‘What Happens Next?’: Are Reproductive Rights Human Rights?

Dr Susan Carland: Welcome back to What Happens Next?, the podcast that examines some of the biggest challenges facing our world and ask the experts, what will happen if we don't change? And what can we do to create a better future?

I'm Dr Susan Carland. Keep listening to find out what happens next.

Dr Tania Penovic: Well, I think that the stigmatisation of abortion does stigmatise and undermine more reproductive healthcare. So we are not just talking about abortion, we're talking about the pregnant body in need of healthcare.

Dr Sab Ventura: I mean, hormonal contraception for men has been shown to be effective for 50 years virtually. However, it's never taken off because in clinical trial, men that have taken it haven't been able to tolerate the side effects.

Paula Michaels: At every level the world around us is literally built for the male body. Every accommodation is made for the male body.

Safeera Hussainy: I'm really worried that it could play out to be like Handmaid's Tale as what's happening in the US, because we know that the US, and what happens over there in terms of healthcare, has repercussions for the rest of the world.

Dr Susan Carland: In the summer of 1955, Gregory Pincus, one of the male co-inventors of the birth control pill, discovered the perfect place to test the new oral contraceptive: Puerto Rico.

Pincus and his colleague, John Rock, needed to conduct large-scale human trials to receive the US Food and Drug Administration's approval to bring the pill to market in the states. But legal, cultural, and religious obstacles stood in their way.

In Puerto Rico, however, the US territorial government was looking for ways to curb endemic poverty via population control. According to PBS's “American Experience”, there were no anti-birth control laws in the books. And although its population was mostly Catholic, residents didn't follow the Pope's prohibition on contraceptives.

When working-class women in a housing project were offered the pill, it was an appealing alternative to sterilisation or abortion, the usual methods they used for limiting their family size. But they didn't know that the drug was still experimental, or that they were participating in a clinical trial.

The researchers also didn't tell them about its potentially dangerous side effects. And, to ensure no accidental pregnancies occurred during the trial, the initial dosage was much higher than it is today.

After a year, the pill was shown to be nearly 100 per cent effective when taken properly, but 17 per cent of the unwitting test subjects complained of serious and sustained side effects, including nausea, dizziness, headaches, stomach pain, and vomiting. According to the Washington Post, three women in the trial died, although the link to the drug is unclear because there was no investigation and no autopsies.

Pincus and Rock dismissed this information outright, believing many of the complaints were psychosomatic – all in the women's heads. Besides, what was a little bloating and nausea compared to the benefits of an effective contraceptive?

The pill was approved by the FDA in 1960 and rushed to market. Although the drug played a major role in women's liberation, it's hard to overlook the deceit and exploitation that helped bring it into the world, led by male doctors, legislators, and drug company representatives who ignored and minimised the legitimate concerns of the women along the way.

The Puerto Rico pill trials were far from the first problematic incident in the history of women's reproductive health and rights. As the events of 2022 have shown us, they certainly won't be the last.

Today we're tackling a new topic on the podcast: reproductive health. Women's reproductive healthcare has historically been overlooked by medical science and is still treated as taboo in many cultures. Is women's healthcare behind men's? How does making reproductive healthcare inaccessible hurt us all? And seriously, what's going on with that male birth control pill?

Before we begin, I'd like to mention that although we use the word “women” throughout the series, these matters are not restricted to cisgendered women alone. All people assigned female at birth are affected by these issues and often face even greater challenges because of them. Including everyone in the conversation and when advancing solutions is the only way forward.

Now, without further ado, keep listening to find out what happens next.

Paula Michaels: Hi, my name is Paula Michaels. I’m an associate professor of history at Monash University and the current head of the school for Philosophical, Historical and International Studies. I am a historian of the Soviet Union and I specialise thematically in the history of medicine. Most of my prior work has been on history of childbirth and on colonial medicine.

Dr Susan Carland: Paula, welcome.

Paula Michaels: Thank you for having me, Susan.

Dr Susan Carland: Why is calling a woman hysterical such a horrific thing to do?

