Speaking of Science: Achieving better outcomes in women's sexual and reproductive health: The SPHERE CRE journey

Working with consumers, policymakers and health professionals, SPHERE’s journey towards creating better outcomes for women has focused on addressing consumer needs, using data to advance knowledge and building system and workforce capacity.

Watch and listen as Professor Mazza discusses the journey of the SPHERE CRE, as well as the real life and long lasting impact it has had on girls, women and gender diverse people nationwide.

Recorded on Thursday 4 September 2025 at 3:00 pm – 4:00 pm AEST.

Video transcript

00:00 Professor Steve Wesselingh
Importantly, I'd like to begin by acknowledging the Traditional Custodians of the lands on which we are each meeting today. I would like to personally acknowledge the Ngunnawal People as the Traditional Custodians of the lands where I am today. I acknowledge and respect their continuing culture and their contributions they make to the life of the nation. I pay my respects to their elders, past, present and emerging, and extend this respect to all Aboriginal and Torres Strait Islanders who are joining us today.

00:33
I would just like to remind everyone before we start that there is an opportunity to ask questions at the end, and I encourage you to do that through the Zoom chat function. And obviously, if you haven't been able to attend one of our webinars, they're all available online, and there'll be a recording of this webinar so that you can watch it again, or if you need to leave early, you can see the end.

For those who might not know it, this week, we celebrate Jean Hailes’ Women's Health Week. This is Australia's largest annual event dedicated to health and wellbeing of all women, girls and gender diverse people. The theme in 2025 is say yes to you.

01:20
Really what that's saying is that each day, the focus has shifted between different health topics with an overarching goal of helping to create a healthier future for all women in Australia. From heart health, to pain, to health checks, mental wellbeing, arming women with the right tools and knowledge to have an informed conversation with their doctor and encouraging them to speak up, check in and prioritise their health and wellbeing. In fact, Jean Hailes has just launched a tool for Australian women that tells them which health checks they might need and when to get them, and if you're interested in that, then the tool is available on the Zoom chat.

02:09
This is a great segue to our guest speaker for today, which is Professor Daniella Mazza. Danielle is the head of the department of general practice at Monash University, and nationally and internationally recognised leader in implementation, research, knowledge and knowledge translation in general practice, she has made a significant sustained and ongoing contribution to advanced general practice and primary health care in Australia in the field of women's sexual and reproductive health. Danielle leads the NHMRC funded SPHERE Centre of Research Excellence, or CRE, which aims to improve the quality, safety and capacity of primary health care services to achieve better outcomes in women's sexual and reproductive health.

The SPHERE CRE is a network of multidisciplinary researchers, health care providers and paradigm shifters driving better sexual and reproductive health outcomes for women through primary care. It works at the forefront of women's sexual and reproductive health, where their research and evidence based statements inform policy, practice and public discourse. Danielle is also a member of the NHMRC MRFF Public Health and Health Systems Committee, which provides really important strategic advice to us at NHMRC and the MRFF.

03:39
I'm really pleased that Danielle has agreed to do this webinar and discuss the journey of SPHERE and how it's achieving better outcomes in women's sexual and reproductive health. It's also special for me too, because I can remember back a while ago when I was at Monash and Danielle was there, and it was so much fun working with Danielle in general practice, and obviously she's taken that to terrific heights since that time.

It's great to have you on board, Danielle, and really looking forward to your talk. Thank you.

04:38 Professor Danielle Mazza AM
Thanks. Thanks so much, Steve for that kind introduction. I was about to say the same. I met you first at the start of my career, and it's so lovely to reconnect with you in your current role, and me being able to give this talk. Thank you so much to the NHMRC for inviting me to talk about what's really my passion and my mission, which is how to achieve better outcomes in women's health, and to talk to you about the SPHERE CRE journey.

I too, would like to acknowledge the traditional owners of the lands on which we meet. For me, it's the Wiradjuri, Woiwurrung and Boonwurrung People of the Kulin Nation and I'd like to pay my respects to elders past and present.

