Pillar 2: Health and wellbeing

The NSW Government has taken significant steps to address domestic, family and sexual violence, including introducing affirmative consent laws, increasing education and awareness of violence against women, and funding domestic and family violence services.

During consultations, women reported safety as their first priority. Domestic, family and sexual violence is perpetrated against both men and women, but women experience violence at much higher rates than men, with 1 in 6 women having experienced physical violence by a partner since the age of 15.⁹²

Domestic and family violence has profound impacts on women’s physical and mental health, contributing more to the burden of disease for women aged 18 to 44 years than any other risk factor (including alcohol, tobacco use and obesity).⁹³ Similarly, sexual violence is linked with significant health impacts, including mental health conditions such as post-traumatic stress disorder, anxiety and depression.⁹⁴

Aboriginal and Torres Strait Islander women experience disproportionate rates of violence, representing nearly 30% of all hospitalisations due to domestic violence between 2010–11 and 2018–19.⁹⁵

Violence limits women’s ability to work and has long-term effects on women’s financial security and wellbeing.⁹⁶ Women who experience domestic and family violence are more likely to have difficulty retaining their job and being productive at work and more likely to have lower incomes.⁹⁷

Violence against women is estimated to cost the Australian economy more than $22 billion every year.⁹⁸

‘Domestic violence is a huge issue and there simply are not enough services and support available. Women should not be living in fear of their partner or other men.’ Survey respondent

Violence against women is preventable. The NSW Government is committed to ending violence against women; this relies on a strong focus on prevention. Preventing violence means considering the broader social, political and economic factors that drive violence against women, as well as the gender inequality that creates the conditions in which violence occurs.

Violence against women is overwhelmingly perpetrated by men. As Our Watch notes, ‘Research shows strong links between the socially dominant forms and patterns of masculinity, sexist attitudes and behaviours, and men’s perpetration of violence against women.’⁹⁹ At its heart, this means that we all need to change the way we think about gender, particularly traditionally ‘masculine’ or ‘feminine’ roles. Primary prevention targets the attitudes, social norms, practices, structures and power imbalances that contribute to violence.

The National Plan to End Violence against Women and Children 2022–2032 and the upcoming NSW Domestic and Family Violence Plan 2022–2027 and NSW Sexual Violence Plan 2022–2027 place high importance on changing behaviours.

Women in some focus communities may experience domestic, family and/or sexual violence at higher rates than other women. In addition, they are likely to experience barriers in reporting their experiences and to accessing help and support.

Culturally appropriate and culturally safe services are critical to reaching out to women in different communities and connecting them to services. Ensuring interventions are appropriate for women who may be more isolated, including those facing issues associated with living in a cross-border area, is a priority in regional areas.

Targeted responses for women with disability are critical to ensure they are supported. Women with disability may not always be able to reach out for support. Healthcare professionals and disability support workers may be the first people to identify signs of abuse and need to have the capability to support women.

‘We know the importance of specialist services for multicultural women. Having a culturally competent person who supports them in language is essential.’ South West Sydney woman

Understanding and communicating women’s and girls’ health needs are fundamental to ensuring women and girls receive appropriate and effective healthcare. Yet women across NSW reported feeling there was not a community-wide understanding of women’s health needs.

Gender bias in clinical trials holds back improvements in women’s health, both through poorer diagnostics and less effective and fewer treatments. Women are under-represented in studies across cardiology, oncology, neurology, immunology and kidney disease.¹⁰⁰ Historically, females were under-represented in pain studies, with 79% of studies only involving male animals.¹⁰¹ Combined with recent research that found women’s pain is different to men’s,¹⁰² it’s clear that a greater focus on and investment in women’s health could improve women’s outcomes significantly.

Neuropsychological conditions like attention deficit hyperactivity disorder (ADHD) and autism are overlooked and not diagnosed early enough in women and girls. Research on gender differences in ADHD shows that girls are being consistently under-identified and under-diagnosed because of differences in the way the condition is expressed between girls and boys.¹⁰³

‘My neurodiversity [autism] was diagnosed at 19. The boys I went to school with were diagnosed at 6. I’ve missed out on over a decade of support at a time that I most needed it because it took so long to be diagnosed.’ Young woman

Managing health in education settings and the workplace

Women’s health conditions and circumstances need to be accommodated in education settings and the workplace. These conditions and circumstances include reproductive health, mental health and the impact of domestic, family and sexual violence.