Paula Michaels: That is such a great question, and I think every woman who's ever been called hysterical knows in her gut that they do not want to be called that. It's because it implies that they're out of control and that they have no ability to reason, that they're being governed completely by their emotions and are thus incapable of being engaged with rationally. It's a very disempowering thing to say to a woman.

Dr Susan Carland: And where does the word come from?

Paula Michaels: So it comes from the Greek word for womb, and it tightly links women's emotional upheavals with their reproductive capacities.

Dr Susan Carland: Right. So, we are hysterical or irrational because we're women.

Paula Michaels: Exactly.

Dr Susan Carland: Right.

Paula Michaels: So, another way of phrasing it – this hopefully is not too vulgar – but the phrase that “women are on the rag” is similarly an invocation of connecting their emotional world with their physiological capacity to reproduce.

Dr Susan Carland: Have we ever done that with men?

Paula Michaels: That's funny you should ask that, because there was a brief period in the 1950s when there was a diagnosis of male menopause that was associating men's more depressive states at middle age with hormonal change. And men so resisted and were so turned off by being diagnosed as menopausal that they started defining the same cluster of symptoms as depression.

Dr Susan Carland: Let's take a little walk down historical lane.

Paula Michaels: That's my favourite lane!

Dr Susan Carland: [Laughter] Throughout history, how has the female body been understood medically, particularly in comparison to the male body?

Paula Michaels: Yeah, it's difficult to talk about one without talking about the other because they're mutually constituted.

Dr Susan Carland: Yeah.

Paula Michaels: And, going back to that original question about hysteria, the female body is linked with nature, and the male body linked with reason – in the Western tradition – that creates this division between mind and body, which we don't see in other non-Western cultures, certainly not in that same bifurcated way.

So there's a long tradition of women being associated with a lack of reason, with highly emotional states, and men being the ones who have power exerted through their superior reason. So going back to that earlier conversation about hysteria, it is a quick way to silence a woman to call her hysterical because of the way it invokes really a millennia of tradition about undermining women's authority by linking them to nature.

Dr Susan Carland: And are we still seeing any of the echoes of this thinking in the way that women's bodies are understood even now medically?

I guess I wonder, one thing I hear about a lot is women with endometriosis saying, “No one takes this seriously. I had to see 10 doctors and suffer for 15 years before anyone was even willing to investigate this properly." I wonder, is that a throwback to the way women's bodies have been medicalised, but also the way that women are seen as weak and emotional?

Paula Michaels: Yes, but it's also connected with the fact that for generations, men have set the research agenda. If men suffered from endometriosis, we'd have had a cure a long time ago, or at least a clear sense of treatment and the origins. But the priorities for research are set by men. And until very recently, also the parameters of how studies are conducted.

So another example that's less clearly gendered are heart attacks. So the symptoms that women experience at the onset of a heart attack are different from the ones men experience, but what we're all taught to look for are the symptoms that men manifest.

And so it takes a researcher who's going to say, “Well, let's just make sure that women actually have the same physiological symptoms, the warning signs of heart attack.” And in fact, they don't. But if you take men and male bodies as normative, then you don't know to look at women's bodies as something that's not deviant or different but equal, but needs special attention.

Dr Susan Carland: But I mean, just as an aside, that's just so significant because you think of the public advertising campaigns that have been around identifying the early signs of a heart attack, and it's so uniformly what we now know is a male experience.

Paula Michaels: That's right. And the other thing is that men are often the ones that are associated. So heart attack is seen as something more masculinised, but actually women are equally likely to be victims of heart attacks.

Dr Susan Carland: That's really interesting.

Paula Michaels: Another example about this way in which this long history of associating women with a lack of reason speaks to the ways in which governments try to regulate women's bodies, because it's from an assumption that somehow women cannot be trusted or have some flawed capacity to make decisions about their own bodily autonomy. Obviously, most vividly on display in abortion regulation.

Dr Susan Carland: Right. Because even when we talk about the term “reproductive health”, that's seen as such a gendered thing. We're talking about women's reproductive... But men have reproductive health issues as well, but it's never really seen as part of that suite of conditions.