05:03
Today, what I thought I would do would be to give you an outline of SPHERE, talk to you a little bit about what it is and what we do and what our journey has been over the last 10 to 15 years, really give you some examples of the research impact that we have had and are having in the areas of medical abortion and long acting reversible contraception.

Talk to you about our initiatives in building workforce and system capacity, how we've gone about our advocacy and what our vision of the future looks like. I've popped some photos on the slide there of the fabulous people I work with. You couldn't get a better job than being an academic and working with such inspiring colleagues from all around the world, and I'd particularly like to pay tribute to Dr Maria de Leon-Santiago, who's in the top, where are you? In the bottom one, right on the right hand side there. Maria has worked with me and is the CRE centre manager. Maria and I worked together for many years, and SPHERE is certainly all the better for having her involved.

SPHERE has some big issues to tackle, and I'd like to really talk to you about what the justification for SPHERE has been. You know, there are close to 6 million women of reproductive age in Australia and the majority of them are dealing with issues to do with their reproductive lives, and if we consider that in Australia, the average age of first sexual intercourse is around 16, the average age of first-time mothers is around 30, and the average age of menopause is 51.

07:23
Then women planning to have one or 2 children typically spend about 5 years being pregnant or being postpartum or trying to conceive. But they actually spend over 30 years trying to avoid pregnancy if they're sexually active and they're typically in the Australian context, using contraceptive methods that have a failure rate of about 9% or higher per year and I look at that slide over 30 years trying to avoid pregnancy, and I feel exhausted because it's a lot of effort that you that you have to put into actually getting that right in order to succeed and for many women, the reality is that they experience unintended pregnancy. The estimates are that about 40% of all pregnancies in Australia are unintended. Another way you could look at that is that one in 4 women have had an unintended pregnancy in the past 10 years, and we know that about 30% of them end up in abortion.

08:43
Now, unintended does not mean unwanted, and many women will continue those pregnancies to term and have babies. But 30% of them end in abortion and we know that in rural areas of Australia, women are 1.4 times more likely to experience an unintended pregnancy, and the other big group more likely to experience unintended pregnancies are younger women, 41% of whom report an unintended first pregnancy.

So, if we think about that problem, then what we're really trying to achieve is what is a fundamental reproductive right, which is having the number of children you want when you want them. In order to be able to do that, we've really got to focus on improving access to effective forms of contraception to prevent pregnancy, improve access to safe abortion when required for unintended pregnancy and help women to plan the pregnancies that they do want to have through improvements in access to and delivery of preconception care, to optimise pregnancy outcomes for both mothers and babies.

10:00
That's quite a lot of work to do, and the vehicle that we are doing it through is our SPHERE CRE and it's really a great vehicle to be able to address this really quite complex problem in a multidisciplinary way, and also recognising that the majority of the care that is involved in both contraception and abortion as well as pre conception care happens in the primary care context.

If you think about that number of about 5.8 to 6 million women of reproductive age across Australia, then certainly primary care is the workforce to be able to manage health service delivery for these issues, because we've got the numbers of healthcare practitioners to do so, and this can't all happen in hospital or tertiary settings.

11:08
Within the CRE structure, we have a very clear goal to affect knowledge translation, and that needs to occur into both policy and into clinical practice. We also need to increase health literacy amongst women and so really, our 3 target groups in terms of knowledge translation are our policy makers that we have to work hard to support and build strong relationships with consumers and consumer groups and the multidisciplinary health group of health professionals that are engaged in service delivery and SPHERE.

SPHERE’s research is focused on 3 key areas, building system and workforce capacity to be able to deliver high quality services, ensuring that we are addressing consumer needs by actually understanding what those needs and preferences are and using data to advance knowledge, to identify gaps and to help us to evaluate the interventions that we're testing.

12:36
Now, this is a bit of a complex slide, but I thought you might appreciate what the journey has been in terms of the funding that we've received and the support we've received and the period of time that it's taken.

