of social movements and individuals (Gray
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2010).2 Collaborative governance has been defined as a ‘governing arrangement
where one or more public agencies directly engage non-state stakeholders in
a collective decision-making process that is formal, consensus oriented, and
deliberative and that aims to make or implement public policy or manage public
programs and assets’ (Ansell and Gash 2007:2).
Health sector partnerships, often complex and multilateral, can be seen as a form
of collaborative governance. Acknowledging the importance and ubiquity of
partnerships and the varied forms they take, VicHealth has attempted to develop
a typology, producing a fact sheet and the Partnerships Analysis Tool to assist
practitioners in their work. Partnerships, VicHealth argues, usually move along
a continuum depending on the level of commitment and degree of joint action.
At one end is networking, which involves exchange of information for mutual
benefit but is not time consuming and does not necessarily involve further
cooperation. Coordination is the next stage on the continuum. Here, information
is exchanged and activities are altered for a common purpose, involving more
time and requiring greater levels of trust than networking. Cooperation, the
next point on the scale, involves a sharing of resources for common purposes
as well as information exchange and a shift in activities. More time and higher
levels of trust are needed, and perhaps detailed agreements. Collaboration is
identified as the most complex and committed type of partnership. As well as
having the features of the other three types, collaboration involves a willingness
to increase the capacity of another organisation and to share turf. High levels
of trust are needed because risks are involved but, offsetting this, there is a
possibility of highly beneficial outcomes (VicHealth n.d.[a], n.d.[b]).
While the VicHealth categorisation is helpful in terms of conceptualising
different partnership forms, in practice, many women’s health activities cannot
be neatly classified. Political action, for instance, can be rather one-sided at least
initially but might develop into a cooperative endeavour. For example, Victorian
women’s health centres engaged in a local-government capacity-building project
in 2008. First, efforts were made to ensure that candidates standing for election
had information about women’s health. Next, candidates were asked to commit
to an action plan, called Safe, Well and Connected: Victorian Local Government
Action Plan for Women’s Health 2008–2012. Endorsement of the plan entailed
commitment to the development of local women’s health strategies, addressing
issues such as mental illness, disability, intellectual disability, violence, family
friendly workplace practices and the concerns of women carers, lesbians and
culturally diverse women (Hudson 2010; Women’s Health in the North web
site). As well as not fitting into any one type of partnership, joint endeavours
often change over time. An interaction might begin as networking, for example,
2  A recent book explores the impact of changing governmental architecture and processes on the efforts of
women’s movements to influence public policy in different countries. See Haussman et al. (2010).
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but develop into committed collaborative activity as linkages are established
and trust deepens. Nevertheless, the VicHealth framework is a useful organising
tool for a discussion of the way women work together and with other agencies
for health.

Networking
Information sharing—the purpose of networking according to the VicHealth
typology—is a basic aspect of women’s health work. Aboriginal women find
that value and empowerment flow from networking together to share health
information. Gatherings also enable them to address difficult issues, such as
violence, meet health providers, extend their networks and affirm their cultural
and spiritual values (Adams et al 2002; Pearse 2002). Centres and services
develop networks, partly to fulfil the needs of their own clients but sometimes to
assist with service provision for clients from other organisations, often in a twoway information exchange. For example, Women in Industry Contraception and
Health (WICH), Victoria (now the Multicultural Centre for Women’s Health),
shared information with Adelaide Women’s Community Health Centre in the
late 1980s, when Adelaide was interested in introducing programs based on
WICH models. It also checked translations for the Victorian Domestic Violence
Education Task Force and for the Prostitutes Collective. It has been consulted
about curriculum development by the Broadmeadows TAFE and about migrant
women’s information needs by the National Women and AIDS Campaign. In
addition, organisations visit the centre to learn about its work and from its
experience. In 1989, WICH was a member of the Victorian Women’s Health
Services Providers Group, Non-English Speaking Background (NESB) Women’s
Health Services Funding Group, the Women’s Health Forum, the Coalition
against Depo-Provera and the Occupational Health and Safety Commission’s
NESB Workers Advisory Committee (WICH Annual Report 1989).
Sometimes what is nominally called a network operates more as a system of
coordination or cooperation in VicHealth’s terms. For example, Western
Australian alcohol and drug agencies formed Wanada, a network that spreads
across that State. Member agencies provide education, advocacy, community
development, prevention, treatment and support services. Members include
women’s health centres and Aboriginal health services and corporations. Wanada
is a member of Community Sector Services and provides services for its member
organisations, including child care for clients and interpreter services—a much
larger role than suggested for a network in the typology (Wanada web site).
In another example, the Government of Victoria took the lead in developing
integrated family violence networks in 1989. Community groups, including
women’s health centres and sexual assault and domestic violence services,
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formed regional networks under the program. Other network members include
representatives from criminal justice, housing and community health. The main
aim is to provide a more coordinated system, geared towards the protection
of victims. In 2006, there were 20 partnerships, funded to provide integrated
services, involving 70 organisations. Clearly, such activity involves more than an
exchange of information. Similarly, the Alice Springs Women’s Shelter convenes
the Central Australian Family Violence and Sexual Assault Network, which
comprises 26 government and non-governmental agencies. As well as sharing
information, the network is involved in planning and advocacy (Commonwealth
of Australia 2008b).

Cooperation
According to the VicHealth typology, cooperative activity includes information
sharing, alteration of activities for common purposes and resource sharing. A
great deal of women’s health action fits into this category. From the early days,
activists shared information and worked together for common benefit. The
collective that later set up the Leichhardt Women’s Community Health Centre
(LWCHC) gave assistance to similar groups in Adelaide and Canberra, as well as
others in Sydney, and produced the controversial booklet What Every Woman
Should Know (Broom 1991:2). As mentioned, women in other States travelled
to Leichhardt, the flagship centre, to learn from experiences there and, for
their part, Leichhardt women travelled locally and interstate, as requested,
to assist new centres. In the process of planning for a refuge and a women’s
health centre, Western Australian women had regular contact with, and support
from, Leichhardt. Adelaide women had similar support (Radoslovich 1994:14).
Leichhardt became a model for the health centre movement and cooperation was
a hallmark of its operations.
Similarly, when the Hobart Women’s Health Centre opened with precarious,
short-term funding in 1987, women from Liverpool Women’s Health Centre
visited to provide training. HealthSharing Women in Victoria and Women’s
Health Statewide, Adelaide, supported the new centre by providing health
information leaflets. There were also links with women in WICH, through
which advice on appropriate services for immigrant and refugee women was
channelled. A similar set of cooperative interactions took place between women
establishing new refuges, who were able to learn from services already in place.
The pattern of supporting new initiatives sometimes attracted the support of
outside groups. In establishing Ngalawa Wingara in Liverpool, many different
groups worked together in what became a full-scale collaboration. Ngalawa
Wingara means ‘to sit and think’ and is an Aboriginal women’s healing space, a
beautifully landscaped area beside the health centre, with stones, plants, mosaic
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decorations and a rock pool. Clients and community women use the space for
quiet time or to meet and talk. A steering committee of local women worked
with health workers and the South Western Sydney Area Health Service, using
the talents of a local artist, to set up the space. Assistance was supplied by local
businesses, including nurseries. The artist worked closely with the steering
group and received support from a group of Hoxton Park elders.
Women’s health centres and services continue to cooperate in the establishment
of new groups and services, as in the early days. Women’s Health Victoria
(WHV), the Breast Cancer Action Group and other Victorian women’s health
services established BreaCan in 2003. Originally funded as a pilot by the
Victorian Department of Human Services, the service provides holistic support,
information sessions, library resources, exercise programs, complementary
therapies and opportunities for women to interact with trained peer-support
volunteers, all of whom have themselves experienced cancer or cared for
someone with cancer. The service is State-wide, confidential and provided
without charge. In 2007, BreaCan expanded its activities to include women
with gynaecological cancers. It subscribes to the philosophy that the best
services are delivered in collaboration with partners and has formed a research
partnership with the Key Centre for Women’s Health in Society at Melbourne
University (now the Centre for Women’s Health, Gender and Society). BreaCan
is community managed and receives operational funding from the Victorian
Department of Health (BreaCan 2009).
Cooperation in the sense of sharing or creating resources for mutual benefit
takes place when State-wide services provide a range of resources for the sector.
For example, Women’s Health NSW has produced a non-governmental women’s
health service training program that can serve as an orientation tool for new
workers and aims to increase knowledge and skills about outcomes-based
planning. Women’s Health Queenslandwide provides comprehensive webbased health information, a library service and a range of education courses
for professionals. Education courses have also been developed for schools,
corporate-sector women and community members. Like its sister organisations,
WHV produces extensive resources. All these agencies undertake advocacy for
the whole sector. In South Australia, the Family Medicine Program at the Royal
Adelaide Hospital established a women’s health training module, in cooperation
with femocrat women’s advisers and community-level women’s health groups.
A recent cooperative venture in Melbourne took the form of an Indigenous
Women’s Health Day, organised by Women’s Health West and a number of
mainstream health services, including the Western Melbourne Division of
General Practice and North West BreastScreen. Held at the Western Suburbs
Indigenous Gathering Place, a two-way exchange of information took place,
during which Aboriginal women discussed their health concerns. Community
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women were able to meet healthcare providers, helping to build a sense of trust.
Women’s Health West continues to collaborate with the Gathering Place. The
service also works with African women, Bosnian women, young women and
women with disabilities, and has programs addressing emotional wellbeing,
violence prevention and mental health, to name a few. All of these endeavours
involve cooperation with a range of local agencies (Women’s Health West web
site).
Cooperation also takes place between Aboriginal community health services and
other agencies. For example, in Victoria, the Gunditjmara Aboriginal Cooperative
and the South Western Centre against Sexual Assault (CASA) worked together
on a successful project to raise awareness about family violence and sexual
assault. An evaluation of the project found it had produced ‘increased and more
relevant community education’ and that the mutual learning from informal
liaison among the workers in both organisations had been ‘most fruitful’.
Moreover, cooperation continued after funding ran out (South Western Centre
against Sexual Assault 2003–04:49–50).
Cooperation is also strong among domestic violence agencies. The North
Queensland Domestic Violence Resource Service (NQDVRS), itself a product
of joint endeavour, and the Coalition on Criminal Assault in the Home North
Queensland applied to the Queensland Government for funding to establish the
Domestic Violence Resource Service for Townsville and Mount Isa in 1993. The
service works closely with the Women’s Centre and Sera’s Women’s Shelter and
provides student places for James Cook University, TAFE and students from
overseas. It has also established a partnership with the Queensland Police Service,
which aims to provide better responses to domestic violence (NQDVRS 2009:1).
The NQDVRS, the Sunshine Coast Domestic Violence Service and the Gold
Coast Domestic Violence Service recently ran a one-year pilot to trial a support
program for women and children staying in their homes after perpetrators had
been required to vacate.
Sometimes women’s health centres join forces with other agencies to help meet
the health needs of rural women. For example, Women’s Health Statewide in
South Australia identified rural women’s health as a priority and attended major
country events, such as field days, to raise awareness of issues and provide
information. It worked with groups such as the Women’s Information Service,
Women’s Legal Services and the Working Women’s Centre in these ventures.
Country visits were coordinated with the work of local health workers. Ways of
enhancing rural health work were explored, which often involved maintaining
extensive relationships with country personnel over a period of years. The
Women’s Shed Project in Oodnadatta, near the Simpson Desert, is a partnership

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between the Northern and Far Western Regional Health Service, Dunjiba
Council and Oodnadatta Health Service. A preventive health program, it uses
the arts as a medium of communication.
Women’s health groups regularly take up one another’s issues, especially when
a threat to existing rights or infrastructure is perceived. As an example, women
concerned with violence took up the abortion issue towards the end of the
Howard Government period (1996–2007), when the preservation of existing
services came under threat, as represented in statements by the Health Minister,
Tony Abbott, and the Prime Minister. In response, Issue 19 (2007) of the
journal Women against Violence focused almost entirely on issues of pregnancy
counselling and abortion, naming government pronouncements as ‘the violence
of misinformation’.

Collaboration
Collaboration sits at the complex end of the partnership continuum in the
VicHealth framework. As well as information and resource sharing, collaborators
must be willing to increase the capacity of one or more outside organisations to
achieve common purposes. Again, much of the activity of the women’s health
movement falls into this category. Groups have worked together extensively to
enhance mutual capacity building, often with outside agencies, including trade
unions, family planning associations and political parties.
The Immigrant Women’s Speakout Association in New South Wales provides a
good example. It has established connections with other agencies, including the
NSW Domestic Violence Network. Staff serve on a number of outside advisory and
steering committees, including the Violence against Women Regional Reference
Group, Family Planning Australia, Women’s Health in Industry Program Steering
Committee and the Australian Domestic and Family Violence Clearinghouse
Advisory Committee. Similarly, Women’s Health NSW, formerly Women’s Health
and Information Resource and Crisis Centres Association (WHIRRCA), has long
experience working in collaboration with other NGOs to enhance capacity. In
2008–09, the Female Genital Mutilation Advisory Committee, the NSW Council
of Social Services and the Primary and Community Health Working Group of
NSW Health were among the committees on which it served. Other groups with
which it is linked include the Multicultural Disability Advocacy Association of
New South Wales, the NSW Police Domestic and Family Violence Stakeholder
Forum, Reproductive Choice Australia (RCA) and the Royal Australian College
of Physicians Health Consumers and Community Partnerships Forum (Women’s
Health NSW web site).

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A recent example of a multi-partner project intended to produce information for
mutual benefit is the Gender, Workplace Injury and Return to Work Research
Project conducted in South Australia in 2003–04. The steering committee was
drawn from a range of stakeholders and researchers. The aim was to explore
people’s experiences following workplace injury and return to work, to shed
light on obstacles and to find out whether men’s and women’s experiences are
the same or different. Project initiators included the Working Women’s Centre,
the Office for Women, the Australian Manufacturing Workers Union, the Equal
Opportunity Commission, Dale Street Women’s Health Service, the Migrant
Women’s Lobby Group and a community representative. During the research
process, views were canvassed among employers, managers, OHS/rehabilitation
coordinators, unions, health and safety representatives and trainers, claims
agents and case managers (WorkCover Corporation and the Working Women’s
Centre 2005).
The promotion of cultural sensitivity has been furthered through collaboration.
In 1981, LWCHC joined with refuges, Family Planning NSW and government
agencies to organise a conference to promote the employment of immigrant
women in established services and to encourage ongoing interaction between
groups providing services in immigrant communities. In addition, it worked
with Annandale Neighbourhood Centre and the Leichhardt Council to produce
a 10-week health project for immigrant girls at the local high school (Stevens
1995:49). A Queensland example of intercultural collaboration is the formation in
1993 of the non-English cultural background (NECB) Women’s Health Reference
Group, to provide information and to advance the health of immigrant women
in the Logan and North Albert areas. Members of the reference group were the
Logan Migrant Neighbourhood Centre, Logan Women’s Health Centre, Logan
Hospital and the South Regional Health Forum. The reference group lobbied
successfully for a NECB health worker for the Logan Women’s Health Centre and
held cultural awareness workshops and seminars.
Major collaborations have also been undertaken in the sexual assault field.
Recently, the Australian Research Council funded a joint project between
the NSW Rape Crisis Centre and the University of Western Sydney, which
investigated the possibility of promoting ethical, non-violent relationships
between young men and young women (Carmody and Willis 2006). From this
research, a six-week education program for young people was piloted and
developed, with the aim of creating opportunities for learning new ways of
negotiating sexual intimacy and promoting ethical, non-violent skills. In 2009,
funding provided by the Commonwealth’s Respectful Relationships Program
was used to train educators and run groups with young people in New South
Wales and Queensland. Collaborators include the AIDS Council of New South

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Wales (ACON) and the National Rugby League in Queensland. Influence has
crossed the Tasman: the New Zealand Ministry of Justice provided funding in
2010–11 for the program to be run in New Zealand.

Collaboration with Communities
Community-development projects are a standard part of the work of women’s
health centres. Meeting complex needs involves day-to-day collaboration with
other service providers and agencies to try to ensure that a full range of services
is available. Women’s health workers recognise that no one agency can effectively
meet more than a fraction of a community’s health needs. For example, domestic
violence services must interact with local doctors, local hospitals, mental health
services and so on, when clients need medical assistance. Similarly, cooperation
with housing authorities, local councils, social service agencies and possibly
local charities might be necessary. The Immigrant Women’s Health Service
(IWHS) in the western suburbs of Sydney works with multiple agencies to help
meet the needs of its clients. It has facilitated the establishment of support groups
for women from 19 cultural groups, which meet regularly at the centre. Other
community-development projects include the Ethnic Communities Sustainable
Living Project and a support group for Vietnamese working women. Among
the agencies with which it collaborates are Women’s Health NSW, the Smith
Family, the Serbian Orthodox Welfare Association, Playgroup Australia, Miller
TAFE Outreach, Granville TAFE, the Multicultural Respite Network, Fairfield
City Council, Liverpool City Council, Fairfield Division of General Practice,
the Benevolent Society, Australian Quarantine Inspection Service, Fairfield
Hospital, Liverpool Hospital, Fairfield Migrant Resource and the Wetherill Park
Police, to name only some (Immigrant Women’s Health Service web site).
Women’s health centres also participate in community efforts to rectify
environmental degradation. From the early 1980s onwards, for example, in the
Dale Street area, concerned residents mobilised in response to problems such
as dust, noise, factory emissions and spills of copper chromium arsenate and
chlorine gas. Centre workers had noticed increases in the incidence of bronchial
disease and ear, nose and throat problems. Dale Street thereupon employed
local women to document the health problems being experienced and develop
strategies to deal with them. The report was presented to a large public meeting,
which included representatives of government and industry. Subsequently, a
favourable public policy response emerged.
Dale Street Women’s Health Centre has been involved in a number of other
community-development projects (Radoslovich 1994:68–70). For example,
it was noticed that many local women worked at home as piece workers. The
centre responded with a support project called ‘Outwork: Reaching an Invisible
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Workforce’ in the second half of the 1990s. Information was assembled and
distributed about OHS issues, rights and entitlements under safety legislation
and workers’ compensation arrangements (Tassie 1997:185). As part of the
project, the centre worked extensively with individuals and organisations,
including employers, doctors, community workers and community groups
representing women from different cultural backgrounds.

OHS Meets a Social View of Health
Extended collaboration took place between feminists in different agencies with
the ultimate aim of overhauling OHS regimes that had been in a state of neglect
for decades (Irving 1979; Pearse and Refshauge 1987:646). Until the 1970s, OHS
was not seen as a health issue. Rather, it consisted of a narrow, prescriptive
regulatory regime, focusing largely on particular industries, such as mining,
manufacturing and construction. Just as medical research had focused on male
bodies, investigations into safety and conditions of employment concentrated
on the safety of men. At the time, women were seen as a low-risk, part-time
or temporary workforce. The occupations considered appropriate for women
were supposed to be safe and were therefore seen as outside the ambit of OHS.
One of the views of the day was that there was no need to include women in
OHS discussions because they could always avoid health problems by staying at
home or working in another industry. For example, the report of the Williams
Inquiry into OHS in New South Wales in the early 1980s failed to discuss the
problems of either migrants or women, dismissing each with a one-line mention
(Dimech 1982:18). It was not until 1985 that women’s occupations were included
in the industrial death registration system (Skues and Kirby 1996; Shoebridge
and Shoebridge 2002:7). Immigrant women were in a particularly vulnerable
position. Their representation in union structures was virtually non-existent
yet as a group they were severely affected by work-related injuries and they
constituted the majority of those suffering from RSI, for example.
Workers’ health action groups were formed in most jurisdictions from 1977
onwards. Many women unionists saw health from a social perspective and worked
to broaden the meaning of OHS, arguing that it should be much more than a set
of minimum safety standards. Rather, employers should have a ‘duty of care’ to
provide a safe, healthy place of work, one that would not only prevent the high
incidence of industrial injuries but would also contribute to physical, mental
and emotional wellbeing. The notion of a healthy workplace was influenced by
ideas from industrial democracy and included the establishment and resourcing
of participatory structures where workers would exercise responsibility and
discretion.

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Women unionists also worked to increase their representation in union
structures, trying to ensure their election as union officials—a process assisted
by funding grants from the Whitlam Government. A critical mass of female
officials meant being able to raise and pursue issues not previously raised inside a
union and being able to establish collaborative links with women’s organisations,
community organisations, political parties and other relevant agencies outside
(Shoebridge and Shoebridge 2002:10). Working women’s centres and women’s
health centres were collaborators in the many coalitions that were formed in the
1980s and 1990s around OHS issues.
After the main health issues were identified, women pressed for OHS provisions
to be incorporated in industrial awards. A preventive focus required that hazards
are eliminated ‘at the source’ rather than compensation being provided after the
event. Seeing OHS as an industrial democracy issue, an argument was made that
union-elected health and safety representatives should have powers to inspect
workplaces, draw attention to conditions needing improvement and stop work
if conditions were considered dangerous (Pearse and Refshauge 1987:636–42).
Women unionists argue that working life affects the rest of life and is therefore
crucial to health. They raised problem issues, such as the availability of flexible
working arrangements to fit with family responsibilities and union provision of
child care, arguing that child care is an industrial issue. Other specific problems
are working with chemicals, stress, sexual harassment, RSI and compensation in
the case of injury. Violence in the workplace is identified as a problem, especially
in nursing homes and hostels, where staff care for people with dementia and
intellectual disabilities. Stress became a more urgent issue in the 1990s, when
job insecurity increased and many women and men did not know whether they
would have a job the following week.
The women’s health movement in most States and Territories had good working
links with women in the union movement. In many cases they knew each other
through overlapping memberships of political parties and unions and a few sat
on policy committees. So while women in trade unions played a crucial role
in advancing women’s OHS, in turn, the broader women’s health movement
supported workers’ health and was a force in shaping a context conducive to
workplace reform.
Liverpool Women’s Health Centre was a pioneer in recognising OHS as a
women’s health issue. In 1975, the Industrial Health Group was formed on the
discovery of a high incidence of musculoskeletal workplace injuries particularly
among immigrant women. About the same time, the trade union arm of the
women’s movement lobbied for federal funding for the Melbourne Working
Women’s Centre, which was set up in 1976. Through the centre, OHS issues
were advanced, along with issues around equal pay and conditions of work
(Pearse and Refshauge 1987:639). The musculoskeletal and RSI conditions that
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disproportionately affected immigrant women workers had previously been
put into the ‘too hard basket’, participants remember. Through collaboration
between members of advocacy networks, however, information about injuries
was publicised and changes in conditions of work were slowly achieved.
In Western Australia, women unionists championed the principle that
employers are responsible for providing safe working environments. They had
close ties with women’s health centres, academics, health policy professionals,
workers’ health centres in other jurisdictions, including the Lidcombe Workers’
Health Centre, and with international organisations. They felt that they had
good access to policymakers under Labor governments and succeeded in getting
improved OHS arrangements written into policy. Union representatives sat on
the health policy committees of the ALP, which was an opportunity not available
under Liberal governments. A women’s OHS committee was established in the
Trades and Labour Council in the early 1980s and the first paid female officer
was appointed in 1983. The incumbent Labor Government met the costs of the
position. The committee was wound up in 1988 but the principles it promoted
found their way into Australian Council of Trade Unions (ACTU) policy and
then into the policies of Work Safe Australia. One Western Australian union
instituted an immigrant workers’ health project in the 1980s, which consisted
of a team of five to six women who visited workplaces over a period of six
months to talk about health and health rights to women in their own languages.
A shortage of resources, however, limited the extent to which such work could
be undertaken.
OHS was a major issue for Queensland women in the 1980s. The Brisbane
Women’s Health Centre shared premises with the Union of Australian Women
which contributed to a cross-fertilisation of ideas. The Women in Trade Unions
Network was formed in 1985 and it became the centre of a large, diverse, feminist
network, which included the Queensland Workers’ Health Centre. Membership
was restricted to unionists but there was close collaboration with domestic
violence and rape crisis networks and other relevant agencies. Helen Abrahams,
a medical practitioner with specialist qualifications in occupational health and
long experience in women’s health in Adelaide and later in rural New South
Wales, was Director of the Workers’ Health Centre from 1982 to 1991.
The network, more resembling a full-scale collaboration in VicHealth terms, saw
its major task as persuading the trade union movement to take more interest in
women’s issues. The Queensland Nurses Union used OHS issues as a vehicle to
further this aim. The network met monthly, inviting expert speakers to talk on
issues such as rape and domestic violence. Both the Workers’ Health Centre,
which had outreach services in workplaces, and the Brisbane Women’s Health

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Centre worked together extensively in relation to immigrant women’s health.
A drive was undertaken to increase union membership of the Workers’ Health
Centre.
Another agency that collaborated to pursue women’s health issues was the Trade
Union Training Authority (TUTA). TUTA provided training in representation
and negotiation skills for unionists at all levels. It also ran education courses
about industrial relations systems and sessions on working women’s issues,
including sexual harassment, which was a notoriously difficult issue to pursue
either in the workplace or in the courts (Thornton 1984; Working Women’s
Centre 1980). Workers from the Brisbane Women’s Health Centre participated
in teaching and women from community organisations availed themselves of
TUTA courses in order to learn negotiation and meeting skills.
Bernadette Callaghan, Queensland Secretary of the Federated Clerks Union in
1983, was the first woman elected to the Queensland Trades and Labour Council
after which women’s health became one of the areas of the council’s work. For
example, it lobbied the Queensland Government to fund the Brisbane Women’s
Health Centre in the mid-1980s. The Federated Clerks Union participated strongly
in the Women in Trade Unions Network but officially it never differentiated
between men’s and women’s health; however, because women constituted a
majority of members, OHS issues were able to be raised.
The Queensland Workers’ Health Centre was heavily involved with other
agencies in OHS campaigns in the 1980s, including campaigns against RSI. An
aggressive educational campaign was undertaken and brochures developed. An
unsuccessful RSI test case was mounted but, eventually, the campaign to bring
about safer processes of work was successful. Noise was identified as a safety
issue and the centre backed a union campaign against it. Action was also taken
concerning the problems facing women outworkers.
A major campaign identified sexual harassment as a serious workplace issue.
Women unionists had posters and brochures produced, forums were held,
meetings organised and resolutions passed. Despite opposition from the national
body of the clerks union, which banned the posters, the campaigns were
successful in articulating and gaining a level of acceptance of the problem as a
women’s health issue. At the time, there was no anti-discrimination legislation
in Queensland.
Because the Queensland union movement was generally conservative,
opportunities for women to generate debate about access to abortion were
limited; however, after the Bjelke-Petersen Government authorised a police
raid on the Greenslopes Fertility Control Clinic in 1985, union members were
persuaded to participate in a protest rally at City Hall.
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In South Australia, there were cooperation and collaboration between the
women’s health movement, the community health movement, trade unions and
the Working Women’s Centre, which was established in 1979. In a relatively
small community where people knew each other, the union movement enjoyed
a particularly good relationship with the women’s movement. There were both
formal links, through organisations such as the SA Coalition for Workers Health
Action, and informal links—for example, overlapping memberships of political
parties and other organisations.
The SA Coalition for Workers Health Action, established in 1984 to promote a
preventive approach to OSH, had a membership drawn from trade unions, the
women’s health movement, the Working Women’s Centre, the community health
and welfare sectors, allied health workers and others. It was a member of the
Australian Coalition for Workers Health Action, which lobbied for legislative
change, changes to workers’ compensation arrangements and for a workers’
health centre. It did not get the centre but it did get the legislative reform. As
in other States, in South Australia, RSI became a major issue. Word-processing
pools had been introduced into the public sector without consultation with
unions. There were no guidelines for use; there was no ergonomic furniture and
no awareness of the health implications of overuse. Women providing wordprocessing services were required to have a keystroke rate of 18 000 words per
hour, which was monitored by a machine. At the end of the week, those who
had under-performed were counselled. The result was what was described as
an ‘epidemic of RSI’, which especially affected immigrant women. The unions,
in close cooperation with women’s health centres and the Working Women’s
Centre, demanded 10-minute rest breaks, a reduction of the key stroke rate to
12 000 words per hour and ergonomic equipment. Sympathetic practitioners
were needed for referral but were difficult to find, so women were referred to
Adelaide Women’s Community Health Centre where staff became expert in the
intricacies of RSI. Similarly, in other States and Territories, women in unions
worked with the women’s health movement and other groups to promote a more
expansive view of OHS.
Meanwhile, women unionists were working to increase their voice at the national
level. In 1975, they demonstrated outside the ACTU Congress, demanding that
working women’s issues be put on the agenda, which was part of a major campaign
to press the council to adopt a Working Women’s Charter. A charter was adopted
two years later, followed by the council-sponsored Working Women’s Charter
Conference in 1978. The Women’s Committee of the ACTU was established
in 1977. It focused on issues such as child care, RSI, flexible working hours
and parental leave. After an intense struggle, the 1981 ACTU Congress made a
historic decision to support women’s right to free, safe, legal abortion (Hague
and Milson 1982:15). The first woman was elected to the executive in 1983 and,
shortly afterwards, the Working Women’s Policy was produced and endorsed.
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The ACTU now campaigns regularly on issues of importance to women workers,
including pay equity, paid parental leave and sexual harassment, and supports
strategies to promote compliance with the Equal Opportunity for Women in the
Workplace Act 1999 (ACTU 2009; Burrow 2008).
In summary, a long collaboration, played out differently in different settings,
took place between groups concerned with women’s health at work. Problems
were articulated, the meaning of OHS was expanded and it was given a place
on Australian political agendas. Legislative reform has been achieved in all
jurisdictions. In South Australia, both major political parties made OHS
election promises before the 1983 election. Reform legislation was introduced
in that State in 1986 and the Occupational Health and Safety Commission was
established, with the Women’s Advisory Committee and provision for women’s
representation on all other committees. The Labor Government in Western
Australia took reform action from 1983 onwards, in response to women’s
advocacy, producing a discussion document that suggested that the focus of
OHS be changed from safety to health. Legislative change was subsequently
developed through a tripartite process and became law in 1987. When Labor
lost office in 1993, however, much of the reform was overturned.
Australian OHS legislation now provides for worker-elected health and safety
representatives—one of the demands of women in the 1970s and 1980s.
Representatives have been given broad powers in most jurisdictions, including
the right to order that work be stopped if conditions are considered unsafe.
All State and Territory legislation provides for the establishment of health and
safety committees, on which both employees and employers are represented,
and everywhere inspectors have wide powers. Arrangements, however, still
vary from jurisdiction to jurisdiction (National Research Centre for OHS
Regulation web site) due to differences in political culture and the incumbency
of governments (Pearse and Refshauge 1987:640).
Occupational health and safety was officially recognised as a priority women’s
health issue in the first NWHP—a tribute to women unionists and their
collaborators who worked hard to bring hidden problems to public attention
and to have appropriate responses embedded in legislation and public policy.

A Note on Working Women’s Centres
Several Working Women’s Centres were established in the 1970s and 1980s to
provide work-related support for women, including those from diverse cultural
backgrounds and those disadvantaged in regard to workplace bargaining. All
‘formed strong partnerships with other community organisations, government
agencies, universities and unions and are experts on women and industrial
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relations issues’ (Queensland Working Women’s Service 2007–08:9). In 1975, the
first two Working Women’s Centres were established, one in Melbourne and the
other in an industrial suburb of Newcastle, NSW: the Hunter Region Working
Women’s Centre. The former was the first trade union women’s research and
advisory centre in Australia, set up under the auspices of the Australian Council
of Salaried Professional Associations. It campaigned for women to take a more
active part in trade union and political life and for women’s issues in employment,
including family friendly policies. It also advocated for reproductive health
rights, including abortion and general women’s health issues (The Australian
Women’s Register, Working Women’s Centre at Melbourne 1975–84). The Hunter
region centre was a multipurpose centre but health has always been the major
focus of its work. From the beginning, it was funded from disparate sources,
including the Commonwealth Health and Hospitals Services Commission
(HHSC) (Broom 1990:15–16).
The Working Women’s Centre was established in South Australia in 1979 by
bureaucratic process. It has always received State funding but is managed
by a community board. It collaborated closely with women’s health activists.
Working Women’s Centres were established in 1994 and 1995 in Queensland,
Tasmania and the Northern Territory, with combined Commonwealth/State
funding. All collaborated extensively with the women’s health movement,
as discussed, and all were primarily concerned with the interests of women
who were not represented by a union. They provided advice, information and
support. Among the range of OHS issues dealt with are RSI, outwork, family
friendly practices, workplace bullying and sexual harassment.
The Workers’ Health Centre was established in Lidcombe, Sydney, in 1977 with
the support of progressive trade unions and Leichhardt Women’s Community
Health Centre but with no government funding. While not exclusively a
women’s centre, it campaigned regularly on key women’s health issues as part of
its core work to raise the profile of workers’ health issues. It was able to organise
migrant women to take action on RSI and made a detailed submission to the
Williams Inquiry into OHS in New South Wales in the early 1980s (Dimech
1982:16). Working Women’s Centres and Workers’ Health Centres have regularly
worked with the women’s health movement on an ‘as needed’ basis.
Working Women’s Centres came under funding threat and were forced to curtail
the services they provided when they opposed the Howard Government’s
industrial relations policies, especially the WorkChoices legislation of 2005.
The New South Wales centre closed towards the end of that year, after a long
and unsuccessful struggle to retain Commonwealth funding without curtailing
its services. The Tasmanian centre closed in August 2006, when the funding
contract it was offered by the Commonwealth stipulated that the money was for
‘the provision of information on WorkChoices only’. Women in the Australian
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Services Union were unable to persuade the Tasmanian Government to meet
the Commonwealth funding shortfall. Three centres, however—those in the
Northern Territory, Queensland and South Australia—survived the Howard
years, only to be told in 2008, under a Labor government, that Commonwealth
funding might be terminated. Months of time-consuming campaigning, letter
writing and meetings with departmental officials took place before short-term
funding was again secured.

Partnerships
Partnerships are located at the complex collaboration end of the VicHealth
continuum. They are often a blend of hierarchy, and market and network
forms of participation and are generally thought of as voluntary. The concept
of partnerships, suggesting that participants are in relatively equal positions,
appears regularly in recent government reports, reflecting its acknowledgment
as an intrinsic element of preventive health care (Baum and Keleher 2002:36). The
National Preventive Health Taskforce discussion paper Australia: The healthiest
country by 2020 envisages partnerships as a key element of almost every type of
preventive healthcare strategy (Commonwealth of Australia 2008a).
Because one of the principles of women’s health is empowerment, building
and promoting strong, collaborative partnerships is a favoured way of working
(Women’s Health in the North web site). Since 2000, health partnerships have
been established in Victoria where there are now 31 Primary Care Partnerships
(PCPs). More than 800 agencies, including women’s health centres, are involved.
A central aim is to ‘facilitate coordination of the provision of a broad range of
services between GPs, community nurses and therapists, youth workers, home
carers and people in numerous agencies’ (Government of Victoria 2002). Victoria
has instituted the Aboriginal Health Promotion and Chronic Care Partnership,
in which government agencies and Aboriginal community health centres work
together on multiple projects.
As part of the Victorian Primary Care Partnership strategy, all women’s health and
community health centres have health-promotion plans for 2009–12. Victoria has
also established partnerships in violence prevention. Lauded as the first wholeof-government approach in Australia, Partners in Prevention is a network of
Victorian professionals who work with young people. Established in 2007, the
network is funded by VicHealth and managed by the Domestic Violence Resource
Centre Victoria (DVRCV). Members meet four times a year to share resources and
information and are involved in a variety of programs, including Relationships
Education and Awareness for Life, a schools program aimed at supporting young
people to experience positive, rewarding relationships. Feeling Safe Being Strong
is a primary-school prevention project run by Bethany Community Support,
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and Respect Protect Connect is a secondary-school peer-education program run
by Women’s Health in the South-East in partnership with the South Eastern
Centre against Sexual Assault. Other projects include performance pieces and
online information and resources (Partners in Prevention web site).
Part of the Victorian Government’s aim in pursuing partnerships appears to be
to save money through better management of the rising incidence of chronic
disease in an ageing population and less use of expensive hospital, medical
and residential care. Such an overriding objective is likely to undermine the
autonomy of partners. And so a study has found: one evaluation of the Primary
Care Partnerships detected a reasonable level of collaboration but there was
limited capacity for agencies to follow their own priorities at the local level
(Lewis 2009). At the same time, early evaluation has suggested that better health
outcomes will follow (Hahn 2002).
Partnerships in violence prevention have also been established in South Australia.
The Western Collaborative Approach (WCA) is a partnership developed in 2005
among 21 key agencies in the area of the Central Northern Adelaide Health
Service. Among the groups involved is Dale Street Women’s Primary Health
Service. The project, which includes Aboriginal people and organisations,
makes use of ‘Change Champions’—men who are prepared to actively oppose
violence against women and disrespectful ways of speaking. It has a reference
group, a leadership group and key area focus groups (Johns 2009:7).
The Hobart Women’s Health Centre has been involved in a recent partnership
with government and other agencies, which examined the health needs of
women from diverse cultural backgrounds. The aim was to improve access
to quality services through the establishment of permanent regional migrant
and refugee women’s health worker positions. Existing State-wide networks
were used to facilitate consultation and to provide support and feedback on
completion. Project steering committee members were drawn from relevant
branches of government, women’s health and rural health services, multicultural
organisations, the Royal Hobart Hospital, TAFE Tasmania, the University of
Tasmania and Devonport City Council (Valencia 2007).
In New South Wales, the Aboriginal Health and Medical Research Council
(AH&MRC), while mindful of the principles of Aboriginal self-determination,
supports partnerships with government, along with collaboration between
relevant governmental departments with responsibility for Aboriginal health.
Formal partnerships with the NSW Government, under which the parties were
to enjoy equal status, were struck in 1995, 1997 and 2001. The aim was to
ensure that the health expertise of Aboriginal communities was channelled into
health policymaking processes. As part of the strategy, partnerships were put in

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place at regional and local levels where health plans were developed. AH&MRC
also participates in formal and informal partnerships with peak organisations
involved in the delivery of health care for Aboriginal people.

Conclusion
So many and varied are the forms of collaboration that it is impossible to
differentiate between types with precision, although VicHealth makes a valiant
attempt. In community-based health care, cooperation and collaboration are
central parts of everyday operations, and women’s health groups have found
strength in working together, supporting each other wherever possible. They
have formed networks, associations, coalitions and service-provider groups
and have worked at all levels of political systems to try to change policies
and so improve women’s health. Women unionists worked collaboratively to
revolutionise the meaning of occupational health and safety and to put the
new version on political agendas. Expectations about what constituted decent
working conditions were raised and women’s rights to control their bodies
eventually became ACTU policy.
One of the distinguishing features of the joint ventures, partnerships and
collaborations being developed in the different health systems is that they have
a population-health focus rather than a focus on individual treatment. Evidence
shows that interventions at the level of community care improve population
health; however, only a very small proportion of Australia’s total health
budget is spent on population-focused programs. In 2008–09, 3.2 per cent of
total Australian health spending was devoted to community health (some of
which is not population focused since individual services are also provided).
Another 2.1 per cent was spent on public health, defined by the Australian
Institute of Health and Welfare (AIHW) as activities that ‘focus on prevention,
promotion and protection rather than on treatment, on population rather than
on individuals, and on the factors and behaviours that cause illness and injury
rather than the illness and injury itself’ (AIHW 2011:2). Total spending on
community health and public health combined therefore was 7.3 per cent of the
total health budget and has been stable over the past decade (AIHW 2010c:119).
Although health promotion and prevention have been on the Commonwealth
policy agenda since 2007, no major investment in health has so far been made.

174

The next chapter presents case studies of two issue-specific sections of the
movement: the maternity-care reform movement and the abortion rights
movement. In the first, there has been less collaboration with other parts of the
movement than we might expect. In the second, collaboration bubbles forth
almost spontaneously when a threat is perceived or an opportunity presents
itself, such is the centrality of reproductive health rights in the women’s health
movement.

5. Working Together for Health

Women hang their health concerns out to dry at the Women on Top
Health Forum, Launceston, June 2008.
Photo: Tracey Wing

Members of the Queensland Women’s Health Services Alliance meeting
in Brisbane, February 2011. Front row from left: Kris Saunders,
Selina Utting, Robyn Liddell, Maree Hawken. Back row from left:
Cathy Crawford, Belinda Hassan, Cathy North, Greta Brennan,
Ruth Tidswell, Kathy Faulkner.
Photo: Queensland Women’s Health Network

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The ‘Mother of All Rallies’, organised by Maternity Coalition. Approximately
3000 women demonstrate in support of expanded maternity-care choices
outside Parliament House, Canberra, 7 September 2009.
Photo: Maternity Coalition

An NT contingent at the Sixth AWHN National Women’s Health
Conference, Hobart, 2010.
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Photo: Tracey Wing

5. Working Together for Health

Marilyn Beaumont, formerly Executive Director, Women’s Health
Victoria, with Professor Karen Grant, University of Manitoba,
at the pre-conference reception, Government House, Hobart, 2010.
Photo: Tracey Wing

Former AWHN convenors Helen Keleher (1999–2005) and
Celia Karpfen (2006–07) at the pre-conference reception,
Government House, Hobart, 2010.
Photo: Tracey Wing

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6. Women’s Reproductive Rights:
Confronting power
No book about the modern women’s health movement and its impact on
public policy in Australia would be complete without including the work of
the maternity-care reform movement and the abortion rights or pro-choice
movement. These two groupings have laboured long and hard to establish
women’s reproductive health rights and to ensure women’s access to a full
range of options. Both have campaigned for women’s rights to control their own
bodies and for rights to the information necessary to participate in decisions
about their own care. Both have worked to undermine patronising attitudes,
to change public opinion and to counter unnecessary medicalisation. And
both struggle in the face of staunch resistance from some of the most powerful
forces to be found in politics. In the first case, the movement is confronted by
sections of the medical establishment, whose power and position it challenges.
In the second case, anti-choice forces, including but not restricted to powerful
religious organisations, mobilise to resist any proposal to liberalise existing
laws. Considering the strength of the interests mobilised against them, women
have made important gains in both areas but there are still major reforms to be
achieved.
I use the term groupings to describe the two movements because in both
cases organisational linkages, internal and external, are loose and fluid. The
early maternity reform groups were not closely associated with either the
women’s movement or the women’s health movement. Many members did not
support feminist goals, while conversely mothers’ rights were not a pressing
issue for most feminists. As more women came to identify as feminists in
the maternity-care reform movement from the 1970s onwards, differences in
priorities and strategies became divisive. Internal dissension and the absence
of strong working links with the women’s health movement have undermined
effectiveness. Abortion law reform, on the other hand, has been a galvanising
force in the women’s and women’s health movements. Because pro-choice
activists are to be found in numbers in all feminist organisations, there is less
need for dedicated abortion law reform groups than there was in the 1960s and
early 1970s. If a threat to existing rights or a window of policy opportunity for
goal advancement is perceived, women’s groups quickly and easily form activist
coalitions. The strong consensus among feminists about the importance of a
woman’s right to control her own body helps to explain why gains have been
possible notwithstanding powerful, well-resourced opposition.

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The Maternity-Care Reform Movement
Members of the maternity-care reform movement, like those of the broader
women’s health movement, saw themselves as agents of social change. They
demanded that women’s agency and women’s bodies be respected and they
worked for an extension of women’s rights. They challenged the unquestioning
acceptance of medical dominance and scientific knowledge that had become
entrenched in the post–World War II period. Information about pregnancy,
childbirth and breastfeeding, they argued, was abysmally hard to come by
when it should be freely available. Moreover, maternity care should be more
holistic, should show greater respect for birthing women and their right to
make informed decisions and should be delivered in continuous, trusting,
collaborative partnerships.
Childbirth, most members of the movement argue, is a normal life event, the
province of women for millennia. From the late nineteenth century onwards,
it was gradually taken over by a predominantly male medical profession and
progressively and unduly medicalised. By the 1960s, dissatisfaction began
to be voiced in Australia and most Western countries about aspects of the
birthing process, including women’s lack of control and authority. Like the
women’s health groups that mobilised a little later, mothers’ groups had dual
objectives: they wanted to improve information and services for women and
influence public opinion to promote structural changes in the organisation of
care. They called for fundamental reform of the rushed, impersonal, hierarchical
and medicalised environments that characterised the labour wards of the day
(Gosden and Noble 2000:71–2; Reiger 2001:1–84). In most jurisdictions, with
the possible exception of some Aboriginal women, there was little choice but
to have one’s baby in a hospital, with its attendant ‘preparations’, the most
unpopular of which were enemas and pubic shaves. Support persons, including
husbands, were generally banished, women were given drugs they did not
want and often left alone during labour. Mothers and babies were separated,
supplementary bottle feeding, which has a depressing effect on lactation, was
common, and family members, including fathers, viewed newborns through
nursery windows.
Prenatal services in the 1960s mostly took the form of medical checks; care of the
medical kind was provided by general practitioners and private obstetricians.
Information about lactation was scarce and rates of breastfeeding were falling
dramatically (Reiger 2001:15–36). In line with international thinking, calls
were made for a change of direction towards more natural childbirth. Women
should be at the centre of the birthing process, there should be less reliance on
analgesics, more freedom of movement permitted during labour and persons able
to provide emotional support should be allowed to be involved. Employing a
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rights approach, maternity-care reform groups argued that women were entitled
to have their voices heard, their needs recognised, their bodies respected and
their childbearing capacities valued (Reiger 2001:37).
Partly in response to these claims and partly due to broader changes, a series
of accommodations was won. Gradually, hospital practices were modified
and labour wards made more woman and family friendly. Traditional labour
wards were refurbished and efforts made to make them look less like hospitals.
Breastfeeding gained acceptance, even in public (at least until the ‘baby’
becomes a toddler). By the early 1980s, birth centres, with more women-friendly
practices and more homely atmospheres, were being established in major
metropolitan hospitals, despite initial opposition from some obstetricians and
midwives (Andrews 2000:23; Reiger 2001:187–262). The medical dominance of
childbirth, however, remained almost entirely intact despite the recognition of
midwives as autonomous professionals in several countries and by bodies such
as the World Health Organisation (WHO) (Reiger 2000:56).