Paula Michaels: That's interesting, isn't it?

Dr Susan Carland: Yeah.

Paula Michaels: Right. It's like, men reproduce too.

Dr Susan Carland: Yeah. [Laughter]

Dr Tania Penovic: Hi, I am Dr Tania Penovic. I'm an associate professor in the Faculty of Business and Law at Deakin University. Dr Susan Carland: Tania, thank you for joining us. Dr Tania Penovic: It's my pleasure to be here.

Dr Susan Carland: Can I start by asking you to explain to the listeners what happened in the US recently with Roe v Wade?

Dr Tania Penovic: No worries. Well, I should start by explaining what Roe v Wade was. So, this was a 1973 decision of the US Supreme Court, which conferred federal constitutional protection on the right to abortion.

Newsreader 1: In two related cases and eight separate opinions, the nine justices made abortion largely a private matter, and ordered the states to make no laws forbidding it, except possibly during the final months.

Dr Tania Penovic: So the right to choose to terminate a pregnancy was found fall within the ambit of the right to privacy, which in turn came from the US constitution's protections of personal liberty.

So this was a fundamental right, but a right that was not absolute. It required balancing with the state's interest in safeguarding maternal health, and also the potentiality of human life, as the court described it.

So to achieve this balance, the court set out a trimester framework barring states from banning abortion during the first trimester, allowing laws that regulate abortion to safeguard maternal health during the second, and allowing higher-level regulation in the third trimester when the foetus had attained viability, in the sense of the ability to have a meaningful life outside the womb.

At this point, the state's interest in protecting foetal life permitted the banning of abortion, except when necessary to preserve a woman's life or health. So that was the ruling. And it was challenged a number of times. And in 1992, it was refined in the case of Planned Parenthood and Casey, where the Supreme Court found that laws which imposed an undue burden on abortion prior to that stage of foetal viability would contravene the right to privacy.

So what these decisions meant was that states could not just ban abortion, state abortion laws had to comply with that constitutional framework set out by the court. And what happened in June was that constitutional framework was demolished by the Supreme Court in the case of Dobbs and Jackson Women's Health Organisation. So a 5:4 majority of the court – the five including the three Trump appointed judges – found that since abortion is not expressly mentioned in the text of the Constitution, or deeply rooted in the history and traditions of the United States, it is not protected by the Constitution. So they overruled Roe.

Joe Biden: It's a sad day for the court and for the country. Let's be very clear, the health and life of women in this nation are now at risk. Dr Tania Penovic: And what this has meant, the states have been free to enact wide-ranging abortion restrictions, and that's what's happening right now.

Speaker 7: Our body. Our right. Our body. Our right.

Nancy Pelosi: The radical Supreme Court is eviscerating Americans' rights and endangering their health and safety.

Speaker 7: Our body. Our right. Our body. Our right.

Dr Tania Penovic: So within hours of the decision about nine states had moved to ban abortion. And now we're on a trajectory of half of US states either having banned or soon-to-be banning abortion.

Dr Susan Carland: For people who just listened to that explanation, they may say, “Well, that's all very interesting and no doubt important, but that's the US. It doesn't really have any relevance here to us in Australia. It's a very different system. By and large, women still can access abortion if they want to in Australia.”

So, other than wondering what's happening in the US, should we have any greater concern than that in Australia about that event?

Dr Tania Penovic: We should absolutely have concern about that in Australia.

So firstly, it shows how vulnerable hard-won gains are. And certainly in Australia, we've been on a trajectory of decriminalisation in the past 20 years, but that is not to say that those hard-won gains cannot be rolled back. So all you really need is a critical mass of politicians who are committed to enacting legislative change. And we've seen those politicians in federal and state parliaments.

And we also need to be mindful of the influence of the US anti-abortion movement in Australia, and that influence has grown. So since the 1970s, our anti-abortion movement has looked to what is happening in the US. We've invited speakers... When I say we, the anti-abortion movement has invited US speakers to advise and undertake speaking tours. And, some of those speakers that the anti-abortion movement has invited are sometimes really quite extreme members of the anti-abortion movement.