12:54
I'm a bit of a latecomer to academia. I didn't really come into it until 20 years ago, but I received my first NHMRC Project Grant back in 2014. I got out my CV and had a look in Sapphire to try and work out what years, everything was awarded.

After that project grant, for the ACCORd project, which was focused on increasing LARC uptake in general practice, then we were successful for our SPHERE CRE application. In 2018, it actually took us 3 go’s to get the CRE the first time, and what followed from there, which is another useful thing that having a CRE does, is that you can leverage it to get further funding because of the amazing kind of infrastructure context that it provides.

14:10
We got a partnership grant, and then what followed was a couple of MRFF grants, some government funding started coming in, and around that same time, we got hit by Covid in 2020, and being within the SPHERE CRE structure enabled us to respond very rapidly to the problems in that Australian women were having at the time in accessing sexual and reproductive health services, essential services like abortion in the environment of Covid and Covid lockdowns.

14:47
Really, because we were all so worried about that, we established something called the SPHERE Coalition, which I'll talk to you a little bit about later, which has really and we hadn't actually written that into our SPHERE application, it kind of emerged out of a great need and the coalition has become one of the central ways in which we drive our policy impact. Impacts and knowledge translation.

15:27
We were successful in getting further CRE funding in 2023 and this coincided with the launch of a Senate inquiry into universal access to reproductive health care, which enabled us to again feed directly into a policy kind of process that was occurring through the government, and I'll talk to you a little bit later on what the results of all of that was as we approached the federal election.

You can see, it's over 10 years of work now from the first project grant that we received and thank you very much, NHMRC and MRFF for all the funding that you've provided to enable us to have the impact that we have.

16:31
Let me tell you a little bit about that research impact and how it's been connected to the research that we've been undertaking. The first area that I'd like to focus on is that of long acting, reversible contraception, which includes both intrauterine devices and implants. These are the classic set and forget forms of contraception that, because they are not user dependent, are one of the most effective forms of reversible contraception that we have, with a reported failure rate of less than 1%.

17:11
Now, when we did this study, back in 2018 looking at what the current LARC uptake was in women aged between 15 and 44, what we found was actually very low rates of LARC uptake in this country, with about 6% of women using intrauterine devices and 4.5% using an implant. This is quite curious, given that internationally, in the developed world, LARC uptake is much, much higher, up to 36% in women under 25 in the UK, Sweden 31% in 2019, and Denmark, which is the kind of world leader in LARC uptake, sitting at around 38% in 2019. Very curious that we had such a discrepancy between our uptake at around 11% and internationally sitting at 38%.

18:24
Perhaps this was one of the reasons why our unplanned pregnancy rates were so high. I guess LARC uptake is also really important, because LARCs are such effective treatments for a whole range of conditions such as heavy menstrual bleeding and endometriosis and so the low uptake is quite a concern in terms of impact on the healthcare system and on the lives of women.

We decided to try and increase LARC uptake through general practice, and this was our ACCORd study, funded by the NHMRC, and we took the idea really from what was happening in the States at the time, where colleagues found that offering free contraception and counseling women in the States led to really massive increases in LARC uptake and reductions in unintended pregnancy and abortion.

We did a complex intervention, which consisted of online training in effectiveness based contraceptive counseling, and this involves actually talking about contraception. If someone comes in and says they're after a pill script, you say to them, oh, have you considered all of your contraceptive options? Draw your chair closer to my desk, let me go through all of the options available to you so we can make sure that you're really getting the one that suits you best.

You start off by talking about the most effective forms of contraception first and then go through a pace of patient centered decision making process to help women decide on what's best for them. We also gave GPs the opportunity to directly book in their patients to a LARC insertion clinic, to be able to access rapidly a LARC insertion for their patients who wanted them if the GP didn't do that insertion themselves.