Maternity-Care Reform Groups
In Australia, the movement was led by the Childbirth Education Association
(CEA), which had been formed in 1961 as the Association for the Advancement
of Painless Childbirth, and by Parents Centres Australia. The Nursing Mothers
Association (NMA),1 now the Australian Breastfeeding Association, began in
1964 as a support group but also lobbied to change rigid hospital practices that
militated against successful breastfeeding. A plethora of new groups supporting
homebirth and maternity reform was established from the 1970s onwards,
including Homebirth Access Sydney, Homebirth Australia, Maternity Coalition,
the Homebirth Network of SA, Mothers and Midwives’ Action Victoria, Natural
Parenting Melbourne, Blue Mountains Homebirth Group, Hunter Home and
Natural Birth Support, Birth Choices South West WA Inc., Nimbin Birth and
Beyond and Joyous Birth, to name just a few. Homebirth Australia is the peak
body for homebirth awareness and promotion.
Other birthing-related groups include the Caesarean Awareness Network of
Australia, Caesarean Awareness Recovery Education Support SA and friends of
birth centres in different States.
The Maternity Coalition (MC) was formed as an advocacy and informationsharing organisation in Victoria and New South Wales in the late 1980s to
influence the State government inquiries into maternity care that had been set
1  Reiger (2001) provides a detailed account of the activities of the NMA, later the Nursing Mothers
Association of Australia, and the CEA.
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up. In the mid-1990s, it clarified its goals and philosophy, working to support
both consumers and midwives as participants in all aspects of policy and health
decision making and in service delivery. It is committed to the promotion of
normal physiological birth and breastfeeding. In 1997, it established its own
journal, Birth Matters, and began to expand beyond the original two States.
In 2011, it is a national, non-profit, umbrella organisation, with some 500
individual and organisational members. It argues for women’s rights to access to
the maternity care of their choice, including community-based midwifery care,
and it strongly promotes continuity of care throughout pregnancy, birth and for
six weeks postnatally (MC 2008; Newman et al. 2011).
At the same time and in line with international developments, Australian
midwives began to organise in what has been called the ‘rebirth’ of midwifery.
Midwives sought to regain their traditional role as autonomous professionals,
caring for women in childbirth, independent of both medicine and nursing.
They developed their own competency standards, codes of ethics and their own
models of care. As Reiger (2000:53) describes it:
[T]his involves a shift away from a medical/scientific framework and
hospital-centric practice towards one emphasising holistic care, the value
of intuitive as well as technical knowledge, a collaborative partnership
with women and new forms of work organisation. The re-emergence of
midwifery away from medical dominance reflects the influence of the
feminist critique of medicalised reproduction.
The National Midwives Association was formed in the late 1970s and became the
Australian College of Midwives Incorporated (ACMI) in 1987. It has branches in
all States and Territories. Other professional groups include the Midwives Action
Group, the Australian Society of Independent Midwives, Midwives Australia,
the Australian Private Midwives Association, Midwives in Private Practice
and the Home Midwifery Association of Queensland. Part of the project to
reclaim midwifery was to gain independence from nursing through a separation
of education programs. Since the incorporation of midwifery into nursing in
earlier decades, a general nursing qualification had been the prerequisite for
postgraduate midwifery training. Associations of midwives in the States and
Territories, supported by groups such as the MC, set about the task of changing
policy to permit the introduction of direct-entry Bachelor of Midwifery degrees.
Prospective midwife practitioners would then have a choice of education
pathways. Rather than a fragmented medical model, a holistic, continuous
model of care is generally promoted. Maternity reform activists want to change
present arrangements under which a woman might encounter upwards of 20
midwives and doctors, with none of whom she has a close relationship, during
the course of pregnancy and birth (Vernon 2011:3).
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A Divided Movement
The maternity-care reform movement in Australia has experienced significant
divisions and persistent cleavages alongside commitment to and enthusiasm for
change. Breastfeeding and childbirth reform groups faced internal divisions
from their inception. They split regularly on personal and philosophical
grounds, which sapped energy and limited the materialisation of a national
voice. The homebirth movement has been particularly prone to serious divisions
on a range of philosophical issues, including disagreements arising from the
coexistence within the movement of several strands of feminism (Gosden 1998;
Reiger 2001:84–108). Moreover, for the most part, the Australian maternitycare reform movement and the feminist women’s movement have largely worked
separately (Reiger 2001:264). Unlike the US situation, for example, in Australia,
the maternity reform advocates of the 1960s and 1970s did not see themselves
primarily as feminists. Although they worked hard to promote women’s rights,
many were socially conservative (Reiger 2001:176). And while not anti-feminist,
some members were primarily committed to childrearing as professional
mothers and were not particularly interested in feminist goals, which they saw
as stressing achievement in the public sphere. Some, especially in the NMA,
feared that promoting women’s workforce rights could downgrade their work
as mothers in the home.
On the feminist side, childbirth, lactation and mothering have not been major
issues, partly due to concerns that such a focus would lead back to essentialism
(Reiger 1999b). Economic independence has always been a high priority,
however, as well as disruption of the public–private split so that women can
participate in both spheres. Work-related issues were therefore emphasised,
including accessible child care, education and training opportunities and equal
pay. Despite differences, however, there were, and still are, many issues of shared
concern, including women’s rights to control their own bodies, unnecessary
medicalisation, the male medical takeover of reproductive and other health
services, patronising attitudes, the inappropriateness of many treatments and
the paucity of information.
Given so much commonality, it is perhaps surprising that collaboration has
not been closer. In the United Kingdom, the United States and New Zealand,
in contrast, links have been close and productive (Garcia et al1998; Kitzinger
2005). One stumbling block in the Australian context is divergent views
about what constitutes access and equity. The issue of private, fee-for-service
midwifery practice remains contentious both inside and outside the maternity
reform movement. Services provided on a fee-for-service basis are generally not
accessible to those on low incomes even when they are publicly subsidised.
The introduction of private, fee-for-service maternity care would create the
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same access and equity problems that currently plague the medical-care system,
unless midwifery fees were set by government. Access to services is a critical
issue in the general women’s health movement and important to those in the
homebirth movement who are committed to the availability of public-sector
birth care for all Australian women ‘across barriers of class and culture’ (Gosden
1998:47).
In the fullness of time, however, some of the differences between the early
maternity-care reform groups and feminist groups narrowed. According to
Reiger, many maternity-care activists became radicalised through their campaign
work, including encounters with hospital systems and medical professionals.
Many others were influenced by the increasingly feminist stance taken by the
homebirth groups that were being formed, sometimes from among their own
ranks (Reiger 2001:159–83). On the other side, as they became established,
women’s health groups began to take a keener interest in maternity care and
related issues, such as postnatal care. At the level of service provision, women’s
health centres responded to the maternity-care needs of their clients. For
example, the Leichhardt Women’s Community Health Centre (LWCHC) provides
a range of reproductive health services, which includes postnatal services and
information and care in relation to postnatal depression (LWCHC web site), and
Women’s Health West in Victoria works with diverse groups of African women
and girls through the Family and Reproductive Rights Education Program
(Women’s Health West web site). The outcome of this convergence was that by
the 1980s, maternity-care and birthing issues were on the agendas of both the
women’s health and the maternity-care reform movements and had found their
way into the first NWHP (Andrews 2000:16). For the most part, however, the two
movements continued to move forward along parallel pathways—a direction at
least partly shaped by limited resources. Unfunded advocacy organisations run
by volunteers, whether they be young mothers or women in paid work, find
it difficult to manage the workload within their own groups. Time constraints
often mean that the establishment of collaborative links is beyond their capacity.

Maternity-Care Reform Becomes a National
Issue
As discussed, the political context of the 1980s was favourable for the
advancement of women’s issues. Concerns found their way onto party political
platforms—a process assisted by increasing numbers of female politicians and
bureaucrats. The development of the NWHP and the National Agenda for
Women in the second half of the decade involved extensive consultation with
women, stimulating debate and raising expectations that governments would
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take effective action to raise the status of women. In this context, the combined
impact of advocacy by so many maternity reform and women’s health groups
created a set of pressures that governments were unable to ignore. In the two
decades following the mid-1980s, upwards of 30 major inquiries into Australian
maternity care, some specifically focusing on services for Aboriginal women,
were undertaken in the States and Territories. Maternity reform groups were
able to influence the inquiries, gaining representation on steering committees
and working parties in some cases and providing consumer representatives in
others.
Maternity care also attracted the attention of two high-level national health
agencies in the 1980s: the Medicare Benefits Review Committee and Australia’s
premier medical research institution, the National Health and Medical Research
Council (NHMRC). The latter body took the unprecedented step of establishing
the Working Party on Homebirths and Alternative Birth Centres in 1986. A
report released the following year endorsed the right of women to choose
where to give birth and urged hospitals to modernise their premises and
practices. A subsequent publication, the Statement on Homebirths (1989), again
supported birthing choices. As an advocate of birth centres and home births
while simultaneously endorsing the importance of the role played by specialist
obstetricians, the NHMRC placed itself in a contradictory position. In 2000,
on the advice of its Health Advisory Committee, both the 1987 and the 1989
documents were rescinded (Andrews 2000:28–9).
The Medicare Benefits Review Committee was established in 1984 to assess
aspects of the operation of the newly reintroduced national health insurance
scheme, Medicare, and to consider whether benefits should be extended to cover
the services of selected allied health professionals. In general, the committee did
not support the extension of fee-for-service private practice. It suggested instead
that the Commonwealth should fund States and Territories to allow allied health
services—such as dietetics, occupational therapy, physiotherapy, podiatry and
speech pathology—to be provided as part of their community health programs.
Allied health professionals would be remunerated by salaries or on a sessional
basis (Commonwealth of Australia 1986a:343–90). In this context, the committee
recommended against an extension of Medicare benefits to the services of
private practice midwives; however, it supported the expansion of birth centres
in hospitals, the provision of public funding for midwifery services outside
hospitals and it recommended a pilot homebirth program to assess feasibility,
safety and costs (Andrews 2000:28).
The State and Territory inquiries of the late 1980s and early 1990s placed a
broader range of birthing issues on the various policy agendas (Reiger 2001:281,
2006); however, no State or Territory embarked upon major structural reform.
The implacable opposition of the Australian Medical Association (AMA), the
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Royal Australian College of Obstetricians and Gynaecologists (RACOG) and the
College of General Practitioners presented an almost insurmountable obstacle.
In 1989, the two colleges issued a joint statement disregarding NHMRC evidence
and emphasising their concerns about the safety of homebirth (Reiger 2001:278).
At stake, of course, are the economic interests of the profession, which has
recognised the profitability of the maternity ‘industry’ since the 1920s (Norling
and Woodhouse 1998:19).
Another obstacle to action is concern about cost, which is always at the
forefront of State and Territory health policymaking because health is the major
expenditure item, consuming approximately one-third of sub-national budgets.
And while savings are possible from moving service provision out of acutecare hospitals into community settings, federal financial arrangements are a
strong disincentive to such experimentation. In the case of maternity care, the
Commonwealth funds most of the cost of services provided by obstetricians
and general practitioners through Medicare. In the absence of additional
Commonwealth money, the States and Territories are reluctant to introduce new
midwifery services for which they would not otherwise have to pay, although
the additional expense would be partly offset because there would be fewer
hospital midwives. The general approach for Australian governments is to
try to shift costs onto the other level wherever possible. It is not customary
to freely assume expenses that are the responsibility of another government.
Moreover, the prevailing managerialist thinking of the day resulted in the
frequent restructuring of government departments, which often dislodged key
policymakers, including femocrats. Under the circumstances, action was taken
on only a few of the recommendations of the various reviews.

Movement at the Local Level
Some scattered innovations, however, began to be undertaken at the local
level. By the mid-2000s, team-based midwifery was being trialled in several
major hospitals in capital cities in an attempt to increase continuity of care.
There are small publicly funded midwifery programs in Perth, in the northern
suburbs of Adelaide and in rural Victoria. The Perth program mainly provides
homebirth services, the Adelaide program targets low-income mothers,
including Aboriginal mothers, and the rural Victoria program is designed to
care for young mothers who do not access antenatal services, including young
women with mental health issues, drug and alcohol dependence and the like. A
successful midwifery-led birthing facility operates from the Mareeba Hospital
in far north Queensland. According to Boxall and Flitcroft (2007), system-wide
reform is more likely to be introduced when policymakers are able to refer
to sufficient examples of successful and popular, midwife-led, locally based
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programs. At this stage, however, most of the hospital-based initiatives, which
are hybrid models, do not achieve high levels of continuity of care because
deeply ingrained practices such as working in shifts are retained.

One Step Forward
Forward movement, albeit on a small scale, came from the Commonwealth in
the form of the Alternative Birthing Services Program (ABSP), initially called
the Birthing Options Program, which was introduced in 1989. The ABSP was
heavily influenced by the views that Australian women expressed when they
were consulted for the NWHP and several State-level inquiries. Insufficient
information, especially for immigrant, Aboriginal and rural women, lack of
control of the birthing process, lack of control over place of birth and difficulties
with continuity of care were all major concerns. Stress, depression and family
disruption were reported by Aboriginal women who are often required to leave
their communities up to six weeks before the birth of their babies. Rising levels
of birth interventions, including caesarean sections, inductions and forceps
deliveries were raised as concerns and women reported that interventions
often proceeded without consultation or discussion. ‘Most birthing women are
healthy and wish to experience normal deliveries in an environment of their
choice’, the NWHP argued (Commonwealth of Australia 1989:22). The NHMRC’s
1987 finding that homebirths were not less safe than hospital births was noted
(Commonwealth of Australia 1989:20–7).
In developing the ABSP, the Commonwealth was not thinking only about
women’s health needs; the program also had a number of perceived advantages.
Structural changes in maternity care would reduce the cost to Medicare because
midwifery-led services would be cheaper than specialist-dominated, hospitalbased services and would provide genuine competition for obstetricians,
which should keep downward pressure on their fees. It might also encourage
specialists to concentrate on high-risk births, where their skills are needed.
Shorter hospital stays would not only save money but would free up beds that
could be used to reduce waiting lists. At the same time, midwifery-led programs
would offer women more choices (Commonwealth Department of Community
Services and Health quoted in Andrews 2000:26–7).
The ABSP was an eight-year program announced concurrently with the first
NWHP. The stated objectives were to encourage the sub-national jurisdictions
to promote greater choice and to promote cost effectiveness in birthing services
through expanded birthing centres and the provision of homebirth services. The
policy supported midwifery-led models of care and included an option through
which the States and Territories might address Aboriginal women’s birthing
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issues. In providing a public subsidy for homebirth, the Commonwealth was
attempting to make services available to low-income women who had not
previously been able to afford private fees. Midwives were to be independent
but were not to be private fee-for-service practitioners. Rather, they would be
employed by sub-national health services on a salaried or contract basis, as
had been recommended by the Medicare Benefits Review Committee (Andrews
2000:31–6).
The ABSP met with vehement opposition from the medical profession. The AMA
President of the day, Bruce Shepherd, claimed that the guidelines discriminated
against doctors and RACOG announced that it did not support homebirth as a
safe option. Moreover, it opposed midwives operating independently of doctors
and hospitals. In the event and in order to accommodate the position of organised
medicine, the program was modified in its second four-year phase. The emphasis
remained on midwifery-led services but homebirth was removed altogether from
the objectives, even though trials had begun in South Australia and Tasmania as
part of the first phase. The second phase placed more emphasis on communitybased midwifery and left the States and Territories to choose whether to pursue
homebirth options. Sub-national jurisdictions were specifically encouraged to
develop appropriate services for Aboriginal and Torres Strait Islander women,
especially in relation to ante and postnatal care (Andrews 2000:37–42).2
Despite the many perceived policy advantages, the ABSP was never a major
program. Indeed, it has been described as ‘largely symbolic’ given that only
$15.3 million was allocated to cover reforms in all States and Territories over
eight years (Andrews 2000:27). Nevertheless, a national program, however
small, can be seen as a positive outcome following two decades of women’s
advocacy. Non-medical approaches to childbirth were put on the national policy
agenda for the first time and birth centres that had been considered radical
15 years earlier gained legitimacy and were expanded. The status of midwives
and midwifery-led practice was enhanced, especially in birth centres, where
midwives gained responsibility and greater autonomy. The ABSP played an
important role in supporting innovative services, including those at Alukura
for Aboriginal women and a publicly funded midwifery service, the Community
Midwifery Program in Western Australia, which includes homebirth. It was
the first Australian public policy to seriously challenge the entrenched medical
domination of maternity care. As Andrews (2000:38) argues, the program
Explicitly challenged the hegemonic medical model of childbirth that
constructed pregnancy as pathological and always a risky business…
2  This ‘encouragement’ was something of an abnegation of responsibility because the Commonwealth has
full constitutional power to make laws in relation to Aboriginal people. Space limitations preclude a discussion
of the initiatives taken under the ABSP, which are reviewed in Andrews (2000).
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The medical hegemonic discourse advocated medical surveillance for all
women so that the few who might really need intervention were not
overlooked. The ABSP approach argued that all women could choose to
have a natural, normal birth free of intervention and that measures should
be in place for those few women who may need medical intervention or
assistance in the case of an emergency.
The ABSP experience also shows that policy change in fields where strong vested
interests hold sway is most likely to take place in very small, incremental steps.

Two Steps Back
The dozen years following the conclusion of the ABSP were not conducive to the
promotion of midwifery-led maternity care at the national level. On the contrary,
the Howard Government strengthened medical dominance in the health system
generally in a number of ways. First, the proportion of Australians holding
private insurance who were therefore able to afford private hospital services
was increased at considerable expense to the public purse, beginning with a
$2 million publicity campaign to promote private insurance in 1996. Then, in
1998, after lesser measures had failed to increase coverage, a 30 per cent public
subsidy for private premiums was introduced. When this measure also failed,
the Commonwealth changed longstanding policy, permitting private insurers
to charge higher premiums to new subscribers as they grow older. Lifetime
Health Cover, as this scheme is called, was accompanied by what amounted to
scare tactics in the 12 months leading up to its introduction. An $8.7 million,
taxpayer-funded publicity campaign urged people to ‘Run for Cover’, with the
result that the numbers of Australians covered by private insurance increased
by 50 per cent (Gray 2004:34–8). Higher private insurance coverage, among
other things, means more financially rewarding fee-for-service private hospital
work for specialists, including obstetricians.
The second windfall for certain groups of specialists, particularly obstetricians
and those providing in-vitro fertilisation (IVF) services, came in the form of
the Extended Medicare Safety Net (EMSN). Introduced in 2004, the EMSN
was supposed to reduce out-of-pocket expenses for citizens; however, an
independent review in 2009 found that, overall, the additional Commonwealth
expenditure had not lowered costs for patients but had rather increased provider
incomes. Moreover, funding was of most benefit to high-income citizens. The 20
per cent of Australians living in the most affluent areas had received 55 per cent
of benefits whereas the 20 per cent living in the least affluent areas had received
only 3.5 per cent (Commonwealth of Australia 2009f:vi). In 2007, 31 per cent
of total benefits under the scheme were paid for obstetrical services and 22
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per cent for IVF procedures. The EMSN was found to have had an inflationary
impact, forming the basis for steep rises in medical fees, with the most profound
effect in the areas of obstetrics and IVF. Between 2003 and 2008, obstetricians
reduced their in-hospital fees by 6 per cent while they increased their out-ofhospital fees by 267 per cent.3 During the same period, in-hospital fees for IVF
services were reduced by 9 per cent but out-of-hospital fees were increased
by 62 per cent. The review team came to the conclusion that doctors were able
to calculate that their patients would qualify for the EMSN and therefore felt
‘fewer competitive market pressures to contain their fees’ (Commonwealth of
Australia 2009f:63, 73).
Thus, the introduction of structural changes that increased private insurance
coverage and underpinned fee increases far in excess of inflation served to
further embed private obstetrical practice. Under such circumstances, it was
unlikely that collaborative or shared care arrangements with midwives would
flourish. Other actions by the Howard Government that demonstrate its lack
of interest in promoting alternative models of maternity care were its return of
the ABSP, along with the NWH Program, to the States and Territories in 1998
and its failure to invite midwives to the National Forum on Medical Indemnity
Insurance, chaired by the Minister for Health and Ageing, Senator Kay Patterson,
in 2002.
Despite the unpromising national political climate, maternity-care reform
groups continued to work for change. MC consciously looked to expand and
invited members Barbara Vernon and Justine Cairns to join its executive—a
move that heralded a period of major advance for the organisation (Newman
et al. 2011:85–6). Realising the need for unity, efforts were made in 2002 to
form a cohesive front. The National Maternity Action Plan (NMAP), a detailed
document supported by research evidence, was written by the leaders of MC
and endorsed by a broad coalition of consumer and provider groups. It was
launched in all jurisdictions and it called on governments at both levels to
support publicly funded, community-based midwifery care in urban, regional
and rural areas. The plan pointed out that the right to choose a midwife as a
leading carer is available to women in a number of OECD countries4 and that
scientific evidence shows good outcomes for both mothers and babies.5 Midwives
are in the best position to provide continuity of care from early pregnancy until
babies are four to six weeks of age, the NMAP argued, and continuity of care
3  This number is not a typographical error.
4  Publicly funded, midwife-led care is readily available in New Zealand, the Netherlands, Britain and
Canada.
5  In the Netherlands, childbirth has never been as medicalised as in other OECD countries. In 2007, 41.5
per cent of women remained in primary care throughout pregnancy, labour, birth and during the postpartum
period, receiving care from a midwife or a general practitioner; 31.3 per cent gave birth at home. Women
are very positive about the quality of the care they receive and intervention and pain relief use is very low
compared with that in similar countries (Weigers 2009). A recent study of more than half a million Dutch
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has been shown to result in fewer obstetrical interventions, such as caesarean
sections. Therefore, as well as providing choice and appropriate care for women,
midwifery-led services would save health dollars (MC web site). The launch of
the NMAP marked the beginning of a period of strong unity within MC. When
in 2003 obstetricians threatened to close their practices in response to high
indemnity insurance premiums, the then President of MC, Dr Barbara Vernon,
welcomed the announcement, issuing a media release claiming that pregnant
women would be better off with fewer obstetricians in private practice.

The National Maternity Services Review
Maternity activists attracted the attention of the ALP in opposition, which
announced that it would develop a national maternity services plan should
it win office in 2007. Another development that put maternity care on the
national agenda was the inquiry of the Productivity Commission into the
health workforce which reported in 2005. It recommended ‘a shake-up’ of the
health industry to break down inefficient professional boundaries and promote
flexibility (Lane In press). Momentum also came from the Maternity Services
Inter-Jurisdictional Committee, set up by the Australian Health Ministers
Advisory Council (AHMAC), which increased dialogue across jurisdictions.
Picking up consumer lobbying around the NMAP, it put forward a framework
to advance primary maternity service provision (AHMAC 2008).
In government, Health Minister, Nicola Roxon, established a National Maternity
Services Review led by the Commonwealth’s newly appointed Chief Nurse
and Midwifery Officer, Rosemary Bryant. The review, which began in 2008,
was asked to examine the full range of possible maternity services and to seek
information on a number of key issues, such as successful models of care for rural
and remote communities and the aspects of the Australian system that fuelled
high intervention rates. Submission writing was facilitated by the intensive
work of MC and other groups and the review received a record number of more
than 900 submissions6—more than twice as many as the National Health and
Hospitals Reform Commission, which sat at much the same time. Submissions
pointed to familiar problems, such as the extremely limited birthing options for
women living in rural and remote areas, exacerbated by the closure of more and
more rural birthing units because of lack of medical staff. The NSW Midwives
Association, the Menzies School of Public Health and the Australian Indigenous
women by British researchers found that there is no difference in the perinatal mortality rate during the
first week of life between homebirths and hospital births. The number of babies who die or need neonatal
intensive care is the same in both groups at seven per 1000 births (de Jonge et al. 2009).
6  Submissions to the review can be found at <http://www.health.gov.au/internet/main/publishing.nsf/
Content/maternityservicesreview-submissions>
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Doctors Association stressed the problems facing Aboriginal and Torres Strait
Islander women whose babies have poorer perinatal outcomes. These submissions
argued what experienced practitioners had known for years: that giving birth
far from home disrupts the link between birthplace and land, separates families,
causes additional and unnecessary stress and is culturally inappropriate and
unsafe.7 Also frequently mentioned were difficulties experienced in obtaining
continuity of care and the inappropriate utilisation of acute-care hospitals for
healthy birthing women, resulting in the overuse of technologies that should be
reserved for women with complications.
The Australian College of Midwives’ submission presented 13 reasons for
Australia’s high intervention rate, including the absence of consistent,
professionally endorsed, evidence-based guidelines for appropriate practice.
David Ellwood, Professor of Obstetrics and Gynaecology at the School of Clinical
Medicine, the Canberra Hospital, made a personal submission, focusing on
intervention rates, the adverse impact of the private health insurance subsidy
on public hospital services and the need for a national approach to maternal
and perinatal morbidity and mortality reporting. ‘The inexorable rise in the
caesarean section rate is something which needs to be addressed as a matter of
some urgency’, Elwood argued. He noted that the rate is significantly higher in
the private sector and commented that it is ‘an odd situation’ when women can
choose elective caesarean sections and be financially supported for doing so but
Aboriginal women are unable to choose to birth naturally on their own country.
He argued that an appropriate response would be to increase the availability of
midwifery-led care. Ellwood also drew attention to the adverse impact of the
EMSN on the capacity of public hospitals to attract medical staff. Incomes are so
good in the private sector, he argued, that it is possible to work part-time and
still ensure a reasonable income. Policies need to be changed ‘so that full-time
employment in the public sector is more competitive with the kinds of incomes
which are now possible in the private sector’ (Ellwood 2008).
On the positive side, submissions drew attention to a number of successful local
innovations. These include the midwifery-led Belmont Birthing Service in New
South Wales, which provides education and preparation for birth, parenting
sessions, breastfeeding information and continuity of care. The service is for all
women in the Hunter region and is linked closely with John Hunter Hospital’s
obstetric services where medical support is available when needed. The Malabar
Community Midwifery Link Service, run by the Sydney Royal Hospital for
Women, is located in an area with a large Aboriginal population. It is considered
to be culturally appropriate, is available to people living in surrounding suburbs
and to Aboriginal women from outside the area. Its high standard of service has
7  See, for example, Australian Indigenous Doctors Association (2008); Baldwin-Jones (1989); Cox (2009);
Fitzpatrick (1995); Menzies School of Health Research (2008).
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been recognised (Homebirth Access Sydney submission). Another successful
model of care has been developed by the Orange Aboriginal Medical Service,
which has links with local professionals, including allied health professionals,
and the Orange Base Hospital.
Submissions to the review by medical unions supported the status quo. It was
argued that Australia had a high standard of safety for mothers and babies that
would be jeopardised if medical control were undermined. Intervention rates
had increased but this was a phenomenon in all OECD countries largely because
mothers are older and there is a higher incidence of obesity and related illnesses.
The AMA supported expanded funding arrangements for midwives but only
if midwives were medically supervised. The idea of independent midwives as
autonomous professionals is anathema:
Highly interventionist government agendas to advance an ideological
cause are likely to create problems in the delivery of maternity services
and exacerbate tensions in interprofessional relationships…The
government should not introduce any publicly funded arrangement
which is based on independent midwife care for mothers and babies in
Australia or use public funds to establish separate streams of midwife
led maternal care on the one hand and medical led maternal care on the
other. (AMA 2008)
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
(RANZCOG)8 argued for a collaborative model in which obstetricians, general
practitioners, midwives, anaesthetists, paediatricians, pathologists and allied
health professionals would work together. It opposed independent midwifery
practice ‘where one particular professional group or individual works in
isolation’. Instead, it proposed a ‘Private Collaborative Model’, under which
private midwives and private obstetricians or private general practitioners
would work together within a framework of agreed protocols and guidelines.
The review released its report, Improving maternity services in Australia, in
February 2009 (Commonwealth of Australia 2009g). It made 18 recommendations
that it suggested the Commonwealth, States and Territories might consider
during the development of the proposed National Maternity Services Plan.
A key recommendation was that the importance of the midwifery role should
be recognised and choice should be enhanced by expanding the range of
maternity-care models on offer. Consideration should be given to changing
Commonwealth funding arrangements, and professional indemnity insurance
for midwives should be supported. Other recommendations included the
development of national multidisciplinary guidelines for collaborative models
8  RACOG amalgamated with the Royal New Zealand College of Obstetricians and Gynaecologists in 1998.
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of care, the expansion of birth centres and the provision of more comprehensive
information for pregnant and breastfeeding women. Four recommendations
related to improving services for Aboriginal women and increasing cultural
awareness (Commonwealth of Australia 2009g:57–9). Homebirth, however,
was dismissed on the grounds that it is the preferred choice of relatively few
women (Commonwealth of Australia 2009g:15–21). In welcoming the report,
Minister Roxon said that it brought better services for mothers and babies ‘one
step closer’. She noted the widespread concern expressed about high rates of
medical intervention, high rates of postnatal depression and the relatively low
rates of breastfeeding (Gordon 2009).
Responses to the report followed predictable lines, with midwifery and nursing
groups welcoming the endorsement of an expanded role for midwives but
expressing reservations about the failure to consider the homebirth option in
more depth. The Commonwealth responded with a very modest $120.5 million
maternity reform package as part of the 2009–10 Budget. Under the package,
the patients of eligible midwives and nurse practitioners9 would have access
to specified Medicare and pharmaceutical benefits. The Commonwealth would
underwrite a new professional indemnity insurance scheme for midwives and
nurse practitioners, deliver more services to rural and remote locations through
the Medical Specialist Outreach Assistance Program, increase scholarships for
general practitioners and midwives and introduce a 24-hour, seven-day-a-week
telephone help and information service (Jolly et al. 2009:8–10).
Legislation to facilitate the new arrangements was introduced into Parliament in
June 2009 and had a turbulent passage. The Senate referred it to the Community
Affairs Legislation Committee for inquiry—an outcome that had been partly
shaped by MC, which had lobbied parliamentarians extensively in order to gain
more scrutiny of the proposals. MC had organised the ‘Mother of All Rallies’ in
September at which approximately 3000 homebirth supporters had converged
on Parliament House. It was also at least partly responsible for the unexpected
support for expanded options shown by a number of speakers in the Senate.
Another round of public hearings was held and more submissions received.
After considering the most controversial issues, particularly homebirth, the
committee satisfied itself that the legislation was sound, that it did not remove
existing rights and would not make homebirth unlawful. It recommended
that the Bills be passed; however, Commonwealth amendments attempting
to clarify the meaning of ‘collaborative arrangements’ resulted in referral to
the Community Affairs Legislation Committee yet again, provoking more
controversy and generating more submissions. The committee concluded that
the proposed collaborative arrangements would allow a flexible approach to
9  The Australian Nursing Federation has argued for access to Medicare benefits and prescribing rights for
nurse practitioners since the 1990s but the proposition has been vigourously opposed by medical unions.
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practice across the country and recommended that the Bills be passed. Senator
Rachel Siewert, of the Australian Greens, produced a dissenting report arguing
that it is unnecessary to legislate for collaborative arrangements since they are
already encoded within regulatory frameworks (Senate Community Affairs
Legislation Committee 2010). In the event, the Commonwealth did not proceed
with its amendments and instead negotiations were held with stakeholders to
work out details. The Senate finally passed the legislation in March 2010.
As promised, the National Maternity Services Plan has been developed and
endorsed by the Australian Health Ministers Conference to cover the five-year
period from November 2010. The plan’s vision is stated as follows:
Maternity care will be woman-centred, reflecting the needs of each
woman in a safe and sustainable quality system. All Australian women
will have access to high-quality, evidence-based, culturally competent
maternity care in a range of settings close to where they live. Provision
of such maternity care will contribute to closing the gap between health
outcomes of Aboriginal and Torres Strait Islander people and nonIndigenous Australians. Appropriately trained and qualified maternity
health professionals will be able to provide continuous maternity care to
all women. (Commonwealth of Australia 2011c:3)
The plan confirms that Australia is a safe place to give birth, except for
Aboriginal and Torres Strait Islander women. It also confirms the comparatively
high rate of interventions in Australia, which in 2007 was 5.2 per cent above the
OECD average. It notes that interventions in the private sector are ‘substantially
higher’ than the average (Commonwealth of Australia 2011c:9). Actions agreed
for the first year include the facilitation of increased access to midwiferymanaged models of care, investigation by the States and Territories of options
for the provision of publicly funded homebirths and identification of the
characteristics of culturally competent maternity care for Aboriginal and Torres
Strait Islander women (Commonwealth of Australia 2011c:61–9). It is too early
to assess the effectiveness of the plan but its success will at least partly depend
on the provision of sufficient Commonwealth funds to induce the States and
Territories to themselves shoulder the costs of services that would otherwise be
paid for mostly by the Commonwealth through Medicare.
The new maternity-care arrangements became fully operational on 1 November
2010. Medicare rebatable services can now be provided by eligible midwives for
care during pregnancy, labour and birth in a hospital—as long as the midwife has
admitting rights—and for home-based postnatal care for six weeks after birth.
Routine tests can be ordered and specified drugs prescribed. The Commonwealth
is underwriting professional indemnity insurance for all eligible midwives,
which has not been available since 2001 when a crisis in the insurance industry
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resulted in the withdrawal of existing policies for midwives. A small window is
therefore open for the development of new care models. Private obstetricians may
enter into arrangements with midwives that allow them to provide continuity
and team-based care, before, during and after birth, although the price might be
prohibitive for many women. Choices for Aboriginal and Torres Strait Islander
women might be expanded, allowing them to birth ‘on country’ or closer to
country but only if midwives and doctors willing to collaborate are available.
Midwifery Group Practices (MGPs), where hospitals employ midwives to look
after women through all the stages of pregnancy and birth, might be expanded.
Currently, MGPs, located largely in metropolitan areas, are in their infancy and
are unable to meet demand. The new legislation will allow the establishment
of private MGPs, provided collaborative arrangements can be negotiated, but
accessibility will be an issue (Vernon 2011:36).
There are, however, a number of hurdles to be overcome before significant
change emerges. In the first place, few midwives currently have the qualifications
and experience to become Medicare eligible. Second, the States and Territories
have the capacity to place barriers in the way of successful implementation
because they, rather than the Commonwealth, have the power to grant the legal
right to prescribe under the Pharmaceutical Benefits Scheme. They also have
the power to grant or withhold hospital visiting rights for midwives. In the
past, some jurisdictions have granted visiting rights; others have not (Vernon
2011:36). Moreover, State and Territory governments do not have full power in
this area because decisions are made at the level of the individual hospital board
where doctors have considerable influence. Further, it is not known what stance
private hospitals will take in relation to visiting rights. Without visiting rights,
a midwife cannot care for a woman in hospital during labour and birth, thereby
severely disrupting continuity of care.
The Commonwealth initiatives have met with a mixed response from the
maternity-care reform movement. The Australian College of Midwives and
the Australian Nursing Federation (ANF), for example, endorse those aspects
of the reforms that support private midwifery practice (ANF 2009; Australian
College of Midwives 2009). Most groups, however, are disappointed that the
Commonwealth is not underwriting indemnity insurance for homebirth
midwives, thus virtually excluding homebirth from the reforms.
The new measures do not make homebirth unlawful but indemnity insurance is
a condition of registration for midwives, as for other professionals. Transitional
arrangements providing exemption from this requirement are due to expire
towards the end of 2011, when homebirth will become illegal. One concern is
that homebirth will then be driven underground (Commonwealth Department
of Health and Ageing n.d.; Jolly et al. 2009:10–13).
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The groups within the movement that have worked to achieve an independent
midwifery profession are extremely disappointed with the requirement that to
become ‘eligible’, midwives must enter into collaborative arrangements with
one or more doctors. Under the new arrangements, doctors must approve of
a woman’s care and may revoke that approval at any time. This gives medical
practitioners control over the way midwives work and control over women’s
choices, at least indirectly. It certainly negates midwifery’s claim to independent
professional status. As Lane (In press) argues, ‘genuine collaboration fails to
flourish under vertical structures’. In her view, we now have a ‘militarised form
of collaboration where midwives are now more firmly relegated to subsidiary
status than ever before by legislative decree’. Critics question the need for
contracts and agreements between private medical practitioners and midwives,
arguing that the existing regulatory framework ensures collaboration between
team members. A study of existing team-care projects in three States shows
that midwives collaborated routinely but that many visiting doctors ‘resisted
authentic collaborative practices’ (Lane In press). It has been pointed out that
independent midwives who might wish to practice in rural and remote areas
will be unable to do so if there is no doctor close by (Barclay 2010:1).
In summary, the path towards maternity-care reform is littered with conflict.
Consumers mobilised to assert the rights of birthing women, midwives struggled
to become independent professionals, while groups within the medical profession
worked to preserve their sphere of practice. Despite intense opposition,
however, public policy has been modified and opportunities for incremental
expansion of midwifery practice have been created. The movement has achieved
a modification of practices associated with childbirth and breastfeeding and has
contributed to attitudinal change over many years. Maternity care is, however,
as medicalised as ever. The structure of health financing, along with entrenched
cultural norms, provides inducements for women to seek medicalised childbirth.
Further, the reforms do not provide women with choice of carer, choice of birth
location or the right to make their own decisions about care—rights that New
Zealand women gained in the 1990s. As a recent analysis argues:
[O]bstetrics, despite increased [numbers of] women entering the
profession, continues to act as an institutional bastion of male domination
of women, overriding women’s agency in childbirth and maintaining
masculine ‘medicine’…while alternative ‘birth models that work’,
emphasising interaction, holistic care and the integrity of organisms,
struggle for legitimacy and support. (Newman et al. 2011:91)

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A Woman’s Right to Choose
Some of the strongest collaborations between Australian feminist groups have
taken place around reproductive rights, particularly the right to safe, affordable
abortion. Building on the work and achievements of existing abortion law
reform associations, the advent of the second-wave women’s movement saw the
formation of multiple groups ready to campaign for a woman’s right to access
abortion and a full range of contraceptives and abortifacients. Some groups
formed to campaign specifically for sexual and reproductive rights. Others were
established with a broader agenda but welcomed the chance to work with likeminded groups. Pro-choice groups have worked with each other, with women’s
health centres and services, with most groups in the women’s movement, with
family planning associations and with groups with a wider focus, such as the
YWCA. Along with campaigns against violence, the struggle for reproductive
choice has been a unifying force in the women’s movement (Goldrick-Jones
2002:123), although as mentioned, many Aboriginal women do not share the
majority view.
Throughout history, women have looked to termination as a response to
unwanted pregnancies despite restrictive legislation and unconscionable
practices; however, prior to the 1960s, abortion was not politicised in Australia.
In contrast with the English situation where the Abortion Law Reform
Association was founded in 1936, in Australia, groups had not yet mobilised to
call for the liberalisation of old laws (Siedlecky and Wyndham 1990:66). In the
United Kingdom, after years of intense debate, the Abortion Act was passed in
1967 legalising abortion up to 28 weeks’ gestation. At the same time, pro-choice
groups had mobilised in the United States and some jurisdictions had begun to
liberalise their laws. These debates spread to Australia where interest in reform
began to be articulated. At the time, governments presided over criminal codes
that retained abortion and regimes that taxed contraceptives and excluded sex
education from schools.
After the passage of the UK legislation, the Australian Humanist Society promoted
the establishment of abortion law reform associations, which by 1971 were set up
in all States and the Australian Capital Territory. In the meantime, changes had
taken place in two jurisdictions as a result of cases where doctors were charged
with procuring abortions. In 1969 in Victoria, the Menhennit ruling set out the
conditions under which abortion could be lawfully performed, which included
the necessity ‘to protect a woman from serious danger to her life or her physical
or mental health’. Three years later in New South Wales, a similar judgment was
made by Mr Justice Levine. The definition of mental health was extended to
include the effects of economic and social stress. Neither the Menhennit nor the
Levine rulings changed the law, as such. The first State to reform its abortion
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law was South Australia, where legislation was passed in 1969 making abortion
lawful when a medical practitioner considers that continuing the pregnancy
involves a risk to the life, physical or mental health of the mother or when there
is a substantial risk that the child will be seriously handicapped. The Northern
Territory passed similar legislation in 1974, while there were two unsuccessful
attempts to introduce legislative reform in Western Australia in the late 1960s
and early 1970s (Siedlecky and Wyndham 1990:78–86).10

Feminists Step up to the Plate
From the early 1970s onwards, feminists formed groups dedicated to the twin
tasks of abortion law reform and the provision of support for women who
needed it. Early groups included the Women’s Abortion Action Coalition, set
up in 1972 in Melbourne, and the Abortion Information Service, opened in
Perth in 1974, which was subject to a police raid early in its existence. A raft of
groups was formed in Adelaide in the early 1970s, including The Body Politic,
concerned with contraception, abortion and health, and the Adelaide Abortion
Referral Service, which later became the Counsellors’ Collective. A Women’s
Right to Choose, which held public meetings every few weeks, was another
Adelaide group.
In Sydney, Control set up an abortion information, referral and counselling
service at Women’s House, in 1973. Pregnancy testing and contraceptive
advice were added later. It lobbied doctors to reduce their fees for abortion and
encouraged them to introduce their own counselling services and to provide
contraceptive advice. All workers were voluntary and rostered themselves to
provide services in the evenings and on Saturday afternoons (Stevens 1995:27).
An associated group was the Women’s Abortion Action Campaign (WAAC),
formed in Sydney in 1972, and in Adelaide and Brisbane in 1973. WAAC’s
purpose was to campaign for the repeal of abortion laws and it organised a
National Conference on Contraception and Abortion attended by more than 400
women in 1975 (Siedlecky and Wyndham 1990:86). Control, Queensland, also
known as the Women’s Pregnancy Advisory and Abortion Referral Service, was
set up in 1977 and operated with the support of Women’s House.
No account of the early campaigns for reproductive rights would be complete
without mention of the work of Jo and Bertram Wainer in Melbourne. Jo Wainer
was the inaugural Secretary of the local Abortion Law Reform Association. As
she remembers it, the group had no language with which to discuss reproductive
rights and had to invent it. The Wainers gathered information about backyard
10  Siedlecky and Wyndham (1990) provide a detailed historical account of Australian struggles for women’s
reproductive rights until the 1980s.
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abortion networks, police corruption and professional abortionists, which
they publicised through every available avenue. In 1969, Bertram Wainer, a
general practitioner, devised a scheme through which police corruption could
be exposed, and afterwards, agitated for a public inquiry. Test cases were
organised to explore the extent of the Menhennit ruling. Because lucrative
business dealings were being exposed, threats were made against the Wainers’
lives. Bertram Wainer was evicted from his surgery and censored by the AMA.
In 1972, he established Australia’s first open abortion clinic, in St Kilda, and in
subsequent years both Wainers continued to campaign (Wainer 2006:1–18).

Coalitions and Collaborations
One of the first major collaborative projects between women’s groups took
place in 1982 when the Right to Choose Coalition was formed by WEL, the
Union of Australian Women, the Women’s Abortion Action Committee, the
Australian Union of Students Women’s Department, the Working Women’s
Centre, Melbourne, the Melbourne Unitarian Church, the ALP Status of Women
Committee and the Women’s Right to Abortion Committee. The coalition
produced a monthly newsletter called Freedom to Choose. The Women’s Abortion
Action Coalition also formed in Melbourne and collaborated with interstate
groups.
Since the 1970s, activism far too extensive to document here has continued in
all Australian jurisdictions, generally involving coalitions of women’s groups.
An account of women’s experiences seeking abortion in Queensland, Tasmania
and South Australia between 1985 and 1992 has been written by Lyndall Ryan,
Margie Ripper and Barbara Buttfield (1994). The work of one of the major
actors, Children by Choice, Queensland, was described briefly in Chapter 2.
The remainder of this chapter provides an overview of recent collaborative
action, including unsuccessful attempts to secure access to medical abortion,
and brief accounts of the three successful campaigns to remove abortion from
sub-national criminal codes.

The Mifepristone Debacle
Access to medical abortion is available in most OECD countries including the
United States but in Australia its use remains illegal in several jurisdictions.
Medical abortion can improve access for the hundreds of thousands of women
who live far from a surgical facility and it is considerably cheaper than surgical
abortion. Availability would increase choice for women, some of whom might
be attracted by greater privacy. The retention of abortion in criminal codes
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restricts availability and can have disastrous consequences for individuals: in
2010, a young Queensland couple was tried for procuring an abortion, using
medicines imported from the Ukraine.11
Some of the problems that the women’s movement has faced when trying to
achieve reform can be attributed to the structure of the Australian political
system, where a single senator can achieve a strong bargaining position if her/
his vote is critical for the government of the day. Brian Harradine, Independent
Senator for Tasmania from 1975 until 2005, was one such and he used the
opportunities that presented to the full. Over the years, he made several attempts
to have access to contraception and abortifacients reduced, to have Australia’s
overseas aid regulated so that abortion and contraceptive provision would be
restricted12 and to abolish the Medicare rebate for abortion. In this last crusade,
he was unsuccessful.
In the early 1990s, RU-486, also known as mifepristone, was available in
Australia, as part of international trials; however, the anti-choice movement
staged an intense campaign against it and in 1996 Senator Harradine proposed
legislation that required the Commonwealth Health Minister to approve the
importation, evaluation, registration and listing of certain abortifacient drugs
and, furthermore, to table approval in both Houses of Parliament within
five sitting days. Despite women’s movement protests and the work of many
parliamentary women, the legislation was passed. Labor Party Senator Rosemary
Crowley wrote to AWHN expressing disappointment that she had been ‘unable
to persuade a majority’ of her colleagues to oppose the amendment. With the
new requirements in place, pharmaceutical companies did not seek approval to
market the drug from the Therapeutic Goods Administration (TGA)—a process
that is expensive, would provoke political controversy and might result in
approval being overturned in Parliament.
This was still the situation in 2006 when, following initial moves by Australian
Democrats Senator Lyn Allison and some fancy footwork and face-saving
manoeuvres by the Howard Government, a Private Member’s Bill to override
the Harradine amendment was introduced from the Government’s own ranks by
Nationals Senator Fiona Nash. The Bill was opposed by Health Minister, Tony
Abbott, and the Prime Minister. Senator Nash enlisted the support of Senators
Judith Troeth (Liberal), Claire Moore (Labor) and Senator Allison in drafting
and sponsoring the legislation (Dowse 2009). A massive support campaign was
organised by pro-choice groups. Twenty NGOs, including AWHN, Sexual Health
and Family Planning Australia, the Australian Reproductive Health Alliance,
11  After waiting for almost two years for a trial in an overstretched court system, the couple was acquitted.
12  The restrictions on overseas aid remained in place until March 2009, when, in response to heavy
lobbying by the women’s movement, the women’s health movement, the Greens and others, the restrictions
were overturned.
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Women’s Health NSW, the Public Health Association of Australia and WEL,
formed a new coalition: Reproductive Choice Australia (RCA). RCA worked to
inform the debate in the media, on the Web and in public forums. It produced
fact sheets, wrote letters and held health information sessions. It monitored
the media, responding to all significant arguments. There were more than 1000
media articles in the 12 months preceding the passage of the legislation. Prochoice members of the Senate supported an inquiry into the proposals, which
extended the period of controversy. After the Prime Minister announced that
a conscience vote would be permitted, RCA systematically lobbied Members of
the national Parliament. The Bill passed through both Houses in February 2006.
Ninety per cent of women senators, regardless of party, voted for the Bill, but
only 46 per cent of men. It was passed in the House on a show of hands because
the Government anticipated the outcome and did not want a division to be
called (Dowse 2009).
The 2006 amendment removed the power of the Commonwealth Health Minister
over the importation of abortifacients, returning authority to the TGA; however,
medical abortion is still not freely available because pharmaceutical companies
have not applied to import and distribute the relevant drugs. Individual doctors
or groups of doctors may apply to the TGA for approval to import and distribute
but this type of strategy is hampered because abortion remains in the criminal
codes of four States and one Territory.