Where women’s health issues, such as menstruation and menopause, are considered taboo or stigmatised, it makes it more difficult for education settings (including schools), workplaces and communities to support women and promote their progression as students and at work. Younger women and girls talked about the impact of periods still being taboo, with pain leading to missed classes, disengagement from physical activity and time off work. This stigma may be experienced in different ways, with women from diverse cultural backgrounds at greater risk. The topic may also be one of sensitivity for Aboriginal and Torres Strait Islander women.

The NSW Government is providing free menstrual hygiene products to all female students at public schools.

The reduction in women’s economic participation due to health issues impacts their financial security, as well as the broader economy. Depending upon assumptions applied, endometriosis and chronic pelvic pain alone are estimated to cost the Australian economy between $1.4 billion to $6.5 billion each year, mostly from lost productivity at work.¹⁰⁴

From menstruation to post-menopause, reproductive health conditions and experiences are affected by:

• social attitudes
• education about reproductive health and available services
• access to appropriate facilities and services
• power relationships
• the medical profession’s approach to reproductive health.

Advancing community awareness of appropriate responses to these health needs in education and workplace settings plays a critical role in improving the health and wellbeing of women and girls.

Women’s reproductive and sexual health covers a broad range of experiences including contraception, respectful and safe relationships, sexually transmitted diseases, menstruation, preconception, pregnancy, infertility, perimenopause and menopause. The impact of these experiences on women and girls can span several areas:

• medical – through conditions that impact negatively on health and wellbeing, such as endometriosis and polycystic ovary syndrome
• social – by affecting women’s ability to participate in all aspects of life freely and safely, such as being able to afford contraceptive and menstrual products
• economic – the impact on women’s access to economic opportunities and advancement, such as workforce participation and educational attainment, as well as the cost of medical and other services.

Women have identified menopause as one of the top health issues where greater research and information is needed to support their health and wellbeing. While 85% of women experience symptoms of menopause,¹⁰⁵ there is still limited discussion about its impact, symptoms or treatments, making women less likely to seek help.

Endometriosis is another critical area of concern, affecting 1 in 9 women.¹⁰⁶ Women and girls often experience long diagnostic delays, with an average of 6.5 years from symptom onset.¹⁰⁷ Recent studies have found that women with endometriosis have a higher risk of several forms of cancer, including uterine cancer, ovarian cancer and breast cancer.¹⁰⁸

Period poverty, including lack of access to menstrual products, may contribute to educational disadvantage, as low-income students may miss school or higher education when they have their period.¹⁰⁹

The NSW Government has made a significant investment to holistically support women’s health and wellbeing. This includes reproductive health initiatives such as:

• $80 million to support more affordable fertility treatments
• $40.3 million for menopause hubs to support women who have experienced or are experiencing menopause and for a menopause awareness campaign.

Women across NSW – particularly those in regional locations – identified the need for access to appropriate, affordable health services. Women who cannot take time off work or who cannot afford to pay for health services for themselves or their families are not receiving the same level of care as those who can.

Mental health supports for all, particularly young women, are a clear priority. The NSW Women’s Health Framework recognises that suicide is the leading cause of death among young women in NSW aged 15 to 24 years, and 1 in 5 women aged 16 to 24 experience high or very high psychological distress.¹¹⁰ This is even higher for young LGBTIQA+ women, who report acute mental distress at more than 3 times the rate of other young women in NSW.¹¹¹

As part of its commitment to improving women's health outcomes, the NSW Government provides funding to Women's Health Centres across NSW. These centres provide counselling and mental health supports, reproductive healthcare and education for the community and healthcare professionals.

The need for holistic and culturally safe health services that are free from racism and discrimination; respond to Aboriginal and Torres Strait Islander women’s health needs; and take into account traditional preventive care, healing practices and medicines has been well documented, including in the NSW Women’s Health Framework and the AHRC’s Wiyi Yani U Thangani (Women’s Voices): Securing Our Rights, Securing Our Future report.¹¹²

Wiyi Yani U Thangani highlights the need to address the social determinants of health for Aboriginal and Torres Strait Islander women and to ensure equitable and accessible health services across all of women’s health needs. The report recognises that Aboriginal and Torres Strait Islander women’s health and wellbeing is interconnected to culture as well as socio-economic factors.¹¹³ Integrating women’s knowledge and healing practices into health systems is critical for women’s health and wellbeing.