We didn't actually train GPS to put in LARCs. What we trained them in was contraceptive counseling, and if you remember the 11% uptake rate that we had in the previous slide, look at the results that we got from this intervention. At 4 weeks, we had 19% of women in the intervention attending GPs, who'd received the intervention, taking up LARC, went up to 46.6% at the 12 month mark, and at the 3-year mark, we followed them up after that, still sitting at around 40% and this is amazing results, really, and so satisfying. I do a lot of primary care trials, it's really hard to get a positive outcome in a primary care trial because it's such a complex environment and they're complex interventions, but pleasingly, we were also able to demonstrate a reduction in unintended pregnancy and abortion in women attending the intervention, GP, so really, tremendous outcome there from our ACCORd study.

22:04
We were also able to demonstrate through a project called EXTEND-PREFER, that increasing knowledge and preference wasn't actually enough to increase uptake of LARC in young women and women from culturally and linguistically diverse backgrounds.

22:31
We put a lot of work into developing multilingual contraceptive choices videos. We did focus groups with women from different ethnic backgrounds to find out what the questions were that they wanted answered in an educational video.

The women, we tested this through Facebook. We surveyed them before and after and 6 months later, and we found very low levels of knowledge of LARC to start with, a swing towards preferring a LARC after watching the video and while there were trends towards increased LARC uptake, we didn't actually have a significant change in the control women.

We hypothesise that this is really because the access issues still remain problematic, even if knowledge and preference is there. I spent a lot of time talking to Ged Kearney and her team and the department in Canberra about these research findings, and to her credit, Ged was able to get together a fabulous Women's Health package, which was announced in February in the lead up to the federal election this year.

24:00
Really a lot of the components of that package drew directly, I think, from the advice that we had been giving them about the outcomes of this research, that the costs were that they cost to patients, and the lack of financial incentive for GPs to be able to deliver these programs were problematic, that GPs needed to be trained and were losing money when they were training, taking time out of their practice to go and train that they needed support once they did train to be able to maintain those services, and that we needed rapid referral pathways for insertion, and that we needed assistance with contraception decision making.

A fabulous range of policy outcomes, from increased rebates is a focus on general practice training, scholarships, the LARC Centers of Excellence, which the tender has just been released and is about to be commissioned, and funding of a contraception decision making tool, and we got some extra things on there, working hard through the payback to get new contraceptive products, also funded by the PBS, all fabulous outcomes for women.

25:44
Let me talk to you now about another area where we've been very active, which has been around access to abortion services. You may or may not know that there are 2 approaches to early medical or early abortion. In the first trimester in Australia, you can access medical abortion currently, up until 9 weeks gestation or a surgical abortion. The problem with medical abortion was that mifepristone, which is the one of the ingredients in MS-2 Step, and MS-2 Step involves the 2 medications required for a medical abortion to occur, mifepristone and misoprostol. When mifepristone was first registered in Australia, many years ago, it occurred in a political environment which was not really conducive to ensuring access for abortion in this country.

26:57
For those who are oldies like me, you may remember a politician called Brian Harradine from Tasmania, very conservative politician who did a deal with Tony Abbott at the time and while mifepristone was registered by the TGA, there were all of these very burdensome requirements that went along with the registration, which really stigmatised and put up hurdles to GPs providing abortion services.

27:38
In 2019 we mapped where medical abortion was being provided and where it wasn't and we published this paper in the MJ. All of the yellow areas which you can see are not in the middle, necessarily rurally. But look at that all down the eastern seaboard, western Victoria, West in Western Australia, South Australia had a legislative ban on primary care provision of abortion had to occur in a hospital setting. So that's why they're all yellow. But all the yellow areas are where not even one GP or one provider or one pharmacist dispensed medical abortion in 2019.

28:22
In the green areas, no GPs were prescribing but there was a pharmacist dispensing. We estimated that about 30% of women in Australia lived in areas where MS-2 Step had not been prescribed by a GP, including about 50% of those in remote Australia.