Working to Liberalise Laws
After more than 40 years of activism, the liberalisation of abortion law has been
achieved in fewer than half the Australian jurisdictions. When criminal charges
were laid against the Queensland couple in 2009, women’s groups moved swiftly
into action. Intense controversy erupted, especially in Queensland, where Labor
was in government and a woman, Anna Bligh, was Premier. A new coalition,
Pro Choice Qld, was established. Large rallies were held, support flowed in from
groups around the country and the Government was urged to remove abortion
from the State’s criminal code, once and for all. Those Queensland doctors
who were facilitating medical abortions suspended operations as fears about
illegality re-emerged. State cabinet approved legislative changes in November
but only to make mifepristone lawful under the same circumstances as surgical
abortion—that is, where there is a serious health risk to the mother. Agitation
for decriminalisation continued but at the end of 2009 Premier Bligh made it
clear that her government had no plans to act. Any reform legislation would
have to be introduced as a Private Member’s Bill and she would not bind her
colleagues to any particular position (Elks 2009). That situation prevails in 2011.
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In three jurisdictions—Western Australia, the Australian Capital Territory and
Victoria—however, women have succeeded in having abortion removed from
the criminal code. In each case, women’s groups mobilised and worked closely
together. In the Western Australian case, controversy broke out in 1998 when
two medical practitioners were arrested for performing an abortion, after a
child had repeated family discussion in a classroom ‘news’ slot. The view of the
authorities involved was that the correct interpretation of Western Australian
law was that abortion was legal only in life-threatening situations. Upon the
arrests, hospitals and clinics cancelled abortion lists and the ANF advised
members not to participate in procedures. Amid rallies and speeches, two Bills
were introduced into Parliament. A member of the Opposition Labor Party,
Cheryl Davenport, introduced an abortion repeal bill into the Upper House,
while Attorney-General, Peter Foss, introduced a less radical Bill into the Lower
House. Unrestrained debate took place over a period of weeks, during which
one member made a three-hour speech! Both Bills eventually passed both
Houses; however, the Upper House responded by ruling the Foss Bill out of
order, leaving only the Davenport Bill before the Parliament. There followed a
period in which a host of amendments, some seriously restrictive, was proposed.
On 6 May 1998, however, the Lower House passed the Davenport Bill, which
made abortion legal in cases where a woman has given informed consent. On 21
May, the legislation was passed in the Upper House. The relevant sections of
the Western Australian Criminal Code were repealed and replaced with a new
section that makes it unlawful for anyone other than a medical practitioner to
perform an abortion. While the campaign for complete repeal failed, termination
is now lawful where a woman has given informed consent.13
The first jurisdiction to achieve complete decriminalisation was the Australian
Capital Territory, after feminist campaigns spread over more than 30 years. The
legislation in force when self-government was handed down required that all
abortions be carried out in a public hospital. Women went on a waiting list,
and afterwards, appeared before a committee, which included a psychiatrist, to
establish eligibility or otherwise. Most women who could afford it chose to travel
interstate rather than be part of the waiting list/committee process. A coalition
of local feminist groups, Options for Women, was active on an as-needed basis in
the Territory from the 1980s onwards, agitating for reform. Members included
Sexual Health and Family Planning ACT (SHFPACT), the ACT Women’s Health
Network (ACTWHN), WEL, the YWCA and representatives from a range of
services, such as the Rape Crisis Centre, the Domestic Violence Crisis Service
and various refuges. After the election of a Labor government led by Rosemary
Follett, in 1991, the Minister for Health, Wayne Berry, introduced legislation
that allowed a freestanding clinic to be established. The legislation had a
13  For a discussion of legal complications that could emerge from the legislation see Stephen (n.d.).
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difficult and protracted passage because not all members of the Government
supported it but it was eventually passed. Subsequently, SHFPACT borrowed a
large sum of money to set up Reproductive Health Services Proprietary Limited
(RHS), adding a fraught responsibility to its list of duties.14 Establishment
was supported by the Health Minister, who made secure premises available at
peppercorn rent, giving ACT women access to a feminist-run service that met
with the ethical code of the Abortion Providers’ Federation of Australia.
In 1994, Minister Berry had a Crimes Amendment Bill prepared, which sought
to repeal the three relevant sections of the Criminal Code. Intense campaigns by
pro and anti-choice forces followed. The proposal was set aside in preparation for
the 1995 election, which the Labor Party lost. In 1998, under a Liberal minority
government, which provided another institutional window of opportunity,
a counterattack was launched by Independent Member of the Legislative
Assembly, Paul Osborne. He introduced a Bill with the stated intention of
reducing the number of abortions. Termination was to be permitted only in cases
of ‘grave medical risk’ or ‘grave psychiatric risk’, with teams of doctors to be
on hand to make assessments. Again, groups of ACT women took to the streets,
holding rallies, speaking to the media and lobbying. At the same time, pro-choice
members of the Government worked to have the more restrictive provisions
of the legislation amended. The modified Health Regulations (Maternal Health
Information) Act was passed into law in 1994, causing enormous problems for the
board of RHS. The legislation required that women undergo a 72-hour ‘cooling
off’ period between their first contact with a doctor and a termination. This
requirement was both demeaning and particularly difficult for women living in
surrounding rural areas. Another requirement was that information, including
pictures of unborn foetuses, be provided to all women seeking an abortion. In
the event, legal opinion was obtained that advised that ‘provision’ did not mean
requiring women to open and read mandated material provided in large brown,
sealed envelopes. Had staff been required to show foetal pictures to clients,
the RHS Board would almost certainly have decided to cease operations. The
legislation remained in place while the Liberal Party held government.
Prior to the 2001 election, Wayne Berry, in opposition, released draft legislation
for the repeal of both the abortion provisions of the Crimes Act and the Osborne
legislation. Candidates were questioned by WEL and other women’s groups
about their attitudes to the proposed legislation at pre-election gatherings. Labor
was returned to government at the October election and, in early December, the
two Bills were introduced into the Assembly. Options for Women was brought
14  RHS caused continual difficulties for its parent association throughout its 12 years of existence. Apart
from ACT Government legislation, which at one time threatened to close the service, there were successive
legal cases to be handled, as challenges came thick and fast, requiring that a lawyer be appointed on retainer.
That the legal situation played havoc with the organisation’s capacity to obtain affordable insurance was only
one of many problems.
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out of abeyance to conduct a support campaign. All the customary strategies
were used, with perhaps one addition: for several weeks, information stalls were
set up in major shopping centres on Saturday mornings. A roster was developed
and women from a variety of organisations went together in pairs, hauling
fold-up tables and boxes of papers, posters and pamphlets. The most common
response from members of the public was ‘You’re joshing me! Are you for real?
Abortion is illegal?’
As in the Western Australian Parliament, the ACT Assembly was the site of
various manoeuvres, including the introduction of alternative legislation by an
anti-choice member. When the time came to vote, no-one could predict what
the result would be but indications were that it would be extremely close. And
so it transpired: the Assembly was deadlocked at eight votes to eight, until
Helen Cross of the LPA, who had not divulged her position, voted with the
six Labor members, one Green and one Democrat to pass the two Bills on 21
August 2002. Cross took the view that retention of abortion in the Criminal
Code was archaic. Although members were free to exercise a conscience vote,
Cross was ostracised and later expelled from her party. The Osborne legislation
was repealed and all mention of abortion was removed from the Crimes Act
1900. The Australian Capital Territory became the first Australian jurisdiction
where abortion is regulated under health legislation like any other medical
procedure. The dogged determination of Berry and his assistant, Sue Robinson,
made a huge contribution to the outcome, as did Helen Cross, of course, the only
member of the LPA who supported the reform.
The most recent success took place in Victoria, where abortion was also
removed completely from the Criminal Code, in 2008. The Victorian campaign
was a long, carefully planned collaboration between many pro-choice groups,
demonstrating the relative ease with which momentum can be mobilised
on this issue. The process began in response to the increasingly hostile
pronouncements about women’s reproductive rights made by members of the
Howard Government, including the Prime Minister and the Health Minister,
Tony Abbott. In 2005, representatives from women’s health and reproductive
and sexual health groups met and agreed to work proactively to protect women’s
rights, forming the Association for the Legal Right to Abortion (ALRA), which
was later incorporated. The association had a broad-based membership and its
major objective was to have abortion removed from the Criminal Code through
a campaign that would last as long as necessary. The approach chosen was
to educate politicians, members of the media and the community about the
problems that arose from the criminal status of a medical service that many
women use. Health professionals and their organisations were encouraged to
make their views public.

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ALRA strategies included meeting all Victorian Members of Parliament,
questioning them about their attitudes to reform legislation and inviting them
to join the ALRA. In the first year, seven ALRA briefing papers were written
and made available on the web site, which had links to the extensive resources
on the WHV web site. A comprehensive range of information papers, including
‘What MPs need to know about termination of pregnancy’, was produced and
disseminated. Resources were developed to facilitate community participation in
the lead-up to the 2006 election. A table of Victorian parliamentarians was drawn
up that included their concerns and voting intentions. All parliamentarians
were provided with information and key women in all parties were approached
for support. Health movement members met regularly with their local Members
of Parliament.
Through the four-year campaign, all briefing papers were reviewed annually
and new papers were written in response to issues that emerged from MP
interviews. In 2006, ALRA and WHV staged a forum, capitalising on an SBS
documentary on the life of Dr Bertram Wainer. Media and communication
expertise was obtained and spokespeople were given media training. Activists
were careful not to make decriminalisation an issue for the 2006 election as part
of a deal with the Premier but they strongly supported pro-choice candidates.
Immediately after the November election, campaigning recommenced. The
Royal Women’s Hospital, the Centre for Women’s Health, Gender and Society,
Melbourne University and WHV cooperated to stage a conference at the end
of November that produced an advocacy tool, Abortion in Victoria, Melbourne
Declaration. ALRA calculated that there were sufficient supporters in Parliament
to pass decriminalisation legislation. The following month, WHAV formed a new
group, the Abortion Law Reform Women’s Health Services Campaign Organising
Group. Its activities included letter writing, media releases, creating copy for
newsletters, meeting with parliamentarians, keeping a list of supporters and
facilitating local electorate activity. Its work was coordinated by WHV and it
made an important contribution to the campaign.
In July 2007, Labor parliamentarian Candy Broad announced her intention to
introduce a Private Member’s Bill seeking decriminalisation, amid a storm of
protest. By this time, however, a number of key professional bodies, including
RANZCOG and the AMA supported decriminalisation. The private Bill was
withdrawn in August after Premier, John Brumby, made a commitment to
pursue reform and asked the Victorian Law Reform Commission (VLRC) to
provide advice on legislative options by March 2008. The Premier argued that
it was essential that the law reflect contemporary community standards. The
commission held multiple meetings with different groups and received more
than 500 submissions. Its report was released in March but remained cabinetin-confidence until June.
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As in other places, campaigning was intense. WHV continued to produce
evidence-based resources for general campaign use. Yet another broad coalition,
ProChoice Victoria, was formed, which included the Multicultural Centre for
Women’s Health, RCA, the Doctors Reform Society of Australia and Marie Stopes
International. It helped to organise rallies and forums, it lobbied, wrote letters
to The Age newspaper and participated in radio and television interviews.
An active web-based advocacy tool was established. Anti-choice campaigners
targeted pro-choice MPs with messages and letters in an effort to change minds
and picketed the entrances to termination facilities. At one point, a 2000-person
anti-choice rally was held and the city was draped with posters depicting
foetuses at different stages of development. At another point, the Roman
Catholic Archbishop threatened to shut down the maternity and emergency
departments of Catholic hospitals if the Bill were passed. In the meantime,
ALRA and WHV continued a strategy of quiet approaches to parliamentarians
and encouragement of active community participation. Community watching
networks were formed in different electorates which fed information back to
WHV about anti-choice activity.
When the VLRC report was tabled in Parliament, activism intensified. The
report recommended three options, two that would leave the situation unclear
and conditional and a third, model C, which would provide for lawful abortion
on the basis of a woman’s informed consent. Parliamentarians who supported
option C were encouraged to make their position known and WHV kept a list.
In August, the Minister for Women’s Affairs, Maxine Morand, introduced the
Abortion Law Reform Bill 2008 into the Parliament. Based on model C, the
legislation proposed to fully decriminalise abortion during the first 24 weeks of
pregnancy, after which women would need the permission of two doctors, who
may approve the procedure if they considered it medically appropriate, taking
into account a woman’s current and future physical, psychological and social
circumstances.
Within Parliament, more than 40 amendments were moved in the Lower
House, most of which sought to impose a variety of restrictions, such as
making counselling compulsory. Similarly, in the Upper House, more than 70
amendments were put forward. In the event, a conscience vote took place on
11 September and the Victorian Abortion Law Reform Bill passed, unamended,
in the Lower House by a vote of 49 to thirty-two. The Bill passed unamended
into law in the Upper House late on the night of 10 October 2008 by a vote
of 23 in support and 17 opposed (Bullimore 2008; Oliver and Hawkins 2008).
Marilyn Beaumont, Executive Director of WHV, described the ensuing scene at
Parliament House as follows:

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Those present to witness this history in the making were dignified and
respectful of the Parliamentary protocols but only until we had made
our way from the Council Chambers. Tears, hugs, clapping and speeches
were some of the range of responses and emotions visible in response
to the stunning outcome for women’s health in Victoria. Our joining
together with so many organisations and individuals in advocacy for
abortion to be removed from the Victorian Crimes Act and for abortion
to be regulated as a health service has been a monumental achievement.
(Personal communication, 13 October 2008)

Conclusion
Activists in the maternity-care and abortion law reform movements have worked
tirelessly for more than 40 years to advance women’s reproductive health rights.
The task has been made gargantuan in both cases because powerful opposing
interests have countered feminist campaigns at every turn. With only their
own skills and the support of female colleagues and sister groups, women have
had to try to match the arguments and campaigns of the resource-rich groups
pitched against them. The maternity-care reform movement turned the personal
into the political when members challenged the medical model of pregnancy
and childbirth care that became entrenched after organised medicine achieved
the subordination of midwives in the first half of the twentieth century. Like
the early abortion law reformers, the issues of respect for women’s bodies and
women’s rights to information and self-determination had to be articulated and
drawn to public attention. Language had to be invented to express concepts and
concerns not previously discussed in public. In both cases, like activists in the
rest of the women’s health movement, women thought of themselves as social
change agents, part of a movement that would raise the status of women and
improve the conditions of their lives.
In both domains, there are major achievements to celebrate but the reforms
are incomplete. Health financing arrangements and cultural norms provide
incentives for women to seek medically dominated care and the prospects of
independent midwifery practice and access to homebirth in the short term look
bleak. Abortion remains in the criminal code in five jurisdictions and medical
abortion, which has been available in comparable countries for more than a
decade, is available to only a tiny number of women in a few special cases. In a
policy area where powerful groups have a lot to lose from change, incremental
reform rather than radical restructuring is, however, the order of the day. The
women of both movements can therefore be justly proud of the reforms they
have achieved. In the next chapter, the main policy responses to the women’s
health movement at the State and Territory level are examined.
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Members of the AWHN Aboriginal Women’s Talking Circle at the Sixth
AWHN National Women’s Health Conference, Hobart, 2010.
Photo: Tracey Wing

The Sixth AWHN National Women’s Health Conference Choir, on stage,
Hobart, 2010.
Photo: Tracey Wing

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The National Aboriginal and Torres Strait Islander Women’s Health
Strategy launched at the Sixth AWHN National Women’s Health
Conference, Hobart, 2010.

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Sandy Angus, co-author, speaking at the launch of the National Aboriginal
and Torres Strait Islander Women’s Health Strategy, Hobart, 2010.
Photo: Tracey Wing

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Kelly Bannister, Conference Convener, with keynote speaker,
Professor Lorraine Greaves, British Columbia Centre of Excellence for
Women’s Health, at the pre-conference reception, Government House,
Hobart, 2010.
Photo: Tracey Wing

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At the Sixth AWHN National Women’s Health Conference, Hobart, 2010.
From left: Denele Crozier and Jilpia Nappaljari Jones, AWHN committee
members, with Jo Willmot and Fran Baum, keynote speakers.
Photo: Tracey Wing

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Territories
The 1980s saw ‘unprecedented feminist activism around public policy
development in health’. (Schofield 1998:128)
If setting up separate services for women was difficult, the objective of
influencing public policy was probably even harder. Consider the circumstances:
groups of feminists, easily dismissed as part of a lunatic fringe, spoke about
taboo subjects in public and circulated a radical critique of an esteemed
institution—namely, the medical-care system. Persuading people of the validity
of their claims was not easy. First, issues and concerns had to be identified
and articulated. Sometimes a new language had to be developed with which to
discuss issues previously hidden from view. Explanations had to be developed
about why things were as they were. Meetings had to be held, agreements
forged, position papers written and arguments disseminated in public places.
Coalitions of support had to be created and maintained. Bureaucratic hostility
was common and often a majority of political party members opposed, did not
understand or were not interested in women’s health perspectives. In some
jurisdictions, women’s health was seen as synonymous with abortion, which
could be counted on to raise intense opposition. The social health perspective
was new and often not well understood so that many health bureaucrats tried to
incorporate women’s health initiatives into the conventional medical paradigm.
This came about partly because of familiarity with past practice and partly
because bureaucracies do not like to establish organisations over which they
have little control. Incorporating women’s health into the medical model would
also maintain trouble-free relations with organised medicine and avoid political
fallout. Influencing public policy was not achieved easily.
The advocacy of the women’s health movement, however, built up such
momentum by the 1980s that political parties felt they could not afford to ignore
it, especially as opinion polls were showing that the ‘women’s vote’ was a force
to be reckoned with. The decade can be seen as a golden age in the development
of women’s health policies, centres and services. As well as general women’s
health policies, strategies to confront domestic violence were formulated and
reforms implemented. Prior to and feeding into the development of the NWHP
in the second half of the 1980s, most States and Territories had initiated inquiries
into women’s health and/or developed their own policies. At the same time,
women’s health policy machinery was introduced in all jurisdictions and at the
Commonwealth level. These new institutional arrangements assisted policy and
program advancement; women’s health advisers and the units they ran were
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crucial in the many-pronged struggles for policy influence that followed. Sexual
assault was the hardest issue to bring out of the wings and position on the
policy stage.

New South Wales
The establishment of health policy machinery and the development of policy
progressed steadily in New South Wales under the Wran Labor Government
(1976–86), even if persuading it to make up the funding being withdrawn by the
Commonwealth was a struggle. A Women’s Coordination Unit was established
in the Premier’s Department in 1977, followed by the establishment of women’s
units in key departments to work with the Coordination Unit—a hub-and-spoke
model as advocated by WEL. The Women’s Advisory Council, the main channel
through which community views were fed into government, was established in
the same year. The council consulted with women, paying special attention to
rural areas. As in all consultations with Australian women, here, health emerged
as a major concern and became an element of the reform agenda. The council
recommended that more women’s health centres be established, more birthing
choices be developed, better contraceptive information be made available and
that participation in health decision making be facilitated.
New initiatives, however, took several years to develop, despite persistent
lobbying by movement members. In June 1984, the Women’s Health Policy
Review Committee was established. The Women’s Health Unit, with a staff of
three to four, headed by the Women’s Health Advisor, Carla Cranny, was set up
in 1985. Most staff members were experts in particular fields and had links with
grassroots women’s groups. By the mid-1980s, the Wran Government had made
a clear commitment to women’s health action.
The Policy Review Committee was charged with identifying the main women’s
health issues, assessing the adequacy and accessibility of existing services and
determining appropriate funding mechanisms. Its final report was presented
in November 1985 and formed the basis of an approach termed ‘a policy in
action’ in the absence of a formal policy. Extra funds were provided for rural
and public hospital sexual assaults centres, and, as discussed, some unfunded
health centres received funding for the first time. By 1986, 19 women’s health
centres, including Jilimi (later renamed Waminda), were being funded by the
State Government. Women’s health coordinators were installed in each of the
health regions, along with women’s health educators and approximately 60
women’s health nurses, who were trained to provide sexual, reproductive and

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breast health services. With increased capacity, women’s health centres were
seeing more than 80 000 women each year (NSW Women’s Advisory Council to
the Premier 1987:187–9).
Bureaucratic resistance to separate women’s health services remained,
nevertheless, even in New South Wales, which has the longest experience and
the most centres. One of the arguments against centres was that NGOs needed
to deliver better services than the mainstream in order to justify a funded
existence.The mix of services provided in the two sectors is too different to
compare quality in any straightforward sense. During this time, NGOs were
evaluated and measures put in place to ensure financial accountability. Some
centres found the requirements of intricate record keeping and statistical
collection onerous, particularly given the straitened financial circumstances in
which they found themselves. Differences in the power of stakeholder groups
were clear: women’s services were required to account in detail for the trivial
funding they received whereas multimillion-dollar hospitals were able to report
in broad-brush terms.
In 1988, the Labor Government was replaced with the neo-liberal-leaning
Greiner Liberal Party Government, which quickly set in place a review of all
NGOs funded by the Health Department. Although the women’s health sector
feared it might lose support, it had established its legitimacy to the extent that
the Premier endorsed the principles of the NWHP in a women’s policy statement
in 1990. In 1995, the government changed hands again and the Carr Labor
Government was elected. A women’s health discussion paper was produced
in 1998, and a policy document, A Strategic Framework to Advance Women’s
Health, indicating directions until 2003, was released in 2000. The document
confirmed a commitment to a social view of health and other principles of the
NWHP, including intersectorality. The four key strategic directions identified
were adoption of a gendered approach to health, collaboration to address social
determinants, advancement of women’s health research and the application of a
health-outcomes approach, based on measurable indicators. In April of the same
year, the Gender Equity in Health statement was released, which recognised
gender as an important determinant of health. It presented an overarching
framework for promoting women’s and men’s health (NSW Health Department
2000:1).
The Women’s Health Outcomes Framework was subsequently developed and
released in 2002. It provided a guide to measuring and monitoring conventional
health outcomes and prioritised mental health and the prevention of violence
against women, as well as preventive health measures, such as smoking cessation.
Influenced by the principles of the NWHP, it acknowledged the social health

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perspective and the importance of health promotion, disease prevention, equity
of access to appropriate and affordable services and a strengthened primary
healthcare system (Women’s Health Unit 2003).
In January 2010, the interim Women’s Health Plan, 2009–2011, was released.
Priority action areas include violence, the Aboriginal Family Health Strategy,
the improvement of the health of pregnant women, and the health of immigrant
and refugee women and women living in regional, rural and remote areas. Each
Area Health Service is required to implement and monitor the plan. The plan
suggested that 2010 was a time of transition because the Commonwealth would
soon release a new NWHP. A full review of New South Wales policies for women
is to be held in 2012 (NSW Department of Health 2010).

Queensland
The Bjelke-Petersen Government, including the Health Minister in the early
1980s, Brian Austin, was not interested in women’s health. Leisha Harvey, only
the second woman in Queensland to hold a cabinet position, took the health
portfolio in 1987 and, after intense lobbying, agreed to set up the Women’s
Health Advisory Council. The Women’s Health Forum was held, attended by
400 women, as part of Queensland consultations for the NWHP; however, there
had been no further policy progress when the Government lost office in 1989.
By then, community consensus about the importance of women’s health had
emerged. Nevertheless, the new Labor Government took time to act, partly
because supporting women’s health apparently meant supporting access to
abortion in the minds of some parliamentarians. Jude Abbs, first Interim
Convenor of AWHN, was an ALP member and introduced women’s health as
an issue. Because policy development on women’s issues lagged behind other
jurisdictions, there was a sense that time had to be made up. Former Women’s
Health Adviser Janet Ramsay describes her experience at Queensland Health as
trying to do 20 years’ of policy development in two years.
The Queensland Labor Party had formed a women’s policy committee, which
saw women’s health as a priority issue, with special emphasis on the needs of
women in rural and remote areas. By this time, diverse groups of community
women were well organised in Brisbane and in regional towns and were ready
to assume responsibility for managing women’s health projects. Networks had
been formed, meetings and forums were held and expectations were high.
The Women’s Health Unit was established in 1991, with between five and eight
permanent, designated women’s health policy positions (Gray 1999:210). Between
1989 and 1995, Anne Warner, Minister for Family Services and Aboriginal and
Islander Affairs, was the only woman in the Queensland cabinet,She was only
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the second ALP woman to be elected to the Parliament and the first to hold
a ministerial portfolio. so her office tended to operate as a centre of women’s
issues.
A discussion paper, Towards a Queensland women’s health policy, was developed
in 1992 followed by a consultation process across the State and in the Torres
Strait Islands. The Royal College of General Practitioners, strongly opposed to
the discussion paper, did its own survey to try to show that women did not
really care about the sex of general practitioners or about women’s health issues.
The Queensland Medical Women’s Society also voiced opposition. Members
were upset, for example, about a proposal to train women’s health nurses.
Within government, it was felt that the support of organised medical groups
was necessary, so extensive negotiations were held.
Queensland Health received 138 written responses to the discussion paper, which
was followed by a green paper with the same name. The Goss Government was
committed to hearing from Queensland women about health priorities but some
members counselled caution at this point, as it was realised that consultation
creates expectations. The green paper provoked considerable controversy and
the abortion issue was again raised. To get cabinet approval, which was extremely
difficult in any case, the ‘A’ word had to be avoided at all costs.Even Family
Planning Queensland felt it had to hold itself aloof from the abortion issue for
self-protection. After a politically fraught passage during which the need for
separate women’s health services was questioned extensively, the Queensland
Women’s Health Policy was launched in November 1993.
The 1993 policy was never reviewed or updated, nor was it properly monitored.
Despite the existence of a relatively well-staffed women’s health unit, little
research or statistical collection was carried out. These omissions were put down
to lack of central direction and coordination. Within government, there was talk
about partnerships with the community sector but no real action was taken to
develop connections or concrete programs. In 1996, the Women’s Health Unit
was formally abolished.
In 2001, Queensland still had no access and equity policies and no bilingual health
workers, except in women’s health centres and services. Women advocating for
the employment of interpreters in health agencies were told that there were not
enough migrant and refugee women to justify the effort. Although women’s
health never had a high profile within government, members of the movement
feel that it was gradually accepted as a legitimate area of public policy. Moreover,
the principles of women’s health are thought to have influenced the direction
of Queensland primary healthcare policy due to compatible principles and
philosophies.
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South Australia
The State health bureaucracy appears to have had an unfavourable view
of the women’s health centre from the start. (Auer 2003)
In the late 1970s, women’s groups in South Australia had mobilised and were
campaigning for separate women’s health services. The Liberal Party won
government at the 1979 election and Jennifer Adamson (later Cashmore), a
supporter of a feminist health perspective, became Minister for Health for the
next three years. Gaining support within government and the bureaucracy,
however, was not easy. It took until the middle of 1982 for the minister to be
given authority to request the South Australian Health Commission to develop a
women’s health policy. A working party was set up and consultations undertaken
but the policy had not been written when the Government lost office.
Labor women had responded to grassroots agitation by establishing a women’s
policy committee within the party in 1978. On gaining office in 1982, a major task
was to finalise the women’s health policy. A philosophical framework supportive
of women’s health was accepted within the party and the importance of opening
channels of communication with women so that they could contribute to policy
was emphasised.
The Adviser on Women’s Health, Liz Furler, who reported directly to the
minister, was appointed in January 1984. Health Minister, John Cornwall,
who supported separate women’s health services, proposed that she become a
member of the Health Commission Executive, but ‘at least a dozen reasons were
advanced over so many weeks by the existing members of the executive as to
why such an appointment would not be “appropriate”. Most of them relied
on the fact that her position did not carry Executive Director status’ (Cornwall
1989:45). At the time, there were no women in senior executive positions at the
commission. When the minister insisted, the Adviser on Women’s Health was
‘grudgingly admitted’ but she was ‘never accepted into the inner sanctum. Nor
was her “pushiness” ever forgiven’ (Cornwall 1989:44–5).
In August 1984, the Report of the Working Party on Women’s Health Policy
was released, which was the first women’s health policy in Australia. Women’s
health, however, had no natural home in the bureaucracy and it took time to
decide where responsibility should be located. Indeed, it took four years to
identify which area should take responsibility for immigrant women’s health.
According to one femocrat involved in the processes, the South Australian
Health Commission resisted all changes recommended in the policy because
bureaucrats did not want to deal with an assortment of small agencies. Under

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the circumstances, it was not hard to get the policy endorsed but it was very
difficult to get a commitment to implementation, maintenance and proper
funding.
In spite of the obstacles, a number of valuable projects were undertaken
after the release of the report, including the establishment of new women’s
health centres, as discussed in Chapter 3. The representative Women’s Health
Consultative Committee to the Health Commission was appointed to advise on
issues raised in the policy. Aboriginal, immigrant and older women, women
with disabilities and single mothers were represented, together with women
from general practice, nursing and the voluntary sector. A program of seminars
on women and health was initiated in regional and rural areas. Abortion services
were improved, along with responses to child sexual abuse. Equal opportunity
for women within the health system became a central issue.
The new Social Health Unit was established in 1986, which was seen as integral
to the Government’s social justice strategy. The Adviser on Women’s Health
became the Director and her office was transferred. The new unit had a staff of
eight, including an Aboriginal project officer. It was not directly responsible
for women’s health and its creation gave rise to considerable controversy. Some
members of the movement wanted a more direct focus on women’s health and
discussion was rekindled about whether it had been a good idea to work with
‘the state’ after all. In the event, the major supporters of the Social Health Unit,
Minister Cornwall and the Director, Liz Furler, both moved away before the unit
had time to make an impact. After their departure, the staff and resources of the
unit were slashed.
In 1988, the metropolitan women’s health centres worked together to produce
a five-year strategic plan, developing strategies around key issues (Radoslovich
1994:62). Under the Brown Liberal Government, however, elected in 1993, the
independence of women’s health centres was lost. Inspired by the neo-liberal
objectives of increased efficiency and expenditure reductions, the regional
centres were amalgamated with community health centres to form regional
community health centres, while Adelaide Women’s was amalgamated with the
Women’s and Children’s Hospital, as discussed above. Severe budgetary cuts
were used to ‘encourage’ cooperation (Radoslovich 1994:104–5). The changes
accorded with the longstanding Health Department position of strong opposition
to separate women’s health centres.
The Olsen Liberal Government released a consultation paper in 2000, as the
first part of a project to develop the Department of Human Services Policy and
Planning Framework for Women’s Health and Well-Being. A key initiatives
paper, Women’s health and well-being, setting out a snapshot of existing
projects, was released in 2001. The Government changed hands in 2002. The
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Women’s Health Ministerial Advisory Council was established by incoming
Health Minister, Lea Stevens, in 2003 and a new Women’s Health Policy was
launched in 2005. It describes itself as ‘a policy like no other’ because ‘it is
about all of us—the whole health system and the South Australian community.
It is about changing health for women, changing health for everyone—but
it starts with women.’ The policy takes a social determinants perspective and
suggests structural reform to achieve a focus on prevention and primary health
care, aiming to achieve ‘health for all’ (Government of South Australia 2005).
Based on the policy, the Women’s Health Action Plan was written and, in 2009,
Women’s Health Statewide produced an evaluation, ‘Women’s Health Action
Plan Report Card’. While a number of programs and strategies were introduced
in key women’s health areas, the major reforms envisaged in the 2005 policy did
not proceed.

Tasmania
In Tasmania, where hospitals have been the central health institution for decades,
awareness of the importance of primary health care was slow to develop. Many
people saw community health as an extension of hospital care into the home
situation, with hospital staff providing the service (Shaw and Tilden 1990:29).
The women’s health movement was therefore without an important band
of community health allies and, while the movement was strong, those with
authority in health policymaking took a long time to respond to the new ideas.
As one femocrat has argued, the road to women’s health in Tasmania has been
‘a twisted and convoluted one: a step or two forwards, some backsliding and a
few quantum leaps’ (Personal communication).
The election of a Labor government and the launch of the first NWHP in 1989
heralded a positive period for women’s health and brought renewed energy from
community groups. Money was made available for a Women’s Health Forum, as
a means of generating input to the NWHP, under which funding was provided
for a women’s health senior policy officer position. Research on women’s health
needs in regional areas was also funded, along with the Hobart Women’s Health
Centre. In subsequent years, various small projects were supported and funding
was directed towards the development of a Tasmanian women’s health policy,
which was launched in 1994. In the mid to late-1990s, a discrete women’s
health program was developed within the Department of Health and Human
Services. Regional coordinators were appointed and an information service was
established. A manager was appointed in 1999 to oversee the program and all
positions were made permanent in the same year.

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During the early 2000s, the Women’s Health Program became part of the
Population and Health Priorities Unit within Population Health, alongside other
priority areas, such as Aboriginal health, immigrant health, youth health and
men’s health. Since that time, there has been a focus on health equity, diversity
and gender mainstreaming. Although it works to improve mainstream services,
the Women’s Health Program aims to achieve change at the level of population
health and is structured around a regional outreach model.
According to the evaluation of the NWHP, the Tasmanian Women’s Health
Program developed within a context where there had been a philosophical shift
from traditional illness orientation towards a social view of health with a focus
on primary health care (Commonwealth of Australia 1993:45). The program
was maintained until 2011 when State finances became stressed. The budget
announced funding cuts across portfolios, including a $100 million reduction in
health funding. The implications for women’s health are not clear at the time of
writing but it is anticipated that a leaner program will result.

Victoria
In Victoria, the Cain Labor Government was elected to office in 1982. Although
the new Premier regarded the women’s policy machinery set up under the
previous Liberal Government with suspicion (Sawer 1990:162), Mary Draper
was appointed Women’s Adviser in 1983. One of the issues she discussed with
the Premier was a women’s health policy. A group of women parliamentarians
and femocrats, in response to grassroots activism, identified women’s health as
a key issue and agreed that the development of a policy should be a priority.
A number of crosscutting forces operated. Within the Labor Party, support for
separate women’s health services was weak and, even among female members,
opinion was divided. The party’s Health and Welfare Policy Committee did
not favour separate women’s services, arguing that community-based services
were important but they did not have to be separate. Many officers within
the Department of Health were hostile; the view that women’s health was a
waste of time and money was strong. As in other States, in Victoria, health
bureaucrats tended to oppose government funding for community groups on
grounds of increased complexity and accountability problems. On the other
hand, there was a commitment to community consultation and an awareness
of lagging behind other jurisdictions on women’s issues.Victoria was certainly
lagging behind New South Wales, perhaps rekindling ancient rivalries. Female
politicians and femocrats were able to use these forces to advantage, assisted by

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opinion polling that showed the electoral importance of attracting the women’s
vote. Kay Setches and her colleagues, who included Joan Kirner and Carolyn
Hogg, are said to have been known as the feminist mafia.
The Labor Party’s health platform for the 1985 election was headed by
policy for hospitals and made no mention of women’s health. Under these
circumstances, many avenues had to be used to promote the development of
a formal women’s health policy. An intense struggle ensued, which included
women parliamentarians persistently lobbying the Premier. Senior bureaucrats,
no matter how resistant, are likely to be responsive to the wishes of the minister
and, in 1985, David White, who supported women’s health, became Health
Minister. Jenny Macklin, later to become a Commonwealth minister and Deputy
Leader of the Labor Party, was a member of the minister’s staff and her work is
regarded as pivotal in the struggle for a positive outcome.
The strongest resistance to separate services was gradually eroded and an inprinciple agreement was reached that the Health Department should develop a
policy. Minister White announced the establishment of the Ministerial Women’s
Health Working Party, under the leadership of Kay Setches, who later joined the
cabinet. Before entering Parliament, she had been coordinator of the Maroondah
Women’s Refuge. A discussion paper was distributed and consultation was
undertaken with thousands of Victorian women.
Many senior parliamentarians, however, were not convinced that funding
community-based women’s health services was a wise move, nor that electoral
advantage would follow. A number of others were simply not interested. The
Cain Government perceived itself as having inherited a poor financial situation
and wanted to prove itself as a sound financial manager.This cannot, however,
be considered a serious justification for inaction, since the amounts of money so
far allocated to women’s health are too small to have a serious budgetary impact,
irrespective of jurisdiction. After another intense struggle, it was agreed to
set up the Victorian Women’s Health Program, as outlined in Chapter 3. In the
event, funding was approved in 1987 prior to the release of the working party’s
final report, Why women’s health, Victorian women respond.
The Women’s Health Policy and Program Unit was established in the Health
Department to implement the changes. The two major policy directions were
long-term structuring of general health services to reflect women’s health
issues and the provision of separate services (Women’s Policy Coordination
Unit 1987:68–9). A women’s health centre was established in each region, and
specialist community-based women’s addiction services and services for young
women were set up under the new program.

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By 1990, the Cain Government was in crisis, the budget deficit was high and
some financial institutions were deeply unstable. Divisions emerged within
the ALP about an appropriate response. There were attempts to regenerate
momentum and to identify important issues for the 1990s but energy was low
and the party’s policy committees were in decline. Although a dynamic leader,
Joan Kirner, took over in 1990, the Government was unable to regain its electoral
strength and it lost office to the Liberal Party under Jeff Kennett in 1992.
Social policies and programs were not Kennett Government priorities but
reigning in expenditure was. Shortly after the election, the health budget was
cut by 12 per cent. The traditional bureaucratic distaste for separate women’s
health services once again emerged in proposals to ‘integrate’ women’s health
centres into primary care services. The number of people working on women’s
health in the bureaucracy was reduced. In 1997, however, Health Minister, Rob
Knowles, asked the Ministerial Advisory Committee on Women’s Health to begin
the development of a women’s health plan for Victoria. A round of consultations
followed and, in 1998, the Department of Human Services and the Ministerial
Advisory Committee on Women’s Health jointly sponsored a women’s health
conference as part of the policy development process. The conference met with
an overwhelming response (Beaumont 1998:6–7.) A women’s health plan was
written before the Government (unexpectedly) lost office, after which the plan
was abandoned. Overall, the Kennett Government era has been described as a
‘policy vacuum’ for women’s health (Johnstone and Bachowski 2000:4).
The incoming Bracks Labor Government was elected on a platform of commitment
to women’s issues. The Ministerial Advisory Committee on Women’s Health and
Wellbeing was established, chaired by Caroline Hogg. After a discussion paper
and further consultations, the four-year Women’s Health and Wellbeing Strategy
was launched in 2002. The strategy focused on the needs of women with the
most disadvantages, particularly in the areas of safety and security, mental and
emotional health and participation. Upon the expiry of the strategy, a group of
women’s health providers collaborated to write a new policy proposal, Women’s
Health Matters: From policy to practice, 10 point plan for Victorian women’s
health, 2006–2010. The plan was endorsed by 30 women’s health and community
groups. The aim was to attract the attention of political parties in the lead-up to
the 2006 election. The document successfully influenced priority setting.
In 2009, WHV released a second 10-point plan for the period 2010–14, which
builds upon the 2006 document and suggests policy directions, including
increased funding for women’s services (WHV web site). In Victoria, the
women’s health movement has had considerable success in building a positive
partnership with the State Government in recent years.

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Western Australia
The Burke Labor Government came to power in Western Australia in 1983 with
a clear agenda to promote the status of women. Deborah McCulloch, former
women’s adviser to the Premier of South Australia, was employed as a consultant
to help develop women’s policy machinery. The Women’s Advisory Council,
which had a strong women’s health focus, was set up in the first year. It is
said that the Government initially listened carefully to the council’s advice. Liza
Newby, who later led the national consultation for the NWHP, was appointed
Director of Women’s Interests in the Division of the Department of Premier and
Cabinet. In 1986, the small Women’s Health Unit was established within the
Health Commission, headed by Thea Mendelsohn.
The Working Party on Women’s Health was set up, which produced a report in
1986. At the time, Ian Taylor, an ally of women’s health, was Health Minister.
A women’s health conference was held to which Liz Furler was brought from
Adelaide as a keynote speaker. Hundreds of women from all over the State
attended, demonstrating the high priority women placed on health. Regional
forums and workshops were held, which were also well attended. Minister
Taylor attended all the forums and took time to talk with women about their
health needs, sometimes for a whole morning. In the meantime, the Women’s
Advisory Council pressed hard to get the recommendations of the working
party accepted; however, the 1986 draft policy was never endorsed.
Infrastructure gains were made in 1988–89, when funding was approved for
rural sexual assault centres in Bunbury and Geraldton, and the embryonic
women’s health centres in Fremantle and Kalgoorlie were provided with small
amounts of funding; however, progress was slow. The Women’s Health Unit had
only one permanent position, supported by a continuous flow of temporary staff.
The situation was exacerbated because the unit could not get information about
the availability of finance. Over time, the influence of the Women’s Advisory
Council waned.
Keith Wilson, no friend of women’s health, took over as Health Minister in
1988 when grassroots women were highly mobilised and were campaigning for
a network of women’s health centres. The minister strongly opposed separate
services and did not support reproductive choice. His early actions included
cuts to the core funding for the WA Family Planning Association. About this
time, Women’s Health Care House was given three months’ notice to quit its
premises, which were earmarked to be bulldozed. Requests that the minister
provide a building were ignored until centre staff wrote an article for the
Western Australian Sunday Times. Premises were offered the following day.

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Within the Labor Party, Minister Wilson is said to have been a ‘majority of one’,
who regularly threatened to resign if the health portfolio were taken from him.
Carmen Lawrence, as Premier, supported her Health Minister publicly in what
is reported to have been an extremely difficult time within the party. Under
the circumstances, Labor women could do little to influence the Government’s
approach.
Within the Department of Health, women’s health became known as ‘the
poisoned chalice’ because association might end a public servant’s career. The
result was that few women in the bureaucracy were willing to be advocates. By
1990, it appeared that Western Australia alone might not join the NWH Program.
The Women’s Health Adviser was told to develop a new set of reference groups
and to focus on introducing changes to the mainstream health system, rather
than plan separate services.
A number of alternatives to separate women’s health services were considered,
including well women’s clinics that would be run from general practitioners’
offices—doubtless a suggestion from medical unions. Another proposal was
to use the NWH Program money to employ women’s health coordinators. In
1990, the matched funding requirement was used to oppose acceptance of the
program, transforming it into a ‘States’ rights’ issue in an effort to gain political
traction.
The Women’s Advisory Council continued to press the Government to join the
NWH Program, supported by community groups. A well-attended meeting,
addressed by Premier Lawrence, was called by WEL to increase the pressure.
Staff in the Commonwealth Women’s Health Unit exercised discretion, keeping
open the opportunity for Western Australia to join after it could have been
closed. Eventually, in March 1991, more than a year late, Western Australia
joined the program, after which most of the State’s women’s health infrastructure
was established. Observers are of the view that if it were not for Commonwealth
money, Western Australia would have a very small women’s health infrastructure.
Any attitudinal changes within government or the bureaucracy at the time of
joining were ephemeral. Participants reported a quick reversion to a policy of
‘what the Government thought women’s health should be’. In summary, after an
initial burst of positive action under the newly elected Burke Government and
Health Minister Taylor, women’s health initiatives were resisted in government
circles, despite strong pressure from parliamentary women, women in the
bureaucracy and women in the community. Moreover, absurdities appeared
regularly. For example, male doctors were given responsibility for managing
the Alternative Birthing Services Program, funded under the NWH Program.
King Edward Hospital for Women henceforth became known informally as King
Edward Men’s Hospital for Women. Under the circumstances, struggling to infuse
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the primary care system with women’s health principles was thought to be much
too hard, given the massive groundswell of support that is needed to support
structural change, and movement members selected their goals strategically. In
the middle of the 1990s, the Women’s Health Policy Unit was reduced to two
bookcases.While the claim is colourful, it is only a slight exaggeration. In 1995–
96, a senior manager had responsibility for women’s health, in addition to five
other portfolio areas. She was able to spend on average only one-sixth of her
time on women’s health (Gray 1999:210).

The Australian Capital Territory
The process of developing a women’s health policy in the Australian Capital
Territory was stimulated by the announcement of the forthcoming NWHP but
interrupted by the introduction of self-government in 1989. Some of the regular
opponents, who feared a policy would legitimate an abortion service, were
active. At the time, the Australian Capital Territory had a relatively extensive
network of community health centres—a legacy of the Whitlam Government’s
constitutional authority in the jurisdiction. Some people held the view that
community health centres could adequately meet the needs of womenThis is not
an entirely unreasonable view, given appropriate women-focused arrangements.
(Broom 1991:80–1). A women’s health adviser position was established in the
mid-1980s by the then ACT Health Authority. Marilyn Hatton was appointed
and work began on a women’s health directory and a formal policy. At the same
time, a small women’s health service was set up by the Health Department. The
distribution of the draft policy was delayed, pending expected initiatives to be
outlined in the NWHP. Women’s Health Development in the ACT was released
in November 1990 in draft form but the document was never finalised or
formalised.
The first ACT Government was headed by the first Australian female head
of government, Rosemary Follett, who set up the Women’s Health Advisory
Committee (WHAC) in 1989. The ACT Women’s Health Network (ACTWHN) was
represented on the committee through its six-year existence. WHAC regularly
consulted with ACT women about their health needs and monitored policy
developments and changes, including the controversial alternative birthing
services program. Under the Follett Government, legislation was changed to
allow abortions to occur in facilities other than a public hospital, as discussed in
the previous chapter. Under the Carnell Liberal Government (1995–2000), the
importance of women’s health was downgraded. Meetings of the WHAC ceased
and, more seriously, Canberra’s relatively extensive network of community
health centres was progressively dismantled.
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Labor was re-elected in 2001, under the leadership of Jon Stanhope, who
remained in power until 2011. A five-year women’s plan was produced, with an
excellent health section setting out key principles. Substantial investment has
been made in transitional housing for families in crisis, for example, including
designated properties for women and children escaping domestic violence.
But, as elsewhere, a serious shortage of low-cost housing remains. In 2008, the
Government embarked on a consultative review of the Women’s Health Services
Plan—a process assisted by a widely representative steering group. A paper,
Health status of women in the ACT, was released in 2008 as a guide to the review.
The 2008–09 Budget announced that $1 billion would be spent on an overhaul
of the ACT public health system, including $200 million to be spent specifically
on women’s services. The $90 million Women’s and Children’s Hospital is under
construction in 2011, along with a new community health centre in a newly
settled, densely populated suburb. Existing community health centres are being
expanded and refurbished.