Health outcomes for people living in rural and remote areas are lower than those in metropolitan areas.¹¹⁴

For women in regional NSW, limited access to services, long wait times and the need to travel long distances have a negative impact on themselves, their families and their communities. The NSW Government's Isolated Patients Travel and Accommodation Assistance Scheme can provide financial support for patients required to travel long distances for treatment.

Women in regional NSW are looking for an integrated long-term solution that encompasses areas such as workforce development and housing for health practitioners.

Women in the regions report difficulties accessing a wide range of specialist care, from sexual and reproductive health services to psychology and psychiatry, speech therapy and other allied health services, affordable dental care, and palliative care.

‘My child has seen 5 different OTs and 6 different psychologists, and I have to take half a day off work every second week to see a psychologist because of the travel.’ Woman from Far West NSW

Mental health and wellbeing are priorities for women. Women reported difficulties in accessing services, particularly in regional areas. Wait times between visiting a general practitioner (GP) – the gateway to other services – and appointments with specialists can be long, sometimes up to 12 months, which can leave women feeling unsupported. Without supports, women may feel like there are barriers to participating in all other areas of their lives. Women with family members who are struggling with mental illness may personally carry the burden.

Between 10% and 20% of women develop a mental illness during pregnancy or within the first year of having a baby. Focus communities experiencing isolation, such as migrant women, have higher rates of postnatal depression compared with non-migrant women.¹¹⁵

‘The strategy should focus on 2 broad things – extending the reach and availability of support services in the region and directing assistance to women who need it.’ Newcastle/Hunter woman

Access to appropriate supports and services from preconception to pregnancy, birth and postnatal care helps ensure better health outcomes for mothers and babies.

Access to preconception care has been shown to improve pregnancy and child health outcomes. Providing consistent healthcare information and including partners are important.

It is crucial that women receive maternity care that acknowledges and respects their culture, beliefs and experiences.

Antenatal care, from pregnancy through to childbirth, should be woman-centred, individualised and reflect the preferences of the woman and her family.

In NSW, considerable progress has been made over the last 2 decades towards improved perinatal outcomes, from the time a woman becomes pregnant to a year after birth. Progress includes low rates of maternal death, 80% of women attending antenatal care in the first 14 weeks of pregnancy, and fewer than 1 in 10 women smoking during pregnancy in 2020. More work needs to be done to address low birthweight, preterm birth, stillbirth and neonatal death, where rates have remained steady. For regional women in particular, improved antenatal and postnatal care is a high priority.

Housing plays an important role as a social determinant of health. Living in unsafe, insecure housing can make it more difficult for women to access healthcare for themselves and their families, to participate in work and to contribute to their communities. Facing constant stress due to housing unaffordability can negatively impact women’s mental health.

Women are affected by housing issues at different stages as their housing needs and financial capacity change. Single mothers and older single women often face barriers to home ownership. This is particularly true of women who separate from their partner with whom they own a home. Only 34% of these women manage to purchase another home within 5 years, and only 44% are able to do so within 10 years.¹¹⁶

Women shared how their inability to access housing impacts every part of their lives, such as when it leads to a poor diet or putting off paying bills to pay rent. In the child protection system, stakeholders report the close link between access to secure housing and the ability of women to continue to care for or regain access to their children.

In the last decade, more older women have been provided with social housing; in 2020–21 the number of older women in social housing increased by 14.6% from 2019–20.¹¹⁷ The number of older women and older women from CALD backgrounds on the social housing waitlist declined by 4.8% and 6% respectively over the same period, but the number of older Aboriginal women on the waitlist increased by 24.2%.¹¹⁸

Women are affected by housing issues at different stages of their lives as their housing needs and financial capacity changes. Older women are the fastest-growing cohort of people experiencing homelessness in Australia, which is a consequence of long-term systemic issues.¹¹⁹ In the decade from 2006 to 2016, the number of older women who reported experiencing homelessness on Census night increased by 44%.¹²⁰

Homelessness is also an important issue for the LGBTIQA+ community, with 32% of trans women and 20% of women of diverse sexualities having experienced homelessness, compared to 13.4% of the general population.¹²¹

Addressing homelessness – particularly for older women – is also a high priority in regional areas.