So in 2015, Right to Life Australia invited Troy Newman, president of Operation Rescue, on a national speaking tour. So Operation Rescue is known for its militant clinic blockades. And that tour didn't proceed because Newman's visa was cancelled on grounds which included his writings, which questioned why abortion-providing doctors are not executed. This in a country where violence directed at abortion providers is really a strategy by some elements of the anti-abortion movement to block abortion access.

What we've also seen in Australia are domestic chapters of US anti-abortion organisations. So these groups have established themselves in Australia, and we've seen Australian actors and politicians increasingly replicate the discourses and the strategies of the US movement. So we need to be mindful of this.

Dr Susan Carland: Are you seeing any indication in your professional experience that we could be starting to trend towards stricter regulations around abortion in Australia?

Dr Tania Penovic: I'm certainly aware of attempts to enact stricter regulations. I mean, abortion in Australia remains a conscience vote issue, but there have been increasing attempts to politicise the issue. And there have been a number of prominent politicians who have been committed to enacting restrictions.

So we need to be very mindful. I think that those attempts are growing as the movement looks to its US counterparts and increasingly borrows it its language and tactics.

Dr Susan Carland: Do you think we could argue that forced birth is a form of gender-based violence?

Dr Tania Penovic: Yes. Yes. Requiring someone to give birth irrespective of their autonomy, their choices, and their circumstances is a form of gender-based violence. And this has been recognised by United Nations human rights bodies.

And there are other violations of reproductive rights that also fall within this category. So these include forced abortion, involuntary or coerced sterilisation, and the mistreatment and abuse of people seeking reproductive healthcare. So for example, some of the conduct that we see outside clinics in the United States, and, until recently, in Australia.

Dr Susan Carland: There's a lot of stigma around abortion. Does that stigma also then trickle down into women accessing other forms of health or reproductive care?

Dr Tania Penovic: Well, I think that the stigmatisation of abortion does stigmatise and undermine all reproductive healthcare. So we are not just talking about abortion, we're talking about the pregnant body in need of healthcare.

So for example, in the US right now and elsewhere where abortion is decriminalised, we see that miscarriage and stillbirth become the basis of questioning. We see, in some countries, women charged with homicide, and this has even happened in the US, but it's more common in El Salvador.

And we also see, where there's uncertainty in the law and stigma, doctors refusing to provide healthcare for fear of loss of licence, litigation, prosecution, so refusal or delay of treatment for miscarriage or for ectopic pregnancy, which is life-threatening. So we see all of those consequences.

[Music]

Safeera Hussainy: Hi, my name is Safeera Hussainy and I'm a pharmacist. I worked as an academic at Monash University, and I'm still affiliated with Monash University as a adjunct associate professor. I currently work as the senior pharmacy research manager at Peter MacCallum Cancer Centre, and I also have an honorary position with University of Melbourne.

My main area of research is women's health and sexual and reproductive health, which I'm very passionate about. And my main role has been to advocate for enhanced access to emergency contraception.

Dr Susan Carland: Safeera, welcome to the podcast.

Safeera Hussainy: Thank you so much. It's a pleasure to be here.

Dr Susan Carland: Can you explain, for those that wouldn't know, what is emergency contraception?

Safeera Hussainy: Sure. So as the name suggests, you use it in emergency situations when you've had unprotected sexual intercourse. For example, the most common reason is when a condom has broken, or when you've missed an oral contraceptive pill.

It's commonly known in the public domain as the morning-after pill. But this suggests incorrectly that it can only be used the morning after.

Dr Susan Carland: And when actually how long can you use them? Up to when?

Safeera Hussainy: Yeah. Really important question, Susan. You can use it up to five days. There are two different medicines available from pharmacies. One can be used up to three days and the other one can be used up to five days.

Dr Susan Carland: And, how do they work?

Safeera Hussainy: Yeah, this is also a really important question and a really important myth to dispel.