The Northern Territory
Despite the small population of the Northern Territory, a strong women’s
movement emerged from the 1970s onwards that tended to be involved in all
women’s issues. The Family Planning Association was set up in 1973 by Jo
Parish, Lyn Reid and members of WEL. At the time, key people in the Northern
Territory Government supported women’s health and money was made available
to support interstate training for family planning staff. In 1974, legislation,
which passed by one vote, made abortion in a public hospital lawful up to 14
weeks’ gestation if there was a danger to the health of the mother or if there was
a danger of serious deformity. Early government support for women’s health
faded, however, and, as we have seen, funding was withdrawn in 1980 from the
centres that women had established in Darwin and Alice Springs.
After pressure from WEL, the Office of Women’s Affairs and Women’s Adviser
position were introduced in 1983. The office was a policy coordination unit,
located in the Chief Minister’s Department, and it works across government. The
Women’s Advisory Council was later established. There was only one woman in
the Legislative Assembly at the time and no women in cabinet, so that these
institutions, which were relatively well resourced, played important roles.
As word about the possibility of the NWHP circulated, Northern Territory
community women began to mobilise more strongly. A submission was
written to the National Agenda for Women requesting funding for a women’s
health conference, as a mechanism to begin formulating a Territory position.
The application was successful and small working groups were formed. The
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conference was held in 1989 and attracted a large contingent of Aboriginal
women. The proceedings were published and distributed to key players,
including the Chief Minister and senior bureaucrats. Widespread ignorance
about women’s health was revealed when, after the proceedings were circulated,
the Women’s Adviser received numerous calls asking what women’s health was
all about.
When the Territory began to implement the NWH Program, there was no
infrastructure in place, apart from Congress Alukura and family planning
clinics in Darwin and Alice Springs (Commonwealth of Australia 1993:46). A
struggle ensued between the Government and the women’s health movement
about how the program money would be spent. The Government wanted to
spend most of the money on consultations, whereas the movement wanted a
Northern Territory women’s health policy and the establishment of a women’s
health adviser position. Staff at the Office of Women’s Affairs felt pressured by
colleagues, who did not understand the notion of a separate focus on women’s
health or did not see value in such a perspective. Nevertheless, members of
AWHN Top End Branch felt they had been able to influence decision making. At
the time, Carmel O’Loughlin, Director of the South Australian Office for Women,
was employed as a consultant. She raised issues at senior levels of the Health
Department and managed to have these concerns accepted—testimony to the
centrality of the femocrat role in the right circumstances.
An advisory committee, consisting of one Commonwealth officer, one Northern
Territory officer and two NGO members, including an Aboriginal woman, was
set up in September 1991 to oversee the implementation of the program. The
women’s health movement proposal for a women’s health adviser position was
rejected outright at first but a change of chief minister and a turnover of senior
bureaucratic staff brought a change of direction. The Women’s Health Adviser
was appointed in 1992 and the Women’s Health Strategy Unit (WHSU), with one
funded position, was created. The Women’s Health Policy was released later the
same year. The policy has eight objectives, which include the reorientation of
mainstream health and welfare services to enable them to be more responsive to
the needs of women. One of the aims is to provide ‘direction for the development
of specialised women’s health services’ but there is no mention of communitybased women’s health centres (Government of the Northern Territory 1992).
The mobilisation of community women and the influence of the NWHP are
reported to have been the springboards for action that resulted in a Territory
policy. In turn, the policy provided a framework within which women employed
in the Government could work. Community women also found it a useful tool
for keeping pressure on political representatives, allowing them to argue for

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action on the issues that the policy enunciated. In the event, most of the NWH
Program money in the Northern Territory was used to provide sexual and
reproductive health information.
The WHSU, with its single women’s health advisor, now manager, position, has
been retained. In 2001, in response to the increasing incidence of heterosexually
acquired HIV infections by young women, the unit conducted a pilot project, in
partnership with the AIDS/STD Program of the Centre for Disease Control. The
aim was to increase awareness of the dangers of HIV among young heterosexual
women. Evaluation of the project was positive, except that the target group
thought the campaign could have been more effective had it been targeted at
young men as well (WHSU 2003). In 2004, the Health Department embarked
on a large project to assemble in one place all available information on the
health and wellbeing of Northern Territory women, with the aim of providing
a resource for policymakers, researchers and health professionals. The result
was a report, The Health and Well-Being of Northern Territory Women: From the
desert to the sea, released in 2005. The report is set within a social determinants
framework. The WHSU envisaged that the report would form the basis for a
revised Northern Territory women’s health policy (Department of Health and
Community Services 2005:2). In 2008, Building on Our Strengths, A Framework
for Action for Women in the Northern Territory, was released. Overall, however,
Northern Territory support for women’s health centres and programs has been
comparatively weak.

Violence against Women Becomes a Policy
Issue
Significant changes have been achieved in public policy and the law in relation
to violence against women since the 1970s, when domestic violence was a
private matter, apprehended violence orders (AVOs) were almost unheard of
and ‘good wives’ suffered in silence. Even among professionals, including
marriage guidance counsellors, the existence of violence in marriage was not
acknowledged and scarcely appeared in the professional literature (Mugford
1989). Under the circumstances, feminists had to identify the most pressing
issues and draw attention to basic but unrecognised anomalies, such as the
plight of women and children trying to escape violence who were ineligible for
public housing because the ‘family’ already had a public tenancy.
All States and Territories, where primary responsibility for criminal justice is
located, have taken policy action, as activism made violence against women ‘one
of the rediscovered crimes of the 20th century’ (McFerran 2007:1). The survey
below is indicative only, capturing a few of the main policies, papers, programs,
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projects and statements of intent that have been produced over the past 30
years. A review of the main policies and programs currently in operation across
Australia can be found in the background paper Time for action, produced by
the National Council to Reduce Violence against Women and their Children
(Commonwealth of Australia 2009a).
The Wran/Unsworth Labor Government in New South Wales (1976–88)
supported refuges by filling the funding gap left by the Commonwealth and
funding new refuges from its own resources (McFerran 1990:1). New South
Wales was the first State to introduce legal reform intended to improve the
remedies available to women experiencing violence. The Task Force on Domestic
Violence was set up, which reported to the Premier in 1981, and was followed by
the Crimes (Domestic Violence) Amendment Act 1982, which implemented many
of the task force’s recommendations. All States and Territories In Queensland
and the Northern Territory action was slower. subsequently enacted similar
legislation, the main thrust of which was to define the range of offences that
constitutes domestic violence and to make AVOs available in cases of violence or
where violence is feared. The onus of proof was changed to the civil standard
of the ‘balance of probabilities’, breach of a protection order became a civil
offence, rules were made to provide for the compelling of witnesses, police
were encouraged to lay charges and their powers of entry to a dwelling were
extended. This round of legislation was influenced by US, Canadian and British
reforms (Mugford 1989).
Further legislative reform took place in New South Wales in 1987, extending the
definition of domestic violence. In 1991, the NSW Domestic Violence Strategic
Plan was developed, as an attempt to coordinate government services. Reports
in the first half of the 1990s drew attention to the uncoordinated nature of
the response and, in 1996, another report, New Directions in Reducing Violence
Against Women, was released by the Department for Women and the Premier’s
Council for Women. This was followed in the same year by the NSW Strategy to
Reduce Violence Against Women (VAW Strategy), the objective of which again
was to try to provide a coordinated, whole-of-government response, focusing on
prevention. A new set of central and regional State structures was put in place.
Actions under the VAW Strategy include the Staying Home Leaving Violence
pilot project in Bega and eastern Sydney, which was extended in 2009 to six
other locations. In 2008, the Government produced a discussion paper, NSW
domestic and family violence strategic framework, as a step in the development
of a new strategic framework (NSW Department of Premier and Cabinet 2008).
Queensland women, organised as the Queensland Domestic Violence Action
Group, lobbied for government action in the 1980s. Subsequently, the Task
Force on Domestic Violence was established. It produced a report, Beyond These
Walls, in 1988, which led to the Domestic Violence (Family Protection) Act 1989,
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now the Domestic and Family Violence Protection Act. The Domestic Violence
Council was established in 1990. The 1989 Act was amended in 2003 to extend
coverage to a broad range of non-spousal relationships, including informal
care relationships, intimate personal relationships and family relationships.
Service providers were given training to equip them for the changes and were
encouraged to develop networks and share knowledge and experiences. The
Stop Violence against Women Campaign was launched in 1992 and, since then,
Domestic and Family Violence Prevention Month has been an annual event.
Concern about violence against women during pregnancy led to the development
of a domestic violence initiative in 1998 as a screening aid in antenatal clinics
and emergency departments. In 2003, the Queensland Centre for the Prevention
of Domestic and Family Violence was established to conduct research, provide
education and evaluate initiatives. A domestic and family violence strategy,
For Our Sons and Daughters, 2009–2014, was launched in 2009. Initiatives take
place under an annual program of action (Government of Queensland 2009).
The Domestic Violence Council was established in South Australia in 1985. It
produced a report in 1987 after which the Domestic Violence Prevention Unit
was set up in the Office of the Women’s Adviser to the Premier. Its purpose
was to implement the reforms suggested by the council. In the early 1990s,
South Australia promoted the formation of a network of domestic violence
action groups across the State. The groups involve representatives of agencies
and organisations working in domestic violence at the local level, including
the police, housing authorities, community corrections, charity groups, regional
health authorities and women’s health agencies (Riverland Domestic Violence
Action Group web site). Action groups include a non-English-speaking
background domestic violence group and a lesbian domestic violence group. The
Women’s Safety Strategy, which is ongoing, was released in 2005. The Whole of
Government Reference Group, involving eight departments, operates and has
convened a number of working parties, including an Aboriginal family violence
group, a culturally and linguistically diverse women’s group and a women with
disabilities group.
The Gray Liberal Government in Tasmania commissioned a report into domestic
violence in 1984, prompted by the murder by her husband of Maureen
Thompson, who had been beaten repeatedly and had eventually obtained a
restraining order, which the police had refused to accept. The subsequent Report
on Domestic Violence in Tasmania made a number of recommendations, some
of which were implemented after intense campaigning by women. The Crisis
Intervention Unit was established in the Department of Community Services in
1985. The Family Violence Act was passed in 2004, and, in the same year, the
Safe at Home strategy began, as a whole-of-government response. The program,
considered groundbreaking in terms of its focus on coordination, was introduced
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by then Attorney-General, Judy Jackson, who was passionately committed to
reform (Australian Domestic and Family Violence Clearinghouse 2006:5–8). It
combines 16 separate initiatives across four government departments. The aims
are to improve safety for those experiencing violence, change the behaviour of
offenders and focus on prevention. A consultant’s review in 2009 found that
these objectives were being partially achieved (Department of Justice 2009).
In Victoria, a domestic violence committee was convened by the Premier’s
Department in 1981, followed by a major report published by the Women’s
Policy Coordination Unit in 1985. The following year, a discussion paper on
child sexual assault was released and the Domestic Violence Incest Resource
Centre established. The Crimes (Family Violence) Act was passed in 1987, which
initiated intervention orders. At the same time, Aboriginal and Torres Strait
Islander and migrant and refugee women took action against violence in their
communities (Weeks and Gilmore 1996:144–5). In 2002, the Victorian Law
Reform Commission was asked to review the 1987 legislation. The Government
responded with the Women’s Safety Strategy (Government of Victoria 2002).
A central aim was to develop a coordinated, integrated response. To this end,
the Statewide Steering Committee was formed and it launched a report in 2005.
Endorsed by 11 ministers, the strategy focused on four areas: protection and
justice, options for women, violence prevention and education, and community
action and coordination.
In 2004, then Police Commissioner, Christine Nixon, took the lead in developing
the Code of Practice for the Investigation of Family Violence, one of the aims of
which was to provide support for aggrieved family members to stay in their own
homes. The new code resulted in a significant increase in the police issuance of
intervention orders. It also encouraged partnerships between the police and the
community. The following year, the Statewide Steering Committee to Reduce
Family Violence produced a major reform framework, entitled Reforming the
Family Violence System in Victoria. The Law Reform Commission reported on
the 1987 legislation in 2006 and recommended new legislation, focusing on the
safety of victims, with various measures to support those experiencing violence
to stay in their own homes (McFerran 2007). The Family Violence Protection
Act came into effect at the end of 2008 and replaces the 1987 legislation. The
definition of family violence has been broadened to include economic and
emotional abuse, police powers have been extended, tenancy arrangements have
been made easier to adjust and measures to encourage increased reporting have
been introduced (DVRCV 2009).
In Western Australia, awareness about the magnitude of violence against women
began to emerge in government circles in the 1980s (Murray 1999:9). The first
action in response to feminist claims was to set up the Task Force on Domestic
Violence in 1985. The task force’s report, Break the Silence (1986), made 103
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recommendations. The Domestic Violence Coordinating Committee, representing
key departments, was established to develop appropriate legislation. The
ensuing policy changes included training projects and financial assistance for
women escaping violence. In 1988, a community education campaign, Freedom
from Fear, was launched, which challenged perpetrators to take responsibility
for their actions.
The Domestic Violence Prevention Council was established by legislative means
in the Australian Capital Territory in 1986, along with the office of Domestic
Violence Project Coordinator. From that time onwards, the expectation has
been that a person acting violently would be removed from the family home.
The Domestic Violence Crisis Service (DVCS), with a 24-hour crisis line, began
operation in 1988 and was subject to major review in 1997–98. In response to
review findings that women wanted the service to support partners as well and
did not necessarily want their relationships to end, the service changed the way
it worked and the language it used, and found ways of ‘engaging respectfully’
with partners, piloting a DVCS Men’s Line (Simpson 2003:6–8).
ACT community-based services have been leaders in developing coordinated
responses to domestic violence, the value of which is now widely recognised.
The Family Violence Intervention Program (FVIP) was established to facilitate
cooperation between agencies in 1998, partly in response to perceptions that
domestic violence was not being taken seriously in the criminal justice system.
It relies on cooperation between 12 agencies, including police, the Office of the
Director of Public Prosecutions, DVCS, Legal Aid and the Office of Family, Youth
and Children’s Services. The scheme is facilitated by a steering committee,
data and evidence are presented to regular weekly meetings and protocols and
practice principles are developed, along with support systems and perpetrator
education programs. Evaluation shows the program to be highly successful and
a national leader (Australian Domestic and Family Violence Clearinghouse 2007;
McFerran 2007; Mulrony 2003b).
In response to pressure from activist women’s groups, the Northern Territory
Government produced the Northern Territory Domestic Violence Strategy in
1994, which was described as ‘all paper, no infrastructure’ (Edwards 1998:46)
because few programs were put in place and those that were, were poorly
resourced. Like other jurisdictions, the Northern Territory has legislated to
specify conduct that constitutes domestic violence, the relationships covered
and to regulate the issuance of domestic violence protection orders. The principal
piece of legislation is the Domestic and Family Violence Act 2007, amended in
2009 to provide for mandatory reporting of serious physical harm by health
workers—a requirement that is highly controversial. The Government’s rationale
is that a message is sent to the community that violence against women and
children is unacceptable. Mandatory reporting has been criticised, however,
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on grounds that there is no evidence that it improves safety, that police lack
the capacity to investigate all reported cases and that health workers might
lack the expertise to meet their obligations. A significant number of women
who experience violence oppose mandatory reporting and might therefore be
deterred from seeking medical treatment (Marcus 2008).
In sum, despite differences in policies and programs, Australian jurisdictions
have produced sets of legislative arrangements with shared features. In all
jurisdictions, courts are empowered to make AVOs and to exclude from a
shared residence the person against whom the order is made. The types of
conduct that constitute domestic violence, the relationships covered and the
penalties for breaching an AVO are all regulated and are all broadly similar. In
all jurisdictions, temporary orders can be obtained quickly and stalking is now
a criminal offence everywhere (Commonwealth of Australia 2009a). There are,
however, still significant differences in the discourses in different jurisdictions,
variations in levels of penalty and, in some places, differences in issue coverage.
For example, emotional and financial abuse and forced social isolation are not
offences in every jurisdiction (Murray and Powell 2009).
As in other areas of public policy, here, ideas frequently spread from jurisdiction
to jurisdiction. In the 2000s, for example, the importance of coordinated,
integrated responses, based on multidisciplinarity, has been recognised in
most jurisdictions. Progress has not been striking and evidence suggests there
are no easy solutions but shared approaches and frameworks do seem to be
producing results (Mulrony 2003b; Willcox 2008:4–6). Another key focus in
most jurisdictions in recent years has been on prevention (discussed further
below), where work with young people is intended to foster respectful and noncoercive relationships (Mulrony 2003a).
Aboriginal women have continued to form their own organisations, such as
Aboriginal women’s councils (Flick 1990:66), and have continued to set up their
own, often unique, services. Aboriginal Legal Services often provide specially
tailored services in relation to violence. In addition, most jurisdictions have
made some attempt to consult with Aboriginal women about their needs. For
example, following consultations in New South Wales in the early 1990s, the
Women Out West Project and the Aboriginal Women and the Law Project
were put in place (Thomas and Selfe 1992). Similarly, some efforts have been
made to better respond to the needs of women with disabilities who are at
least twice as likely to be assaulted, raped and abused as women without a
disability. In response to research undertaken by the Victorian Women with
Disabilities Network in 2008, the Government funded a policy officer position
for the network and Victorian Police have sought to use the evidence in their
review of the Police Code of Practice (Healey 2009:8–9).For an indication of
the multiplicity and variety of such programs, see the Australian Domestic and
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Family Violence Clearinghouse web site database of good-practice programs by
jurisdiction:
<http://www.austdvclearinghouse.unsw.edu.au/au_resources.
html>
Australia has been slow to act in relation to domestic homicide—an area where
policy responses began more than a decade ago overseas. Fatality reviews were
established in the United States in the 1990s, for example, with a view to finding
patterns and commonalities. In Australia, intimate partner homicides have not
declined and might be increasing (Oberin 2009:4). In response to the death toll,
Victoria established Australia’s first domestic violence review panel in 2008, led
by the Coroner’s Court. In May 2009, the Queensland Premier announced the
establishment of the Domestic Violence Death Review Panel, following a fouryear campaign by women. The panel will oversee research and provide advice
to the Government. Towards the end of 2009, the New South Wales Government
set up a permanent expert panel, chaired by the Coroner, to investigate all
domestic violence-related deaths (Barrett Meyering 2010:9–11; Pollard 2009).

Sexual Assault Enters Public Policy
Persistent efforts over the last 30 years (especially by feminists in western
contexts) have aimed to render sexual violence a visible concern by
challenging the idea that it is a private matter. (Carmody 2009:3).
After an early start and three decades of activism, sexual assault remained a
marginalised issue (Carmody and Carrington 2000:142–3). Amanda GoldrickJones (2002:123) argues that Australian feminists began to campaign for rape
law reform long before well-known American analyses of rape, such as Susan
Brownmiller’s book Against Our Will (1975), were written. Activism has
included lobbying for law reform, public shaming, developing support services,
mounting campaigns involving videos, films, pamphlets, stickers, posters and
billboards, writing books, journal articles and conference papers, doing radio
and television interviews, making community education announcements,
training professional staff and students and direct action, including street
marches and tree-planting ceremonies (Carmody 2009:3).
There are a number of reasons that feminists found it hard to keep this policy
issue on the public agenda. First, service provision and legislation are State
and Territory responsibilities, so there has been no national overview of the
sector or the problems it faces. Further, victim-blaming justifications are strong
and have persisted. Moira Carmody argues that the radical feminist analysis
of the causes of rape had to be modified before governments were prepared
to act; piecemeal reform was manageable, whereas structural transformation
was not (Carmody 1990:304). Even in professional circles, rape was often left
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off agendas of crime-prevention conferences, for example, despite knowledge
about the severe health and other problems caused. Similarly, rape is still left
off homelessness agendas, although it is known to be a major reason for young
women’s, and possibly young men’s, homelessness. It was also left off drug and
alcohol agendas, although the majority of women clients at drug and alcohol
agencies identified as sexual assault survivors (Doyle 1996:44).
Slowly and painstakingly, however, feminist activism produced policy
responses. South Australia took the lead in establishing the first review of
rape law and procedures in the mid-1970s. As a result, rape within marriage
became an offence and the definition of rape was extended. In response to
feminist agitation in New South Wales, the Premier set up a task force to inquire
into sexual violence in 1978. WEL had put forward a draft Bill, Rape and
Other Sexual Offences, written by Dr Jocelynne Scutt in 1976. The draft Bill
eventually influenced legislation in New South Wales, the Australian Capital
Territory, Tasmania, the Northern Territory, Victoria and New Zealand (WEL
NSW 2005). A child sexual abuse task force was set up in Queensland in the
mid-1980s. In Victoria, a regional network of sexual assault services is part
of the women’s health program initiated in 1987. At that time, seven centres
were already operating and an additional three were approved (Women’s Policy
Coordination Unit 1987:69). By the 1990s, policy responses in the States and
Territories included the provision of counselling servicesCounselling services
are always in heavy demand and there are generally long queues. and medical
services within hospitals (instead of being delivered by police surgeons), the
development of protocols and guidelines for providing support to survivors and
the development of training packages for professionals, including the police and
court personnel. Legislative reforms included removal of the rape-in-marriage
immunity and reform of the rules governing the conduct of trials, including
a bar on cross-examination in relation to sexual history (Carmody 1990:305;
Carmody and Carrington 2000:341; Australian Capital Territory 2005:4–6).
Persistent advocacy saw government efforts stepped up in the 1990s. The
Queensland Government launched the Women’s Health Sexual Assault Program,
a pilot, in 1991, which provided rape crisis and sexual assault support services.
Additional funding for existing and new support services was made available
in 1993–94 through the Women’s Health Prevention of Violence against Women
Program. In New South Wales, the Department of Women commissioned a study
of sexual assault trials in 1996; the ACT Law Reform Commission released a
discussion paper on sexual assault in 1997 and produced a report in 2001; the
1998 Task Force on Sexual Assault and Rape reviewed Tasmanian policies; the
Victorian Law Reform Commission completed a reference on sexual offences in
2004; and the Western Australian Government introduced reform legislation in
the same year (Australian Capital Territory 2005:6).
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While no jurisdiction has a specific policy on sexual assault and the issue is usually
considered under violence and safety agendas (Keel 2005b:4), legislation has
resulted in significant advances. Evidence about the complainant’s sexual history
is not allowed anywhere, except in the Northern Territory, where it is allowed
with the permission of the court. There are exceptions, however, depending
on relevance. Corroborative evidence is not required in any jurisdiction—that
is, a conviction may be made on the evidence of a single witness. In practice,
however, it is lawful for juries to be warned that witnesses might not be reliable.
The power of a court to subpoena documents, including those that might have
been produced in a confidential relationship between a complainant and a
counsellor, has been restricted, except in Queensland. Provisions vary from
State to State, however, and exceptions are made in particular circumstances.
In terms of defining sexual intercourse, all jurisdictions have expanded 1970s
definitions with considerable variation. Similarly, determinations of the
meaning of ‘consent’ have been brought into law everywhere but provisions are
not uniform. In some jurisdictions, the prosecution is not required to prove that
the accused knew that the complainant was not, or might not be, consenting,
whereas, in others, awareness and intention must be proven. In Victoria and
New South Wales, accused persons must now demonstrate that consent was
actively and consistently obtained. Provisions also vary in relation to incest
but in every State and Territory, sexual intercourse between close relatives is a
criminal offence (Carmody 2009:12; Heath 2005).
In terms of support for women and girls who have experienced sexual violence,
a tapestry of services—some government, some non-government—is spread
across the land. In New South Wales, major hospitals have sexual assault units,
with trained personnel who provide forensic, support and counselling services.
Evidence may be given to the police only with the complainant’s consent. The
work of the NSW Rape Crisis Centre has been discussed. There are 29 publicly
funded sexual assault services in Queensland, 20 of which are NGOs, along with
a State-wide helpline. Yarrow Place Rape and Sexual Assault Service in Adelaide
offers a full range of crisis services for adults but, as it is the only agency in
the State, country areas have limited services. Yarrow Place collaborates with
other agencies in the criminal justice system, such as the Office of the Director
of Public Prosecutions, and works in partnership with such agencies as the
Victim Support Service. Tasmania’s sexual assault support services (SASS) are
community based and informed by feminist principles. They cover the three
health system regions, offering comprehensive services, including support
services for men. All engage in advocacy and lobbying. Galileo House offers
services for children and young people up to the age of eighteen years. Victoria’s
network of 16 sexual assault centres (CASA), offers free, 24-hour emergency

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support services, including medical, legal and court support. The CASA Forum
is a State-wide agency, providing training, community education and legal
information. CASA also undertake advocacy work.
In Western Australia, the Sexual Assault Resource Centre (SARC) provides 24hour crisis services for adults in the metropolitan area who have been affected
by sexual violence within the previous two weeks. It has a State-wide mandate,
and provides referrals, a telephone consultation service for regional professionals
and education and training, including training to provide forensic services. It
chairs the Sexual Assault Services Advisory Group, on which relevant agencies
are represented. Regional services are located in the Goldfields, Albany,
Geraldton, South Hedland and in the Kimberley. A number of regional hospitals
also provide sexual assault services.
The community-based Canberra Rape Crisis Centre offers a 24-hour crisis line and
comprehensive, culturally sensitive support services, including legal services.
It meets regularly with a range of relevant agencies and engages in advocacy
work. Its executive officer at the time, Veronica Wensing, was awarded the
2009 Telstra ACT Businesswoman of the Year. Finally, in the Northern Territory,
SARC Darwin is a government centre that provides 24-hour medical services
by female doctors. There are regional offices in Katherine, Tennant Creek and
Alice Springs. Ruby Gaea Centre against Rape is run by a feminist collective and
provides extensive support and referral services for women and children.

Sexual Assault Prevention
Sexual assault prevention is a complex and challenging area for policymakers,
educators, researchers and service providers (Carmody 2009:1), but recent
research and debate have produced ‘a conceptually rich and empirically robust’
set of ideas (Clark et al. 2009:7) that are now finding a place on policy agendas.
Primary prevention aims to change the underlying causes of violence, modify
attitudes, undermine myths and create new standards of acceptability.The
notions of primary, secondary and tertiary prevention are similar to those used
in primary healthcare discourse. Primary prevention takes place before problems
occur; secondary prevention addresses groups at elevated risk or provides early
intervention in the face of early signs of violent or victim behaviour; tertiary
prevention aims to prevent a recurrence of sexual violence and/or alleviate
ongoing effects (Carmody 2009:5).
A number of prevention research and pilot projects have been initiated recently.
A sex and ethics research and violence prevention project was jointly undertaken
by the University of Western Sydney and the NSW Rape Crisis Centre between
2005 and 2008. Young people from metropolitan and rural New South Wales
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were interviewed to find out what they thought about sexuality and sexual
assault prevention education and how they negotiated sexual relationships.
Findings were that education had not prepared them for the complexity
of intimate relationships or given them positive skills. Subsequently, a sex
and ethics education program was developed to help young people navigate
relationships and develop non-violent skills. At the same time, the Violence
Prevention, Intervention and Respectful Relationships Education in Victoria
Secondary Schools Project was being conducted by VicHealth. The project
mapped the prevention programs already in operation, identified and explored
best practice in violence prevention and developed a capacity to contribute to
policy making and program design. Its 2009 report, Respectful Relationships
Education, found that some very good violence-prevention programs were
operating in Victorian secondary schools but that most were short term, did not
engage the whole school and had not been properly evaluated. An exception is
the Sexual Assault Prevention Program for Secondary Schools, developed by
CASA House. It involves a whole-of-school approach, delivers staff training,
and peer education and programs are offered to all levels, rather than to selected
groups. The aim is to promote sustainable, school-owned change (Government
of Victoria 2009b:5, 59–71).
Various primary prevention programs are now being piloted with funding
support from the Commonwealth, under its Respectful Relationships Program.
The Sex and Ethics Program, which has been developed to operate in other
settings as well as schools, has received funding to train educators and to run
groups in three non-metropolitan New South Wales locations and through
the AIDS Council of New South Wales. In Queensland, educators are being
trained through the National Rugby League to run groups with young men.
Pilot projects include the implementation of a prevention program in three
ACT secondary schools by the Melbourne Royal Women’s Hospital CASA and
Canberra Rape Crisis Centre. Provisions include professional development
for school staff, train-the-trainer peer education programs and a theatre
production. The Northern Territory Department of Education and Training
provides teacher-training programs, based on South Australia’s Keeping Safe
program. The Western Australian Departments of Health and Education are
developing respectful relationships education programs for remote-area schools
in partnership with SHine South Australia. In Victoria and Tasmania, La Trobe
University is trialling and evaluating a Respectful Relationships program for
people with intellectual and other cognitive disabilities. A variety of other State
and Territory-funded preventive programs also operates (ACSSA web site).
Another significant Commonwealth-funded project has been commissioned
by the National Association of Services against Sexual Violence (NASASV) to

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develop standards for best practice in sexual assault prevention education. Six
principles, regarded as ‘relevant, achievable and inspirational’, were produced
as a set of guidelines (Evans et al. 2009:2–3).
The primary prevention programs aiming to reduce and eventually eliminate
violence against women and girls are in their early stages and results from pilots
are not yet available; however, the distance travelled is significant when we
remember that an issue that could not be spoken about in public 40 years ago is
now ‘part of young people’s education’ (Keel 2005a:24).

Conclusion
The Australian women’s health movement has succeeded in influencing policy
in the States and Territories in many ways. Over the years, particularly in
the ‘golden’ 1980s, all jurisdictions developed and adopted women’s health
policies or strategies. Women’s health centres have continued to operate even
when Commonwealth support has been withdrawn. Services for women and
children experiencing violence have been publicly supported, although intense
and time-consuming struggles have often been required to maintain funding.
Measures to address the problems created by domestic and sexual violence
have been developed and adopted. Whereas in the 1970s there was almost no
support for women and children trying to escape from violence, many services,
well coordinated in some jurisdictions, are now available, although there are
never enough to meet demand. All jurisdictions have modernised their laws
in a number of ways. Service providers in public agencies, such as the police
force and the courts, have been trained in feminist approaches through feministdevised training modules. Surveys show that community attitudes have changed
positively in response to feminist arguments. Whereas women were once
required to ensure their own safety, men are now increasingly expected to take
responsibility for violence, including sexual violence. More recently, primary
prevention initiatives have been expanded with the aim of promoting healthy
attitudes and behaviours among the young—a project that has real prospects
for reduced violence in the future.
On the negative side, discussed more fully in Chapter 10, women’s health centres
and services are not sufficiently resourced to meet demand. In the violence
field, many projects have been one-off pilot programs, too localised to have a
significant general impact. Moreover, they often raise expectations that cannot
be fulfilled and leave a significant void when terminated. And a number of
policies can be classified as symbolic gestures, giving the impression that action
is under way but with no funded implementation plan and no follow-up.
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In the 1970s, both domestic violence and sexual assault were buried in the
private sector from whence they were extracted by feminist crusades. Yet,
of the two issues, it has been much more difficult to keep sexual violence on
policy agendas and to change attitudes towards it, even among professionals. A
recent review of sentencing and judicial comments in 2008 Victorian judgments
found that stranger rape and rape with violence were regarded as more serious
than known-offender rape and attracted heavier sentences. There was also a
disconnect between judicial comments about the enduring effects of rape by a
known assailant and the sentences applied, leading researchers to suggest that
‘judges are subject to influence by rape and sexual assault mythology’ (Kennedy
et al. 2009:19). In searching for explanations about why these myths are so
strongly held, Australia’s heavily masculinist culture, discussed in Chapter 2,
comes to mind. So, too, do the infamous statements of certain judges in relation to
acceptable sexual behaviour. Anecdotal evidence suggests that many Australian
boys are taught that ‘real men’ do not hit women whereas less, if anything, is
said about sexual violence. Perhaps part of the explanation is that ‘rougher
than usual handling’ is tacitly accepted and has its roots deeply embedded in
Australian culture.

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8. Commonwealth Policy Responses
Commonwealth receptiveness to the claims of the women’s health movement has
waxed and waned, depending on the political leanings of the party in power.
Support under the Whitlam Government was replaced with withdrawal of
funding and abnegation of policy responsibility under the Fraser Government.
Renewed support during the period of the Hawke and Keating Governments
(1983–96) saw women’s health again recognised as a legitimate national policy
sphere. The next Commonwealth Government, the Liberal-National Coalition led
by John Howard (1996–2007), was hostile to feminism and completely withdrew
from a women’s health policy role in 1997. Labor returned under the leadership
of Kevin Rudd in 2007 and brought with it a commitment to a second NWHP,
following calls from the movement for revision and revival since 1995. Thus,
the two major parties have displayed very different attitudes to women’s health.
But while the contrasts are sharp, the case is not entirely black and white: nonLabor governments have supported occasional initiatives and Labor’s support
has sometimes been less than wholehearted. Moreover, no matter which of the
parties has held power, the women’s health sector has always been seriously
under-funded. The launch of the NWHP in 1989 can be seen as the pinnacle of
the movement’s policy achievements at the national level.

Women’s Health in a Changing Society
In September 1985, more than 700 women gathered in Adelaide for Australia’s
Second National Conference on Women’s Health: Women’s Health in a Changing
Society. There they resolved that a national women’s health policy should be
developed, to be in accord with the World Health Organisation (WHO) strategy
of ‘Health for All by the Year 2000’. In particular, the policy was to be based
on the social view of health, recognising that population health is improved if
individuals and communities are able to participate in health policy decision
making (Kerby-Eaton and Davies 1985:47). The processes of policy development,
the conference suggested, should be a shared enterprise between Commonwealth,
State and Territory governments, the women’s health movement and community
groups. The resolution called for the establishment of a working party to further
the proposal. In passing this resolution, participants were returning to the first
recommendation of the inaugural National Women’s Health Conference in 1975,
which had resolved ‘that a separate policy be formulated on women’s health
needs and services’ (Commonwealth Department of Health 1978:2).

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The second resolution of the Adelaide conference called for the establishment of
a parallel national women’s health program, which would give effect to the aims
of the policy and operate within its guidelines. The Commonwealth was asked
to commit to ongoing funding.
Four years later, the world’s first National Women’s Health Policy was endorsed
in principle by all Australian health ministers in Burnie, Tasmania, on 21
March 1989. It was launched by the Prime Minister, Bob Hawke, the Health
Minister, Neal Blewett, and NSW Health Minister, Peter Collins, at Westmead
Hospital, Sydney, on 20 April 1989. Policy development had been a lengthy but
participatory process. Both the policy and the program were broadly consistent
with the principles articulated in Adelaide. State and Territory governments
had been involved in formulation and there had been extensive participation
in decision making. Estimates have it that the representatives of more than one
million women from diverse backgrounds and all parts of the country were
consulted.
The Adelaide women’s health movement members who organised the conference
knew what they wanted from it: they wanted to put women’s health firmly on
the national political agenda and they wanted endorsement for a national policy.
With that endorsement in hand, they were then able to persuade the then
Deputy Secretary of the Commonwealth Department of Health, Ann Kern, of
the validity of the proposal. Health Minister, Neal Blewett, was supportive and
was not averse to the Commonwealth taking a leading role. The Secretary of the
Commonwealth Department at the time, Bernie Mackay, previously DirectorGeneral of Health in New South Wales, was interested in health promotion.

The First National Women’s Health Policy
In November 1985, two months after the conference, the Prime Minister
announced that a national policy on women’s health would be developed, which
would partly fulfil Australia’s international obligations following the Nairobi
conference marking the end of the UN Decade for Women (Commonwealth of
Australia 1989:1). At the same time, he outlined proposals for what later became
known as the National Agenda for Women. As in so many previous consultative
processes, women’s health had emerged from the agenda consultations as a top
priority.
Liza Newby, who had been Director of the Women’s Interests Division of
Premier and Cabinet in Western Australia, was appointed Special Adviser to
Commonwealth Health Minister Blewett in 1987 to coordinate development

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of the new policy.1 The following October, a subcommittee of the Australian
Health Ministers Advisory Council (AHMAC) on Women and Health was
created to assist with the process. The original subcommittee was broadly
representative: Commonwealth representatives included the Medical Services
Adviser, a representative from the office of the minister, a representative
from the Office of the Status of Women (OSW) and a representative from the
Australian Institute of Health and Welfare. Women’s health advisers or, in some
cases, directors of medical services, represented the States and Territories. Nongovernmental membership included representatives of Aboriginal and nonEnglish-speaking background women, the Consumers Health Forum, the ACTU,
the Royal College of General Practitioners, the Australian Nursing Federation
(ANF) and the Australian Women’s Health Network. In policy machinery terms,
a Commonwealth women’s health unit had been set up by the Fraser Government
in 1978 but had been abolished a couple of years later by the Lynch razor gang,
a ministerial cost-cutting team. The new Commonwealth Women’s Health Unit
was set up in 1985.
Following informal discussions with a range of stakeholders, including service
providers, women’s groups and government representatives, Newby, with
the AHMAC Subcommittee, wrote a preliminary paper, Women’s health: a
framework for change, a discussion paper for community comment and response.
Minister Blewett, who had read a draft and contributed to the document,
released it in February 1988. Commonwealth money was allocated for an
extensive consultation process.
Responsibility for organising consultation meetings was delegated to
women’s health advisers in the States and Territories. Pre-consultation forums
were sponsored in those jurisdictions that had little or no women’s health
infrastructure at the time—namely, the Northern Territory, Queensland and
Tasmania. In some States, for example, South Australia, a coordinator, who
worked with key groups and individuals, including femocrats, was employed
to oversee consultation arrangements. Background papers were prepared for
meetings so that when the Commonwealth team met with women, there was
a level of familiarity with a range of issues. Consultations took place in both
metropolitan and rural areas, including day-long workshops, and were well
attended. More than 300 submissions were received from government and nongovernmental agencies, unions, health professionals, professional organisations,
groups of women and individuals (Commonwealth of Australia 1989:2–4).
A major effort was made to work with Aboriginal women’s groups to facilitate
participation. Special meetings were organised and, in a few cases, individual
appointments were made. Large numbers of Aboriginal women took part in
1  The position had been advertised in 1986 but had not been filled.
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the NT consultations. There was, however, a view that including Aboriginal
women’s concerns and preferences in the NWHP might detract from the work
being undertaken at the same time to develop the National Aboriginal Health
Strategy. In any case, many women thought that a separate, dedicated process
was needed to properly capture the views of Aboriginal women. Immigrant
women (or, as they were called at the time, NESB women) participated strongly
and wanted their concerns included.
Consultation organisers remember that the women who attended were
constructive and positive and put forward practical suggestions. They saw
health from a social perspective, they knew what they wanted from the health
system and they knew what was missing from the services on offer. On the
basis of the consultations and submissions, the first NWHP was written in
the second half of 1988 and in early 1989, largely by Laurie Gilbert, Director
of the Commonwealth Women’s Health Unit from 1987 until the end of 1989,
in collaboration with the AHMAC Subcommittee. A steering committee was
established to pilot the policy through departmental processes.

Obstacles Confronting Commonwealth
Femocrats
A number of difficulties beset the femocrats charged with writing the policy
and having it endorsed. The Women’s Health Unit had a very heavy workload
and it was short of staff. Many staff members were on short-term appointments
and on very steep learning curves. Some positions were approved but never
filled; even at the Commonwealth level, women in the bureaucracy are reported
to have been ‘very wary’ of moving to an area with a feminist label, fearing
that career advancement would be jeopardised. The result was that the team
writing the NWHP was smaller than intended. Moreover, the unit had to deal
with ordinary departmental work as well, which included responsibility for
producing input to the women’s budget statement, responding to ministerial
questions and the requirements of interdepartmental committees and producing
all the preliminary report documents that went to AHMAC.
Another problem was simple disruption. There were three reorganisations
of Commonwealth government departments during the development and
implementation of the policy. Having been called the Department of Health
since its foundation in 1921, the department had three different names in the
second half of the 1980s, there were three different departmental heads and the
Women’s Health Unit had four division heads and three different locations. These

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changes made the job of Commonwealth femocrats difficult. The continuity
necessary to drive reform processes was difficult to achieve in rapidly changing
circumstances.
Two of the policy’s key supporters in the Commonwealth Department, the
Secretary, Bernie McKay, and the Deputy Secretary, Ann Kern, both left in 1987,
at the beginning of the development phase. As at the sub-national level, for
many senior bureaucrats, women’s health was not a high priority and was a
contentious issue for others. Moreover, policy changes were being made on the
basis of what women said (during consultations), which was a departure from
standard practice that was not widely accepted. Traditionally, experts made
policy, in what they knew to be in everyone’s best interests, advised by organised
medicine in processes that were generally secret. In addition, departmental
officers were concerned about opposition from organised medicine and a real
effort was made to get the support of medical unions. In this, Dr Cathy Mead,
Chair of the Working Group of the AHMAC Subcommittee on Women and
Health, played a crucial role. She is medically trained, understands the issues
and, broadly, succeeded in containing medical opposition. Christine Giles,
Manager of the Victorian Women’s Health Policy and Programs Unit and also a
member of the AHMAC Subcommittee Working Group, is said to have been able
to persuade key Commonwealth bureaucrats to support the project. That Health
Minister Blewett offered positive support was crucial to the outcome. The whole
process was timed around elections in order to gain maximum political mileage
for the Commonwealth. Completion was scheduled to be in time for the budget
cycle preceding the 1990 election.
It is reported to have been touch and go whether Australia’s health ministers
would endorse the policy and there was uncertainty about whether meaningful
sums of money would be allocated to the program. Budget decisions the
previous year did not inspire confidence. Proposals had been made to fund
projects identified as needed in NWHP consultations but none was successful
(Szoke 1988:33). Femocrats and AHMAC Subcommittee members worked hard
to generate support for funding. They held meetings with the Women’s Caucus
Committee of the Federal Parliamentary Labor Party. Labor women could then
inform women in their constituencies of progress, maintaining momentum. A
great deal of lobbying was done, which included discussions with State and
Territory health ministers and senior departmental officers. This laborious
process eventually brought about a significant change in attitudes.
The change, however, was not enough to transform women’s health into a highpriority item; participants remember a budgetary allocation process that was
completely ad hoc. The Women’s Health Unit was required to put up costing
proposals for the 1988–89 Budget, on the understanding that initiatives in all five
action areas would be funded. The cost was to be $100 million over five years, to
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be shared between the Commonwealth and the States and Territories—a modest
enough proposal. A women’s health branch of the Commonwealth department
was also to be established to implement the program. In the event, only the first
three action areas were funded. Combined Commonwealth, State and Territory
funding totalled only $33.72 million over four years or just under $8.5 million
per year (Commonwealth of Australia 1993:6). Given that Australian health
expenditure between 1989 and 1993 averaged $32.09 billion per year (AIHW
1997:2), this was a tiny sum of money.
The proposed Women’s Health Branch was never established. An additional
$6 million for alternative birthing services, $3 million for the provision of
reproductive health services in rural areas and $1 million for breast and cervical
screening programs were allocated. In States with relatively small populations,
the amount of money for specific services was ridiculously small. For example,
in Western Australia, the total Commonwealth funding for the alternative
birthing services program was $35 000.