The NSW Homelessness Strategy 2018–2023 outlines the NSW Government’s approach to preventing homelessness and supporting people, including women, who are experiencing homelessness. The strategy:

• identifies and supports people who are at risk of homelessness early
• provides effective supports and responses
• creates an integrated, person-centred service system.

‘I feel like becoming homeless is something that could happen to me and many older women.’ Woman from the Central Tablelands

• Address the abuse of older women through the Ageing and Disability Commissioner and the Preventing and Responding to Abuse of Older People (Elder Abuse) NSW Interagency Policy.
• Expand NSW Health–funded Twenty10 specialist counselling and group support programs for young trans and gender-diverse people.
• Continue to support the National Action Plan for Endometriosis (introduced in 2018).
• Continue piloting free menstrual hygiene products in 30 schools across Western Sydney and Dubbo, and planned rollout across NSW.¹²²
• Continue to implement the NSW Department of Education's Wellbeing framework for schools, to create learning environments that enable students to be healthy, happy, engaged and successful.
• Complete the rollout of Wellbeing and Health In-reach Nurses in high-needs schools across the state.
• Continue the very successful Get Healthy Information and Coaching Service, which supports women to reach their healthy lifestyle goals, with a particular focus on pregnant women.
• Expand Aboriginal Child and Family Centres, which co-locate universal health, early childhood education and other family services.
• Continue the Isolated Patients Travel and Accommodation Assistance Scheme to provide financial assistance to patients who need to travel long distances for treatment.
• Extend the Pregnancy Family Conferencing program and Sustaining NSW Families home visiting program.
• Revise the SAFE START policy related to antenatal and postnatal mental health and psychological screening of all mothers birthing in public maternity facilities.
• Extend access to support for mild to moderate perinatal depression to women in rural, regional and remote areas.
• Provide 3,400 dwellings under the Social and Affordable Housing Fund.
• Deliver approximately 200 sustainable, social and affordable housing dwellings for women experiencing domestic and family violence through the Community Housing Innovation Fund partnership with the community housing sector.

Implement measures announced in the Women’s Opportunity Statement, which provide targeted support for a range of women’s health needs, including:

• helping prevent street harassment by investing in public infrastructure including street lighting, pathway upgrades and CCTV
• $40.3 million for menopause hubs and menopause awareness campaigns
• $80 million to help families access fertility treatments
• $5.2 million for postnatal mental health¹²³
• record investment in child development and family support via Brighter Beginnings and the Affordable Preschool Program.

Other initiatives beyond the Women’s Opportunity Statement include:

• implementing the NSW Domestic and Family Violence Plan 2022–2027 and the NSW Sexual Violence Plan 2022–2027
• establishing a new eating disorders treatment centre in Newcastle to provide wraparound care in a home-like environment
• establishing Westmead Integrated Mental Health Complex
• establishing a tailored suicide prevention service for people of diverse sexualities and genders (to be operated by ACON)
• establishing a new trans mental health and wellbeing service funded by NSW Health and operated by ACON
• establishing 2 specialist acute mental health care units for mothers and babies
• developing digital health initiatives such as the Digital Baby Book.

• Develop a dedicated plan to address family and sexual violence in NSW Aboriginal and Torres Strait Islander communities and support Closing the Gap priorities.
• Increase knowledge and awareness of, and clinical support for, women’s reproductive health, including reviewing research and exploring ways to improve experiences in education settings and the workplace.
• Continue developing telehealth to improve the reach and responsiveness of medical care.
• Develop a strategy for women and girls in correctional and youth justice centres with a focus on trauma, women and girls as parents, Aboriginal and Torres Strait Islander women and girls, and the transition from correctional centres to life in the community.
• Improve access to early intervention, mental health and wellbeing support for girls.
• Ensure the Housing 2041: NSW Housing Strategy addresses the needs of women and girls at risk of housing insecurity and homelessness.