I would like to endorse the comments of the member for Reid and the member for Lilley, who both expressed their appropriate support the Medical and Midwife Indemnity Legislation Amendment Bill 2021. I support the bill, although I think it is still quite a complex matter, and I think the bill itself doesn't go far enough in providing adequate insurance for practising midwives in Australia.

In this place, I've been a somewhat repetitive speaker about support for the health of children and young Australians. I think this bill will go part of the way to encouraging better pregnancy care in Australia, but there is certainly no real, comprehensive policy on perinatal care in Australia, and that is a great deficiency. Since I came into this parliament in 2016, I've been trying to promote a child health policy called The First 1,000 Days.

This provides health care for children, from preconception, through pregnancy and up until the age of two years. If we can provide the very best health care that we can for children in that time frame—the first 1,000 days of life—then we know that the health and economic outcomes will be much, much better than trying to retrofit health policy once children are older.

The First 1,000 Days, in particular, looks at the work that we can do for things like preventing stillbirth, which has already been mentioned; improving pregnancy outcomes; reducing premature birth; reducing the incidence of low-birth-weight babies; and reducing the number of preventable causes of neonatal disability, such as rubella, foetal alcohol syndrome and other infections during pregnancy. People are talking about a particular virus that can cause injury to an unborn child, cytomegalovirus, which there is a developing immunisation for. All these things mean that the outcomes for children are much, much better and therefore the health costs over life are much reduced.

Pregnancy is a dangerous time. Pregnancy loss amongst already recognised pregnancy is as high as 15 per cent, but unrecognised pregnancy loss is certainly much greater. Up to 50 per cent of all fertilised eggs are lost even before implantation. Miscarriages occur in up to one in five confirmed pregnancies before 20 weeks. However, having said that, Australia is one of the safest places in the world for a baby to be born. Perinatal death occurs, including stillbirth at term, about eight times per 1,000 births in Australia.

There were 2,790 babies who died in the perinatal period in Australia in 2018. Three-quarters were stillbirths and the remaining almost 700 were neonatal deaths. We estimate that, with appropriate care, up to a third of the stillbirths and a third of the neonatal deaths could have been prevented. Part of the way that we can prevent it is by providing good pregnancy care. I've worked with many midwives over many years who have provided wonderful care to women during pregnancy.

But pregnancy care includes many other things. It includes things like advice about when to get pregnant and about contraception. It includes advice about how to stay healthy during pregnancy, avoiding toxins such as alcohol and cigarettes, avoiding recreational drugs, avoiding things like infections that could be prevented, avoiding poor diet, and treating illnesses that occur during pregnancy and trying to manage things like gestational diabetes.

All of these are managed mostly by midwives. Whilst they can be managed through GPs, obstetricians and gynaecologists, in this day and age the gap costs of seeing doctors and midwives privately are quite expensive and beyond the reach of many of Australians, so people are having to resort to being seen in public hospital obstetric outpatient units. These are very good and they're staffed by excellent midwives, but waiting lists are long and in some of the rapidly growing suburbs they cannot cope with the load.

There's the cost of investigations during pregnancy. The gap cost for an obstetric ultrasound is as high as $100 in many areas of Australia, so people are avoiding them because of those gap costs and are not getting adequate investigations during pregnancy, and this can have outcomes for health care. There is no overall plan from this government and certainly from many of the state governments about Australia-wide obstetric care, and that's a huge deficiency in Australia.

In other countries, it's totally different. The Scandinavian countries have fantastic electronic records and fantastic pregnancy health care which is all provided by the state, free of charge. This includes midwifery care during pregnancy; it includes postnatal care, and that's very important; and it also includes hospital care. Yet, in Australia, if people want to see an obstetrician privately during their pregnancy and have regular follow-up care, the cost can run into many thousands of dollars. Again, that is prohibitive for many people, certainly in my electorate of Macarthur. The government has no plan to be able to reduce this, which is a great tragedy and which I think is not leading to the best possible care.

We rely on our midwives. This bill will improve the pool of midwives available for obstetric care, but it doesn't go far enough. We need an Australia-wide plan and Australia-wide support for this policy. There's nothing from the government on this. This tweaks that a little bit, but it doesn't really change the outcomes for many pregnancies.