Some people think that they work by preventing implantation of a foetus in the uterus, but they actually delay or prevent ovulation. So it's like casting a net on the egg so that it doesn't meet with the sperm and doesn't result in a pregnancy.

Dr Susan Carland: Why do you think there are so many misunderstandings about what emergency contraception is? Like you said, there is this big misunderstanding that it's in fact preventing an embryo, or a foetus, or whatever term you want to use, from being implanted, when that is not the case at all. How have things gotten so confused?

Safeera Hussainy: Yeah, it's because it was a postulated mechanism of action similar to the birth control pill when it originally came out. And then data from clinical trials and what we call phase four trials, when it's out in the community, has shown us that that's not the case.

And it also originates from the US So the FDA, which is the drug administration body who approves all the medications in the US, they have actually retained this postulated mechanism of action on their levonorgestrel, which is one of the products, or Plan B, is the trade name.

Dr Susan Carland: Mmm.

Safeera Hussainy: They've retained that mechanism of action on their label until today. And it's been disproven.

And so I think that's what's propelled this confusion in the community, firstly amongst health professionals who would've originally been trained in a university degree that this was the way, or this is the way, that emergency contraception works. And since then, the new data has come out showing that it doesn't. And if they're not keeping up to date with knowledge and doing continual professional education, then that myth just perpetuates.

And also it gets talked about in a lot of women's health magazines and through friends and family.

Dr Susan Carland: But this is quite significant because this is a very politicised issue now.

There's a very big difference between preventing an egg from being released and preventing an embryo from attaching to the uterine wall.

When we look at what's happening in America and just attitudes socially towards abortion, these would now be perceived as totally different things, and would absolutely affect the way that women might feel about accessing emergency contraception, but also the availability of emergency contraception.

Safeera Hussainy: Yeah, you've hit the nail on the head with that one.

They're definitely two different mechanism of actions, and it also points to the fact that the medical definition of pregnancy, and when pregnancy starts, is different to some of the right-wing activists or conservatives who believe when a pregnancy starts.

So they believe that it starts at the point when the egg and sperm meet, which is not the medical definition. And, that has again been taken out of context in the US, and it doesn't help that this label for Plan B still has that mechanism of action on it and they're refusing to remove it.

Dr Susan Carland: So does that mean – and you might not know this, so if you don't, feel free to say that – but does that mean now therefore in the US with the overturning of Row v Wade, emergency contraception is now not available because it's seen as enacting abortion?

Safeera Hussainy: Definitely there's been mass-buying of emergency contraception because of the criminalisation of abortion in most states and the belief that Republicans have that the abortion tourism is occurring, so that people are moving between state lines to go and get an abortion. And that's what they're trying to block.

So a lot of women are going out and buying emergency contraception, which is still available from pharmacies. But there is a fear definitely that it's going to run out. The supply's not going to be able to keep up with the demand.

Dr Susan Carland: What are some of the barriers that women face in accessing their preferred sorts of pregnancy prevention medications?

Safeera Hussainy: This is such a vital question. There's so many barriers. I actually don't even know where to start.

But if we start by talking about emergency contraception itself, when we look at pharmacists, there are still pharmacists whose knowledge is not up to scratch around how emergency contraception works. They're still doing a little bit of gatekeeping, and this is not representative of the whole profession, but it's small pockets now.

There are abortion deserts in Australia, and when the previous health minister, Greg Hunt, was shown this data on these abortion deserts, that fueled the need for getting a telehealth item to prescribe medical abortifacients in the pandemic. So that's when he sat up and realised, “Actually this is a big gap in care”.

So then there's a cost of an abortion, there's access issues, there's travel to get one, especially if you live in a rural or remote area of Australia. And there are complete lack of doctors in there.

And also, if there are doctors, they're not advertising this as a service. There's an underground network apparently, word of mouth, where that's how women find out that there's this doctor who's the abortion doctor, because they don't want to be stigmatised as that.

Dr Susan Carland: The burden of responsibility for family planning often falls on people who can become pregnant, and not their partners. So what about men?