Infrastructure Established under the NWH
Program
The NWH Program was initially funded for four years, following which
funding of $59.512 million or just less than $15 million per year was approved
for a second four years—a modest increase. The projects that were funded
were enormously diverse and varied considerably from place to place, partly
depending upon the infrastructure already established. As a cost-shared
program, Commonwealth/State/Territory assessment committees were formed
in each jurisdiction to recommend the funding of selected projects to ministers.
Community support had to be demonstrated before funding would be approved.
The terms of reference of the AHMAC Subcommittee were altered to allow it to
take responsibility for monitoring and overseeing implementation.
A number of national projects were undertaken in the first four years, mainly
in professional training and education. These included an education package
for schools, focusing on the effects of sex-role stereotyping; an education kit
for general practitioners, with fact sheets in 10 languages; a general practitioner
education project, intended to improve knowledge of women’s health issues; a
continuing education package for nurses, focusing especially on rural and remote
area work; and a distance learning package for midwives (Commonwealth of
Australia 1993:23–7). During the second four years, the national effort consisted
of small projects, including continuing education for general practitioners, the

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development of outcomes and performance indicators for women’s health and a
collaborative services project for older and isolated women (Commonwealth of
Australia 1997:109–17).
Of the States and Territories, New South Wales had the most extensive women’s
health infrastructure. Instead of establishing new centres and services, a number
of mainstream reforms were introduced, including the establishment of regional
women’s health coordinators, ethnic obstetric liaison programs, Aboriginal
antenatal outreach, multicultural family planning and health services for older
women. Twenty-eight of the 89 projects were directed towards the needs of
rural women (Commonwealth of Australia 1993:28–32). During the second four
years, funding was mainly allocated to continue the innovations of the first
four years; however, a small number of NGO services were funded, including
family planning and rape crisis services, information for immigrant and refugee
women and services for Aboriginal women (Commonwealth of Australia
1997:19–20). One of the programs was the Aboriginal Maternity Service, located
in the northern NSW town of Tamworth, providing antenatal, intrapartum
and postnatal services for Aboriginal women and non-Aboriginal women with
Aboriginal partners. Among its health-promotion activities were support for
breastfeeding and information about good nutrition, exercise and the benefits of
smoking cessation. An infant immunisation rate of 100 per cent was achieved.
In keeping with tradition and grandmothers’ stories, the message was that
Aboriginal women are ‘the best nurturing mothers in the world’ (Nichols and
Hurley 1999:24–8).
In Queensland, where the existing women’s health infrastructure was limited,
the focus was on funding separate women’s health services, as discussed in
Chapter 3. In addition, the Mobile Women’s Health Service was funded, staffed
by 15 women’s health nurses trained to work as independent practitioners.
Service provision included reproductive health services, together with
counselling, stress management and preventive health education. A number of
smaller projects were also funded (Commonwealth of Australia 1993:35–7). In
the second four years, 97 per cent of the funding was allocated to Queensland’s
eight community-based women’s health centres (Commonwealth of Australia
1997:22–3).
In South Australia, services for women living in non-metropolitan areas
were identified as the top priority. The Country Women’s Health Services
Advisory Group was set up in 1990, replaced with the broader State Steering
Committee in 1991, which met monthly to oversee proposal development and
implementation. Clinical and health promotion services for rural and remote
women were funded, community women’s health nurses were employed and
the Women’s Health Business Project for Aboriginal women was undertaken. A
‘008’ women’s health information line was introduced, along with a newsletter,
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Stating Women’s Health (Commonwealth of Australia 1993:41–3). During the
second four years, funding continued for services for women living in rural and
remote areas, and, in all, 17 Country Women’s Health Services were set up, all of
which were integrated into existing services. Each service was required to have
a Women’s Health Advisory Committee, facilitating discussion and community
participation. A number of respondents to the evaluation questionnaire rightly
identified the low level of funding as a major obstacle to achieving program
goals (Commonwealth of Australia 1997:23–5).
The first two years of the program in Tasmania focused on local research to
identify needs, followed by seed funding for a range of one-off programs,
intended to be innovative and participatory. A strategic planning document
was produced, with identified priorities and plans for regional women’s health
programs. The Health for Women in the Workplace project, the Flinders Island
Women’s Health Project, the Centre for Excellence in the Middle Years Project
and the Social Health Project were set up (Commonwealth of Australia 1993:43–
6). Ongoing funding for the Hobart Women’s Health Centre was provided in the
second phase, along with the employment of three Regional Women’s Health
Coordinators whose responsibilities included service development, training,
advocacy for mainstream sensitivity to women’s needs, information provision,
consultation, initiation of best-practice models and policy advice. Each region
of the State developed a Women’s Health Strategic Plan (Commonwealth of
Australia 1997:26–8).
The NWH Program enabled Victoria’s network of women’s health services, set
up under the Victorian Women’s Health Program, to be expanded. The network
of sexual assault services was also extended to provide after-hours cover and to
cater for the needs of rural areas. The Multicultural Centre for Women’s Health
received additional funding for information services, along with Healthsharing
Women. Other projects included support for Greek women who suffered mental
illness, an older women’s housing project, a service mapping project, an access
and equity program for immigrant and refugee women needing to use sexual
assault services, a good practices in mental health project and statistics and
evaluation framework projects (Commonwealth of Australia 1993:32–5). Support
for this network of services continued in the second four years.
Western Australia, as we have seen, did not come into the program until 1991.
All the State’s women’s health centres except Perth’s original centre and the
Fremantle multicultural women’s health centre were established with NWH
Program funding. New regional sexual assault centres were also established and
existing ones expanded. Women’s health information services were set up and
a variety of quality-assurance, research and data and service development and
monitoring projects was introduced (Commonwealth of Australia 1993:38–40).
In the second four years, support continued for women’s health infrastructure
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so that by 1997 the program was funding five sexual assault referral centres
in regional areas and 11 community-managed women’s health centres in both
metropolitan and rural locations (Commonwealth of Australia 1997:25–6).
Effectively, only one project, a community-controlled women’s health centre,
could be financed from the funding available to a small jurisdiction such as
the Australian Capital Territory. Nevertheless, the opening of the centre was
cause for jubilation among activists. Tiny amounts of money were provided
for information provision, which included pamphlet and booklet production,
translation of information material into languages other than English and a
limited number of community workshops (Commonwealth of Australia 1993:49–
50). Funding distribution in the second four years replicated that in the first. In
the Northern Territory, there were few dedicated women’s health services before
the program and this situation was maintained. Program grants were advertised
in 1991 and projects funded include the Aboriginal and Torres Strait Islander
Women’s Health Service in Darwin, with another in Tennant Creek, a cervical
cancer screening program for Aboriginal women, the establishment of a carers’
network and a project supporting the development of culturally appropriate
health-promotion services by Aboriginal health workers. Family Planning NT
received money to provide reproductive and sexual health education forums
for young people. The AIDS Council of Central Australia was funded to employ
a women’s HIV/AIDS project officer, and the Wunara Aboriginal Corporation
received money for the ‘Beat the Grog Signs’ project (Commonwealth of
Australia 1993:9). In the second four years, a total of 39 projects were funded,
approximately half of which were managed by community-based organisations
and the other half by the Territory Health Service. As in the Australian Capital
Territory, in the Northern Territory, the amount of money available was small
(Commonwealth of Australia 1997:28–30).

Criticisms of the Policy and Program
Apart from criticisms of the inadequacy of program funding, some women
felt that the NWHP and the NWH Program reflected the concerns of AngloAustralian, middle-class women. Whatever the validity of the view, projects for
a diversity of cultural groups were funded. It is true, however, that the concerns
of Aboriginal women were largely left aside, as discussed. Regrettably, the
National Aboriginal Health Strategy, which was meant to address Aboriginal
women’s health, was never sufficiently funded or effectively implemented.
A 1994 evaluation found gross under-funding by all governments, lack
of accountability and lack of political support for the National Council of
Aboriginal Health, which had been established to oversee implementation. The
evaluators recommended that the Commonwealth renew its commitment to
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the principles underpinning the strategy, that it accept the holistic Aboriginal
view of health and that it recognise the importance of local community control
(Commonwealth of Australia 1994:2–3).
Immigrant and refugee women were positioned differently but the long-term
outcome was no more satisfactory. As part of the National Agenda for Women,
the Commonwealth–State Council on NESB Women’s Issues was established in
1989 (Commonwealth of Australia 1991:66). The council chose health as its first
priority, not because the health of immigrant women was not addressed in the
NWHP, but because it was felt that the special health problems faced by NESB
women warranted a dedicated strategy. Thus, it produced the National NonEnglish Speaking Background Women’s Health Strategy (NESBWHS) in 1991.
The main concerns identified were high rates of workplace-related illnesses
and injuries and a higher than normal incidence of poor mental and emotional
health. The strategy was intended to complement the NWHP (Commonwealth
of Australia 1992:xi–xxxiii). Like the NWHP, the strategy took a social view
of health, offered a strong critique of conventional medical care and advocated
inter-sectorality.
This strategy, too, failed to attract resources and became essentially ‘an unactioned information document’ (Schofield 1996: 30–5). On the basis of
major presentations, the Third AWHN National Women’s Health Conference
recommended that the strategy be updated and implemented (Davis et al.
1996:13–14). No action was taken, however, and soon afterwards, the Keating
Labor Government lost office.

The Indirect Impact of the NWHP
The existence of a national policy, endorsed by all State and Territory health
ministers, strengthened the position of local-level femocrats and the policymakers
who supported them. They were able to argue that the principles and priorities
of State and Territory women’s health policies and strategies should be in line
with those of the NWHP. The national policy also provided protection for
women’s health infrastructure. For example, one of the first acts of the newly
elected, neo-liberal-leaning Greiner Government in New South Wales was to
review Health Department-funded NGOs, which raised fears within the sector.
Shortly afterwards, however, government statements endorsed the principles of
the NWHP: national recognition of the claims of the women’s health movement
produced a stronger level of legitimation than would otherwise have existed.
Jennifer Cashmore, former SA Minister for Health, who overcame opposition
and secured agreement to begin work on a women’s health policy, attested to
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the importance of the national policy’s influence. In her view, her party’s policy
developed for the December 1993 SA election would have been unthinkable had
it not been for the NWHP.
Perversely, however, the existence of the NWHP could be used to justify
inaction when the political climate was unfavourable. For example, in 1996–97,
femocrats in Western Australia who had developed proposals for a State women’s
health policy were told this was not a priority and, furthermore, that there was
no need for a State policy since the national policy had been endorsed.

Domestic Violence and Sexual Assault Enter
the Commonwealth Policy Agenda
The first Commonwealth policy directly addressing domestic violence was part
of the National Agenda for Women. It was the three-year National Domestic
Violence Education Campaign (NDVEC), run by OSW and judged ‘very successful’
by the Agenda Implementation Report. At the same time, a survey was run to
plumb attitudes to domestic violence. A high level of social sanctioning was
found: one in five people considered physical violence by a man against his wife
to be acceptable sometimes, more than half thought it was okay to yell abuse
and one-third still thought it a private matter (Laing 2000:4). The campaign
raised community awareness of violence but because violence support services
received no additional funding, service providers were ‘stretched to the limit’.
One set of evaluators argued that action as well as rhetoric was needed from the
Commonwealth (Earle et al. 1990:4–6).
In 1990, the National Committee on Violence against Women was established
by the Keating Government, with a budget of $1.35 million over three years, or
$45 000 a year. The committee was charged with covering all forms of violence
against women, initiating research and undertaking education work, with
special emphasis on the requirements of groups with special needs, all with a few
thousand dollars a year. A position paper was produced in 1991 (Commonwealth
of Australia 1991:63–4) and the National Strategy on Violence against Women
was introduced in 1992. Its aims were to share information and coordinate the
policies, programs, law enforcement and legislation in the different jurisdictions.
It had no programs of its own nor did it provide funding for the States and
Territories, which were expected to continue to support their own programs and
any new initiatives that might be proposed. Heads of government were asked to
deliver annual statements on eliminating violence against women. The strategy,
which, with so little funding, was more of a public relations exercise, ran until
the Government lost office in 1996. The Women’s Safety Survey conducted in
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1996 by the Australian Bureau of Statistics (ABS) showed that 7.1 per cent of
Australian women had experienced an act of violence in the previous 12 months
(Commonwealth of Australia 1996).
The next Commonwealth initiative was the Howard Government’s Partnerships
against Domestic Violence (PADV), introduced in 1997; $50.3 million was
committed over the six years to 2004. Again, one of the objectives was to encourage
Commonwealth, State and Territory coordination, not that the Commonwealth
had many activities of its own at this point. New project funding was provided,
which was intended to be seed money for prevention research. An additional
$25 million was committed, primarily to set up the Australian Domestic and
Family Violence Clearinghouse, which publishes newsletters and papers on key
issues and new initiatives. PADV was criticised both for its location within a
conservative discourse and for the paucity of its funding (Chappell 2001:66–7).
Ruth Phillips (2006) argues that the results of the 1996 Women’s Safety Survey
‘compelled’ the Howard Government to maintain a policy on violence against
women but that the terminology was changed to ‘family violence’, ‘family
dysfunction’ and ‘family breakdown’, suggesting that violence was not primarily
‘against women’, thereby obscuring the links between gender and power.2 This
shift in terminology can be seen as an example of what Howe (2009:28) calls the
act of ‘disappearing’ men’s violence, in a context where ‘it’s still not permissible
to name it as such’. Men and women, outside feminist forums, she argues, still
engage in denials and disavowals. Nevertheless, funds were provided, including
for projects in Aboriginal communities and for early intervention for children
at risk. After three years, PADV is said to have run out of political steam and no
major Commonwealth announcements were made between 1999 and 2003.
The next Commonwealth initiative was a community awareness campaign,
‘Violence against Women, Australia Says No’, launched in 2004, after delays
during which the Prime Minister is reported to have altered the language. The
campaign operated through TV, cinema and magazines. It provided a 24-hour
helpline and resources in secondary schools (Carrington and Phillips 2006).
Community education materials were also made available through the PADV
web site. Phillips concludes that, while PADV acknowledged violence as a
problem and funded some worthwhile projects, ‘both the discourse and the
practice’ undermined the potential for the long-term structural and attitudinal
change that is necessary to reduce violence against women (Phillips 2006:214).
Previous Commonwealth anti-violence strategies had included sexual assault
but the Howard Government moved to address the two separately. It launched
2  Many Aboriginal women prefer the term ‘family violence’ because it covers the full range of traumas that
individuals and families suffer, including domestic violence, rape, child abuse and spiritual and cultural abuse
(Lester 1992:38).
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the National Initiative to Combat Sexual Assault in 2001, under which the OSW
commissioned consultants to undertake research on the criminal justice system
and sexual assault, with a view to developing a framework for sexual assault
prevention. An international literature review on assaults against females
sixteen years of age and older was followed by analyses of existing research in
Australia, the United Kingdom, Canada, New Zealand and the United States.
The Australian Centre for the Study of Sexual Assault (ACSSA) was set up under
this initiative. ACSSA provides information to assist policymakers and develops
evidence-based, prevention-oriented strategies. All forms of sexual assault are
investigated but there is a focus on women and girls over fifteen years of age
and adult survivors of child sexual assault (Commonwealth of Australia 2004a;
Carrington and Phillips 2006).
In 2005, the Commonwealth announced that PADV had concluded and would
be replaced with the Women’s Safety Agenda, which was to include both
domestic violence and sexual assault. The program would have $75.7 million
over four years and would build on the groundwork of PADV and the National
Initiative to Combat Sexual Assault. Under the agenda, funding was continued
for the Australian Domestic and Family Violence Clearinghouse (Carrington and
Phillips 2006). Towards the end of its term of office, the Howard Government
introduced significant changes to the Family Law Act that have implications for
women and children experiencing violence. Said to be the result of lobbying by
fathers’ rights groups, the changes introduced shared parenting after separation
and mandatory participation in dispute resolution. The changes have been
heavily criticised for putting parental rights, particularly fathers’ rights, ahead
of the rights of children. Mediation is not required in cases involving violence
or child abuse. However, because violence and abuse are often difficult to prove
and the consequences of unproven accusations can be heavy, there is concern
that many women refrain from speaking out (DVRCV 2008).
The Rudd Labor Government, elected in 2007, appointed the National Council
to Reduce Violence against Women and their Children (hereinafter called the
National Council), in May 2008, thereby fulfilling an election promise. The
then Prime Minister, who had been involved in domestic violence policy
development in Queensland in the early 1990s, was committed to action and
in the early 2000s, he became a White Ribbon Ambassador. The Minister for
the Status of Women, Tanya Plibersek, was equally committed, and the White
Ribbon campaign had close ties with her office. The National Council was
appointed for a year to provide advice on the development of an evidence-based
national plan. It undertook research and consultations with approximately 2000
stakeholders. A five-part report, Time for Action: The National Council’s plans
for Australia to reduce violence against women and their children, 2009–2021,
was released in April 2009. On the release of the report, the Government agreed
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to act on 18 of the 20 priority recommendations. It also agreed to develop a
national plan through the Council of Australian Governments (COAG) because
many of the council’s recommendations require cooperative action between
levels of government.
The new funding commitments were $12.5 million for a 24-hour, seven-day-aweek telephone and online crisis service, $26 million for primary prevention
projects, including $9.1 million over five years for the respectful relationships
program and $17 million for a public information campaign. Some $3 million was
allocated for research on nationally consistent laws and perpetrator programs.
These are not large funding commitments and WWDA has requested clarification
about possible overlaps with previously announced funding (Parkinson 2009:6).
The Australian Law Reform Commission has been asked to work with State and
Territory law reform commissions to examine the interrelationship of relevant
laws. The Violence against Women Advisory Group was appointed for two
years from September 2009, to advise on issues raised in the council’s report
and to oversee the establishment of the National Centre of Excellence, which
will evaluate the effectiveness of strategies, improve best practice and support
workforce development.
The National Council’s report and the Commonwealth’s commitment to action
have been welcomed by women’s movement spokeswomen, who are cautiously
optimistic about the potential for valuable outcomes. The council has been
commended for the quality of its work. The personal commitment and statement
of zero tolerance made by then Prime Minister Rudd were both well received.
The reform project is seen as ambitious but Commonwealth leadership on
violence against women and girls, including sexual assault, is regarded as well
overdue. According to Julie Oberin, longstanding movement activist and Chair
of WESNET, the Rudd Government’s approach to domestic and family violence
and homelessness ‘has for the first time in history, the capacity to radically
address decades of neglect in these fields’ (Oberin 2009:2). She acknowledges,
however, the enormity of the problems and the huge obstacles to be overcome.
In February 2011, the National Plan to Reduce Violence against Women and
their Children was launched. It is intended to be a framework for a single,
unified strategy for the next 12 years (Commonwealth of Australia 2011d). Six
national outcomes have been formulated, which are that communities are safe
from violence, that relationships are respectful, that Indigenous communities
are strengthened, that services meet the needs of women and their children
experiencing violence, that justice responses are effective and that perpetrators
stop the violence and be held to account. The document incorporates the first
three-year plan, which will focus on prevention. Proposed actions are support
for local community work to reduce violence against women, commitment to
the continuation of the respectful relationships education program in schools,
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telephone support for frontline workers, perpetrator programs with their own
national standards, a national centre of excellence that will focus on evaluation,
the continuation of Personal Safety and Community Attitudes Surveys to track
the effectiveness of policies and an Australian Law Reform Commission inquiry
into the impact of Commonwealth laws. There is also to be a national recognition
scheme for domestic and family violence orders, including a national database.
Outcome six proposed by the National Council—that systems be made to work
together effectively, through coordinated, evidence-based responses—has been
dropped from the national plan. It is much too early to evaluate the impact of
the Plan which will depend on levels of political commitment and resources.

Responses to Violence in Aboriginal
Communities
Violence in Aboriginal communities and the destructive impact of colonisation
are well documented. Aboriginal women and members of their communities
have continued to work in their own ways on what many, but not all, call
‘family violence’. Larissa Behrendt has compared the characteristics of
Aboriginal dispute-resolution mechanisms with those of the British legal
system. She explains that Aboriginal approaches encourage the participation of
all community members who feel they have an interest in either a dispute or its
outcome and that resolution processes take place before the family and/or the
community, acknowledging the social context of dispute resolution (Behrendt
2002). Thus, even if Aboriginal people trusted the criminal justice system, many
would approach family violence quite differently. In general, the facilitation of
community responses is preferred, with a focus on healing families, rather than
punishing individuals. In some approaches, male perpetrators are integrated
back into their communities after punishment, treatment and healing (Keel
2004; Memmott et al. 2006).
Among the initiatives that women have had a part in developing are night
patrols, initiated in the Northern Territory as a self-policing mechanism and
later adapted and modified in other places. Night patrols assist in ensuring social
order, preventing potentially violent situations and assisting the vulnerable. By
2003, they were described as ‘a distinctive feature of the community landscape
in Indigenous Australia’ (Blagg 2002:200; Blagg and Valuri 2003:7).
Other women-led responses include constructing family healing centres instead
of refuges, establishing shelters on women’s law principles, which render them
out of bounds for men, and using sacred objects in women’s spaces as a deterrent
to male violence. Traditional women’s business has been reinstated in some
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settings as a dynamic factor in community life, along with the reinforcement
of grandmother law, under which senior women become involved in dispute
resolution, sometimes through mediation (Blagg 2002:4).
While some projects are women-only initiatives, others involve both men and
women. The Aboriginal and Islander Health Worker Journal has published
annotated indexes of Indigenous health information, which provide an
overview of health projects up to 2008. Other responses include mentoring
schemes, worker gatherings for networking and sharing knowledge, theatre
projects around family violence and community-controlled counselling projects
oriented towards social and emotional health (Memmott et al. 2006).
All Australian governments have funded projects intended to address violence
in Aboriginal communities. The main Commonwealth initiatives in recent years
include the Family Violence Prevention Legal Service (FVPLS) program, first
established as a pilot project and an initiative of the Aboriginal and Torres Strait
Islander Commission (ATSIC) in 1998. The initial aim was to meet the legal needs
of victims of family violence. The program provides assistance predominantly to
women and children. In 2004–05, on the abolition of ATSIC, control passed to the
Commonwealth Attorney-General’s Department, after which the program was
expanded, both in services and in functions. It was extended again in 2006–07,
and since that time 31 community-controlled services have been funded. The
Early Intervention and Prevention Program was added and the program now
provides counselling, practical support and assistance, information regarding
support services and referrals. Educational and community-awareness projects
and early identification and prevention strategies have also been developed. In
2006, 5717 clients presented themselves to the Family Violence Prevention Legal
Service (FVPLS) (Commonwealth of Australia n.d.).
Under PADV, there were new initiatives for Aboriginal people. The first was
the National Indigenous Family Violence Grants Program (NIFVGP), which ran
between 1999 and 2004 and provided funding for 74 community-based projects.
The principles of cultural appropriateness, holism, intersectorality, local
community control and leadership and community development were embedded
in the design. Following this, FaHCSIA funded a number of programs including
the Family Violence Partnership Program (FVPP) and the Family Violence
Regional Activities Program (FVRAP). Under the FVPP, the Commonwealth
contributed $37.3 million over four years, and through agreements with the
States and Territories family violence and child-protection initiatives were put
in place. Under FVRAP, support was provided for grassroots projects that had
been identified in communities and operated through centres called Indigenous
Coordination Centres. FaHCSIA also ran a number of other programs, including

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the Stronger Families and Communities Strategy and the Family and Community
Networks Initiative. In addition, COAG ran trials in eight community locations
in 2002 and 2003 (Memmott et al. 2006).
This is not the place to discuss the contentious NT National Emergency Response
introduced by the Howard Government in 2007 and continued by the Rudd and
Gillard Governments. As a top-down policy, however, there is wide concern that
it ignores the demonstrated principles of best practice. Experts argue that the
program flies in the face of evidence that successful programs are built from the
ground up in collaboration with communities (Kelleher 2009:13–14). Evaluation
of the NIFVGP, for example, showed that projects to address family violence are
best developed, driven and nurtured by Aboriginal people at the community
level (Memmott et al. 2006:22).
According to Hannah McGlade, a Perth-based Aboriginal human rights lawyer,
the new national plan needs to go much further than the recommendations
made in the council’s report. She recommends three specific strategies: the
establishment of a national research and capacity-building agency, specifically
addressing violence against Aboriginal women, to be located within the proposed
National Centre of Excellence; the placement of the victims of violence at the
centre of proposed healing centres; and the funding of Aboriginal women’s
legal services in all Australian jurisdictions rather than relying on the erroneous
notion that mainstream services can serve the needs of Aboriginal women and
children. McGlade argues that the new national plan ‘must unequivocally
recognise and affirm that Aboriginal women play a central role in ending the
violence’ (McGlade 2010:4–5).
The national plan does recognise the centrality of Aboriginal women in reducing
violence:
The National Plan is focused on supporting Indigenous communities
to develop local solutions to preventing violence. This includes
encouraging Indigenous women to have a stronger voice as community
leaders and supporting Indigenous men to reject violence. Improving
economic outcomes and opportunities for Indigenous women are critical
to reducing violence. (Commonwealth of Australia 2011d:20)
As mentioned, the third national outcome of the plan is that Indigenous
communities are to be strengthened; however, as in so many other cases, results
will hinge largely upon whether resources are made available to pursue these
objectives.
The women’s health movement has been able to influence a number of other
Commonwealth policies, the most important of which are reviewed briefly
below.
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Better Health Policy
The movement succeeded in having the terms of reference of the 1985 Better
Health Commission expanded. The commission was established to examine the
health status of Australians and to recommend national goals for improvement.
Originally, its terms of reference asked it to report on ‘the major preventable
health problems of women in their reproductive years’; however, the minister
agreed to extend the terms of reference to include the ‘health problems of
women of all ages’, after the 1985 National Women’s Health Conference. Women
on the commission, including Dr Janet Irwin, argued for a comprehensive,
social view of women’s (people’s) health and women at the grassroots level were
able to make contributions. Ultimately, the commission, which reported in
1986, endorsed the WHO ‘Health for All by the Year 2000’ initiative. When it
came to addressing the question of ‘why women’s health should be given more
consideration than men’s health’, it decided, however, that women’s illnesses
were not different from those of men but that women’s health needed attention
because it did not get proper consideration from a ‘male dominated health care
system’ that excluded humane and caring values (Commonwealth of Australia
1986a:147–8)!

Women’s Health Research
Research and data collection formed one of the five priority areas of the NWHP
but, initially, no funding was provided. In 1989, however, the Commonwealth
Department of Community Services and Health funded a workshop, which
was asked to develop a list of research priorities as a guide to funding under
the Health and Community Services Research and Development Grants (Broom
1990). Subsequently, and just before the 1993 election, Prime Minister, Paul
Keating, announced that the Commonwealth would fund a major longitudinal
study on women’s health. Submissions were called and a contract awarded
for the project, later renamed Women’s Health Australia. It received its first
resources in 1995 and is managed by a multidisciplinary team of researchers
from the Research Centre for Gender, Health and Ageing at the University of
Newcastle and from the University of Queensland (Lee et al. 2005). The aim is to
collect data and evidence that can be used to inform policy.
The study involves three age cohorts and includes more than 40 000 women
over 20 years. It examines attitudes and lifestyles, together with the biological,
psychological, social, economic and lifestyle factors that influence health
outcomes. Women’s use of time is studied, including the impact of paid and
unpaid work, family roles and leisure. It also identifies women’s health-service
needs and evaluates the adequacy of the services on offer. Findings are released
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regularly. The only new funding announced with the 2010 NWHP is $5.3 million
to enable the project to recruit a cohort of younger women—an extension that
AWHN and the movement had supported for some time.

Policy Responses to Trafficking
In 1999, the Howard Government introduced legislation amending criminal
code provisions on slavery. The new legislation imposes penalties on people
responsible for bringing women into Australia under ‘slavery-like’ conditions.
Prosecutions under the new law were slow but, in 2008, the High Court found a
brothel owner guilty of slavery. Further prosecutions followed in Victoria. The
Howard Government replaced deportation with the offer of temporary visas for
women willing to help police and made provision for some support services.
Significant problems with the visa system remained, however, and, in 2009, the
Commonwealth introduced further reforms. Project Respect has worked for all
these changes and now advocates legislative reform that will allow trafficked
women to receive compensation. It wants to see programs introduced to alter
attitudes and for sex slavery to be incorporated into violence-prevention
policies (Maltzahn 2009). The Victorian Parliament’s Drug and Crime Prevention
Committee held an inquiry into People Trafficking for Sex Work and tabled its
final report in June 2010. It made some 30 recommendations, including that a
whole-of-government Sex Industry Regulation, Policy and Coordination Unit be
established in the Department of Justice.

Women with Disabilities and Public Policy
The influence of women with disabilities on Australian policy has been
disappointing, despite the tenacity and professionalism of members of Women
with Disabilities Australia (WWDA), which received one of four National Violence
Prevention Awards in 1999. The association campaigns on an expanse of issues
and produces valuable resources. It has worked extensively on violence against
women with disabilities, for example, and has produced reports, action plans,
model processes and national information kits. Spokeswomen draw attention to
the fact that their concerns are regularly overlooked by the disability movement,
the women’s movement, the women’s health movement and by governments at
all levels (Howe 1999; Meekosha 1990, 2001; Tilley 2000). Meekosha (1990:36–7)
argues that the uncritical acceptance of physical strength and self-reliance by
feminism has had the effect of excluding some women while, at the same time,
many doctors and others hold a view that women with severe disabilities should
not be mothers. Margaret Cooper and Diane Temby (1995) point out that even
under the first NWHP and Program, women with disabilities were ‘relatively
marginalised’.
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Some commentators explain this situation by pointing to the low status
generally accorded women with disabilities. Chenoweth (1997:26) has argued
that this group of women is so devalued that they are denied even a sexual
identity and exist in a state of ‘extreme marginalisation’. WWDA works to
undermine the multiple surrounding myths, many of which controvert basic
human rights. Myths include the claim that women with intellectual disabilities
are promiscuous, that they should not have children because they are not fit
mothers and that sterilising women with disabilities will protect them from rape
(Chenoweth 1993:4).
Recent research confirms that there are still major knowledge gaps about the
experiences of women with disabilities, including the experiences of Aboriginal
and immigrant and refugee women, and major gaps in policies and available
services (Healey 2009:8). In terms of public policy responses, Tilley (2000) points
out that although women with disabilities are often mentioned in the preambles
of policy documents, they are nevertheless almost entirely ignored when it
comes to developing and funding appropriate programs. Certainly, disability
policies in Australia have consistently failed to apply a gender lens. Most have
proceeded on the assumption that men and women experience disability in the
same way and that there is therefore a common set of issues.
Governments have enacted legislation with the aim of benefiting people with
disabilities. The national Disability Discrimination Act was passed in 1992,
which provides protection for men and women against discrimination on the
basis of disability. A set of standards specifying rights and responsibilities about
equal access and opportunities for people with a disability accompanies the Act.
Successive Commonwealth, State and Territory disability agreements have been
hammered out, the first of which was signed in 1991. It provides a framework
for the development, delivery and funding of specialised services. Through the
agreements, governments share responsibility for the provision of programs and
support services.
In 1994, the Commonwealth developed the 10-year Disability Strategy, which
helped to meet its obligations under the Disability Discrimination Act 1992. The
strategy aimed to enhance equal opportunity for Australians with disabilities
and improve the accessibility of services, such as transport, telecommunications,
education, health, housing and so on. Among a number of other national
projects are the National Disability Advocacy Program, National Auslan
Interpreter Booking and Payment Service, National Print Disability Services
Program and the National Disability Conference Initiative. Australia ratified the
UN Convention on the Rights of Persons with Disabilities in July 2008. The
convention contains a stand-alone article on women with disabilities and the
text is cognisant of gender throughout. Governments are therefore obliged to
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prioritise women with disabilities as a group warranting specific attention and
to take positive action to ensure that women and girls with disabilities enjoy the
full gamut of human rights and freedoms.
After advocacy by WWDA, the National Partnerships Against Domestic
Violence Taskforce agreed to fund a national project to develop information
resources for women with disabilities who experience violence. This was the
first Commonwealth-funded project on women with disabilities and violence,
and WWDA members participated on various committees. The national plan
recognises that ‘policy solutions to address domestic violence and sexual assault
must take into account the diverse backgrounds and needs of women and their
children’ (Commonwealth of Australia 2011d:11). It argues that
new perspectives and strategies are required by all Australian
governments in the delivery of best responses, as early as possible to
victims of violence. Women may require specialised support based on
individual needs in recognition of issues such as age, English language
proficiency, disability, sexuality and prior victimisation.
The plan does not, however, explore the way policy solutions might need to
differ to respond appropriately to women with diverse needs.
Following on from the National Disability Agreement in 2008, the National
Disability Strategy (Commonwealth of Australia 2011b) was developed and
written by the Commonwealth, States and Territories, under the auspices of
COAG. It will help to fulfil the country’s obligations under the UN convention.
The strategy is based on extensive consultations and 750 written submissions
and was endorsed by COAG in February 2011. It sets out a national plan with
the stated aim of improving life for Australians with a disability, their families
and carers for a decade. In theory, at least, all Australian governments are now
committed to a unified national approach. Implementation and evaluation plans
are to be worked out in the first year, in what is envisaged as a participatory
process. As part of the strategy, the Productivity Commission is undertaking
a study of the costs, benefits and feasibility of a national long-term care and
support scheme, including a national disability social insurance scheme.
The commission is being assisted by an associate commissioner, an expert in
disability issues and an independent panel of experts.
The influence of the women’s movement is apparent in that this strategy
which, unlike previous documents, employs a gender lens. It recognises that
women and men have different needs, priorities and perspectives and that
some experience multiple problems. It draws attention in several places to the
disadvantages experienced by women with disabilities, such as high levels of
violence, including sexual violence, lower levels of participation in paid work
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and poorer economic outcomes and discriminatory attitudes in relation to
parenting. It discusses the need for a coordinated and comprehensive approach,
in which governments work together and with the wider community, stressing
that ‘the views of people with disability are central to the design, funding,
delivery and evaluation of policies, programs and services’ (Commonwealth of
Australia 2011b)—all familiar ideas for those who take a social perspective of
health. This document argues explicitly that ‘the Strategy is based on a social
model of disability and recognises that attitudes, practices and structures are
disabling and can prevent people from enjoying economic participation, social
inclusion and equality’ (p. 16).
It remains to be seen whether funds will be allocated to put appropriate policies
and programs in place.

Neo-Liberalism Comes to Women’s Health
Since the 1990s, a set of political ideas very different from that of the 1970s
has increasingly dominated political discourse. As neo-liberalism gradually
supplanted social liberalism,3 health and social policy expansion gave way to
attacks on the authority of government and attempts to dismantle and de-fund
as many programs as politically possible. It is true that the Commonwealth
committed itself to a further four years of funding for the NWH Program in 1992
and later to funding for the longitudinal study of women’s health. Otherwise,
however, little of an expansionary nature took place, even though Labor held
office until 1996. At the State level, too, funding was tightened and the women’s
health policy machinery began to be dismantled.
The health and social policies of the Kennett Liberal Government (1992–99)
in Victoria illustrate the influence of neo-liberalism and demonstrate the
hardship and distress that follow the withdrawal of support from services
that were under-funded and oversubscribed in the first place. Between 1992
and 1994, Victorian Government spending on health and community services
was cut by 27 per cent. After 1994, instructions were given that 54 per cent
of required government budget savings were to be found from the sector.
The accommodation support program was cut by $7.5 million or 12 per cent.
Large numbers of residential care units were closed, including refuges, respite
care centres, centres for disabled people and drug and alcohol rehabilitation
centres. Researcher Olga Bursian interviewed workers from family support,
3  Neo-liberalism can briefly (if not very accurately) be described as a view that envisages a small role for
governments and a large role for markets in the distribution of material resources. An expanded role for
government, such as that attempted by the social liberal Whitlam Government, is seen as an illegitimate foray
into realms that should remain in private hands.
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foster care, maternal and child health and residential care programs to find out
about workloads, stress factors, morale, worker’s relations with management,
training opportunities, job security and the general impact on women’s lives.
She found that the cuts resulted in heavier workloads, more complex demands
on workers, fewer services to refer people to and fewer preventive services. In
foster care, workloads were found to be unmanageable. Autistic, violent and
psychiatrically disturbed children were housed inappropriately with children
with fewer problems. High to intolerable stress levels were reported among staff
and management alike. Professionals found themselves acting against their best
judgments, volunteers were asked to carry out complex tasks for which they
had insufficient training and uncertainty about funding led to anxiety because
positions could be de-funded without notice. Occupational health and safety
problems emerged and pay and conditions were eroded (Bursian 1995).
It was in this atmosphere that the Howard Government set about formulating
a range of health policies that had a deleterious impact on low-income groups,
particularly women (Gray 1999, 2004). It divested itself of policy responsibility
for women’s health through the introduction in 1997–98 of the National Public
Health Partnership, although it continued to provide Commonwealth funds.
Under the so-called partnerships, funding was broadened into eight public
health programs: the NWH Program, the Alternative Birthing Services Program,
the National Education Program on Female Genital Mutilation, Breast Screen
Australia, the National Cervical Screening Program, the National Childhood
Immunisation Program and the National Drug Strategy. The women’s health
movement, through the AHMAC Subcommittee on Women and Health, resisted
this change for a number of reasons, not least because the language of the
discussion papers was the language of commodification, elitism and social
control (Broom 1998c).
During the development of the bilateral Public Health Outcomes Funding
Agreements (PHOFAs), it was suggested that a number of standards and
safeguards should be incorporated but, in the event, few performance measures
were developed and none related to women’s health programs. There was no
longer any legal requirement that the States and Territories should spend any
proportion of the money that was channelled through the agreements on women’s
health. Initially, Commonwealth funding was guaranteed only until 1999, when
the first set of agreements expired. The implementation of the Public Health
Partnerships was a major defeat for the women’s health movement.
A second set of agreements, negotiated in 1999, this time for a five-year period,
did include certain outcome measures in relation to women’s health, including
that health departments should maintain community-based services for women

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and that they should foster partnership and collaborative arrangements between
gender-specific health services and mainstream services. The sub-national
jurisdictions were required to report yearly against the criteria.
In keeping with intentions to reduce the size of government, the AHMAC
Subcommittee on Women and Health was disbanded in 1998. The chief
reason cited was cost saving. The capacity of the women’s health movement to
contribute to policy and to obtain information from policymakers was thereby
significantly weakened. Under the partnership, a steering group of chief health
officers was established, with a representative from the Australian Institute of
Health and Welfare (AIHW) and the National Health and Medical Research
Council (NHMRC). There were no longer channels through which the views of
consumers, trade unions, general practitioners, nurses and the women’s health
movement could flow.
The Commonwealth seemingly took no further interest in women’s health
until 2004 when the PHOFAs came up for renegotiation. During the process,
information circulated that the draft agreements for the period 2004–09
contained no reference to women’s health. Rumour had it that a draft clause
explicitly stated that Commonwealth money was not to be spent on any program
not stipulated in the new agreements.
The AWHN Management Committee went into crisis mode. Representatives
from all States and Territories met in Melbourne to discuss and decide upon
strategy. Press releases were written and released, a background paper was put
together and disseminated and an explanatory letter was written, which was
sent to all relevant parliamentarians in every jurisdiction. A lobbying strategy
was worked out that would involve Commonwealth, State and Territory
governments, because all would sign the new agreements. Members made
appointments to meet with State and Territory politicians, especially women.
At the national level, as Deputy Convenor of AWHN, I unsuccessfully sought
an appointment with Health Minister, Tony Abbott. Instead, I met several times
with ministerial staff in June 2004 and was assured that there was ‘no hidden
agenda’ and that the Commonwealth was willing to consider an extra category
to be included in the new agreements, called ‘promoting women’s health’. This
category was a possibility, I was told, if it did not restrict the Government’s aim
of promoting as much ‘flexibility’ as possible in service delivery.
At the same time, small delegations of AWHN Committee members met with
senators from the two minor parties, the Australian Democrats and the Greens,
where the point was made that without intelligence from community groups,
such as AWHN, they did not get to hear about proposed policy changes. As a
result of discussions, Senator Lyn Allison asked a series of relevant questions
on notice in the Parliament. These included asking whether a 2003 review had
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recommended a stronger Commonwealth role in women’s health, whether the
absence of mention of women’s health in the draft PHOFAs indicated reduced
Commonwealth commitment and whether the Commonwealth had any plans to
review the NWHP. She also requested that a copy of the review of the previous
year be made public. Senator Allison’s questions brought the Commonwealth’s
attempt to deliver a deadly blow to women’s health into the light of day whereas
previously it had lurked in the mists of hearsay.
At the time, speculation about the date of the 2004 national election was
being fuelled by the Prime Minister’s refusal to comment (Bennett et al. 2005).
Women’s groups thus began to prepare, making arrangements to talk with key
parliamentarians. WEL made several deputations, in which AWHN participated,
including one to Shadow Health Minister, Nicola Roxon. At these meetings, the
threat to women’s health under the proposed PHOFAs and the need to review
the NWHP were both discussed. An AWHN delegation made a presentation
to the Labor Women’s Caucus Committee in July 2004 where the same issues
were raised. The delegation asked for an election commitment from the Labor
Party to review and renew the NWHP. Although no commitments were given,
support was promised and the view was expressed that review of the policy was
a project to which Labor women might be able to secure agreement. When the
2004–09 agreements were finally signed, they retained reference to all existing
women’s health programs—a major achievement for the movement.

The Second National Women’s Health Policy,
2010
The Third AWHN National Women’s Health Conference passed a resolution
that the NWHP should ‘be updated and extended to take account of issues
of increasing importance to women in the late 1990s’ (Davis et al. 1996:14).
Similarly, the Fourth AWHN National Women’s Health Conference, in Adelaide
in 2001, argued that Commonwealth leadership was necessary to ensure that
funding and commitment for women’s health were maintained across the nation
(AWHN 2001:9).
During the PHOFA period, the States and Territories continued to support the
existing women’s health infrastructure and sometimes small advances were
made. Nevertheless, after 10 years of neo-liberal Commonwealth government,
the participants who met at the Fifth AWHN National Women’s Health
Conference, in Melbourne in 2005, were pessimistic about the prospects of a
women’s health revival. The only glimmer of light was the support for AWHN’s
proposals expressed by members of the Labor Women’s Caucus Committee. At
the conference, an inspiring address was delivered by Ilona Kickbusch, well
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known internationally as an innovator in public health, women’s health, health
promotion and global health. She suggested that women’s health groups needed
to build coalitions with like-minded groups, identify possible funding sources,
stage women’s health summits in all jurisdictions and develop an assemblage of
strategies, including internet strategies, media strategies and ‘get out the vote’
strategies.
While such an agenda was daunting for the movement and the almost penniless
AWHN, the speech was inspirational and ideas from it found their way onto
AWHN planning agendas. Improved electronic communication strategies were
developed, coalitions were built and the membership base was strengthened.
Women’s health summits were held in three States and in 2006 AWHN began
planning a national summit. The first step was the development of a draft
discussion paper, which set out a new national agenda for women’s health.
The paper was circulated widely for comment and feedback. In September
2007, a national summit was held at Parliament House, Canberra, to which
approximately 120 representatives of national organisations with like interests
were invited, along with Commonwealth parliamentarians. The AWHN position
paper was presented, further feedback was requested and, after incorporation
of the final contributions, the paper was published in March 2008 as Women’s
Health: The new national agenda. Hundreds of copies were distributed across
the country to parliamentarians, key stakeholders and all relevant health and
women’s organisations.
Shortly after the summit, as part of a health policy package for the 2007 election,
Shadow Health spokeswoman, Nicola Roxon, announced that, if elected, her
party would develop a new national policy on women’s health that would
encourage specific services for women and would promote women’s participation
in health decision making and management. She also pledged that the focus of
the health system would be shifted to achieve more preventive health care,
enhanced health promotion and greater attention to managing and monitoring
chronic disease. The women’s health movement greeted the announcement with
excitement; women’s health had been missing from the national policy agenda
for more than a decade.
Early in 2008, the AWHN committee met to devise a plan to influence the shape
of the second NWHP. The strategy had two major elements. The first was to
contact relevant Commonwealth, State and Territory politicians and bureaucrats
to keep them informed of the movement’s views and priorities. The second was
to maintain regular communications with members and interested organisations,
to let them know about developments and to gather views and contributions.
After Labor came to office, more than a year passed before the policy development
process was launched with the publication of a background paper, Developing a
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women’s health policy for Australia: setting the scene. The first consultation was
held at Parliament House, Canberra, in March 2009. The meeting was chaired
by Professor Sally Redman, Director of the Sax Institute. At the meeting, a
consultation discussion paper, Development of a new national women’s health
policy, was launched, which was an expansion of the earlier document. Both
recognised a social view of health as central and both recognised that there
are significant health inequalities between different groups of women. The new
policy, it was argued, needed to focus on those groups with the highest risk of
poor health, including Aboriginal and Torres Strait Islander women.
The invited participants were from 14 groups, including AWHN. A woman from
Congress Alukura was invited but was unable to attend. Minister Roxon was
present in the morning. She said the Commonwealth was not afraid to make
decisions that would not have a major impact for 10 to 20 years and was not afraid
to work across Commonwealth, State and Territory boundaries. The minister
acknowledged that many factors affecting women’s health, such as economic
and physical security, are located outside the health portfolio but she envisaged
that the main thrust of the new policy would be within the portfolio. Among
the issues raised in discussion were the paucity of services for rural women, the
need for a greater understanding of difference and different patterns of health
and illness, the OHS problems faced by immigrant and refugee women, violence
against women, economic security, personal security and the need for a national
sexual and reproductive health strategy. The importance of health education to
teach practitioners about cultural and gender competence was stressed, together
with the need for prevention and health-promotion programs.
In the second phase of the consultation process, March to June 2009, the
organisations present at the round table were asked to consult with their
constituencies and then make submissions to the Department of Health and
Ageing (DOHA) by July 2009. The submission process was open to any group
in Australia and AWHN developed a template to facilitate contributions. DOHA
received almost 100 submissions by the middle of the year.
As discussed, AWHN and the Aboriginal Women’s Talking Circle managed a
project through which Aboriginal women were consulted and an Aboriginal
women’s submission was written, with funding support from FaHCSIA. From
September to December 2009, DOHA held consultation forums in all capital
cities, six regional cities and in Fitzroy Crossing in north-west Western Australia.
The policy was released on 29 December 2010. There was no official launch.
The new policy covers key women’s health issues, including many of the views
and experiences put forward in consultations and submissions. Its stated
purpose is to continue to improve the health and wellbeing of all Australian
women, especially those at greatest risk of poor health. It is framed within a
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social health perspective and identifies the need to promote equity between
groups of women through a focus on the social determinants. It acknowledges
that women’s access to resources, such as income, education, employment, social
connections and safety and security, including freedom from violence, influences
their health outcomes and their ability to access services. The policy recognises
health inequities between groups, with certain groups, particularly Aboriginal
and Torres Strait Islander women, having poorer outcomes (Commonwealth of
Australia 2010b:7–8).
The social determinants of health are to be addressed through five policy goals:
highlighting the significance of gender as a key determinant; acknowledging
that women’s health needs differ throughout their lives; prioritising the needs
of women with the highest risk of poor health; ensuring that the health
system responds to all women with a clear focus on illness prevention; and
health promotion. Effective, collaborative research, data collection, monitoring
and evaluation and knowledge transfer are to be supported. The short-term
focus, however, is on the burden of disease in four priority areas: prevention of
chronic disease and control of risk factors, mental health and wellbeing, sexual
and reproductive health, and healthy ageing.
While the new policy expresses much that the movement endorses, it is extremely
disappointing in a number of ways. First, the contribution of women’s health
centres and services over decades is not acknowledged which is also, in effect,
a refusal to acknowledge the crucial importance of strong primary health care.
Second, chronic disease is to be addressed through the control of risk factors,
such as obesity, unhealthy eating and physical inactivity. Disappointingly,
however, the policy does not explore the risk factors in the light of their social
determinants. Third, and most importantly, any actions that are to be undertaken
to address either social determinants or the burden of disease are vague and
unclear. It is extremely important that the social determinants of illness be
linked to specific actions that will reduce the impact of those determinants.
Such actions, of course, require resources and it is disappointing that the only
funding announced with the policy is for Women’s Health Australia, a laudable
project and one strongly endorsed by the movement but in itself insufficient as
a national effort to address the social determinants of women’s health.

Conclusion
On the whole, Commonwealth Labor governments have responded positively to
the women’s health movement, formulating a broad array of policies, strategies,
programs, plans and initiatives. The high point of the movement’s influence
was in the 1980s and early 1990s when, as one commentator argued, feminist
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thought and action to improve women’s health had a strong influence on reform
debates (Dwyer 1992b:211). The NWHP was an international first and influenced
policy overseas as well as in the various Australian jurisdictions. The NWH
Program expanded specialised women’s health centres and services and funded
a variety of new projects. The separate women’s health sector has produced
best-practice models of service delivery, especially in the area of preventive
health care, which have had an influence on mainstream discourse and practice.
Physical and sexual violence against women and girls, OHS, the health needs
of Aboriginal women and women with disabilities and immigrant women, bestpractice cancer treatment, maternity-care reform, strong primary, preventive
health care and a social view of health are all issues that the movement has
succeeded in drawing to public attention.
It can be argued that viewed from one angle, the women’s health movement has
changed the face of national health policy discourse. We have a new national
women’s health policy, which captures many of the arguments feminists have
made, a national plan against violence against women and the National Disability
Strategy that recognises social determinants and employs a gender lens. The
large and avoidable differences in health outcomes for people situated differently
are recognised in public policy documents for everyone to read. It is unlikely
that a commission set up to focus on better population health would now claim,
as the Better Health Commission did in 1986, that the diseases suffered by men
and women are the same. Moreover, it is no longer so easy to claim, brightly,
that Australia has some of the best average health outcomes in the world while
ignoring serious disparities between groups.
From another angle, however, much of the changed focus and language can
be seen as symbolic. Symbolic politics, in the simple sense, is a surrogate for
substantive political action. The symbols used carry political meaning that is
an end in itself and distract from the reality that policies and programs are not
being developed. In this case, the use of the language of the social determinants
of health, preventive health care and gender analysis gives the impression of an
appropriate policy response to contemporary evidence. At the level of actual
decision making, however, the focus is still squarely on hospitals and medical
services, and new investment in primary health care, for women or anyone else,
is small. The second NWHP is an action-free zone at the time of writing, a
classic attempt to appease the women’s health movement without spending any
money. Even at the pinnacle of achievement, the obstacles that femocrats and
the movement encountered during the development of the first NWHP and the
small amount of funding eventually allocated show that politicians perceived
the need to be seen to be taking appropriate action while in reality making only
a minimal investment.