The other thing that is very important in midwifery care is postnatal care. We've heard, from the member for Reid and the member for Lilley, about the problem of postnatal depression, but there are many other postnatal problems that can be avoided with appropriate midwifery care. They include postpartum infections, postpartum bleeding, postpartum iron deficiency and other vitamin deficiencies, difficulties with breastfeeding, difficulties with maternal infant bonding, problems with post-delivery contraception et cetera. These are things that can be managed very well by our very good midwives.

As I said, I've worked with many, many of them, as a team, and certainly many of them have saved my bacon on a number of occasions. Because they have very good personal relationships with the mothers and also with the babies, they know when things are not right and they know when treatment is required. So the more we can do to support midwifery care the better. This bill doesn't go far enough and there's much more we could do.

This bill will support midwives who provide hospital care. It doesn't support those involved in homebirths, and, while I'm not a supporter of homebirths, it is a reality and we need to do more to support midwives who are providing homebirths. By doing that, I'm sure we can avoid some of the problems that can occur.

We also need to do more with our Indigenous population. For them, it is very important to have birth on country, and we need to do more to support our Indigenous population to provide those services. In a couple of weeks time, I'm visiting the Shoalhaven area to look at a birthing unit run by the local Indigenous community. It's staffed by midwives and they provide a fantastic service to the local Indigenous population, and we need to do everything that we can to support units like Waminda around the country.

We need to do much more to improve obstetric services in our country towns and regional centres. It's been very difficult to recruit obstetric care, even to outer metropolitan electorates like my electorate of Macarthur, because the costs of insurance are high. The gap cost for providing obstetric care is prohibitive for many people, so fewer and fewer people are using private obstetricians and more reliance is put on the public hospitals. Many of our outer metropolitan, rural and regional obstetric services are not able to provide the levels of care that we would expect in 21st century Australia.

There is much, much more to be done, and from this government, again, we have no overall plan. They are nibbling at the edges but are not really providing a comprehensive policy solution to obstetric care in Australia, and it's time that we had it. It's all right if you live in the centre of Sydney close to the big teaching hospitals: North Shore Hospital, Prince Alfred Hospital, Prince of Wales Hospital. I've worked at all those hospitals, and they have wonderful obstetric services, but we need to look at ways of replicating those sorts of services in outer metropolitan, rural and regional areas.

The only way we can do that is by improving the number of midwives available for services. Recently the midwives at my hospital at Campbelltown threatened to go on strike because of underfunding and understaffing. They were persistently made to work hours—double shifts et cetera—that they believed were not allowing them to provide the service that they wanted to their clients.

We need to do much, much more, and it requires a policy solution. It doesn't require just nibbling at the edges. There needs to be a comprehensive obstetric-care management plan for the whole of Australia, and that should include not just the teaching hospital inner-city areas. It needs to be in outer metropolitan, rural and regional areas. If you go to any rural area, you will find one of the biggest health complaints from young couples is that they cannot get obstetric care close to where they live.

Many families have to relocate to the city to be able to have their babies. For poorer people that is prohibitively expensive. We need better outreach services from our major obstetric units. They need to take responsibility for the levels of care not just in their local areas but in the rest of the country. It's no longer reasonable that health care should be better if you live next door to North Shore Hospital or Prince Alfred Hospital than if you live in country New South Wales or the South Coast or the North Coast. We need to do much better with providing comprehensive care around Australia. We need to recruit more midwives. We need to make it viable for them to provide a service to people in the community, and we need to make sure that people can afford their care.

My personal view is that all obstetric care should not come at a cost to the patient, because we need the very best care for our children. I've mentioned the first thousand days. This is a comprehensive policy that provides health care from prior to conception, through the pregnancy and afterwards to the age of two and includes a whole range of things like child development, infant nutrition, breastfeeding, developmental assessment—a whole range of health issues that we can do through an appropriately trained and appropriately funded midwifery workforce. Some of the biggest supporters of the first-thousand-days policies have been midwives. Indeed, they have been Indigenous midwives, because they know how important those early times are for the future of their children and the future of their communities.

So, whilst I support this bill, it's only a very small part of the solution. All of us who are parents and grandparents understand how much we invest in our children, but the country needs to do that as a whole and make sure that all our children have access to the very, very best health care that they can get.

I'd like to say at the end how grateful I have been for all the midwives who have helped me in my career. The work they do is just fantastic. I have been privileged to work with some fantastic obstetric carers, including midwives and obstetricians. Long may they continue to provide the care that they do. Thank you.