I had a close colleague, Karen Price, who was then the RACGP president. Karen worked so hard during Covid with Greg Hunt to try and improve health service delivery. She got me an appointment with Greg Hunt, and I went to see him with a policy brief that included this map soon after it was published in 2021 and I said to him, look at what's happening. There's all these women that can't even access a medical abortion, and this is not good. To his credit, he took this straight on board, and I'll show you the outcome in a minute.

29:39
But the other thing that we were able to do through SPHERE was to showcase the work of my amazing colleague, Professor Wendy Norman from Canada, who is this investigator on the SPHERE CRE in Canada, has a lot of similarities to the Australian context. Rural metro workforce, a very strong general practice and primary care system. Wendy had been able to convince Canadian regulators to deregulate medical abortion and make it just like any other normal prescription. She published a follow up of the safety and use of normally prescribed mifepristone in the New England Journal, and I was also able to bring that evidence to the TGA and to the minister and to the department and show the impact of deregulation was that rates of abortion didn't increase, safety didn't change, but the numbers of providers of abortion tripled.

From those 2 pieces of research, we have had fantastic policy outcomes, with medical abortion being available, funded by Medicare, through sexual and reproductive health, telehealth item numbers, and this has meant that women in remote or rural areas of Australia and areas where there are no medical abortion, providers can, through telehealth, funded by Medicare, access an abortion.

This is different to other telehealth item numbers that have patient restrictions on them you need to have seen the GP or the practice in the last 12 months face to face in order to access normal telehealth item numbers, but for the sexual and reproductive health item numbers, you don't need to do so.

This enables remote access, not only for abortion, but also for advice around contraception and menopause and other SRH areas. Fantastic credit to Greg Hunt for recognising the issue and acting on it very quickly.

These item numbers were made permanent in July of last year, and equally, a credit to the TGA and Robin Langham and others who worked hard to deregulate medical abortion. They removed stigmatising and unnecessary mandatory training and certification regulations, and MS-2 Step is now able to be prescribed and dispensed like any other medication, with practitioners having a professional responsibility to train in the areas where they are providing services and provision has now been opened up also to nurse practitioners and endorsed midwives.

33:04
I think, really important and impactful outcomes. I want to just spend some time talking about what SPHERE is doing around building workforce and system capacity, which is really important to being able to both improve access to services and quality of services.

We're going about this in several ways, using several different approaches, and I thought you'd be interested to see the work that we're doing there.

The first thing that we've been focused on has really been trying to understand what our workforce actually is, because not all GPs or primary care practitioners actually are involved in the delivery of these services.

We've been able, through working with partners such as Marie Stopes, who are the sponsor of MS-2 Step medication, to understand that prior to deregulation, there has been only about 10% of GPs nationally who were certified to prescribe medical abortion.

34:34
We're working on some research at the moment to understand the impacts of deregulation that occurred a couple of years ago now on the numbers that are currently providing, but we do know through some survey work that we've been doing that. The practitioners that do provide these services in general practice are really providing low numbers. It's not like working in a family planning clinic where you might be doing a lot of abortions, or in private abortion clinics. In general practice, the average is around one to 5 per month. We also know that there's, up until this point in time, there's been no formal GP trainee training occurring in medical abortion. That's quite different to implants, where the overwhelming majority of GPs nationally have been trained in implant insertion, and all GP registrars are trained to do it.

When it comes to IUDs, our estimates are around 20% of GPs have been trained or are providing these kinds of services. Again, it's a very low volume practice and no formal GP trainee. Training has occurred to this date, and we know also from research studies conducted by our colleagues within SPHERE that following training only a low number of providers commence IUD insertion provision, and not all of them sustain that practice at 12 months.

We really have to understand what to do in these kinds of circumstances, and what we thought would be a good idea, and what the NHMRC also helped us to establish was the AusCAPPS network, which is an online community of practice, which is a bit like a Facebook group, but is much better curated and moderated than Facebook.

This community of practice has various elements. You can chat with peers and experts. You can post a problem that you might have in your clinical practice, or a question that you might have, and get responses from your peers as to how to solve that issue and get advice from experts about that.