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Elaine Lomas, Operations Manager, NACCHO, supported by Irene Peachey,
entertains the Sixth AWHN National Women’s Health Conference with an
address entitled ‘Cooperation and collaboration between NACCHO and
AWHN and the Talking Circle’—not a hilarious topic in anyone else’s hands!
Photo: Tracey Wing

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Senator Claire Moore, representing the Commonwealth Government, with
Kelly Bannister, Conference Convener, and Gwen Gray, AWHN Convener,
at the Sixth AWHN National Women’s Health Conference, Hobart, 2010.
Photo: Tracey Wing

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Raquel Kerdel and Bessie Rigney (SA Aboriginal Women’s Committee),
Carla Vicary (Murray Mallee Community Health Service) and Edie Carter
(SA Aboriginal Women’s Committee) at the Sixth National AWHN
Women’s Health Conference Party, Hobart, 2010.

A Western Australian contingent at the Sixth AWHN National Women’s
Health Conference Party, Hobart, 2010.
Photo: Tracey Wing
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AWHN committee members and a couple of guests: Marion Hale,
Kelly Bannister, Andrew Mitchell, Gwen Gray and Peter Howe at the
pre-conference reception, Government House, Hobart, 2010.
Photo: Tracey Wing

Women’s Health West board members and staff at the Sixth AWHN
National Women’s Health Conference Party. From left: Karen Passey,
Linda Memery, Georgie Hill, Sally Camileri and Dr Robyn Gregory,
Executive Officer.
Photo: Tracey Wing

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Responses
Having surveyed the history of women’s health policy development since the
1970s, it is now time to return to the questions posed in the introduction. Why
is Australia the only country to have enacted two national women’s health
policies? Why is it also the only country to have attempted to establish a national
network of community health centres? Why is it a leader, internationally, in
developing public responses to domestic violence? And what are the conditions
that have come together at different times to create windows of opportunity
for structural health reform? As in most areas of public policy, the reasons for
particular outcomes are multidimensional, directed and shaped by numerous
pressures. As well as facilitating factors, there are almost always countervailing
forces, particularly in a policy area such as health—the largest industry in all
OECD countries. It is an area where ethical issues abound, where large incomes
are at stake and where profits depend on the policies adopted. In the Australian
federation, health is particularly complex, not just because nine governments
share responsibility but also because of the peculiar Australian arrangements
where most doctors operate as private businesspeople, outside the control of
government, while drawing the lion’s share of their income directly from the
public purse, with virtually no conditions attached.
Before attempting to answer the questions posed, this chapter examines the
main forces that came together to facilitate the policy uptake of women’s health
concerns. The last two questions, concerning the main obstacles to policy reform
and the reasons that the structures of the health system remain intact despite
strong evidence in favour of change, are addressed in the final chapter.
There is no question that the Australian women’s health movement has been
relatively successful in comparative terms. No other country has developed two
national women’s health policies and multiple sub-national policies and very
few have national strategies or even women’s health plans. Internationally, a
few national women-specific health initiatives have been taken. The Irish
Department of Health developed its Women’s Health Plan in 1995, when the
permanent Women’s Health Council was established. In Canada, the first national
women’s health statement was released in 1990; however, because the Provinces
have constitutional responsibility for health, there was no national policy.
The Health Minister at the time, Mary Collins, was influenced by Australian
developments and owned a copy of the NWHP. The Glasgow Women’s Health
Policy was launched in 1992 and updated and relaunched in 2002. WHO Europe
has designated the Glasgow work, which was influenced by Australia’s first
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NWHP, an example of good practice. New Zealand, the United States and the
United Kingdom all had strong women’s health movements but none has made
policy responses that compare with Australia’s.
Moreover, Australia stands out in the area of direct service provision: no other
country has a network of publicly funded, independent women’s health centres
and services. In the four other major English-speaking democracies, women
did attempt to set up separate health centres but on a smaller scale and only
a handful remains. Violence against women in its many forms has been put on
policy agendas in many countries but research published in 2002 shows that the
Australian effort compares well with other countries (Weldon 2002). The policy
responses developed since Weldon’s study mean that Australia is probably still
among the leading nations.
Perhaps most importantly, the social view of health or socioeconomicdeterminants perspective that has guided the movement’s actions and advocacy
since the 1970s is more widely understood and is now acknowledged regularly
in major Australian health policy documents. The vexed question of why a
social perspective is not more prominent in actual health policy decisions will
be addressed in the final chapter.
Health policymaking is notoriously difficult and generally undertaken amid
intense controversy. A leading Canadian economist has called it ‘the issue
from hell’ (Evans 1993). Women’s health policy fits into the same mould and
movement members faced many obstacles when trying to get their concerns
heard. In the early years, the ideas being put forward were unfamiliar and often
seen as extremist. Women’s groups lacked authority, status, legitimacy, political
experience and resources. The men in the senior positions in the bureaucracies
frequently resisted the new ideas and others were dubious about the wisdom
of establishing separate services. Medical unions have always opposed any form
of alternative services that might reduce the size of private medical markets
by substituting for doctor-provided services. Since the rise of women’s health
activism, many women doctors appear to have taken the movement’s criticisms
personally. It took time, energy and considerable perseverance therefore to
persuade policymakers of the validity of the claims. Even where acceptance
emerged, it was often fragile and transitory.
A number of forces were, however, working in the opposite direction to facilitate
policy expansion, as summarised below.

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Factors Facilitating Policy Adoption

• A strong, grassroots movement able to put effective pressure on political
parties.
• The first centres and services established in a radical change context.
• Women working for change, often behind the scenes, in political parties and
trade unions.
• The Australian practice of employing feminists in advisory and policy
development roles: the femocrat phenomenon.
• Women’s policy machinery installed in all nine government bureaucracies.
• The election of responsive governments that believed they needed the
women’s vote.
• The underdevelopment of the Australian health and welfare system.
• The openness of Australian government, allowing activists access to decision
makers.
• Programmatic Australian political parties.
• Federalism perhaps a facilitating factor, perhaps not.
• The strong strand of social liberalism in Australian political culture.
These influences are now examined in turn.

Grassroots Activism
The early Australian women’s health movement comprised strong, broad-based
grassroots groups. In her study of 36 democratic governments to explore the
reasons for responsiveness to the problem of violence against women, Weldon
found that the mobilisation of a strong, autonomous women’s movement was a
major factor in explaining successful outcomes. By ‘autonomous’, Weldon means
independent of political parties and other organisations. She also suggests that a
proliferation of groups is a sign of strength and, as we have seen, there has been
a remarkable proliferation of women’s health groups over the past 35 years. Selfgoverning women’s movements are effective because they are able to articulate
problems on their own terms and exert outside pressure on political parties to
take up their issues. Women’s movements that are organised mainly from within
political parties, such as in Italy, have been less successful in having violence
taken up as a political issue (Weldon 2002:79–86). The Australian women’s
health movement, being grassroots based, is quite independent in Weldon’s
sense, although some members belonged to political parties, unions and the like
as well.
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The achievements of the movement suggest a very strong commitment among
grassroots women; some were health professionals and others had special skills
but, on the whole, ordinary women mobilised in numbers to work for better
health services and social change. In no other country did so many passionately
committed women determine to set up their own health services. Australian
women were prepared to take whatever forms of direct action seemed necessary
to establish services where women’s bodily integrity, views and decisionmaking rights would be respected. If, after testing conventional avenues, it was
felt necessary to break the law, they did so. Nardine refuge workers in Perth,
for example, squatted in an empty State-owned house with a woman and her
children who had been waiting for months for public housing. The police were
called, the family was evicted and several Nardine workers were found guilty
of trespass and put on good behaviour bonds (Murray 1999:8). But women’s
housing problems were publicised.
Women went to extraordinary lengths to sustain the services they created,
giving hours of their time and often their own money, working through all
available channels to influence decision makers. As well as marches and other
forms of direct action, they held forums and speak-outs, wrote letters and
petitions, circulated policy papers, made appointments with politicians and
bureaucrats and sought media coverage. As services became established, an
institutional base from which to work became available and action tended to take
more conventional forms; however, street marches and demonstrations, such as
the ‘Mother of All Rallies’ staged by homebirth advocates in 2009, are still held
in support of reproductive rights. Such visible activism, especially when it is
electorally close to home, is not easy for politicians to ignore. A strong women’s
movement alone, however, is not sufficient to shape public policy, as periods of
government inaction and regression demonstrate. It was necessary for a number
of other influences to be operating simultaneously.

Favourable Political Opportunity Structures
The policy context in which the early movement operated was extraordinarily
favourable for the introduction of new policies, especially those that would
benefit the least advantaged. Radical equality-seeking social movements were
active across the OECD, calling for everything from minority rights, industrial
democracy and environmental protection to disarmament and a new world
economic order. In Australia, community health, public health and Aboriginal
health movements were emerging, buttressed by accumulating evidence that
a biomedical model of health care was unnecessarily and dangerously limited.
Extensive disquiet about Australian health and welfare services grew as research
showed that people, especially the elderly, were living in dire poverty and
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were unable to access basic services, despite the impact of one of the longest
economic booms in Australian history. The publicly subsidised private health
insurance system, of most benefit to the well-off, came under heavy attack.
In this context, a Labor government was elected in 1972, after 23 years in
opposition, on a platform of extensive social policy reform. The political climate
of the day was conducive to sweeping policy change—an opportunity as radical
as it is rare—and its impact continued well into the 1980s. The converse, of
course, is the steady emergence of neo-liberalism as the dominant discourse,
which supplanted the social justice emphasis of the preceding period. The
support of the Whitlam Government at a formative stage was fundamental to
the women’s health project because it established an institutional foundation
for the movement. The institutional base was expanded and consolidated under
supportive sub-national governments and the Commonwealth in the 1980s and
early 1990s but the early support was crucial.

Women in Political Parties and Trade Unions
Women in political parties and trade unions frequently cooperated with
grassroots health groups and worked hard within their organisations to create
the conditions where women’s health concerns would be reflected in policy.
Arguments have been made that a greater proportion of women in legislatures
facilitates policy advancement. In Australia, however, the movement’s greatest
policy successes were in the ‘golden’ 1980s before women entered legislatures
in large numbers. As more women entered parliaments at both sub-national
and national levels, women’s health slipped rather than advanced as a policy
priority, suggesting other, more powerful forces at work, such as the advent
of neo-liberalism. This finding is consistent with that of Weldon in her crossnational study of policymaking on violence. She found no relationship between
the percentage of women in legislatures and government responsiveness to
violence (Weldon 2002:87–104).
This finding does not, however, negate the very important role that numbers of
women played within parties and trade unions in the pursuit of women’s health
concerns. Nor does it negate the role that women parliamentarians still play on
selected issues. In the early days, women set about educating party and union
men concerning feminist perspectives—a process that involved hard work and
often required written papers. Political party women had to explain the meaning
of a women’s health perspective. In trade unions, women worked to change
the ambit and the meaning of OHS and to promote the principles of industrial
democracy. The influence that they were able to exert sometimes did depend on
their numbers: more women in unions meant that ‘new’ issues such as workplace
sexual harassment were able to be raised and pursued. For women in political
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parties, their low numbers were perceived as a barrier to change. According to
one party member, women’s issues often placed women parliamentarians in an
uncomfortable position of opposition to their male colleagues. Moreover, the
few women who were elected were contacted about everything feminist, which
was a heavy load. On issues other than abortion, however, male politicians were
generally prepared to accept women’s perspectives in the 1970s and 1980s. But
this was not always the case and the role of women parliamentarians, working
collaboratively, was sometimes crucial. For example, in Victoria, a small group
of women parliamentarians, in close connection with outside groups, women
in the bureaucracy and women in ministers’ offices, pushed hard against very
strong male opposition to have the Women’s Health Program adopted in the
mid-1980s. In Queensland, it was very difficult for women to persuade male
members of the Goss Government to participate in the NWH Program because
women’s health was so closely associated with abortion in many minds.
From the mid-1970s until the early 1990s, there was a strong perception among
members of both major political parties that the women’s vote had to be courted
(Auer 2003), a perception at least partly created by the findings of opinion polls.
The ability to persuade male party members that electoral advantage would
follow from women’s health innovations was crucial to success. As a New South
Wales female parliamentarian told me in the early 1990s, the men in the party
were aware that the women in the party could deliver the women’s vote. But
where men were not so convinced, the political battle was harder.
Party structures through which women might have worked had existed within
the major parties for decades but the role that women played had been largely
auxiliary (Sawer and Simms 1984:131–40). Women were instrumental in having
new committees and caucuses established in State and Territory ALP branches
in the 1970s and 1980s, which facilitated issue articulation. The National Labor
Women’s Conference and National Status of Women Policy Committee were
established in 1981. In the Liberal Party (LPA), a number of feminist groups
were established in the early 1980s, including the Liberal Feminist Network
in Victoria, with counterparts in New South Wales, South Australia and
Queensland. The first National Liberal Women’s Conference was held in 1986. The
National Country Party, now The Nationals, similarly made changes to increase
the representation of women in party structures. In some jurisdictions, women
were able to ensure that they were represented on policy committees, including
health committees. Labor women tried to push policies through at every level:
at national conferences, State and Territory conferences and at national women’s
conferences. Many LPA women supported women’s health issues within their
parties but often faced strong opposition from men. For example, the LPA had
been in power in South Australia for almost three years before Health Minister,
Jennifer Adamson, was able to announce that a women’s health policy would
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be developed, fulfilling an election commitment. Women from the conservative
parties were sometimes able to prevail, however. One such instance occurred
when female members actively opposed National Party government efforts to
tighten, rather than liberalise, abortion laws in Queensland in the 1980s. Party
women were able to garner enough support to defeat the proposed legislation.
In unions, as in political parties, women worked to ensure that they were
represented on committees and elected as officials. As we saw in Chapter 5,
women in unions created networks with women’s organisations, community
organisations and political parties. In many cases, union women were also Labor
Party members and sometimes members of the women’s health movement as
well. Women in unions constituted part of a health movement that succeeded in
having workers’ health and working women’s centres established.
Opportunities to progress women’s health varied from jurisdiction to jurisdiction,
depending, in part, on political culture. Queensland was widely viewed as ‘a bit
of a backwater’ until the 1990s. In Western Australia, the sections of the ALP
platform that dealt specifically with women were only an outline of principles
until the mid-1980s, when they were rewritten to include feminist concerns.
The difficulties of achieving attitudinal change were immense in a State such as
Tasmania, where the entire health system had centred on hospitals for decades.
Tasmanian political party women struggled to gain legitimacy for the unfamiliar
concept of a social view of health. In some cases, the appointment of party
women to key health positions produced results. For example, Anne O’Byrne
was appointed Chair of the Tasmanian Northern Region Health Board in the
mid-1990s and was able to establish a women’s health issues subcommittee,
which was given responsibility for administration of women’s health financing.
Many women in political parties worked closely with grassroots women. Senators
such as Patricia Giles (1981–93), Margaret Reynolds (1983–99) and Dr Rosemary
Crowley (1983–2002) worked extensively with women’s groups on a wide range
of feminist issues, including women’s health. Particularly in small jurisdictions
such as South Australia, women politicians from all parties invited women’s
health movement members to contact them and sometimes offered to speak on
their behalf. Political party women were sometimes willing to collaborate with
NGOs when shaping the questions to be asked in parliament. Where minor
parties have been a significant political force, women’s health generally gained
active allies, both at the Commonwealth and the State and Territory levels.
For example, Christine Milne was able to influence a review of the Tasmanian
Department of Health in the late 1990s in ways that would support women’s
health. Greens Senators Christabel Chamarette and Dee Margetts facilitated a
number of Health Policy Think Tanks at Parliament House in the mid-1990s,
at which a social view of health was explored and endorsed. Senator Kerry
Nettle (2002–08) was a strong supporter of women’s health and worked with
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the movement wherever possible to promote issues and perspectives. The
predominantly female parliamentarians of the Australian Democrats were
generally strong movement allies. Senators Natasha Stott Despoja and Lyn
Allison supported women’s health perspectives throughout their time in the
Senate from the mid-1990s until 2008. Senator Stott Despoja put forward a
number of health-related Private Member’s Bills, including legislation intended
to regulate pregnancy counselling services and ensure the provision of full
information about options, a Bill in support of stem-cell research and a Bill with
significant women’s health implications intended to prevent patent law from
applying to naturally occurring genes.
Marian Sawer (2011) suggests that the increasing numbers of women in
legislatures and in high office have often ‘had to leave feminist values at the
door’, due to the changing political context where equal opportunity and social
justice issues have been steadily pushed off political agendas. The women’s health
experience bears this out at the national level in view of its lost salience after the
mid-1990s. Women are, however, still playing an important role. At the national
level, female parliamentarians, regardless of party, have been far more likely
than their male colleagues to support health-related reform legislation where
a conscience vote has been allowed. Between 1996 and 2006, conscience votes
were taken on five pieces of legislation, relating to four issue areas: euthanasia,
research involving embryos, human cloning and the importation of RU-486. The
most striking feature of voting was the extent to which women supported the
Bills in both Houses. On average, 86 per cent of women in the Senate and 80 per
cent in the House of Representatives voted in favour, compared with 44 and 61
per cent of men, respectively. In the case of LPA senators, 87 per cent of women
supported the Bills, compared with 32 per cent of men (McKeown and Lundie
2009).
An infrequent but nonetheless productive development has been the emergence
of cross-party political action by women in the national Parliament. In 1983,
LPA Senator Kathy Martin, Democrats Senator Janine Haines and ALP Senators
Patricia Giles and Susan Ryan banded together to support ratification of the
UN Convention on the Elimination of All Forms of Discrimination against
Women (CEDAW). The Pregnancy Counselling (Truth in Advertising) Bill 2006
was co-sponsored by Senators Stott Despoja, Judith Troeth (LPA), Carol Brown
(ALP) and Kerry Nettle (Greens). Party collaboration is a regular feature of the
operation of the Parliamentary Group on Population and Development (PGPD),
formed in 1995, which raises awareness about international population and
development issues, especially sexual and reproductive health issues. It works
with the United Nations and with NGOs, such as the Australian Reproductive
Health Alliance (ARHA), Sexual Health and Family Planning Australia (SH&FPA)
and the International Planned Parenthood Federation. Membership includes
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representatives from all parties, including men. The most celebrated instance
of cross-party collaboration between women, discussed in Chapter 5, took place
in 2006 in relation to the removal of the Harradine amendment, which had
restricted the importation of RU-486. In this instance, political party women
worked extensively with NGOs, particularly the many groups represented by
Reproductive Choice Australia (RCA).
To summarise, in the early years when a feminist health perspective was
being articulated and disseminated in organisational structures and beyond,
small numbers of women in legislatures and trade unions, in cooperation
with femocrats and grassroots women, played a crucial pioneering role. At a
time when feminist issues have been driven off agendas, the role that women
parliamentarians have been able to play is more limited, despite their increasing
numbers. As in all areas of public policy, multiple influences are at work and the
proportion of women in legislatures is but one.

The Work of Femocrats
There is general agreement in the literature that femocrats—feminists who took
positions in bureaucracies and worked for reform from inside rather than outside
government—succeeded as agents of policy change (see, for example, Eisenstein
1996; Sawer 1990). The evidence of women’s health experience supports such a
view. Neither feminist critiques of bureaucracy1 nor the difficulties of working
in less than friendly structures prevented Australian feminists from entering
the public service in increasing numbers from the 1970s onwards. Following the
lead of the Commonwealth, which appointed the first adviser on women’s affairs,
Elizabeth Reid, in 1973, all jurisdictions appointed women’s affairs specialists
during the next two decades and all, at some time, appointed women’s health
advisers. Most of these women had experience in the women’s movement, the
the women’s health movement, or both. And while this phenomenon facilitated
policy advancement in one sense, it deprived the movement of some of its
energies (Lynch 1984:38).
The first women’s health adviser was Liz Furler, appointed Ministerial Adviser
in South Australia in 1984. She later worked as a femocrat in Tasmania before
being appointed to the Commonwealth Health Department. Carla Cranny was
the first Women’s Health Adviser in New South Wales, appointed in 1985. A
women’s health advisory position was created in the Australian Capital Territory
in the mid-1980s, filled by Marilyn Hatton. In Victoria, Christine Giles was
appointed to manage a new women’s health unit, set up in 1987, and Thea
1  Discussed in Chapter 1.
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Mendelsohn took a similar position in Western Australia in the same year. The
position of Senior Policy Officer, Women’s Health, was established in Tasmania
in 1989, with Vicki Pearce the first incumbent. Jude Abbs became Queensland’s
first Women’s Health Adviser in 1991, and Jen Roberts was appointed to head
the single-position Women’s Health Strategy Unit established in the Northern
Territory in 1992. Feminist ministerial advisers were also key players in policy
advancement in some jurisdictions, operating in much the same ways and within
the same set of opportunities and constraints as femocrats.
Given that key stakeholders compete for position in policymaking processes,
feminists in senior bureaucratic roles are in a position to advance a women’s
agenda. Femocrats played crucial roles on numerous occasions in promoting
women’s health issues. In New South Wales, for example, feminists working in
the bureaucracy are held to have been invaluable to the early women’s health
centres, especially when Commonwealth funding was slashed and the State was
being asked to pick up the shortfall. Femocrats were crucial to the passage of
the first NWHP through policy development processes in the Commonwealth
bureaucracy and important in gaining support for it at the State and Territory
level. In New South Wales and Victoria, at least, femocrats cooperated with
maternity consumer groups and offered them increased access to policymaking
in the 1990s. Members of the Australian Midwifery Action Lobby Group (SA)
and Mothers and Midwives Action (Victoria) were in ‘regular contact’ with
women in the bureaucracy and the politicians who supported reform (Reiger
2006:333).
Even where femocrats were unsuccessful in achieving immediate gains, as in
women’s health in Western Australia in the mid-1980s, their work can be seen
as having advanced issues and paved the way for future policy expansion.
In women’s health units, women were in a good position to choose the most
appropriate strategies for the situation. For example, during lean times in
Western Australia, femocrats decided to focus on one or two issues rather than
try to advance the whole women’s health agenda. They put themselves in a
position to take advantage of opportunities, major and minor, that presented
themselves. One women’s health service is said to have been established because
a femocrat inserted its announcement into a minister’s speech.
One of the recurring themes in the scholarly literature (see, for example, Dowse
1984; Eisenstein 1996; Sawer 1990; Summers 1986) is that femocrats faced
serious dilemmas. Their working environments were often hostile to feminism
but at the same time they were expected to maintain close connections with
‘sisters’ outside—a relationship considered conspiratorial in some quarters. It is
generally thought that to be successful, the trust of key people had to be gained,
inside and outside government, which was an objective not always achieved. In
the early days, in particular, many community women were suspicious of the
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role of femocrats, while at the same time seeing them as a possible buffer between
themselves and male politicians (Smith 1984:5). At the same time, the femocrats
in the Commonwealth Women’s Health Unit were viewed with suspicion in their
own workplace during the formulation of the NWHP. There was a belief in the
department that they were in league with community women and that far too
much money would be expected for the project. Another concern was that the
unit did not have the confidence of medical unions.
Some femocrats report having been fortunate enough to find mentors who
encouraged, supported and advised on how best to pursue their aims. Senior
personnel in finance were considered to be crucial allies since, ultimately, their
approval or at least acquiescence was needed. One strategy devised in one State
to promote trust was to take key departmental men out to lunch, where they
were introduced to feminist friends and colleagues, thus demonstrating that
feminists were real people!
Femocrats had different views about the appropriateness and usefulness of
relationships with grassroots groups. Some experienced women regarded
themselves as accountable to the women’s movement and thought grassroots
support was essential to pressure policymakers. Other femocrats found it difficult
to keep contact with the movement outside and believed it was impossible to
maintain friendships. They feared being isolated from departmental information
if they were seen to be too close to community women. Responses tended to
vary from jurisdiction to jurisdiction. In some places, it was felt that no hint
of a connection with outside groups was acceptable. Elsewhere inside/outside
relationships could be maintained in a state of delicate balance. One femocrat
told me she never openly acknowledged outside groups although she worked
with them extensively. While some information could never be divulged, ways
could be found of releasing information without breaking rules or betraying
ministers, including participation in public seminars and forums. Femocrats
in the Commonwealth Women’s Health Unit were in frequent touch with the
media, giving out information about policy developments. Articles were also
supplied for magazines, including medical journals.
Networking was an important element of the work of most femocrats, who
report enhanced effectiveness through links both inside and outside the
bureaucracy. Inside, femocrats established ongoing links with each other and
with key people in other departments. For example, staff of the Commonwealth
Women’s Health Policy Unit worked closely with the OSW and other relevant
departments, including social security and finance. In the health sector at the
State and Territory level, femocrats often attended women’s health network and
health service provider meetings. Interaction was also facilitated by overlapping
organisational membership: some femocrats were also members of political
parties, NGOs and so on.
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Other constraints within which femocrats worked were the inability to speak
out publicly and the requirement that policy proposals be moderate. They also
found it difficult to work in the face of frequent departmental restructures that
occurred, for example, during the development of the NWHP and in New South
Wales in the 1980s. Frequent restructuring also made life difficult for community
women because working relations were disrupted. As neo-liberalism became
more prominent and feminist ideas lost some of their salience, organisational
changes resulted in women’s health units being located far from the top levels of
policymaking, whereas initially they had been considerably closer.
While there is general agreement within the movement that women’s health
femocrats played a positive role, occasional criticisms were expressed, illustrating
the contradictions of the role. In one jurisdiction, community women felt that
the women’s health unit had achieved little, and it has been argued that towards
the end of the 1980s the feminist bureaucracy in New South Wales appeared to
be ‘less of an interpreter for the grassroots and more of a publicist for the Labor
government’ (McFerran 1990:203). McFerran also acknowledges, however,
the contributions made, especially to the refuge program, and she argues that
‘turning the state back on itself’ is ‘an artful game’ in which the relationships
between femocrats and community groups are crucial (McFerran 1990:191).

Women’s Policy Machinery
The influence of femocrats is closely related to the impact of the policy units in
which many of them worked. As discussed, women’s health units or dedicated
policy positions were established in all jurisdictions in the 1980s and 1990s.
This type of machinery was more extensively developed in Australia than in
comparable countries, with perhaps the exception of Canada (Sawer 1989:427,
1990:xv–xvii). The original proposals to set up special institutional structures
came from the women’s movement itself. In 1974, ACT WEL wrote a submission
to the Royal Commission on Australian Government Administration, suggesting
that permanent task forces on women’s issues, staffed by senior officers, be
established in government departments. Functions were to monitor activity
and policy and program development, to initiate research and to liaise with
target groups, interdepartmental committees and advisory councils. The
royal commission accepted the proposal and recommended that departments
be ‘encouraged to develop women’s units on an experimental basis’ (Sawer
1990:28–9). Thus, the machinery itself resulted from feminist advocacy.
In her 36-country study of policy responses to violence, Weldon found
that women’s policy machinery was an important factor in making political
institutions more responsive to women’s claims. Policy units had introduced
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the category ‘women’ as a policy priority and had provided a basis for policy
administration, research and review that would have otherwise been lost in
the spaces between government departments. Women’s policy machinery,
Weldon found, ‘partially corrects for the organisation of government around
the priorities of historically dominant groups of men’ (Weldon 2002:135). The
general assessment of the women interviewed was that women’s health policy
machinery had performed an extremely useful role.
A major piece of women’s health policy machinery was the Australian Health
Ministers Subcommittee on Women and Health, set up to help coordinate the
development of the NWHP. As a Commonwealth, State and Territory body,
with NGO and professional representation, it operated as a forum where
women’s health experts from across the country could meet, bring ideas from
their constituencies, learn from each other, formulate new ideas and develop
strategies. During the implementation of the NWH Program, it reviewed and
monitored progress and accepted references from AHMAC. Other roles were
to produce and disseminate information and monitor and evaluate mainstream
health policy for its impact on women (Commonwealth of Australia 1993). An
effective body for advancing women’s health policy, it was disbanded in 1998
by the Howard Government.
Women interviewed for this book also remarked upon the difficulties that
emerged from not having sufficiently strong women’s health policy machinery.
In one jurisdiction, having only two women’s health positions devoted to policy
development, implementation, contract management and evaluation of services
was a serious constraint. The arguments from this study support the findings
of others that special units facilitated the development of women-friendly
policies and contributed to positive attitudinal and behavioural change (Sawer
1990). Some of the examples discussed by Eisenstein include rape law reform,
the positioning of violence against women on the national policy agenda, the
establishment of women’s health centres and services and the development of
the NWHP (Eisenstein 1996:43–64). Only in one jurisdiction was it felt that
women’s health policy machinery had not been particularly useful.

Responsive Governments
The election of sympathetic governments stands out above all others as the
key factor facilitating the progress of the movement’s aims. This finding is
contrary to that of Weldon, who found that office-holding by parties ‘on the
left’ could not explain policy variation. Weldon does find, however, that it is
interaction between a strong women’s movement on the outside and sympathetic
policymakers on the inside that has produced the most robust policy responses,
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responses that were strengthened further where women’s policy machinery
was in place. To partly reconcile the two positions, it could be argued that the
sympathetic policymakers that Weldon found to be crucial have been more
often found in the Australian case in the ALP (and the minor parties). Moreover,
‘sympathetic’ insiders have been more numerous under Labor governments,
which appointed most of the femocrats. In any case, Weldon’s study is narrower
than this one in the sense that it covers only one policy area, violence, whereas
we have been able to observe the approaches of the two main parties across
the gamut of women’s health concerns. Whether it be at the State, Territory
or national level, it is clear that Labor regimes have been more interested in
introducing policies in response to women’s health concerns.
The orientation of government is one of the central features of ‘political
opportunity structure’ as identified by social movement theorists (Gray 2008).
Favourable political opportunity structures operated in most jurisdictions at
some point during the first 15 years of the movement, which was a crucial time
for getting ideas accepted and services established. At the national level, the
ALP supported women’s health each time it held office after 1972. Although
supportive of refuges, the Fraser Coalition Government cut funding for women’s
health centres, the Community Health Program and for feminist refuges between
1975 and 1981. The Howard Coalition Government was openly hostile to women’s
health, resiling from any policy role and passing program responsibility to the
sub-national level. An example of its intransigent opposition to feminism is its
attempt to suppress the Access Economics report that showed that domestic
violence cost the Australian economy $8 billion per annum. The report was
not released until The Australian newspaper filed a successful freedom-ofinformation application. The previous year the Government had taken money
from the violence and sexual assault budgets to pay for the postage of antiterrorism fridge magnets (Sawer 2008a:7).
A similar pattern is evident in the States and Territories, where ALP governments
have taken a more positive stance than their Liberal or Coalition counterparts.
Queensland provides a clear example. After 32 years of non-Labor government,2
which had opposed all policies on women’s health, including OHS reform, the
Goss Labor Government was elected in 1989. In quick succession, a women’s
health policy unit, a domestic violence policy unit, a gender equity unit, a
women’s safety program in the Queensland Police Service and a women’s policy
unit in the Office of Cabinet were established. A women’s health policy and a
violence against women policy were developed in 1993 and a range of special
women’s health projects was funded, including a secretariat for the Queensland

2  Variously Country/National Party/Liberal Coalition governments and, after 1983, a National Party
government.
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Women’s Health Network (Mason 1994). These efforts might have been less
expansive than feminists had hoped but they stand in sharp contrast with the
record of preceding governments.
This is not to argue that all Labor governments have enthusiastically supported
women’s health reform or that all non-Labor governments resisted. Occasional
innovations were made by non-Labor governments, such as the decision
to develop a women’s health policy in South Australia in 1982. The Greiner
Government in New South Wales in the late 1980s and early 1990s, neo-liberal
in orientation, saw no need to expand women’s health services but continued
to support them at existing levels. And while the Greiner Government began
to dismantle the women’s policy machinery, the incoming Labor Government
completed the process. In one jurisdiction, women reported that non-Labor
governments very quickly realised the political and service provision value of
cheap and popular women’s health services. It was also realised that a political
backlash would follow any attempt to dismantle them.
Some Labor governments have resisted reform. The Dunstan Labor Government
in South Australia was reluctant in the 1970s to ‘buy into’ Commonwealth
programs, such as community health centres and women’s health centres. Some
members of the Western Australian Labor Government in the late 1980s and
early 1990s approached the women’s health project with either hostility or
indifference. And, as discussed, Labor governments have engaged in symbolic
politics, giving the impression of substantive action, as in the case of a second
NWHP. After 1986, it took six years of intense daily struggle for the movement
in Adelaide to persuade a Labor government to support the Pregnancy
Advisory Centre. Reproductive rights are always controversial but the press
was supportive, there was strong support from women in the Liberal Party and
committed feminist bureaucrats were working on the case, yet progress was
very slow. Notwithstanding exceptions, the majority of key Australian women’s
health initiatives have been taken under Labor regimes.
The electoral success of the ALP in the 1970s and 1980s was crucial in setting
women’s health services on a relatively strong foundation. The level of
commitment that the Whitlam Commonwealth Government displayed has not
been seen since. Addressing the First National Women’s Health Conference in
Brisbane in 1975, Prime Minister Whitlam said:
The basic problem…resides in the attitudes which individuals and
institutions within our society have towards women, their health and
their bodies…the aim of this conference must be to understand, challenge
and change these attitudes…Good health care for women…must be
based on adequate and sensitive research into causes and methods of
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treatment but ultimately it can only come from a correct understanding
of how women feel about their bodies and a correct understanding of
the lives they live. (Commonwealth Department of Health 1978:18)
One of the femocrats of the early years takes the view that without the Whitlam
Government and supporters in the Health and Hospitals Services Commission
(HHSC), the women’s health movement might have quietly faded away.
The steady decline in the salience of women’s issues can be seen in the reduced
support for national women’s health conferences since the 1970s. Prime Minister
Whitlam opened the first conference in 1975, which was organised and funded
by the Commonwealth as its ‘special contribution to International Women’s
Year’. The call for papers prompted ‘a massive response’ and 950 women and
men attended (Commonwealth Department of Health 1978). Five volumes of
proceedings were produced and published by the Commonwealth, producing a
valuable resource. A senior Commonwealth Health Department official worked
with the organising committee for the second conference in 1985, together with
several officials from the South Australian Government. The Commonwealth
and South Australian governments, both Labor, provided financial support. The
conference was opened and closed by Senator Pat Giles, who conveyed apologies
from Health Minister, Neal Blewett (Kirby-Eaton and Davies 1986:3–7). Senator
Giles also opened the third conference, in Canberra in 1995, which was closed
by Health Minister, Carmen Lawrence, whose department provided financial
support (Broom 2001:100–1). The Howard Commonwealth Government refused
to contribute financially to either the fourth or the fifth conferences and chose
not to send representatives. All senior Commonwealth politicians, including
senior Labor women and the Prime Minister, declined AWHN’s invitation to
attend the Sixth National Women’s Health Conference in 2010; however, the
Commonwealth made a financial contribution of $50 000 and was represented
by Senator Claire Moore. Nevertheless, since the early 1990s, Commonwealth
interest has fallen steeply. This decline is not so apparent at the sub-national
level where, in some cases, good working relationships are in place.
Labor held power for a considerable part of the 1970s in New South Wales, South
Australia and Tasmania. In the 1980s, the years of significant policy advance,
Labor held office for most of the decade in all States except Queensland. From
the sub-national level, momentum steadily percolated upwards to culminate in
the first NWHP and Program under the Hawke Commonwealth Government.
This period of Labor Party dominance was not only unusual in Australia; it was
also counter to international trends at the time. In other large English-speaking
democracies, except New Zealand, the 1980s was a period of conservative party
dominance. The Conservative Party was in power in Britain from 1979 until
1997, in Canada from 1984 until 1993 and, in the United States, Republican
administrations ruled from 1981 until 1993. Women’s health policy did not
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advance markedly under the Lange Labour Government in New Zealand, which
became an adherent of neo-liberal ideas and seriously alienated traditional
supporters, particularly women. Thus, when national and sub-national women’s
health policies were being advanced in the 1980s, Australia was the only OECD
country with a strong women’s health movement as well as a preponderance
of responsive governments, which is a situation that can be classified as a very
favourable political opportunity structure.

The Australian Party System
The Australian party system is another factor that seems to have contributed
to the achievement of women’s health policy objectives. Political parties that
have reasonably well-developed sets of policies, as in Australia, play a key role
in policy advancement. In the predominantly two-party system, politicians use
policies to differentiate themselves from their opponents and to compete with
each other for electoral support. In this process, a level of consensus is reached
within parties and relatively detailed policies are produced and presented to
the electorate. There is considerable exposure of issues and policy alternatives,
which are scrutinised by the media and promoted and defended by leaders.
Britain, Canada and New Zealand, like Australia, all have strong, programmatic
political parties, with the result that different experiences in these countries
cannot be attributed to the nature of parties. The absence of this type of party
system in the United States, however, helps to explain why that country, despite
its strong women’s health movement and the early focus on separate services, did
not develop women’s health policies. Parties in the United States exist primarily
to choose candidates and facilitate their election, not to be agencies of policy
advancement. Further, party structures are decentralised and non-hierarchical,
making agreement on policy unlikely (Herrnson 1994:83).
Australian parties, particularly at the sub-national level, have regularly
announced advances in women’s health policy as part of their election strategies,
as did the Rudd Government when it promised a second NWHP and a focus on
violence against women during its 2007 election campaign.

The Women’s Health Movement and the
Australian Health and Welfare System
One of the reasons for the relative strength of the Australian women’s health
movement, I suggest, was uncertainty of access to publicly provided services,
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including hospital, medical and social services. The publicly subsidised system
of private health insurance left approximately 20 per cent of the population with
no insurance and another group of similar size with serious underinsurance in
the early 1970s. A study in South Australia in 1973–74 found that the main
reason for imprisonment for debt was unpaid hospital bills (Scotton 1978:130).
National health insurance was introduced in 1975 but the system was steadily
dismantled by the incoming Coalition Government, which reintroduced user
charges and reinstated private health insurance (Gray 1984). Uncertainty
about access prevailed again until 1984 when national health insurance was
reintroduced.3
Strong women’s health movements emerged in Britain, New Zealand, the United
States, Australia and, a little later, in Canada. When measured in expenditure
terms, the English-speaking democracies all have relatively weak welfare
systems. It might be that women in continental European and Scandinavian
countries felt less disadvantaged because they had more secure access to health
and social services. Further, it is plausible that a social view of health is more
likely to develop in the context of welfare state weakness, where, when all other
things are equal, the poorer conditions of women’s lives lead to poorer health
outcomes.
The connection between welfare state development and the strength of women’s
health movements is speculative4 and needs further study; however, some
corroborative evidence exists. Although there has been an active women’s
health movement in Britain, women set up few separate services. An exception
is the Women’s Therapy Centre in London, which was established because
psychotherapy was difficult to obtain under the National Health Service
(NHS) (Broom 1991:63). Otherwise, women in Britain were reluctant to set up
separate services for fear of appearing to promote private medicine at a time
when the NHS was under threat from conservative forces (Doyal 1983:23; Elston
1981:203). The situation is entirely different in Australia where women from
low socioeconomic groups—the main users of services provided free in feminist
health centres—have always been less likely to hold private health insurance.
Relatively good access to hospital, medical and other services might be part of
the reason New Zealand and Canadian women also set up fewer separate services.
In the United States, women did set up their own services in the early years;
however, public funding was not available as it was in Australia, so maintaining
the services was more difficult.
3  National health insurance has lowered financial barriers to access; however, because successive
governments of both persuasions have allowed out-of-pocket expenses to increase, serious obstacles to access
have developed again.
4  Other factors could be differences in the degree to which medical attitudes are patronising, better access to
reproductive health services, greater economic security through access to well-paid work and so on.
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Access to Government
Australian political institutions have a reputation for being relatively accessible,5
which has contributed to policy advancement. A former femocrat expressed
the view that a person does not have to be an Oxbridge graduate to get access
to senior levels of government. This might be related to the relative youth of
Australian political institutions and the relative weakness of perceptions of
social class. Professor Lesley Doyal, a British women’s health expert who is
familiar with Australian experience, is of the opinion that the relative openness
of Australian government is an important factor in explaining different policy
outcomes in Australia and Britain. In her assessment, members of the movement
in Britain do not expect to have access to senior politicians and public servants,
nor do they expect the creation of special women’s policy machinery. And they
certainly do not expect to be recruited to fill positions at senior levels of the
bureaucracy.
Access to policymakers is particularly open in smaller jurisdictions, where
people sometimes wear more than one hat and often know each other personally.
Movement members in South Australia and Tasmania reported generally being
able to arrange meetings with politicians and bureaucrats when they wanted
them. Access depends partly on the political persuasion of the government in
power. A government generally responsive to equality-seeking movements is
more likely to permit access for women’s groups. And none of the factors that
impact on policymaking operates independently. Rather, they interact together so
that the presence of femocrats working in women’s policy institutions facilitates
access for outside groups in a political culture that endorses consultation and
some level of citizen engagement with government.
Relatively easy access to policymakers might help explain why the Australian
women’s health movement has been more successful than its British counterpart
but further study is needed to answer the question of whether Australian
government has been significantly more open to women’s groups than
governments in other English-speaking countries.

5  Evidence shows that different groups have very different access, both formal and informal, to Australian
government. Matthews (1976) found that there was a massive over-representation of producer groups in
Australian government institutions, such as advisory committees, and a serious under-representation of
other groups, particularly disadvantaged minorities, including women, Aborigines, welfare recipients and
immigrants.
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The Role of Australian Federalism
In other studies of the impact of federalism on public policy, including women’s
policies, I have found that federal institutions can be both an asset and an
obstacle. My argument has been that the way federalism works depends on its
interaction with a range of other forces in the policy development environment
and that its operation changes from time to time and from place to place (Gray
1991, 2006, 2010). Evidence from this historical study supports my earlier
conclusions.
It has been argued by some that federalism impedes the development of public
policy. The system, it is said, fragments the power of government, gives rise
to conflict and controversy between levels, allows interest groups greater
opportunities to obstruct policy processes, creates overlap and duplication and
generally results in weak, conservative government (reviewed in Gray 1991:9–10).
Federalism does increase policy complexity. In the case of the first NWHP,
activities that fed into the policy process took place in nine jurisdictions over
nearly two decades. Activists had formed a multitude of groups, organisations,
networks and centres at the community level and worked for reform in all
jurisdictions. In each place, governments responded differently and each had
their own policy agendas, sometimes innovative, sometimes not. Before the
NWHP could be launched, endorsement was required from all nine Australian
health ministers, advised as they were by nine different sets of bureaucrats.
Until the last minute, health movement members, national and sub-national
officials and Commonwealth and State and Territory femocrats had reason to
fear that the policy would not be endorsed.
Institutional arrangements can have a different impact at different times
depending on the other forces operating. For example, Australia is noted for its
federal financial imbalance, which gives the Commonwealth control of the purse
strings. This is a decided advantage for women’s policies, including women’s
health, when a sympathetic government holds power at the national level.
Conversely, it can be an enormous disadvantage, as when the Fraser Government
slashed its funding for women’s health centres, community health centres and
feminist refuges. Generalisations therefore are likely to be fragile; however, one
generalisation that can be made for the Australian federation—but not for all
federations—is that the federal financial imbalance restricts the capacity of
State and Territory governments to make policy innovations, especially where
large outlays are required.
Complexity notwithstanding, a federal division of power can, at times, facilitate
the maintenance and/or advancement of policy. When the Northern Territory
Government was unwilling to support the establishment of the Central Australian
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Aboriginal Congress health centre in the mid-1970s, funding was obtained from
the Commonwealth. Similarly, when the Commonwealth reduced funding for
the Community Health Program and women’s health centres, women were able
to appeal to the State level for assistance. In unitary systems, such options might
not be available.6 The States eventually agreed, after a struggle, to support
the centres from their own coffers. Another example of federal arrangements
working well for women took place between 1996 and 2007 when women’s
health centres, services and policies continued to be maintained or advanced
in all jurisdictions, despite an antagonistic Commonwealth. These arguments
are consistent with those of Louise Chappell (2001) who found that federal
arrangements had allowed policy in relation to domestic violence to continue to
develop at the sub-national level during the Howard years. Chappell reviews a
number of studies that suggest a similar situation in relation to HIV/AIDS policy
and policies for Aborigines.
The election of supportive governments at the same time in a number of
jurisdictions can generate interest and create a favourable policy context, as in
the 1980s. British observer Lesley Doyal is of the opinion that Australia’s federal
institutional structure is another of the reasons that women’s health policy is far
more developed than in Britain: it facilitated experimentation and innovation in
a number of jurisdictions.7
As well as creating opportunities, federalism can create obstacles to policy
expansion. During the second half of the 1970s and in the 1980s, when the
non-Labor government in Queensland refused to support women’s health,
activists applied for Commonwealth funding through various avenues but were
ineligible for national support because they were not national organisations.
An example of sub-national obstruction took place during the Whitlam
Government period when South Australia was governed by the Dunstan Labor
Government, which was generally assumed to be reformist. For whatever reason,
the South Australian Health Commission was allowed to strenuously oppose the
Commonwealth proposal to fund the Hindmarsh Women’s Health Centre. As
discussed in Chapter 1, the approach of the Victorian health bureaucracy was
similar. Indeed, one of the major obstacles facing the Whitlam Government’s
health reform program was created by federalism: its constitutional power to
fund many of the projects it wished to support was limited.