Dr Sab Ventura is a senior lecturer at the Monash Institute of Pharmaceutical Sciences and a researcher in male reproductive pharmacology. He's leading a team that's developing a non-hormonal contraceptive for men.

Dr Susan Carland: Sab, welcome.

Dr Sab Ventura: Thank you very much, Susan.

Dr Susan Carland: Is there much of a demand for male contraceptive pills?

Dr Sab Ventura: Well, the social science at the moment suggests that perceptions have changed in the last say 10 or 20 years. And a lot of young men, particularly late teens to early 30s, that age bracket seems to be very keen to have some sort of male contraceptive that they can use.

Dr Susan Carland: That's interesting. Why do you think it's changing generationally?

Dr Sab Ventura: Yeah, I think society's becoming a bit more in tune with what's best for the world, and particularly things like women having more opportunity for career progression so they can choose when to have children. So, the more options for contraception that there are, the more choices women will have.

Dr Susan Carland: Medically, there are a lot more contraceptives available for women. Why is that? Is it easier medically to design?

Dr Sab Ventura: Yeah, that's a good question. So biologically, it probably is easier to stop women's fertility because they only ovulate one egg per month, whereas men will have a hundred million sperm in an ejaculate. So you have to stop a hundred million sperm, compared to just one egg per month.

Having said that, it's not that hard. So it is possible to, say, make mice or rats completely infertile if we want to.

Dr Susan Carland: And do you think men will be more interested in something like a contraceptive pill as opposed to a condom or something more permanent like a vasectomy?

Dr Sab Ventura: Absolutely. And I think that's one of the things that the young generation is keen on.

I mean, it's a generation where popping pills are quite normal. So I think if they had a daily pill to take, yes, that it'd be far more convenient than certainly a vasectomy and a condom, which is quite interruptive and can dull sensation.

Dr Susan Carland: Thinking about the contraceptive pill that you are designing at the moment with your team, would that have fewer side effects because it's not hormonal than so many of the ones that women take?

Dr Sab Ventura: Absolutely. Absolutely. That's why we've tried to design a non-hormonal one. I mean, hormonal contraception for men has been shown to be effective for 50 years, virtually. However, it's never taken off because in clinical trial, men that have taken it haven't been able to tolerate the side effects.

Dr Susan Carland: Huh.

Dr Sab Ventura: Not that they're any different to what women get, just that men just can't tolerate them. Whereas women tend to be, “Yeah, I can do this.”

Dr Susan Carland: Wow. There's a lot in that.

Dr Sab Ventura: Yeah.

Dr Susan Carland: I wonder... This is obviously completely outside your area, so I'm asking you as an individual and not as the head of pharmaceuticals [laughter]: Do you think women were more willing to put up with it because the attitude was, “Well, it's this or having a baby that I'm not ready to have”, whereas for men, yes, obviously they would be the father, but they're not the one carrying the baby, so the threshold is lower?

Dr Sab Ventura: Yeah, that's an interesting question. I think you're right. I think women obviously will have more of the burden if they do get pregnant.

However, I do think it's changing a little bit. And I do think that men are feeling more responsible if a woman gets pregnant, they still feel like they are responsible for something, and responsible for the upbringing of that child if it gets born. So that's certainly changed.

But, I mean, I guess the woman is always going to have the greater responsibility than the man.

Dr Susan Carland: So just so I'm clear, are you saying that there already are male contraceptive pills that are successful and available, but just almost no one takes them?

Dr Sab Ventura: Well, they're not on the market or anything, but they have been tried in clinical trials, and they are effective in that they can make a male infertile. It's just the side effects that men can't tolerate, which just means they haven't progressed any further.

Dr Susan Carland: Wow. This is astounding to me.

Dr Sab Ventura: [Laughter] Well, there was even a historical clinical trial back in the ‘20s or ‘30s where they used male prisoners somewhere in the US to try a certain enzyme inhibitor as a male contraceptive. And again, it was effective. However, what happened was whenever the men who were taking the pill drank alcohol, they would get terribly sick. And that was enough to stop the trial.

