Reproductive justice: a right, not a product.

Last month, the Australian government made a change to the Overseas Students Health Care (OSHC) Deed that will improve access to reproductive healthcare for thousands in Australia. After over a decade of strong advocacy from international student groups and women’s health organisations like MCWH, many international students will no longer have to wait 12 months to have pregnancy related care covered by their private health insurance, which they are required to take out as a condition of their visa.

This waiting period seriously limited the reproductive rights of international students. Students who wanted an abortion were forced to pay up to thousands of dollars out of pocket. While sadly, some were forced to have reluctant abortions due to high out of pocket hospital fees, and even more for access to vital antenatal care, which can be life-saving for both mothers and babies. The waiting period also reflected gender discrimination within Australia’s migration and health regimes, with cis men’s sexual and reproductive healthcare not being subject to the waiting period.

So why were private health insurers allowed to deny international students coverage for pregnancy related care in the first place?  In 2011 private health insurers were concerned that pregnancy related care was costing them too much, and they argued for a waiting period to be added to the deed, which was agreed to. In that same year, one of the largest providers of Overseas Student Health Cover, Medibank, recorded $428 million in record profits.

But it’s not only private health insurers who profit from international students’ exclusion from public healthcare. Migration agents and educational institutions also take a commission from international students’ health insurance, pushing up premiums. A further welcome change to the OSHC deed is a new 12% cap on third-party referral commissions, a change made to keep premiums down for students as insurers are expected to raise premiums in reaction to the removal of the waiting period.

Most Australians know that private health insurers aren’t doing it tough. But international students, particularly women, are. Many students face financial insecurity, with limited work rights, no access to social security and housing exploitation, making healthcare even less affordable. These issues also contribute to increased vulnerability to violence. In one study, over 40% of women international students reported experiencing sexual violence since moving to Australia, with these experiences correlated with housing stress, financial insecurity, and lack of social support. As one student put it, “When I came here as a university student, I spent so much money on tuition fees and contribute to tax in Australia and when I encounter this tough situation, I just feel like I’m being left kind of alone”.

While we should all welcome the changes to the deed with open arms, some points of discrimination remain. For one, the waiting period will still be in place for those whose insurance plans are for less than two years. Students with coverage still face a confusing health system and stressful claim process with unpredictable costs. In a recent study by MCWH and Melbourne University, one international student mother shared, “The issues with costs were the most stressful. I didn’t know the medical terms in English for maternity related things, so I couldn’t fully figure out what was covered”.

Insurers, agents, colleges and universities should do more to support the health and safety of the students they profit from. They could do this by engaging bilingual educators and service navigators to help students access and claim services, train staff in how to confidentially and responsively support international students experiencing violence, and provide transparent, up-front, bilingual information about accessing sexual and reproductive health services in Australia.

But while improving international students’ private health coverage is important, a more effective way to ensure reproductive justice, health, and safety for international students is to expand access to public healthcare, social security and violence support services, and to improve these systems for everyone, regardless of visa status, gender, university enrolment or race. Everyone in Australia should have access to healthcare as a right, not as a product, just as everyone should have the right to be free from violence, and to choose when, how and whether they have children.