6  In unitary systems where regional and local governments have a measure of financial independence,
however, the options are similar.
7  We need to be cautious, though, about such generalisations: federalism could equally provide an
unfavourable opportunity structure depending on the stance of governments towards a particular issue.
Moreover, in practice, very few nations have only one level of government. Experimentation and innovation
are features of local government activity under favourable institutional arrangements.
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While it allows for innovation and experimentation in different jurisdictions
when conditions are favourable, federalism also contributes to an unevenness
of services across jurisdictions. The Northern Territory has no women’s
health centres in 2011, for example, and Tasmania has only one. There is also
considerable variation in the sexual assault services across the country and
in levels of funding commitment. New South Wales has many more agencies
per capita than any other State. By 1990, it had 33 sexual assault services, one
incest centre and one rape crisis centre, all of which received at least some
public funding. At the same time, Western Australia, with almost one-third of
the population, had only three publicly funded services. Queensland, which
had more than half the population of New South Wales, had only two centres.
There was no national policy overview at that time, with its potential to lead to
more uniformity (Carmody 1990:304–8). Perhaps more seriously for the women’s
health project, without the policy impetus and the money that came with the
NWHP, it is safe to argue that the women’s health sectors in some States, notably
Queensland, Western Australia and Tasmania, would be very much smaller
than they are. By this point, they might even have disappeared. Thus, different
political cultures in different parts of a federation generate unevenness in policy
development, which also arises from experimentation and innovation. This is
a problem if the dominant ethos is that citizens should have equal access to
services, which tends to be the case in Australia and is certainly the position
taken by the women’s movement.
Federalism, then, has shaped women’s health policies in different ways at
different times. Like any other system of government, its operation depends
upon the policy environment of the time and the impact of other interacting
policy influences. A detailed examination of federalism is outside the scope of
this book; however, many of the advantages and disadvantages so commonly
claimed to emanate from federal institutions are features of unitary systems
that have strong, relatively independent local or county government, such
as in Scandinavia and many European countries. Moreover, all governmental
systems create divisions of power when they divide responsibilities into
separate portfolio areas. Such divisions might cause deadlocks and delays,
as in the 1980s when the Commonwealth Department of Health approved
and supported the establishment of Congress Alukura but the Department of
Aboriginal Affairs tarried for some three years before committing the necessary
funds (Carter et al. 1987). Departmental divisions certainly set up barriers to a
comprehensive, whole-of-government response to problems such as violence
against women. In summary, federalism is far from the only set of institutional
arrangements that divides the power to govern. The way it operates depends on
the interaction of many other policy influences so that it is very difficult to make
firm generalisations about its impact even in a single federation.
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Social Liberalism in Australia
A strong strand of social liberalism runs through Australian political culture.
In contrast with its distant cousin, market or neo-liberalism, social liberalism is
sympathetic to extensive government intervention in economic and social life
and underpins the Australian practice of looking to government rather than to
individuals or the private sector to help solve problems. A positive view of the
role of the democratic state might be expected in a nation where white settlement
was established by government, where extensive government intervention was
necessary if settlements were to grow and where all the early institutions, such
as hospitals, were government institutions. Since the nineteenth century, social
liberalism has been an important force in Australia, and the policy responses
called for by the women’s health movement fit comfortably within that
philosophical perspective.
Social liberal ideas in Australia derive from the work of English thinkers,
including T. H. Green, L. T. Hobhouse, J. A. Hobson and J. M. Keynes, who
developed a sustained critique in the late nineteenth and early twentieth
centuries of laissez-faire or market liberalism.8 Their work provides a
philosophical foundation for the welfare state. These thinkers held that the role
of government should be expanded to ensure a decent standard of living for
all citizens and to provide the conditions under which individuals could reach
their maximum potential. Rather than the minimal government role of laissezfaire liberalism, the democratic state, it was argued, has a moral duty to create
the conditions for equality of opportunity and freedom from insecurity and
deprivation.
Over the past century, many observers of political life have remarked on the
extensive use that is made of the Australian state (government). ‘Australian
democracy has come to look upon the state as a vast public utility, whose duty
is to provide the greatest good for the greatest number’, wrote historian W.
K. Hancock in 1930 (Hancock 1961:55). More recently, A. F. Davies (1964:4–5)
argued that ‘Australians have a characteristic talent for bureaucracy…[which] is
exercised on a massive scale in government, economy and social institutions’. As
Marian Sawer has shown, strong social liberal ideas have influenced Australian
public policy for more than a century. Australian feminists, for example, have
never trusted free markets and have espoused social liberal ideas and supported
state intervention since the first wave of the movement (Sawer 2003). The calls
that second-wave feminists made upon the state, then, are in keeping with an
established and important seam in Australian political thought.

8  Neo-liberalism is the modern manifestation of laissez-faire or classical liberalism.
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The deeply embedded support for social liberal ideas helps to explain, first, the
relative success of the Australian women’s health movement, especially in the
early years, and, second, why the movement’s approach has differed from that in
countries where more individualistic, market-liberal ideas are stronger. Marian
Sawer (1994:162) has drawn attention to an important difference between the
Australian and US women’s movements:
Because of the tradition of seeking reform through political action rather
than litigation, the language of Australian feminism has drawn upon
shared value systems (the dominant social liberalism) both to mobilise
supporters and to persuade power-holders. Australian feminism has
not split like the American women’s movement over issues of equal
rights versus issues of special needs or individual autonomy versus
the ethic of care because social liberalism contained all these elements.
The Australian women’s movement has been able to draw upon them as
required for the political purposes of the day.
Social liberal ideas are embedded in the political cultures of other countries,
including Britain, Canada and New Zealand. As discussed, however, when
women’s health movements were at the peak of their strength, political
opportunity structures were unfavourable in those countries because
conservative governments held power.
Despite the strength of the tradition, social liberal ideas have been strongly
challenged by neo-liberalism in recent years, which is a large part of the
reason that the commitment to social justice and feminist objectives has visibly
weakened. The popularity of neo-liberal ideas among politicians and other
opinion leaders in Australia over the past three decades might suggest that
social liberalism is no longer an important political force. Australian opinion
polling, however, consistently shows support for high levels of public spending
on health, age pensions and education. A 2004 review of major polls found
that in the previous 15 years, when faced with a choice between tax reductions
and increased spending on social services, Australians increasingly favour the
latter. One of the conclusions was that ‘a government which cuts taxation while
eroding the standard of health, aged care and education services is unlikely to
have the support of public opinion’ (Grant 2004:26). An explanation for this
paradoxical situation is not attempted here, except to say that the interests with
the resources to place their views on political agendas and to make contributions
to the campaign funds of political parties appear to be the voices that are being
heard. There is still strong support for women’s health policies and programs,
which the Commonwealth is currently choosing to ignore, except at a symbolic
level. Present-day neo-liberal leanings aside, a majority of citizens consistently
supports well-funded health and education services.
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Conclusion
A combination of forces and influences interacted together to put women’s
health on Australian policy agendas and to induce governments to act. The
strength and tenacity of the grassroots movement were very important factors,
together with the dedication and commitment of women working in women’s
services over almost four decades. The context of a strong reform environment
in which the early movement worked was important, as were related factors
such as the relative weakness of Australian social policies and programs, which
meant that there was significant community support for general social policy
reform. The relative openness of Australian government helped the movement
to put its claims before senior personnel and, once issues found their way into
party platforms, at least some of them were implemented when a party came to
power. Women in political parties and unions worked hard to persuade the men
in their organisations to accept women’s health ideas. The early and extensive
establishment of Australian women’s policy machinery and the appointment
of femocrats in key positions were distinctive Australian developments that
promoted policy uptake. The strong relationship that often existed between
feminists in the bureaucracy and feminists outside was often used to promote
policy advancement. Although it is impossible to measure the independent
impact of separate influences, the strength of the Australian women’s health
movement, the election of supportive governments and a political culture that
endorses social liberalism were key factors. Moreover, all these influences
interacted together in various ways, sometimes reinforcing each other and
constituting a countervailing force to opposing interests.
To return to the questions posed in the introduction, a complex array of
interacting influences is the reason that Australia is the only country to have
enacted two national women’s health policies and to have attempted to establish
a strong national network of community health centres. Policy development was
supported by a community health movement and an Aboriginal health movement
and led by strong exponents of structural reform—the same policymakers who
supported women’s health. And, of course, the women’s health movement and
the community health movement provided support and legitimacy for each
other. One difference between the two areas is that health policy experts led
developments in community health whereas women at the grassroots led the
charge in women’s health, as they did in the Aboriginal health movement. A
similar set of policy forces has placed Australia among the leading countries in
its response to violence against women.
Finally, what are the conditions that came together at different times to create
windows of opportunity for structural health reform? In the case of the
introduction of national health insurance and the Community Health Program in
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the 1970s, the first facilitating factor was that the Commonwealth Government
was strongly committed to policy action and actively led public debate. That
is, the ALP had formulated relatively detailed, evidence-based policies and had
explained them to the community over several years. Because the proposals were
controversial, debate had been long and intense and party members had worked
hard to articulate the policies. By the time the party came to office, significant
numbers of Australians understood and supported the proposals. Second, the
activism and support of the health reform movement, including the women’s
health movement and the Aboriginal health movement and mobilised general
women’s and welfare reform groups, made it easier for the Commonwealth to
pursue major change and harder for the Opposition to oppose, although oppose
it did very strongly. Outside support, national and international, helps to shore
up the political determination necessary to succeed against powerful opposing
medical unions and other interests, such as the insurance industry. Thus, a
reform-oriented policy environment, featuring strong support for social liberal
rather than neo-liberal policy responses, strongly mobilised community support
groups, evidence-based policies with supporters and a political party with
strong political will, prepared to take the role of opinion leader, were crucial
elements of policy opportunities. The planets in the policy universe rarely line
up so well.

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10. A Glass Half Full…
Australian women’s health activists, in their long quest for the changes that
will improve women’s health—and the health of the whole population—have
reason to feel both gratification and disappointment. For although they can
lay claim to remarkable achievements, some of the most important goals are
yet to be achieved. Moreover, along the way, crucially important opportunities
for structural health reform have been missed. In the early days, movement
members identified a set of problems, many of them rarely discussed in public,
and then worked persistently until community attitudes shifted, decision
makers took notice and policy responses were made. As a result, new laws and
new programs to advance women’s health were devised and funded across the
country. The movement itself set up an infrastructure of community-based
healthcare centres and services to support women in their daily lives and at
times of distress and crisis. This infrastructure serves as an institutional base for
the movement, supporting intelligence gathering, information sharing, policy
development and advocacy work. Taking up the health reform ideas of the
1970s and applying a gender lens, the concept of a social health perspective was
developed and disseminated. Arguably, wider understanding and acceptance
of the social view of health is the movement’s most important accomplishment.
Unfamiliar in the early 1970s when the comprehensiveness of hospital and
medical services was rarely questioned, the social perspective now explicitly
informs most Commonwealth, State and Territory health policy documents.
On the other side of the ledger, the women’s health sector has always been
seriously under-funded, which has restricted its capacity to meet immediate
needs and to develop innovative and collaborative health-promoting strategies.
It also restricts its capacity to expand its constituency because, being thinly
scattered, only a few women can have access to the services it provides. While
the mainstream health system has responded to some aspects of the feminist
critique, it remains heavily centred on the medical model, with its focus on
treatment services. The best-practice models of preventive health care developed
in the community sector have not yet had a system-wide impact, mostly because
structural incentives steer provision in the direction of high-turnover treatment
services. Health reform has been high on the national agenda since 2007, where
policy documents recognise social determinants and talk about the importance
of prevention. Yet proposals to strengthen primary health care—the locus of
any significant preventative effort—have so far been restricted to supporting
the services provided in general practitioners’ surgeries on a fee-for-service
basis. The 1970s vision of a holistic, prevention-focused, primary healthcare
system is still the stuff of dreams.
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Nevertheless, innovative models of practice continue to be developed in the
small community-based worlds of women’s health, Aboriginal health and
community health. The States and Territories, within the limited finance
available to them, are generating innovative approaches to primary health care
through partnerships and collaborations with the community sector and others.
And after a small injection of extra funding that came with the Emergency
Response, policymakers in the Northern Territory’s Aboriginal medical services
are leading the way in Australian health reform, as the Aboriginal health
movement led the way in the 1970s.
This concluding chapter looks at the achievements of the women’s health
movement and the goals that are still to be reached. It then examines the reasons
that structural reform has been so hard to achieve, returning to the last question
posed in the introduction: why, despite the wealth of evidence and the advocacy
of women and other public health reformers, have the key structures of the
health system remained virtually unchanged since the 1970s?

Two Steps Forward
At the local level, in female-run centres and services, women participate in
health decision making, which is held to be the gold standard by health experts.
The services provided are highly valued by those who use them, particularly
by disadvantaged and marginalised women. Primary prevention undertakings,
infrequently available in the hospital and medical systems, are tailored to
meet local needs. Self-help is supported, health literacy is promoted and
group programs are developed. Support and referral services and communitydevelopment projects are part of everyday practice, along with interaction and
collaboration with local service providers.
Currently, 65 community-based, feminist women’s health centres are providing
services nationally, along with almost 400 refuges, shelters, safe houses and
information and referral services for women escaping violence. Sexual assault
services have been established in all States and Territories. Some are still
independent and community based, others are government run, sometimes
informed by feminist principles, sometimes with community representatives
on their boards. There are approximately 150 community-controlled Aboriginal
health centres, in which women play important roles. In addition, there are
specialist centres, such as Children by Choice in Queensland, the Multicultural
Centre for Women’s Health in Victoria and Aboriginal women’s health centres.
Informed by a social perspective of health and illness, these organisations
provide an extensive range of medical and non-medical services, tailored to
respond to the expressed needs of the communities in which they are located.
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In women’s health centres, participation in health decision making is a daily
reality. Clients are familiar with the concept of participation and they feel a sense
of involvement with the centres they attend and a capacity to influence what
happens there. Community women are often involved in centre management,
and participation in the many group programs on offer opens the way for health
development, empowerment, companionship, and the giving and receiving
of support (Broom 1996:24–5, 1997:278). This is all the more valuable because
women’s health centres serve a clientele that is markedly disadvantaged
compared with the female population overall. Clients are significantly more
likely to have been born overseas, to identify as being Aboriginal or Torres
Strait Islander, to have lower education levels and below-average incomes, to
have been unemployed in the past year, to be lone mothers and not to be buying
their own homes (Broom 1997:277). These are the women who are least likely
to participate in civil society and most likely to have poor health outcomes.
Women’s health centres also undertake outreach work enabling them to make
contact with women who might otherwise be excluded and whose needs often
go unrecognised. Workers in women’s health centres are caring for women while
at the same time assisting them to gain skills to care for themselves. And judging
by the popularity of the centres, they are doing these jobs well.
The number of women’s health advocacy groups continues to grow, supporting
more women and drawing attention to an ever-broadening sweep of health
issues. Professionals, including legal, law enforcement, allied health and medical
professionals, have received training in feminist health perspectives and cultural
competence. The latter now appears in the curriculums of some medical schools
(Ambanpola 2005).
Influenced by other social changes as well, the way women experience
encounters with medical and hospital systems has shifted in response to the
feminist critique. Professional attitudes are less patronising and judgmental
and women’s health concerns are less likely to be trivialised. Finding a woman
doctor, particularly a general practitioner, is likely to be easier, as women
now enter medical training in much the same numbers as men. Raising public
awareness of problems, such as the over-prescription of tranquillisers and the
dangers of certain drugs, has resulted in increased health literacy and more
careful practice. Following earlier overseas developments, moves are at last
being initiated in Australia to ensure that appropriate numbers of women are
included in research projects.
The hundreds of refuges scattered across the country provide essential services
for women and children, where previously there were almost none. Since
the early days, when volunteers responded as best they could to the needs
of the women and children landing on their doorsteps, feminist refuges have
undertaken political advocacy as well as providing support services and crisis
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accommodation. As the expertise and professionalism of workers increased, the
range of services was broadened and became increasingly sophisticated. Where
budgets allow, refuges provide child care, children’s programs, child-protection
services and programs to enhance parenting skills. They assist with legal and
financial matters and with access to long-term housing. Counselling services
are provided and families are assisted to deal with health issues. As well as
advocacy and community education, refuges provide outreach and training.
Staff regularly contribute to policy development and interact with a plethora
of government and non-governmental agencies as part of efforts to coordinate
complex sets of services (Gander and Champion 2009).
Peak bodies, at both the sub-national and the national levels, support the sectors
and act as a conduit to government. WESNET, the national peak body representing
almost 400 agencies, identifies areas of unmet need, draws attention to new and
emerging issues and stimulates debate within the sector through its newsletter
and through forums and conferences. It lobbies governments to improve policies
and expand services and undertakes research, including research on needs in
rural and remote communities. The links between homelessness and violence
have been explored and publicised and model national domestic violence laws
have been drawn up (WESNET web site). State and Territory peak bodies
also play crucial roles. In New South Wales, for example, the Women’s Refuge
Movement has operated for more than 30 years, advocating for the needs of the
sector and the clients of the 57 refuges it represents.
Since the first faltering efforts of volunteers to respond appropriately to the often
desperate women who contacted them, sexual assault centres have been slowly
transformed into highly professional agencies in all jurisdictions, although
there is considerable variation from place to place. Victoria, for example, has
a statewide network of hybrid services that are government run but have
community boards, while New South Wales has a mix of government and nongovernmental agencies.
Significant attitudinal changes to violence and sexual violence against women
and children have been realised, largely through the efforts of the movement
and the policies formulated in response. A large national survey undertaken by
VicHealth in 2009 found that 98 per cent of respondents recognised domestic
violence as a crime—an increase of 5 per cent from a 1995 benchmark survey.
People were also more likely to understand that domestic violence takes a
variety of forms. As well as actual physical harm, it includes threats of harm and
psychological, verbal and economic abuse. In 1995, one in seven respondents
thought that women who are raped ‘ask for it’. By 2009, however, only one in
20 people took this view (VicHealth 2010:8, 37, 42). Thus, as Alexandra Neame
argues: ‘Historical explanations of the causes, characteristics and prevalence of
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sexual assault have changed dramatically over the past three decades, primarily
in response to effective campaigning by feminists to challenge the many myths
surrounding rape and other forms of sexual violence’ (Neame 2003:6).
The movement can count among its achievements Australia’s two national
women’s health policies, the NWH Program, the National Plan to Reduce
Violence against Women and their Children, the National Disability Strategy
and the many crucial State and Territory policies and strategies. Since 2007,
violence against women has been a priority item on the Commonwealth’s policy
agenda. Of developments in this area, Leslie Laing wrote in 2000:
Within a quarter of a century, a subject once shrouded in secrecy has
assumed a prominent place on the agenda of all State and Territory
governments, and the Federal government. It is salutary to recall that,
less than a century before the first feminist actions to place domestic
violence on the political and social agenda, it was lawful for a man to
beat his wife; women could not own property, nor could they have the
custody of children. Clearly much has been achieved. (Laing 2000:5)
Since 2007, the profile of gender-based violence as a women’s health issue has
been raised by the leadership of the Commonwealth Labor Government and the
report of the National Council. A national plan is now in place that offers the
possibility of sustained action across jurisdictions.
A social view of health, promoted consistently by the movement for 40 years,
has now entered the health policy lexicon. For example, the National Health
and Hospitals Reform Commission (NHHRC) report commends the work of
WHO’s Commission on the Social Determinants of Health and supports its
call for governments to take action in addressing those determinants. Some
of the objectives identified by the NHHRC, such as strengthening consumer
engagement and voice through increased health literacy, fostering community
participation and empowering consumers, follow women’s health principles
and are well established in practice in the women’s health and Aboriginal
community-based sectors (Commonwealth of Australia 2009c: 7, 96).
The gains of the past 40 years are all the more impressive because pioneering
women had so few resources, so little knowledge about the operation of
government and policymaking and were novices when it came to submission
writing and advocacy work. What has been said of the women’s health movement
in the United States can equally be said of the Australian movement:
Few other recent social movements have addressed questions of health
and medical care so directly, and few have contributed a practice so
relevant to changing health beliefs, health practices and health care
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institutions…the totality of the feminist contribution to public health
practice is greater than the sum of its individual parts. (Freudenberg
1986:30)
Yet the precious opportunities to achieve population-health gain opened up by
the movement and its allies have been largely wasted. Funding for the women’s
health sector has always been niggardly, crushing its potential to make a greater
contribution to population health. Most importantly, the structural reforms
needed to redress the imbalance between medical and hospital services and
community-based primary health care have been absent from the Commonwealth
agenda for decades, except for a brief moment when it was raised by the Rudd
Government only to fade into oblivion as vested interests in health took up their
battle positions. Moreover, as well as failure to invest in primary health care (as
opposed to primary medical care), successive Commonwealth governments have
presided over glaring structural impediments to the accessibility of conventional
hospital and medical services, undermining the universal access that Medicare
is supposed to provide.

One Step Backwards: Under-funding
The women’s health sector has always been run on a shoestring. The needs of
even the small number of women who have a service located nearby and want
information, advice and care have never been adequately met, even under the
Whitlam Government. Since then, no government has been prepared to provide
funding at more than a minimal level. For clients, frustration, unnecessary
suffering, traumatised children and avoidable ill health are some of the penalties
being paid. For the Australian public purse, the costs are high. Medicare foots
a large bill for avoidable illness and unnecessary hospitalisation. In the violence
area alone, Access Economics calculated the cost at $8.1 billion per year in 2004
(Commonwealth of Australia 2004a:64–8).
Under-funding of the women’s health sector results in high levels of frustration
among women working at the coalface because they cannot provide the
services that are patently needed. Managing in straitened circumstances
contributes to poor morale and cynicism. Professional development is thwarted
and recruitment is always a problem because the pay on offer is unattractive.
Forward planning is impossible without financial security and even simple
matters, such as leasing premises, can become a major stumbling block. Policies,
especially pilot programs, are often largely symbolic and leave a local vacuum
when they terminate. In some jurisdictions, women (both inside and outside
government) feel that the women’s health movement has been ‘used’ by political
parties and bought off cheaply. At the sub-national level, political mileage has
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been gained from the announcement of new but minimally funded services in
marginal seats. At the national level after more than a decade of hostility, the
movement has no choice but to settle for the 2010 NWHP, released in the dead
of night, which does not acknowledge the contribution of the community-based
sector, much less provide funds to sustain it.
The situation of the Hunter Women’s Centre in New South Wales illustrates
the dilemmas that accompany financial parsimony. The centre has been unable
to attract a doctor since 2003 and therefore cannot provide medical services,
despite high demand. The absence of medical staff also means that the centre
is unable to employ nurse practitioners, who are permitted to work only with
the backup of a doctor. Moreover, because rates of pay are low, it cannot attract
allied health professionals, such as dieticians. In 2008, the waiting list for
counselling services was approximately six months. The centre was forced to
reduce the length of appointments and refer women elsewhere. Another strategy
is to try to promote more self-help skills. Only a partial response can be made to
expressed need and only a minimal response to requests for outreach services in
surrounding regional areas. The planning question is always which services can
be cut, rather than how services can be organised to meet client needs.
A similar situation prevails at Leichhardt Women’s Community Health Centre
and most other centres, including those that provide crisis services, such as
family violence outreach. At Leichhardt, waiting lists are not kept because there
are no resources to manage them. Appointments are given on a first-come, firstserved basis. The centre would like to employ a domestic violence counsellor
and a counsellor familiar with the needs of adult survivors of childhood
sexual assault but has no money to do so. Salaries are based on the social and
community services (SACS) award, which results in lower pay rates than in
either the government or the private sectors, so it is difficult to attract skilled
professionals. The centre survives because older, experienced staff members are
strongly committed to its philosophy. Staff members report, however, that a
partner earning a good income is an essential support mechanism.
Funding to support women and children who have experienced violence remains
inadequate. If it was shocking that there were virtually no services for women
escaping violence in the 1970s even when their children were being sexually
assaulted, it is a national disgrace that almost 40 years later women and children
are still turned away because services are not funded to cope with demand. In
rural and remote areas, there are very few support services. Unable to access
crisis accommodation, women and children often return to violent situations,
with all the painful and wasteful health problems that follow. The best available
data indicate that one in every two women escaping violence and looking for
accommodation in domestic violence homelessness services is turned away
(Gander and Champion 2009:25). Nor, amazingly, do refuges receive funding to
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cover the cost of accompanying children, although governments acknowledge
the value of investing in young people. Accommodation shortages result in
many women and children being referred to motels and caravans, sleeping in
cars, staying temporarily in overcrowded housing and/or returning home to
perpetrators (Commonwealth of Australia 2009a:76).
Moreover, homelessness policies do not take sufficient account of violence
against women. Crisis service providers still struggle to persuade governments
at all levels that domestic violence is the major cause of homelessness in Australia
(Gander and Champion 2009:25). There are very few crisis services for older
women, so that older homeless, single women are in no better position in 2011
than they were in the 1970s (McFerran 2009:5–7). In addition, acute shortages
of affordable housing nationwide mean that bottlenecks develop and extreme
pressure is put on refuges with the result that client recovery is delayed.
The National Council’s finding that refuges, shelters and outreach services
are inadequately funded has not so far resulted in any significant increase in
resources. Staff shortages are such that there is often only one domestic and
family violence ‘safe at home’ worker to cover a whole rural region or only two
workers for an entire metropolitan area.1 The connections between homelessness,
domestic violence and sexual assault are not sufficiently recognised in policies.
The incidence of sexual assault amongst homeless people is high, especially for
women and young people, but there are no specialist services to meet their needs.
Indeed, while policies generally note the position of groups that experience
higher levels of violence, including women with disabilities, Aboriginal and
Torres Strait Islander women, women in rural and remote areas and so on, the
women’s services sector cannot respond appropriately to clients with complex
needs.
Sexual assault services have developed priority criteria to help manage heavy
demand with the result that women categorised as non-urgent might have
to wait months for counselling. In some jurisdictions, rape crisis facilities
have been asked to provide services for men without additional funding.
Some services are forced to close on one or more days a week and many have
difficulty offering adequate after-hours services, court support, legal advice,
services for children, preventive resources, community-development initiatives
and advocacy in relation to issues such as child protection. The capacity to
collaborate effectively with other organisations is reduced, finding time to
offer student placements is difficult and staff training is limited due to resource
constraints. In some places, there are even long waiting lists for support group
programs. In such circumstances, the capacity to undertake prevention work
is limited. As Carmody (2009:16) argues, if primary prevention is to be taken
seriously, ‘we need a skilled and adequately remunerated workforce that not
1  These issues are discussed in Barrett Meyering (2009); Braaf (2008); Morrison (2009); Oberin (2009).
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only understands the content of the programs they are delivering but have a
clearly articulated theoretical stance to the work they do and understand why
they do it’. The inability to obtain post-violence accommodation, counselling
and support and the lack of well-funded prevention programs lead to high and
avoidable ill health, which extends into old age. Community-sector workers
continually operate at the limits of their capacity—a workplace situation that is
not health enhancing.
There is strong agreement that services in the violence sector need to be
coordinated and integrated. The National Council (Commonwealth of Australia
2009a:7,187) argues that integrated strategies and action plans need to be
developed at both sub-national and local levels. Plans should reflect input from
the police and justice systems, and from education, community, health and
human services, it is argued, and should include performance indicators, targets
and time lines. Currently, only Victoria, Tasmania and the Australian Capital
Territory are attempting to coordinate their responses (Willcox 2008:5). The
National Council’s recommendation that mechanisms be put in place to ensure
that systems work effectively together has been omitted from the new National
Plan to Reduce Violence against Women and their Children.
Inadequate funding limits the extent to which services can carry out prevention
work. There is agreement that educational efforts need to include school
students, university students, community leaders and service providers and
they need to be expanded. The present Commonwealth Government recognises
this problem and is currently supporting ‘Respectful Relationships’ programs.
As with so many past efforts, however, the present projects are pilots—they
might not continue and are unevenly spread across the country. Only $9.1
million over four years has been allocated to cover projects in various settings
(Plibersek 2009). The new national plan envisages that prevention programs will
be continued but no announcement has been made about funding allocations at
the time of writing.
In terms of appropriate training, a 2009 consultation in New South Wales found
that the police and general practitioners still lacked important knowledge about
domestic violence, healthy relationships and women’s rights (Peters 2009:3).
Existing services are not adequately funded to do the training, protocol
development and integration work that is required to ensure that the mainstream
and community agencies respond appropriately to violence against women and
children. Experts argue that training for judges, magistrates, registrars, court
volunteers and the like must be made compulsory (Oberin 2009:6).
Another problem is that research has been so under-funded that information
about violence against women and the services they seek is limited. We are
not even sure whether levels are lower, stable or increasing (Commonwealth of
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Australia 2009a:15–21). Oberin (2009:4) argues that intimate partner homicide
might be increasing. Information is not collected consistently across the country
and the data that exist have serious limitations. National data are currently too
poor to be used to measure and evaluate the effectiveness of interventions.
At a time when violence against women occupies an important place on policy
agendas, women’s services workers report feeling sidelined and undervalued
(Gander and Champion 2009:26). Refuge workers are experts in the complex
needs of women and children who have experienced violence and in the
strengths and weaknesses of service systems. They have a long history of
contribution to policy, legislation and research. But this expertise is not utilised:
leading advocates argue that there is still a lack of systematic and meaningful
consultation. They point out that neither WESNET nor Homelessness Australia
is represented on the Prime Minister’s Council on Homelessness (Oberin
2009:10). As Gander and Champion conclude: ‘It appears that the breadth and
depth of our interventions, and the multilayered nature of our work, is not
worth mentioning, building upon, or even maintaining with adequate funding’
(2009:26).
This argument is underscored by the lack of reference to the work of the
women’s health sector in the 2010 NWHP. Given that dozens of submissions
from the sector were received, the oversight cannot be unintentional.
Because primary prevention efforts in the violence sector have been weak and
sporadic, it is not surprising that many old myths and beliefs remain strong,
despite positive attitudinal change. Moreover, some attitudes are shifting in
directions that are not supported by evidence. Almost half (49 per cent) of
Australians in the VicHealth survey cited above still believe that women could
leave violent relationships if they really wanted to and 80 per cent said they
found it difficult to understand why women would remain. Twenty per cent
of men and 17 per cent of women believe that domestic violence is excusable
when perpetrators get so angry they temporarily lose control and 27 per cent
of men and 18 per cent of women would excuse domestic violence where
perpetrators are genuinely sorry afterwards. Thirteen per cent of people still
agree that women ‘often say no when they mean yes’ and more than one-third
of Australians believe that rape results from men being unable to control their
sexual urges! Further, the belief that women lie about violence is still strong:
49 per cent agreed that women make false statements in order to improve their
chances in custody cases. Only 61 per cent of respondents agreed that women
rarely make false claims about rape, with men and boys more likely to support
or excuse violence than women and girls (VicHealth 2009:7–9).
In relation to attitudes that persist despite significant social changes, it appears
that many doctors still approach women in a disrespectful manner. The major
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finding of a 2011 health survey undertaken by Equality Rights Alliance is that
women, especially young women, experience the services they receive as poor in
terms of the negative way they are treated by medical professionals. Open, nonjudgemental communication, respect and willingness to listen were identified
as positive elements of medical encounters that were often missing. 55.3 per
cent of the women surveyed would not recommend their general practitioners
to other people! Women were also concerned about financial, geographical and
physical barriers that reduced access to services.2
Sexual assault remains one of the most under-reported crimes in Australia,
with an estimated reporting rate of less than one in five (Commonwealth of
Australia 2009a:19). Social stigma, which flows from longstanding myths and
the perception that legal processes are overly concerned with the rights of the
accused, operate to deter reporting. Other problems include non-supportive
environments for complainants, lack of expertise amongst relevant professionals
and the unpredictability of judicial discretion. Women whose first language is
other than English, Aboriginal women and women with disabilities experience
even greater barriers (Neame 2003).
In summary, then, the National Council (Commonwealth of Australia 2009a;
2009b) confirmed what the women’s services sector has been saying for many
years: serious problems arise from under-resourcing, including difficulties
accessing crisis and emergency services. There are long waiting lists for all
kinds of services and support, including housing, and difficulties accessing
legal advice and timely forensic examinations. Moreover, resource constraints
prevent women’s health workers from developing innovative responses to the
needs that women living in their areas express. All of which is very bad not
only for women’s health but also for everyone’s health. As a recent WHO report
on women’s health argues, ‘improving women’s health matters to women, their
families, communities and societies at large. Improve women’s health—improve
the world’ (WHO 2009:6).

Explaining the Half-Full Glass: Constraints on
policy advancement
How do we explain the less than full support of successive Australian
governments, national and sub-national, for the women’s health enterprise? How
do we explain the lack of progress towards the structural changes necessary
to create a more comprehensive health system when the evidence so clearly
2  The survey report can be found on the Equality Rights Alliance website at <http://equalityrightsalliance.
org.au/projects/stronger-policies-and-programs-womens-health>
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supports such a direction? In answering the first question, it is hard to escape
the conclusion that women’s health is still not seen as fully legitimate. Indeed,
at times, suggestions are made that separate women’s health services are no
longer needed. Having usefully blazed a trail in the early years, the argument
goes, these relics of a bygone era should be incorporated into the wider health
system. If the mainstream health system had embedded ‘prevention and early
intervention into every aspect’ of the system, as suggested by the NHHRC
(Commonwealth of Australia 2009c:95), the argument mighthave some validity.
The community-based sector and the hospital and medical sectors, however,
still provide very different sets of services, as we have seen. And even where
secondary and tertiary prevention are practised, there is enormous variation
across the country. For example, a few divisions of general practice have been
innovative, improving the comprehensiveness of their services, as have a few
group practices. For the most part, however, the mainstream operates firmly
within a medical, individual treatment model.
Second, the under-funding of the sector means that it has been unable to expand
its support base, which, in turn, limits its political relevance. While extremely
popular with clients, the spread of services is too small to reach more than a tiny
proportion of Australian women, so limiting the number of women supporters.
Moreover, because many clients are disadvantaged, they are less able than
advantaged women to exercise their political voice. The women’s health sector
therefore is a political lightweight, dependent on government largesse and
struggling to lobby effectively for its own expansion.
Third, while some sub-national jurisdictions have shown considerable support
for women’s health, the financial centralisation of the Australian federation
renders them unlikely to be generous funders, even under buoyant conditions.
Moreover, the Commonwealth can, and does, manipulate the federal financial
balance at will: the Howard Government, for example, reduced the national
share of hospital funding from 44.3 per cent in 1998–99 to 38.6 per cent in
2006–07 (AIHW 2010c:ix), leaving the States and Territories seriously short of
discretionary spending capacity. Fiscal centralisation, then, is a large part of the
reason that the States and Territories have kept a tight rein on women’s health
funding.
In summary, less than complete legitimacy, low political resources and the
Australian federal financial imbalance combine to undermine opportunities
for policy expansion. The advance of neo-liberal ideas and the relatively new
phenomenon where both major political parties seem able to ignore voters’
preferences for well-funded public health and education systems have resulted
in to a poorly funded sector that struggles to meet even urgent needs. Turning
to probe the second question concerning the slow progress towards a more
comprehensive health system, we find a somewhat different set of forces at work.
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Structural Barriers to Improved Population
Health
As well as political barriers to greater government investment in primary health
care, there are also entrenched structural barriers that impede full access to
treatment in the hospital and medical systems. While treatment systems are
only part of what it takes to improve population health, they are nevertheless
a key element of any health system. Structural barriers include (but are not
limited to) the fee-for-service system of doctor remuneration, the Australian
preference for small medical practices, increasing user charges and imbalance
in the geographical spread of services. Financial barriers also inhibit access
to allied health services, including dentistry, physiotherapy, dietary advice
and the like. Further, there is still excessive emphasis on a medical model of
care in medical and nursing education with insufficient emphasis on training
to increase awareness of cultural, sexuality and gender differences. Culturally
inappropriate services are a barrier to access.

Barriers to Accessing Medical Services
The fee-for-service method of payment works as an economic incentive for
doctors to see as many patients as possible, as quickly as possible, producing
high turnover, curative medicine. It discourages the longer appointments
necessary for thorough check-ups, for the management of complex and chronic
conditions and to engage in primary prevention work. Internationally, fee-forservice remuneration has come under heavy criticism. One OECD assessment
argues that it gives physicians ‘full discretion’ over the level and mix of services
and creates incentives ‘to expand the volume and price of the services they
provide’ (OECD 2003). Policy in a number of European countries is moving away
from fee-for-service towards other forms of payment and it has been replaced
completely with contract and salaried payment in New Zealand. Recent research
shows that the percentage of New Zealanders who go without care because of
cost has fallen since 2004 when this change came into operation (Schoen et al.
2010:2327).
Although Medicare is a type of national health insurance, it provides only
partial coverage against the cost of medical services outside hospitals. Australian
user charges—that part of the cost of a service paid for by the user—have been
allowed to increase steadily and are now among the highest in the world (Schoen
et al. 2010:2327). There is a large international literature showing that user
charges constitute a serious financial barrier to access, especially for low-income
people (reviewed in Gray 2004:65–77). In 2009, 22 per cent of Australians went
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without care because of cost, 21 per cent paid user charges of $1000 or more and
8 per cent reported being unable to pay medical bills or having serious problems
paying (The Commonwealth Fund 2010). Moreover, the cost of accessing the
services of allied health professionals, including dieticians, physiotherapists,
psychologists, counsellors, podiatrists, dentists, midwives and alternative
therapists, is beyond the financial capacity of a great many Australians and is
especially difficult for low-income women. These structural impediments mean
that those lower down on the social gradient are often missed by conventional
medical systems, bringing to mind ‘the inverse care law’ coined by Welsh doctor
Julian Tudor Hart some 40 years ago. ‘The availability of good medical care’,
Hart argued, ‘tends to vary inversely with the need of the population served’ in
systems where market forces are allowed to operate (Hart 1971:405).
Some people are deterred from accessing services because health professionals
are not trained in cultural or gender competence or trained to understand the
health problems faced by those with non-heterosexual orientations. Aboriginal
people report experiencing racism when using mainstream services, while
people from backgrounds other than Anglo-Australian often find that the
circumstances of their lives are misunderstood. For similar reasons, GLBTIQ
people identify appropriate health services as a priority.
The inverse-care law operates strongly in relation to residents of rural and remote
areas. There, services of all types are in short supply, despite evidence that rural
people suffer poorer health than people living in metropolitan areas.3 If we were
to take population health seriously, reforms would need to be implemented
to modify and, in an ideal world, eventually eliminate, all of these structural
barriers. Australian health policy has failed to deal with the overt barriers that
impact adversely on access to hospital and medical treatment, which does not
augur well for the prospect of introducing the structural changes needed to
strengthen the primary health care system.

Structural Barriers to a Stronger Primary Health
Care System
The important barriers weighing against the development of a more
comprehensive healthcare system include cultural factors, financial forces and
the stake that powerful medical unions and other groups have in preserving the
system as it stands. Ideas about what is appropriate and necessary in a health
system take a long time to change. The century-old idea that a health system
3  We do not have problems of such magnitude in education because educators do not operate as private
business entrepreneurs.
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provides hospital and medical services and not much else is taking a long time
to fade. Because there are so few comprehensive primary healthcare centres in
Australia, most people have no experience of the care on offer and are probably
unfamiliar with what is done in the name of holistic primary health care. What
we do know, however, is that when people have an opportunity to access such
services, they are prepared to line up on the pavement outside to do so.
In the 1970s, government members and committed bureaucrats ‘talked up’ the
value of primary health care, whereas in the twenty-first century most health
debate centres on hospitals and their waiting lists—a situation that vested
interests find easy to manipulate. Despite passing discussion of preventive
health care, recently focusing narrowly on chronic disease and ‘lifestyle factors’,
opinion leaders are not promoting the value of community health care. When it
comes to taking concrete, funded action, most policymakers, it seems, still see
health policy as predominantly about hospital and medical services. Cultural
factors are important as well, especially in maternity care: Australian women
have become accustomed to having their babies in hospitals since there are
so few alternatives. Perhaps they are about to become accustomed to having
their babies by caesarean section. While RANZCOG defends Australian levels
of caesarean section, these rates are high by international standards. Indeed all
the English-speaking industrialised countries have high rates, except for New
Zealand, which is now placed about the middle. The OECD country with by far
the lowest caesarean section rate is the Netherlands, where medicalisation is less
than anywhere else and where approximately one-third of babies are born at
home (OECD 2011).
A preference for solo or small group practice, supported by the financing system,
is another structural barrier to comprehensive, primary health care. Evidence
shows that teams of health professionals are necessary to deliver an integrated
range of preventive, educational, counselling, caring and social advocacy
services, as well as conventional medical services, as the NHHRC recognised.
Another problem with solo or small group practice is lack of accountability.
Peer review of work is uncommon and the sharing of ideas and collegiality that
comes with teamwork is not available. Health teams have been introduced in
some European countries and in New Zealand and Canada.
Money is another factor militating against investment in primary health care.
Even for the Commonwealth, the cost of hospital and medical services, which has
increased faster than other prices for decades, is a large budget item. Containing
hospital and medical costs is a major objective in all OECD countries and has not
been fully achieved. Under these circumstances, it is difficult for governments
to find new money to invest in community-based services. Delaying investment,
however, ensures the continuation of a destructive spiral: low spending on
primary health care results in avoidable illness and unnecessary hospitalisation,
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which leads to unnecessarily high cost to the public purse and, in turn, results
in low spending on primary health care. The NHHRC drew attention to this
dilemma, commenting on the lack of any nationally coordinated mechanism
to deliver preventive health care. In relation to chronic disease, it argued
that Australia spends less than 2 per cent of the health budget on ‘a problem
which consumes a major proportion of health expenditure’ (Commonwealth of
Australia 2009c:51). The Commonwealth responded by setting up the National
Preventive Health Agency in 2010 with the aim of driving the Australian
prevention agenda. It is too early to see if it will have an impact.
Finally, powerful interests vehemently resist structural reform. Health is
an area where there exist exceptionally powerful vested interests. Medical
professionals are respected, influential and have abundant resources to devote
to political campaigns. Doctors’ trade unions regularly and consistently
attack governments that want to make changes that might undermine medical
interests. In the Australian case, this is any policy that might threaten or even
encroach upon private, fee-for-service medical practice. In addition, the private
insurance industry, pharmaceutical companies and makers of high-tech medical
equipment, like doctors, want to see continued high investment in curative
medical care; investment in primary health care is not in their interests. At the
Commonwealth level, what passes for health policy—and what is sometimes
even called health reform—is mostly about the supply of hospital and medical
services, about how they will be paid for (from the Treasury or from private
pockets) and how much medical professionals will be paid for providing them.
Although the Commonwealth decides policy about hospital and medical services,
the States and Territories do make health policy.4 All jurisdictions provide
at least some community health services, including early childhood health
centres, community nursing and the like. Some have a network of community
health centres, preserved since the 1970s, as in Victoria. Constitutional power
for community health primarily rests at the sub-national level, so, in theory
at least, the States and Territories should be the innovators in primary health
care. The fiscal imbalance in the Australian federal system is, however, a strong
disincentive to infrastructure expansion.