Dr Susan Carland: Wow. Yeah. I actually don't know what to do with all this information. [Laughter]

Is part of the problem, maybe, that women haven't been open enough about how unpleasant hormonal contraceptives can be for us? So that maybe men don't realise women just have it, and it's uncomfortable or it causes these side effects, and women just deal with it. So men don't realise just how unpleasant it can be for women?

Do we need to complain more as women, is what I'm asking you? Yes, or yes?

[Laughter]

Dr Sab Ventura: It would probably help. But I think the problem was that they developed one for females first. So all the women started taking it, and then everyone else in the society thought, “Oh, well, it's under control now. We don't really need anything else.”

If it had have been the opposite way around and men had it first, it might have been different.

Dr Susan Carland: Hmm. When do you think we might start seeing male contraceptions on the market?

Dr Sab Ventura: That's hard to say. It's really dependent upon how much money went into the research. I mean, the whole field is moving so slowly because there's just not enough money to make the research go any faster.

I mean, it might never happen. It depends. It needs to be a change in demand, really.

Dr Susan Carland: Why is there not enough money? Is it because there's a sense from pharmaceutical companies that men just aren't that interested? It's like you said, “It's being managed well as it is. We don't need to really change anything.”

Dr Sab Ventura: Yep. Couple of things there.

Firstly, a pharmaceutical company, if they're going to develop something like a male contraceptive, they'll probably have to put a billion dollars into it. They want to be sure they're going to get that money back at least, and they really want to be sure that they're going to make some decent profit after that. So I can't really see that at the moment.

The other thing is the people in charge of all these pharmaceutical companies and government grant-giving bodies of medical research, they're all older men, virtually. So they're the people who think we don't need it, really. And that's a generational thing and might change as younger people get into positions of power.

Dr Susan Carland: Generational shifts in power take time, of course, and some of our expert guests fear that that clock is ticking. Here's Safeera again.

Safeera, if you cast your mind 50 years into the future, imagine we don't change anything in Australia when it comes to women's access to reproductive medication. What does the future look like to you?

Safeera Hussainy: I'm really worried that it could play out to be like Handmaid's Tale as what's happening in the US, because we know the US and what happens over there in terms of healthcare has repercussions for the rest of the world. I'd like to think that our healthcare system is better designed, and it can protect the rights of women.

But at the same time, I don't think we're taking the right lens that we need to take, which is a reproductive justice lens. So access to medications, access to services has to be viewed through this reproductive justice lens where everyone has the personal right to bodily autonomy, and they have the right to choose whether they become parents and also whether they parent... Or if they can parent in safe and sustainable communities. I don't think we're quite there yet.

So if we don't do anything, for example, if we don't remove this gender Medicare gap, as well, that exists – where, for example, the rebate for an ultrasound for the scrotum is higher than the rebate for a ultrasound for the breast or a pelvic examination, which is just absolutely ridiculous. So women have these huge out-of-pocket costs. And even for the copper IUD, that's around $100 just for the medication, but that doesn't cover the cost of the insertion fee.

Dr Susan Carland: Why is the ultrasound for the scrotum so much cheaper than for any female body part? [Laughter] What's that about?

Safeera Hussainy: Yeah, you tell me.

So I think men's bodies and perhaps their illnesses are prioritised more than women's. And, a life course approach has not been taken for women's health. And, we are far, far behind reaching this Sustainable Development Goal. One of them is maternal and newborn child health, and we have not reached that at all.

Dr Susan Carland: Human rights, reproductive and otherwise, are at stake around the world, and the hard-won gains of women and AFAB people are on the line. To avoid sliding into the dystopian Gilead of The Handmaid's Tale, we must take action. Next week on What Happens Next?, we'll talk to some of the people at the coalface of reproductive health and rights.

Thanks to all our guests today, Dr Tania Penovic, Dr Paula Michaels, Dr Sab Ventura, and Dr Safeera Hussainy. For more information about their work, visit our show notes. You'll also find links to all our sources there.

Stay tuned next week for part two of reproductive health on What Happens Next?.