4  They also run the hospitals, of course, but even though they pay for more than half of the costs of
hospitals, it is the Commonwealth that sets the parameters of both the financing system and overall policy.
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The Rudd/Gillard Governments and Health
Reform
The election of the Rudd Commonwealth Government in 2007 on a platform of
health reform held considerable promise. As well as a second national women’s
health policy and a men’s health policy, the Government committed itself to
‘Closing the Gap’ between the health outcomes of Aboriginal and Torres Strait
Islander people and other Australians. In an important respect, present-day
Australian governments wishing to strengthen the primary healthcare system
have an advantage over the pioneers of the 1970s because there are now many
successful models in the community sector. In addition, epidemiological evidence
is much more robust and we now know more than ever before about ‘the causes
of the causes’ of poor health outcomes. Evidence supporting reform is available
in abundance: the Australian Institute of Health and Welfare (AIHW 2010b), for
example, argues that cardiovascular disease, which it calculates is suffered by
two million Australian women, is highly preventable and treatable.5 The institute
has also identified ‘potentially preventable hospitalisations’—hospitalisations
that would probably have been unnecessary if timely and appropriate nonhospital care had been available. In 2008–09, there were approximately 690
000 potentially preventable hospitalisations, which represent 8.5 per cent of all
admissions. Apart from pain, suffering and death, unnecessary hospitalisation
is enormously expensive, given that in 2008–09, Australian spending on
hospitalisation totalled $31.3 billion.
In pursuit of its health reform agenda, the Rudd Government established the
National Health and Hospitals Reform Commission (NHHRC) in 2008, with terms
of reference that included ‘a greater focus on prevention’. The commission’s final
report, A healthier future for all Australians (Commonwealth of Australia 2009c),
drew attention to growing inequalities in access to services, particularly for
Aboriginal and Torres Strait Islander people, rural dwellers and those needing
dental, mental health and aged-care services. It emphasised the need for wideranging reforms, including stronger preventive health care and the need to
embed preventive health services in hospital and medical systems. It argues that
we have a ‘health system skewed to managing sickness rather than encouraging
wellness’ and that ‘when it comes to funding community-based activities, allied
health care and preventive activities compared with funding pharmaceuticals…
and medical services’, the playing field is not level. It recommends ‘significant
investment in primary health care infrastructure’ through, among other things,
the establishment of multidisciplinary, comprehensive primary healthcare
centres and services (Commonwealth of Australia 2009c:51, 102–4).
5  Some 17.6 per cent of women suffered from cardiovascular disease compared with 15.3 per cent of men,
both mostly in older age groups.
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The National Primary Health Care Strategy and the National Preventive Health
Taskforce were also established. The National Preventive Health Taskforce
emphasises the importance of strengthening Australia’s primary healthcare
system and expanding community-based preventive and outreach services,
particularly in low socioeconomic communities. It argued that ‘action and
leadership on preventive health is urgent and long overdue’ (Commonwealth
of Australia 2009d:6). Stephanie Bell, Chair of the Aboriginal Medical Services
Alliance, NT, remarked that the task force had drawn ‘strongly on 30 years of
work by Aboriginal community-controlled health services’ (Bell 2010:4).
The recommendations of these reviews, at a time when the Commonwealth
was committed to reform, created a favourable political opportunity structure
for investment in health, as well as in hospital and medical services. Many
of the initial proposals, however, including the key undertaking that the
Commonwealth would assume responsibility for all primary health care,
have been modified or abandoned in response to political manoeuvrings. The
assumption of responsibility for primary health care by the Commonwealth had
the potential to promote structural change since a single level of government
would be steering policy. Moreover, the machinations of fiscal federalism would
have been eliminated, although it would still be possible to shift costs, this time
onto consumers, by increasing user charges or allowing them to creep upwards
as the Commonwealth has done for many years.
Members of the health research community who are committed to structural
reform have been highly critical of the Rudd/Gillard reform package. For
example, Armstrong (2010) argues that
[t]here has been an unnerving willingness to ignore the advice of
countless experts regarding the need for substantial investment in
primary health care and prevention and early intervention in mental
health and dental health and to address underpinning issues, such as
the social determinants of health to reduce demand for hospital care.
The major spending decisions announced in 2010 and 2011 support such an
analysis, since most of them are directed towards strengthening hospital and
medical services. There were no new allocations for community health or for the
women’s health sector.
Two areas, in particular, of the reform proposals attracted vociferous criticism
for their omission: mental health and Aboriginal health. Current research
shows that only one of every three Australians with mental health problems
receives treatment. Fifty-four per cent of people who have been homeless and
41 per cent of people who have been in prison have a mental health disorder. In
Victoria, one-third of the people shot by police had been diagnosed previously
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with mental illness. Estimates show that mental ill health costs the economy
$20 billion per year. Australian of the Year in 2010, Patrick McGorry, a mental
health expert, claimed the sector had been locked out of the health reform
processes and the head of the National Advisory Council on Mental Health,
John Mendoza, resigned in June 2010, arguing that Commonwealth parsimony
was incomprehensible, given that 1200 people are turned away from public and
private psychiatric units every day. Eventually, the Commonwealth responded
positively to this blistering criticism: it allocated $1.5 billion over five years
to mental health in the 2011 Budget—a modest enough sum considering the
shortcomings that have been allowed to build up for more than half a century.
Commonwealth policy has been criticised on two main counts in relation
to Aboriginal and Torres Strait Islander health. First, the continuation of
the NT Emergency Response has been condemned by a range of bodies and
individuals for its human rights violations and lack of effectiveness. Critics
include Aboriginal leaders, the United Nations, Amnesty International, the
Australian Indigenous Doctors’ Association and the AMA. Second, the funding
commitments announced as part of ‘closing the gap’ have been deemed
inadequate and misleading. And although almost half of Australia’s Aboriginal
people live in cities and suffer avoidable health problems, no new spending has
been allocated (Russell 2009).
The political exigencies of Labor’s health reform efforts since 2008 are too
complex to relate here. In relation to primary care, the Commonwealth is
establishing two new sets of institutions: GP Super Clinics and Medicare Locals.
Both sound as though they might be authentic primary health care organisations.
Theoretically, both entities have the potential to operate as such. Under the
right sets of rules and with the right leadership, both might adopt a populationhealth focus and develop innovative, participatory, health-promoting programs
for their local areas. Fee-for-service medical practitioners providing fee-forservice medical services have, however, been positioned at the centre of both
organisations, which does not augur well for the adoption of a social health
perspective unless we conceive of change in terms of geological time.
Significant structural changes are required if the Australian health system is to
be made more effective and more equitable and if it is to devote more energy
and resources to improving population health. Population-health strategies
need to be planned over the long term, which is a requirement that is difficult
to achieve if governments are listing from crisis to crisis in treatment services
provision, real or perceived. As the WHO reminds us, health systems do not
automatically ‘gravitate towards the goals of health for all through primary
health care’. Rather, without planning, trends are towards a disproportionate
focus on specialised curative care, fragmentation and commercialisation (WHO
2008b:xiii).
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Meanwhile, in the Northern Territory, primary health care reform in the
Aboriginal community-controlled health sector is proceeding apace on the basis
of the additional $50 million per year allocated under the Emergency Response.
While condemning the loss of identity and the disempowerment that flows from
many aspects of the Response, especially from lack of community ownership,
a group of doctors and administrators quickly saw a window of opportunity
to strengthen primary healthcare services (Boffa et al. 2007). Because welldeveloped structures and relationships were already in place, the increased
funding could be managed within the existing system. Under the scheme, the
health workforce has been increased by 251 full-time equivalent positions. A
2011 evaluation found that despite ongoing challenges, the new initiatives are
proving to be extremely successful (Commonwealth of Australia 2011a). Watch
this space!

Conclusion
While experience shows that major health system change is difficult in Australia,
as elsewhere, it also shows that it is not impossible: major structural changes
were introduced in the 1970s and at several points since. The women’s health
movement, the Aboriginal health movement, the community health movement
and key policymakers recognised 40 years ago that treatment services are only
a part of what a good health system should provide. Therefore, women’s health,
community health and Aboriginal health infrastructure was established. The
1970s left a positive legacy for the Australian health system: the infrastructure
might have been preserved and expanded incrementally without undue political
fuss or financial cost. Having structures already in place is a major political
advantage because the fiercest battles generally take place around new ventures.
It has been open to any Commonwealth government since the 1970s to make
incremental investments in the community health sector, including the
women’s health sector. Small but regular funding increases would have become
substantial over time. Before it came to office, the Hawke Government made a
commitment to restore the Community Health Program funding that the Fraser
Government had withdrawn. In government, however, it restored funding only
to 1975 levels, which meant a large shortfall since the interim period had been
one of very high inflation. Moreover, no adjustment was made for population
increases. Political exigencies did not pressure that government to go back on
its commitment and it could have supported growth in the community-based
sector without undue budgetary stress. Aboriginal community-based health
services could have been expanded incrementally, as is happening in the
Northern Territory at present. The women’s health sector need not be so short
of money that it has to stretch to meet the most urgent needs of the women who
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queue up outside. It may be a long-term process to change community attitudes
and to realise the benefits of violence-prevention programs but refuges should
not be forced to turn away women and children who need shelter and support.
This only adds to the burden of ill health, with all the unnecessary pain and
expense that that involves. In the scheme of total health expenditure, spending
on community health is tiny. Even small funding increases over the years would
have made a significant difference and would almost certainly have reduced
overall health expenditure by preventing unnecessary illness. The pity is that
leadership, commitment and political will have been wanting.
So while the Australian women’s health movement has some remarkable
achievements of which it can be justly proud, opportunities have been created
to achieve a great deal more. The movement remains strongly committed to a
social view of health and will continue to insist that the 1970s vision of a health
system providing comprehensive, community-based primary health care as
well as hospital and medical services is not beyond the capacity of Australian
governments. The survival of a strong, activist women’s health movement in a
‘post-feminist’ era demonstrates the priority that Australian women place on
health. It also demonstrates the inability of hospital-based systems to respond
appropriately to the need for strong primary health care. The women’s health
movement, along with like-minded activists in Aboriginal health and public
health, is carrying forward the struggle to have a social determinants perspective
take its place beside a biomedical perspective in mainstream health policy.
The health of all Australians stands to gain.

325

Appendix 1:
Time line of key events, 1960–2011
1960
• Australian Labor Party developed plans for comprehensive health reform.
• Critique of curative medicine developed, particularly well articulated in
Canada.

1961
• Childbirth Education Association established.

1964
• Australian Breastfeeding Association set up, originally named Nursing
Mothers Association.

1966
• Council for Aboriginal Women of South Australia set up.

1967
• Castonguay Report released in Quebec recommending community health
centres.

1969
• Boston Women’s Health Collective formed.

1970
• National Council of Aboriginal and Islander Women established.
• Women’s Liberation (WL) formed.

1971
• Aboriginal Medical Service established in Redfern, Sydney.
• Abortion Law Reform Associations set up in all States and the Australian
Capital Territory.
327

Reaching for Health

• Australian feminists wrote sex information pamphlet, branded obscene by
newspapers.
• First edition of Our Bodies, Ourselves published.
• Quebec began to set up Province-wide network of community health centres.

1972
• Children by Choice, Brisbane, family planning and abortion information
service set up.
• Election of the Whitlam Labor Government.
• Health Commission Act (NSW) paved the way for community health centres.
• Joint Women’s Action set up in Canberra (Aboriginal and non-Aboriginal
women).
• The Body Politic formed in Adelaide.
• Women’s Electoral Lobby (WEL) established in Melbourne.
• Women’s Abortion Action Coalition set up in Sydney.

1973
•
•
•
•
•
•
•
•

Control formed in Sydney; began abortion referral service.
Migrant Women’s Association established in Sydney.
Murawina Aboriginal Preschool and Women’s Hostel set up in Sydney.
WL organised speak-outs in Sydney and Melbourne; health emerged as
major issue.
Women’s Abortion Action Campaign set up in Brisbane and Adelaide.
Women against Rape formed in Melbourne.
Women’s Commission held in Sydney; health emerged as a major issue.
Women’s Health Collective formed in Melbourne.

1974
•
•
•
•
•
•
•
•
328

Abortion Information service opened in Perth.
Adelaide Women’s Shelter opened, also known as Naomi Women’s Shelter.
Blacktown Community Cottage opened in Sydney.
Bonnie Women’s Shelter opened in Western Sydney.
Brisbane Rape Crisis Centre opened.
Brisbane Women’s House Health Centre opened.
Canberra Rape Crisis Centre opened.
Canberra Women’s Refuge opened.

Appendix 1: Time line of key events, 1960–2011

•
•
•
•
•
•
•
•

•
•
•
•

Collingwood Women’s Health Centre opened in Melbourne.
Elsie Women’s Refuge opened in Sydney.
Hobart Women’s Shelter opened.
Hunter Region Working Women’s Centre opened; now Hunter Women’s
Centre.
Lalonde Report released in Canada.
Launceston Women’s Shelter opened in Tasmania.
Leichhardt Women’s Community Health Centre established in Sydney.
Liverpool Women’s Health Centre opened in Sydney; later participated
in establishing Rosebank Sexual Assault Service, Dympna House, incest
counselling service and others.
Nardine Women’s Shelter opened in Perth.
Sydney Rape Crisis Centre opened; now NSW Rape Crisis Centre.
Women’s Health and Community Centre opened in Perth.
Women’s Liberation Halfway House opened in Melbourne.

1975
• Aboriginal Women’s Centre set up in Darwin.
• Alice Springs Women’s Centre, primarily a refuge, opened in Northern
Territory.
• Darwin Women’s Health Centre opened.
• Dismissal of the Whitlam Labor Government; election of the Fraser Coalition
Government.
• First National Women’s Health Conference held in Australia in Brisbane.
• Hindmarsh Women’s Health Centre opened in Adelaide.
• Industrial Health Group formed at Liverpool Women’s Health Centre.
• Women’s Health and Community Centre Rape Crisis Centre opened in Perth.
• Women’s House Health Centre opened in Brisbane.
• Working Women’s Centre set up in Melbourne.

1976
•
•
•
•

Adelaide Rape Crisis Centre opened.
Central Coast Women’s Health Centre opened in Gosford, New South Wales.
Christies Beach Women’s Shelter opened in South Australia.
Draft Bill on Rape and Other Sexual Offences, written by Dr Jocelynne Scutt
for WEL, influenced State legislation.
329

Reaching for Health

•
•
•
•

Marrickville Women’s Refuge opened in Sydney.
Marty House opened in Sydney for women with substance abuse issues.
Sexual Assault Resource Centre opened in Perth.
Foundation of Rehabilitation with Aboriginal Alcohol Related Difficulties set
up by Aboriginal women.

1977
• Australian Council of Trade Unions (ACTU) adopted Working Women’s
Charter.
• Alice Springs Women’s Health Centre opened in the Northern Territory.
• Bankstown Women’s Health Centre opened in Sydney.
• Bessie Smyth feminist abortion clinic opened in Sydney.
• Bringa Women’s Refuge opened in Dee Why, Sydney.
• Cawarra Women’s Refuge Aboriginal Corporation established in New South
Wales.
• Powell Street Clinic set up in Homebush, Sydney.
• Women in Industry, Contraception and Health (now Multicultural Women’s
Health Centre) established in Melbourne.
• Women’s Committee established within ACTU.
• Women’s Coordination Unit established in NSW Premier’s Department.
• Women’s Health Care House opened in Perth.
• Women’s Pregnancy Advisory and Abortion Referral Service set up in
Brisbane.
• Workers Health Action Groups formed from this year onwards.
• Workers Health Centre, Lidcombe, Sydney, established.

1978
•
•
•
•
•
•

330

ACTU sponsored Working Women’s Charter Conference.
Anne Women’s Shelter opened in South Australia.
Geelong Rape Crisis Centre opened in Victoria.
Task Force to Inquire into Sexual Violence set up in New South Wales.
Warrina Women’s Refuge opened in Coffs Harbour, NSW.
Migrant Women’s Refuge established in Melbourne.

Appendix 1: Time line of key events, 1960–2011

1979
• Cawarra Aboriginal Refuge opened in Sydney.
• Elizabeth Hoffman House emergency accommodation and support for
Aboriginal women and their children opened in Melbourne.
• Sexual Assault Service, Queen Victoria Medical Centre, opened in Melbourne.
• Wagga Wagga Women’s Health and Support Centre opened in New South
Wales.
• Working Women’s Centre established in South Australia.
• Working Women’s Centre opened in Adelaide.

1980
• Adelaide Women’s Community Health Centre opened.
• Dawn House, providing accommodation and support services, opened in
Darwin.
• Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women’s Council established in
Central Australia to provide health and human services.

1981
•
•
•
•
•
•
•
•
•

ACTU decision to support women’s right to free, safe, legal abortion.
Alice Springs Women’s Shelter opened in Northern Territory.
Blue Mountains Women’s Health Centre opened in New South Wales.
Domestic Violence Committee convened by Premier’s Department of Victoria.
Women’s Health and Information Resource and Crisis Centres Association
(WHIRCCA) established.
Wirraway Women’s Housing Co-Operative opened in Moree, New South
Wales.
Women’s Community House opened in Alice Springs, Northern Territory.
Women’s Place, for homeless or intoxicated women, opened in Sydney.
Refuge Ethnic Workers Program set up in Melbourne.

1982
•
•
•
•

Federation for Aboriginal Women set up in Victoria.
Louisa Lawson House opened in Sydney.
Right to Choose Coalition set up by WEL.
Women’s Health Resource Collective, later Women’s Health Information
Resource Collective, opened in Melbourne.
331

Reaching for Health

• Working party established to develop women’s health policy.
• Brisbane Women’s Community Health Centre opened.

1983
• Election of the Hawke Labor Government.
• Elizabeth Women’s Health Centre opened in South Australia.
• First woman elected to the ACTU Executive; Working Women’s Policy
developed.
• Health in the Workforce Factory Project set up in Sydney.
• The Women’s Cottage set up, Hawkesbury District, Sydney.
• Toora Single Women’s Shelter, now Toora Women, opened in the Australian
Capital Territory.
• Women’s Advisory Council established in Western Australia with a focus on
health.
• Mookai Rosie Bi-Bayan, Aunty Rosie’s Place, providing services for rural and
remote Aboriginal women and children, opened in Cairns, Queensland.

1984
• Western Women’s Council set up in Wilcannia, New South Wales.
• Jilimi, now Waminda Aboriginal Women’s Health Centre, opened in Nowra,
New South Wales.
• Immigrant Women’s Support Service opened in Brisbane.
• Migrant Women’s Lobby Group established in Adelaide.
• Illawarra Women’s Health Centre opened in New South Wales.
• Elisabeth Women’s Community Health Centre opened in South Australia.
• Southern Women’s Health and Community Centre opened in South Australia.
• Dale Street Women’s Community Health Centre opened in South Australia.
• Refuge Ethnic Workers Program opened in Victoria.
• SA Coalition for Workers Health Action established.
• First Australian Women’s Health Adviser, Liz Furler, appointed in South
Australia.
• Women’s Health Policy Review Committee set up in New South Wales.
• Report of the Working Party on Women’s Health Policy released in South
Australia.
• Report on domestic violence in Tasmania released.
• Domestic Violence Incest Resource Centre established in Victoria.
332

Appendix 1: Time line of key events, 1960–2011

1985
• Second National Women’s Health Conference held in Adelaide.
• Crisis Intervention Unit set up in Department of Community Services,
Tasmania.
• Darwin Counselling Group established to provide sexual assault services.
• Domestic Violence Council established in South Australia.
• Immigrant Women’s Resource Centre opened in Sydney.
• Immigrant Women’s Speakout Association formed in Sydney.
• Migrant Women’s Support and Accommodation Service opened in Adelaide.
• Multicultural Women’s Health Centre opened in Fremantle, Western
Australia.
• Shoalhaven Women’s Health Centre opened in New South Wales.
• Southwest Women’s Child Sexual Assault Resource Centre, later Rosebank,
opened in Sydney.
• Task Force on Domestic Violence established in Western Australia.
• Women in Trade Unions Network formed in Brisbane.
• Women’s health ‘policy in action’ commenced.
• Women’s Health Unit established in New South Wales and, thereafter, in
most jurisdictions.

1986
• Albury–Wodonga Women’s Health Centre opened in Albury, New South
Wales.
• Australian Women’s Health Network established.
• Break the Silence, task force report on domestic violence, released in Western
Australia.
• Central West Women’s Health Centre opens in Bathurst, New South Wales.
• Coffs Harbour Women’s Health Centre opened in New South Wales.
• Domestic Violence Prevention Council set up in the Australian Capital
Territory.
• Dympna Accommodation Program opened in Sydney.
• Goldfields Women’s Health Centre opened in Western Australia.
• Migrant Women against Incest Network established in New South Wales.
• Ministerial Women’s Health Working Party established in Victoria.
• Multicultural Women’s Resource Centre set up in Broken Hill, New South
Wales.
333

Reaching for Health

• NHMRC Working Party on Homebirths and Alternative Birth Centres
established.
• NSW Women’s Refuge Resource Centre established.
• Queensland Women’s Health Network established.
• Sexual Assault Referral Centre opened in Darwin.
• Sexual Assault Support Service opened in Hobart.
• Women’s Centre opened in Cairns, Queensland, to provide sexual assault
crisis services.
• Working Party on Women’s Health established in Western Australia.

1987
• Australian Health Ministers Advisory Council (AHMAC) Subcommittee on
Women and Health created.
• Australian College of Midwives Incorporated established.
• Blacktown Women’s and Girls’ Health Centre opened in Sydney.
• Campbelltown Women’s Health Centre, also known as WILMA, opened in
Sydney.
• CASA House Centre against Sexual Assault opened at Royal Women’s
Hospital, Melbourne.
• Congress Alukura women’s health, maternal and child health centre opened
in Alice Springs, Northern Territory.
• Domestic Violence Prevention Unit set up in South Australia.
• Hobart Women’s Health Centre opened.
• Immigrant Women’s Health Service opened in Fairfield and Cabramatta,
Sydney.
• Lismore and District Women’s Health Centre opened in New South Wales.
• National Domestic Violence Education Campaign undertaken by the Office of
the Status of Women (OSW).
• Penrith Women’s Health Centre opened in Western Sydney.
• Regional network of sexual assault services set up in Victoria.
• Ruby Gaea, providing sexual assault services, opened in Darwin.
• Special Adviser to the Commonwealth Health Minister, Liza Newby,
appointed.
• Why Women’s Health, Victorian Women Respond working party report
released.

334

Appendix 1: Time line of key events, 1960–2011

1988
• Beyond These Walls, report of the Task Force on Domestic Violence,
Queensland, released.
• Domestic Violence Crisis Service set up in the Australian Capital Territory.
• Domestic Violence Resource Centre opened in Queensland.
• Freedom from Fear, community education campaign on domestic violence,
conducted in Western Australia.
• Geraldton Sexual Assault Referral Centre opened in Western Australia.
• Gloria Brennan ATSI Women’s Centre opened in East Perth.
• Healthsharing Women established in Victoria.
• Key Centre for Women’s Health in Society, now the Centre for Women’s
Health Gender and Society, founded at Melbourne University.
• Sexual Assault Counselling Service opened in Alice Springs, Northern
Territory.
• Waratah Support Centre for sexual assault and domestic violence opened in
Bunbury, Western Australia.
• Women’s Health Service for the West opened in Victoria.

1989
• Alternative Birthing Services Program commenced.
• Domestic Violence (Family Protection) Act (Qld) enacted.
• First National Women’s Health Policy and National Women’s Health Program
launched.
• Integrated Family Violence Networks established in Victoria.
• Laurel House opened in Launceston, Tasmania.
• Maternity Coalition established.
• Patricia Giles Centre, offering services for GLBTIQ people, opened in Perth.
• Whitfords Women’s Health Centre, now Women’s Healthworks, opened in
Western Australia.

1990
• Canberra Women’s Health Centre, now Women’s Centre for Health Matters,
opened.
• Cumberland Women’s Health Centre opened in Sydney.
• Domestic Violence Council established in Queensland.
• National Committee on Violence against Women established.
335

Reaching for Health

• Perth Women’s Centre opened.
• Townsville Women’s Community Health Centre opened in Queensland.
• Women’s Health Development in the ACT released in draft form.

1991
•
•
•
•

Domestic Violence Strategic Plan released in New South Wales.
Geraldton Women’s Health Centre opened in Western Australia.
Rockhampton Women’s Health Centre opened in Queensland.
Wide Bay Women’s Health Centre opened in Queensland.

1992
•
•
•
•
•
•
•
•

Brisbane Rape and Incest Survivors Support Centre opened.
Edith Edwards Women’s Centre, refuge, opened in Bourke, New South Wales.
Ipswich Women’s Health Service opened in Queensland.
Logan Women’s Health Centre opened in Queensland.
National Strategy on Violence against Women introduced.
North-East Women’s Health Service opened in Victoria.
Northern Territory Women’s Health Policy released.
Women’s Health Strategy Unit established in Northern Territory.

1993

336

• Eastern Goldfields Sexual Assault Research Centre opened in Western
Australia.
• Hedland Women’s Health Service opened in Western Australia.
• Goulburn North-Eastern Victoria Women’s Health Service opened.
• Mirrabooka Multicultural Women’s Health Centre opened in Western
Australia.
• Non-English Cultural Background Women’s Health Reference Group formed
in Queensland.
• Queensland Women’s Health Policy launched.
• Rockingham Women’s Health Service opened in Western Australia.
• Women’s Health Prevention of Violence against Women Program set up in
Queensland.
• Women’s Health Victoria formed through amalgamation of Healthsharing
Women and the Women’s Health Information Resource Collective.
• Yarrow Place, incorporating the Adelaide Rape Crisis Centre, opened.
• Yorgam Aboriginal Corporation, providing support services for people who
have experienced violence, opened in East Perth.

Appendix 1: Time line of key events, 1960–2011

1994
•
•
•
•
•
•
•

Gladstone Women’s Health Centre opened in Queensland.
Gosnells Women’s Health Service opened in Western Australia.
Gympie and District Women’s Health Centre opened in Queensland.
Northern Territory Domestic Violence Strategy released.
South Australian women’s health centres lost their independence.
Tasmanian Women’s Health Policy launched.
Working Women’s Centres set up in Queensland and Tasmania.

1995
• Third AWHN National Women’s Health Conference, Canberra.
• Women’s Health Australia longitudinal study on women’s health commenced.
• Working Women’s Centre set up in Northern Territory.

1996
• Election of the Howard Coalition Government.
• New Directions in Reducing Violence against Women released in New South
Wales.

1997
• Immigrant and Refugee Women’s Coalition opened in Victoria.
• Partnerships against Domestic Violence introduced.

1998
• Abortion removed from the Criminal Code of Western Australia, replaced with
small section making it illegal for anyone other than a medical practitioner to
perform an abortion.
• A Strategic Framework to Advance Women’s Health released in New South
Wales.
• Family Violence Intervention Program commenced in the Australian Capital
Territory.
• Family Violence Prevention Legal Service initiated by ATSIC.
• Task Force on Sexual Assault and Rape set up in Tasmania.

337

Reaching for Health

1999
• National Indigenous Family Violence Grants Program introduced.

2000
• Women’s Health NSW established (formerly WHIRCCA).

2001
•
•
•
•

Australian Centre for the Study of Sexual Assault established.
Fourth AWHN National Women’s Health Conference, Adelaide.
National Initiative to Combat Sexual Assault introduced.
Women’s Health and Well-Being initiatives paper released in South Australia.

2002
• Abortion removed completely from the Criminal Code of the Australian
Capital Territory.
• Aboriginal Family Violence Prevention and Legal Service opened in Victoria.
• Four-year Women’s Health and Well-Being Strategy released in Victoria.
• National Maternity Action Plan developed, led by Maternity Coalition.
• Women’s Health Outcomes Framework released in New South Wales.
• Women’s Safety Strategy introduced in Victoria.

2003
• BreaCan established in Victoria.
• Queensland Centre for the Prevention of Domestic and Family Violence
established.

2004
•
•
•
•

Family Violence Act (Tasmania) enacted.
Safe at Home strategy commenced in Tasmania.
Violence against Women, Australia Says No campaign commenced.
Howard Government attempted to exclude women’s health from Public
Health Outcomes Funding Agreements (PHOFAs).

2005
338

• Fifth AWHN National Women’s Health Conference, Melbourne.
• New Women’s Health Policy launched in South Australia.

Appendix 1: Time line of key events, 1960–2011

• Reforming the Family Violence System in Victoria released.
• The Health and Well-Being of Northern Territory Women: From the desert to
the sea released.
• Women’s Health Services formed from the amalgamation of Women’s Health
Care House and Women’s Health Services, Perth.
• Women’s Safety Strategy released in South Australia.
• Yinganeh Aboriginal Women’s Refuge opened in Lismore, New South Wales.

2006
• Northern Territory Emergency Response introduced.
• Reproductive Choice Australia, a coalition of 20 NGOs, established.

2007
•
•
•
•

Domestic and Family Violence Act (Northern Territory) passed.
Rudd Labor Government elected.
Partners in Prevention set up in Victoria, funded by VicHealth.
Australian Labor Party announces commitment to develop Second National
Women’s Health Policy.

2008
•
•
•
•
•
•
•
•
•
•
•
•

Abortion removed completely from the Criminal Code of Victoria.
Construction of a new ACT community health centre announced.
Construction of a new ACT Women’s and Children’s Hospital announced.
Family Violence Protection Act (Victoria) passed.
National Council to Reduce Violence against Women and their Children
appointed.
National Health and Hospitals Reform Commission established.
National Maternity Services Review established.
National Preventive Health Taskforce established.
New South Wales Domestic and Family Violence Strategic Framework
released.
WHO Social Determinants of Health Report released.
Women’s Health Services Plan developed in the Australian Capital Territory.
Women’s Health: The new national agenda published by AWHN.

339

Reaching for Health

2009
• A healthier future for all Australians, report of NHHRC, released.
• Australia: The healthiest country by 2020, report of National Preventive
Health Taskforce, released.
• Domestic Violence Death Panel, chaired by Coroner, set up in New South
Wales.
• Domestic Violence Death Review Panel established in Queensland.
• For Our Sons and Daughters, 2009–2014, domestic violence strategy,
Queensland, released.
• Pro-Choice Queensland established.
• Review report, Improving Maternity Services in Australia, released.
• Time for Action: The National Council’s plans for Australia to reduce violence
against women and their children, 2009-2021

2010
•
•
•
•
•

Interim Women’s Health Plan, 2009–2011, released in New South Wales.
Modified maternity care arrangements began operation.
National Maternity Services Plan endorsed by Australian health ministers.
Second National Women’s Health Policy released.
Sixth AWHN National Women’s Health Conference, Hobart.

2011
• National Disability Strategy developed after consultations.
• National Plan to Reduce Violence against Women and their Children
launched.

340

Appendix 2:
Women interviewed for this book
Adele Thomas
Ann Hodge
Anne Deanus
Anne Warner
Belinda Whitworth
Bon Hull
Carmel O’Loughlin
Carolyn Mason
Cathy Miller
Chloe Mason
Christine Giles
Cynthia Croft
Di Jones
Else Franks
Fran Bladel
Helen Abrahams
Ilse O’Farrel
Jane Dunsford
Janette Gay
Jen Roberts
Jo Parish
Joyce Stevens
Judith Dwyer
Judith Watson
Judy Wotherspoon
June van der Klashorst
Kay Anastassiadis
Laurie Gilbert
Lisa Gardiner
Liza Newby
Lyn Reid
Lynnley McGrath
Mary Draper

Ali Sinclair
Ann Levy
Anne O’Byrne
Annie Zafer
Bernadette Callaghan
Cait Calcutt
Carol Cragg
Carolyn Pickles
Cathy North
Chris Brown
Claire Shuttleworth
Deborah Gough
Di Sergey
Fiona Owen
Gloria Garton
Helen Creed
Iris Ritt
Janet Irwin
Janine Combes
Jennifer Cashmore
Jocelyn Auer
Judith Blake
Judith Elsham
Judy Edwards
Julie Byles
Kas Eaton
Kay Setches
Lee Barker
Liz Ahearn
Lois Gatley
Lyndall Ryan
Margaret Reynolds
Megan Halbert

Andrea Shoebridge
Anna Moynahan
Anne Sinclair
Bebe Loft
Bernadette O’Connell
Carla Cranny
Carol Lowe
Cath James
Cheryl Davenport
Chris O’Farrell
Cora Gabonton
Denele Crozier
Elizabeth Stroud
Fiona Percy
Heather Bolden
Helen Radoslovich
Jan Powning
Janet Ramsey
Jean Collie
Jenny Beauchamp
Jocelyn Hanson
Judith Cleaver
Judith Roberts
Judy Elton
Julie Dawson
Kathy Solomons
Kim Boyer
Lesley Garton
Liz Furler
Lyn Mackenzie
Lynette Pugh
Marilyn Beaumont
Meredith Taylor
341

Reaching for Health

Mervyn Cheung
Miriam Taylor
Nancy Peck
Paula Watt
Raquel Aldunate
Rose Sorger
Sandra Nori
Sharon Jackson
Silvia Kinder
Sue Abbey
Thea Mendelsohn
Vicki Pearce
Yvonne Allan

342

Michael Jones
Morven Andrews
Onella Stagoll
Philomena Horsely
Rennie Gay
Ruth Dewar
Sandi MacKintosh
Sharon Paul
Stefania Siedlecky
Sue Yarrow
Tim Webster
Wendy Silver

Michelle Kosky
Nancy Layton
Patricia Giles
Rachel Green
Ronelle Brossard
Ruth Morgan
Sharon Hetzel
Shirley Patton
Stephanie Mayman
Susan Stratigos
Vicki Hiscock
Yoland Wadsworth

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387

Index
Abbott, Tony, 162, 201, 205, 268
Abbs, Jude, 105, 140, 218, 288
Aboriginal Health and Medical Research
Council of NSW, 173
Aboriginal health centres, 8, 9, 97, 155,
161, 172, 309, 322, 324
Aboriginal Medical Service, 8, 37, 193,
306, 322, 327
Abortion Act, United Kingdom, 198
Abortion Providers’ Association of
Australia, 204
Abortion, ix, 1, 2, 3, 24, 25, 26, 27, 28,
32, 43, 46, 52, 60, 61, 62, 63, 64, 80, 81,
96, 107, 145, 162, 168, 169, 171, 174, 179,
198–208
Abrahams, Helen, 105, 167
Adams, Karen, 149
Adelaide Women’s Community Health
Centre, 65, 90, 106, 107, 146, 158, 169,
221, 331

Australian Greens, 4, 195, 201, 268, 285,
286,
Australian Institute of Health and
Welfare, 35, 67, 174, 247, 268, 321
Australian Labor Party, 4, 10, 13, 15, 59,
81, 94, 95, 103, 105, 106, 107, 109, 113,
140, 143, 167, 170, 172, 191, 200, 201,
202, 203, 204, 205, 206, 217, 218, 219,
220, 222, 225, 245, 249, 254, 257, 261,
266, 269, 270, 272, 283, 284, 285, 286,
290, 292, 293, 294, 304, 309, 323, 327,
328, 329, 332, 339
Australian Lesbian Medical Association,
135
Australian Medical Association, 95, 185,
188, 193, 200, 206, 323
Australian Nurses Federation, 194, 196,
247
Australian Reproductive Health Alliance,
286
Australian Services Union, 171
Australian Society of Independent
Midwives, 182

AHMAC Subcommittee on Women and
Health, 141, 249, 267, 268

Australian Women’s Health Network,
viii, 15, 127, 139, 140–146, 148, 149,
201, 218, 230, 254, 263, 294, 337–340

Alternative Birthing Services Program,
187–189, 227, 228, 250, 267, 335

Berry, Wayne, 203–205
birth centres, 181, 185, 188, 194, 334

Angus, Sandra, 149

Bjelke-Petersen, Joh, 66, 112, 168, 218

apprehended violence order, 231

Blewett, Neal, 140, 246, 247, 249, 294

Australian Centre for the Study of Sexual
Assault, 257

Bligh, Anna, 202

Australian College of Midwives, 182, 192,
196, 334
Australian Community Health
Association, 105, 140
Australian Council of Trade Unions, 167,
169, 170, 174, 247, 330, 331, 332
Australian Democrats, 4, 201, 268, 286
Australian Domestic and Family Violence
Clearinghouse, 256–7

Boston Women’s Health Collective, 28,
30, 34, 37
Bracks Government, 225
BreaCan, 160, 338
Breast Cancer Network of Australia, 133
breastfeeding, 99, 180–183, 192, 194, 197,
251, 327
Brisbane Rape Crisis Centre, 61, 77, 134,
328
389

Reaching for Health

Brisbane Women’s House Health Centre,
43, 66, 77, 104–105
Britain, 26, 27, 29, 31, 67, 190, 294, 295,
296, 297, 299, 302
Broad, Candy, 206
Broom, Dorothy, 30, 31, 38, 43–45, 57, 64,
82, 110, 111, 141, 144
Burke Government, 226, 227
Cain Government, 119, 223, 224, 225
Callaghan, Bernadette, 168
Canada, 6, 7, 26, 35, 40, 190, 257, 279,
290, 294, 295, 296, 302, 319, 327, 329
Canberra Rape Crisis Centre, 240, 241,
328
Carr Government, 217
Cashmore (Adamson), Jennifer, 220, 254
Central Australian Aboriginal Congress,
8, 9, 97, 145, 298
Centre for Women’s Health, Gender and
Society, 160, 206, 335
Centres Against Sexual Assault, 92, 119,
120, 161, 239, 240
Chamarette, Christabel, 285
childbirth, 3, 24, 25, 34, 180, 183, 188,
190, 197, 208
Children by Choice, 80, 81, 96
Coalition government, 4, 95, 245, 292,
296, 329, 337

390

community health, 6–11, 13, 18, 20, 75,
94, 96–98, 100, 107, 146, 155, 156, 174,
169, 185, 221, 228, 229, 279, 282, 292,
298, 299, 303, 306, 319, 320, 322, 324,
325, 327, 328, 339
community midwifery programmes, 188,
192
community participation, 6, 7, 9, 11, 156,
206, 207, 252, 309,
Congress Alukura, 92, 98, 145, 188, 230,
271, 300, 334
consciousness-raising, 28, 29, 58, 59, 68,
69
Consumers Health Forum, 140, 141, 247
Control, Queensland, 199
Control, Sydney, 62, 199, 328
Convention on the Elimination of All
Forms of Discrimination against
Women, 286
cooperation, 155–174
Cornwall, John, 106, 220, 221
Cross Borders Domestic Violence Service,
100
Cross, Helen, 205
Crowley, Rosemary, 201, 285
Davenport, Cheryl, 203
DES Action, 108, 129
Disability Discrimination Act 1992, 264

Coalition of Activist Lesbians, 136

Domestic Violence Crisis Service, 235

Coalition of Australian Governments,
258, 261, 265

Domestic Violence Network, NSW, 162

Coalition of Women’s Domestic Violence
Services, 150

Domestic Violence Resource Centre,
Victoria, 172

collaboration, 155–174

Draper, Mary, 223

Community Employment Program, 105,
118

dual strategy, 14, 111

community health movement, 7, 10, 146,
169, 303, 324

Dwyer, Judith, 111

Community Health Program, 75, 94, 112,
113, 292, 299, 303, 324

Extended Medicare Safety Net, 189–90

Domestic Violence Resource Centre, 134

Dunstan Government, 95, 293, 299
Eating Issues Centre, 131

Index

Family Planning Association NT, 229, 253

Johnson, Joyce, 68

Faust, Beatrice, 42

Karpfen, Celia, 142

Fraser, Malcolm, 13, 75, 94, 112, 155, 245,
247, 292, 298, 324, 329

Keleher, Helen, 25, 142

Fredericks, Bronwyn, 47, 149

Kirner, Joan, 224–225

Frohmader, Carolyn, 123, 142

Knowles, Rob, 225

Furler, Liz, 106, 220, 221, 226, 287, 332

Kong, Grace, 9

Geelong Rape Crisis Centre, 61, 78, 330
Gilbert, Laurie, 38, 248

Labor Women’s Caucus Committee, 249,
269

Giles, Christine, 249, 287

Lajamanu women, 100

Giles, Patricia, 140, 285, 286, 294

Lalonde Report, 6, 7, 329

Gillard Government, 17, 321–324

Lawrence, Carmen, 227, 294

Goss, Wayne, 81, 105, 219, 284, 292

Leichardt Women’s Community Health
Centre, 45, 50–52, 62, 96, 103, 130, 159,
163, 184

Greenslopes Fertility Clinic, 168
Greiner Government, 217, 254, 293
Hatton, Marilyn, 228, 287
Hawke Government, 13, 145, 149, 245,
294, 324, 332
Hawke, Bob, 246
Hayes, Anne-Marie, 142
Health and Hospitals Services
Commission, 13, 66, 70, 171, 294
Henry, Dot, 149
Hobart Women’s Health Centre, 92, 107,
147, 159, 173, 222, 252, 334
Hoffman, Elizabeth, 68
Hogg, Carolyn, 224
hormone replacement therapy, 34, 37
Howard Government, 15, 149, 162, 171,
172, 189, 190, 201, 205, 245, 256, 257,
261, 263, 267, 291, 292, 294, 316, 337
Immigrant Women’s Domestic Violence
Service, 48
Incest Survivors Association, 131
Irwin, Janet, 96, 262
Jackson, Judy, 234
Jean Hailes Foundation, 134, 138
Johnson, Betty, 137

Kennett, Jeff, 139, 225, 266

Levine ruling, 198
Liberal Party of Australia, 4, 94, 131,
204, 205, 220, 225, 284, 286, 293
Liverpool Women’s Health Centre, 51, 52,
61, 62, 96, 155, 159, 166, 329
longitudinal study on women’s health,
262, 266
Macklin, Jenny, 224
Margetts, Dee, 285
maternity care reform, 19, 98, 131,
180–197
Maternity Coalition, 176, 181, 335
McCulloch, Deborah, 226
Medea, 130
Medicare Benefits Review Committee,
185, 188
Medicare, 185–187, 194, 195, 201, 310,
317, 323
Mendelsohn, Thea, 226, 287
Menhennit ruling, 198, 200
Midwives in Private Practice, 182
Migrant Women against Incest Network,
117, 131
Milne, Christine, 285
391

Reaching for Health

Morand, Maxine, 207
Multicultural Centre for Women’s Health,
61, 80, 158, 207, 306
Multicultural Women’s Health Centre,
101, 333
Nappaljari Jones, Jilpia, 99
National Aboriginal Community
Controlled Health Organisation, 8
National Aboriginal Health Strategy, 248,
253,
National Agenda for Women, 13, 142,
184, 229, 246, 254, 255
National Association of Services against
Sexual Assault, 151, 241
National Committee on Violence against
Women, 255, 234
National Council to Reduce Violence
against Women and their Children, 67,
76, 232, 253, 257, 258, 259, 309, 312,
313, 315, 339, 340

National Women’s Health Program, 80,
90, 105, 108–110, 119, 144, 146, 190,
227, 230, 231, 250, 252, 253, 266, 267,
273, 284, 291, 309
NESB Women’s Health Strategy, 254
Nettle, Kerry, 285, 286
New Zealand, 257, 280, 294, 295, 296,
302, 317, 319
Newby, Liza, 38, 140, 226, 246, 247, 334
Ngaanyatjarra Pitjantjatjara
Yankunytjatjara Women’s Council, 90,
100, 331
non-Labor, 245, 292, 293, 299
NSW Rape Crisis Centre, 240
NSW Women’s Health Policy Review
Committee, 104

National Disability Strategy, 265

occupational health and safety, 14, 62,
165–170

National Domestic Violence Education
Campaign, 255, 334

OECD, 3, 17, 19, 39, 156, 190, 193, 195,
200, 279, 282, 295, 317, 319

National Health and Hospitals Reform
Commission, 309, 316, 319, 320, 321,
340

Office of Aboriginal and Torres Strait
Islander Health, 149

National Health and Medical Research
Council, 34, 185, 268

Office of the Status of Women, 142, 148,
247, 255, 257, 289, 334
Older Women’s Network, 137

National Midwives Association, 182

O’Loughlin, Carmel, 230

National Network against Trafficking in
Women, 138

Operation Pegasus, 134

National Party, 95, 285, 292
National Plan to Reduce Violence against
Women and their Children, 258, 309,
313, 340
National Preventive Health Task Force,
172, 322, 339, 340
Nationals, The, 4
National Women’s Health Policy, 14–16,
38, 66, 89, 110, 119, 140, 143, 145, 146,
149, 170, 184, 187, 215, 217, 218, 222, 223,
392

226, 228–230, 245, 248, 249, 253–255,
262, 263, 269, 270, 273, 279, 280,
288–291, 293–295, 298, 300, 311, 314

Osborne, Paul, 204–205
Our Bodies, Ourselves, 29, 82, 328
out-of-pocket expenses, 63, 189, 296
Parish, Jo, 229
Parliamentary Group on Population and
Development, 286
Partnerships against Domestic Violence,
78, 256, 257, 260
partnerships, 155–157, 159, 172–4, 219,
234, 256, 265

Index

Pearce, Vicki, 288
Personal Safety and Community
Attitudes Survey, 259

Rudd Government, 17, 257, 258, 295, 310,
321–324, 339
Rudd, Kevin, 245

political opportunity structure, 94, 153,
292, 295, 302, 322

Salthouse, Sue, 153

primary health care, 4, 7, 12, 13, 16, 17,
25, 60, 98, 111, 155, 222, 223, 272, 273,
305, 306, 310, 317, 319–325

Sawer, Marian, 43, 286, 301–302

Public Health Association of Australia,
202
public health movement, 4, 7, 18, 53, 282
Public Health Outcomes Funding
Agreements, 143, 267, 268, 269, 337
Quebec, 6, 7, 327–328
Queensland Women’s Health Network,
127, 141, 145, 146
Rachel Forster Hospital, 96
Rape Crisis Centre, Melbourne, 60, 77
Redfern Aboriginal Medical Service, 8,
9, 327
Reid, Elizabeth, 287
Reid, Lyn, 66, 229
Reproductive Choice Australia, 162, 202,
289, 339
Reproductive Health Services, 204
Respectful Relationships Program, 241,
258, 313

Sanger, Margaret, 25
Sax, Sidney, 10, 13
Scutt, Jocelynne, 238, 329
second-wave feminism, 19, 24, 27, 46,
198, 301
Setches, Kay, 224
Sexual Assault Resource Centre, Perth,
79–80, 119
Sexual Assault Support Service, 239
Sexual Health and Family Planning ACT,
63, 145, 203
Sexual Health and Family Planning
Australia, 162, 201, 286
Siedlecky, Stefania, 96
Siewert, Rachel, 195
social determinants of health, 5, 11, 12,
16, 23, 40, 41, 104, 106, 217, 222, 231,
272, 273, 305, 309, 322, 325, 339
social gradient in health, 39, 318
social liberalism, 266, 281, 301–303

Richards, Rose, 81, 99

social view of health, 4, 7, 9, 14, 23,
38–41, 53, 57, 60, 82, 165, 217, 223, 245,
254, 271, 273, 280, 285, 296, 305, 309,
325

Roberts, Jen, 288

Stanhope, Jon, 229

Robinson, Sue, 205

Supported Accommodation Assistance
Program, 67, 101, 113, 115, 151

Reynolds, Margaret, 285

Royal Australian and New Zealand
College of Obstetricians and
Gynaecologists, 193, 206, 319
Royal Australian College of Obstetricians
and Gynaecologists, 186, 188, 193
Royal Hobart Hospital, 173
Royal Women’s Hospital, Melbourne, 129,
132, 140, 206, 334

Sydney Incest Survivors Collective, 131
Sydney Rape Crisis Centre, 60, 76, 329
Taylor, Ian, 109, 226, 227
Trade Union Training Authority, 168
Union of Australian Women, 64, 105,
129, 167, 200

393

Reaching for Health

user charges, 7, 16, 63, 296, 317–318, 322

Women’s Electoral Lobby, 27, 42, 59, 65,
66, 69, 72, 77, 78, 103, 141, 143, 145,
200, 202–204, 216, 227, 229, 238, 269,
290, 328, 329, 331

VicHealth, 152, 157–159, 162, 167, 172,
174, 241, 308, 314

Women’s Emergency Services Network,
151, 308, 314,

Victorian Women with Disabilities
Network, 135, 236

Women’s Health Association of Victoria,
147, 206

Wadsworth, Yoland, 140

Women’s Health Australia, 262, 272, 337

Wainer, Bertram, 199, 200, 206

Women’s Health Care House, 52, 61, 65,
93, 109, 130, 133, 226, 330, 339

United States, 5, 7, 25, 26, 27, 28, 29, 36,
37, 58, 75, 136, 183, 198, 200, 237, 257,
280, 294, 295, 296, 309

Wainer, Jo, 199
Waminda, 61, 62, 91, 98, 110, 111, 216,
332
Ward, Biff, 42
Warner, Anne, 218
Wensing, Veronica, 240
White, David, 224
Whitlam Government, 103, 112, 166, 228,
245, 266, 283, 293, 294, 299, 310, 328,
329
Whitlam, Gough, 10, 293, 294
Wilson, Keith, 226, 227
Wilson, Roland, 145
Women against Incest, 130
Women against Rape, Melbourne, 328
Women in Industry Contraception and
Health, 29, 79, 158, 159
Women in Trade Unions Network, 50,
167, 333
Women with Disabilities ACT, 135
Women with Disabilities Australia, 135,
142, 258, 263–5
women with disabilities, 46, 76, 127, 135,
236, 263–5, 273, 312, 315,
Women’s Abortion Action Campaign, 32,
199
Women’s Addiction and Recovery
Service, 133

394

women’s health policy machinery, 121,
215, 216, 223, 226, 247, 266, 291
Women’s Health Queenslandwide, 160
Women’s Health Victoria, 36, 108, 160,
206, 207, 225
Working Women’s Centres, 61–63, 161,
163, 166, 169, 170–172, 200, 285
Working Women’s Charter, 169, 330
World Health Organisation, 7, 9, 16, 40,
181, 245, 262, 279, 309, 315, 323, 339
Wran Government, 95, 103, 216, 232
YWCA, 19, 64, 136, 198, 203