We have a database in there of people that you can refer to providers near you. We have a fantastic resource library that's got guides on how to how to establish new clinical services, checklists, patient information, webinars, podcasts, links through training, case discussion, topic libraries. It's really a fantastic network. You can be as active or inactive or passive in it as you like. We now have over 3000 participants from around the whole of Australia. GPs, practice nurses and pharmacists.

AUSCAPS has been so successful that the federal government decided to take over funding it once the Partnership Grant finished, and we've got funding until 2027. I just was in Canberra last week, telling the department that it would be good if they could align AusCAPPS funding with their other LARC initiatives in their budget so that it can continue to support new providers, especially as they commence provision in community settings.

38:48
We are also trialling new models of care to help deliver services and improve access, particularly in regional areas and with priority populations and these are 2 MRFF funded trials, both of them are actually almost complete, and I'm very excited. We're having the ORIENT wrap up investigator workshop next week. We're going through all of our outcomes, and they're looking quite good, and Alliance, similarly, has already started informing policy makers about the outcomes.

39:37
Alliance is a trial that is training community pharmacists to deliver contraceptive counselling when women come in to get their medical abortion pills dispensed, or when they're seeking emergency contraception, we're training them similar to how we train the GPs in the ACCORd study to deliver effectiveness based contraceptive counselling and refer on to a contraceptive provider.

This is not a trial about pharmacy provision of contraception. It's about counseling and referral. We're paying the pharmacists handsomely to deliver that contraceptive counseling. We're asking them to do it in a private consulting room in their pharmacy, and we're supporting them with a co designed bundle to deliver that kind of counseling, and with all of the pilots and trials happening in community pharmacy, this trial is very well positioned to inform not only federal governments but state governments about the role of pharmacy in contraceptive service provision, and it's a very exciting trial.

The ORIENT study is looking at nurse led models of care to improve access in general practice in rural and regional areas. We've used a similar co design bundle. We've trained nurses to deliver implant insertion and again, this is directly informing the current primary care reform strategy, which is looking at extended scope of practice for primary care practitioners.

The third way that we're building our capacity in primary care is through evidence to support practice and SPHERE has played a key role in both guideline development and implementation in primary care. It's fantastic now to have national abortion guidelines and the RACGP has endorsed those guidelines, which is also fantastic, and the Red Book preventive care guidelines, which is now in its 10th edition. I chaired the development of that 10th edition and ensured that the women's health chapters were expanded and very rigorously put together in terms of their recommendations, and that those guideline recommendations and the way they're presented to GPs are very accessible.

42:48
We've done a whole range of things, publications in the journals, statements through our coalition, webcasts, used lots of different strategies to get the evidence out there into practice on how to deliver quality care.

One example of a project that we're doing, which is supporting practitioners, is through the National Endometriosis Action Plan. SPHERE has been funded by federal government in partnership with the RACGP to develop an endometriosis and pelvic pain management plan. This is structured through chronic disease care planning, and it will be web based. We're currently piloting and evaluating our pilot and the management plan is scheduled for release in May of next year.

43:44
Just like to finish up by talking about our work in in in advocacy. I started off life as a clinician, then became a researcher, and now have come to understand how to do advocacy. As I mentioned earlier, the vehicle that we use to do the advocacy work and the policy translational work of the SPHERE CRE is our coalition. Basically it's a fairly loose kind of format people who are interested in women's sexual and reproductive health and reproductive rights gather together every couple of months on Zoom. We set up an agenda of what needs doing, what needs attention. We develop consensus statements and policy briefs, and then we prosecute those through dissemination on social media, letters to parliamentarians, meetings with different organisations, and we've had some terrific outcomes.

A key one has been through our sub addition to the Senate inquiry into universal access to reproductive health care, where a lot of our recommendations were considered and incorporated into the final recommendations of that Senate inquiry, and those recommendations have been endorsed through Mark. What's the word for bipartisan endorsement from the political parties across the board?

There's a lot of progress happening as a result. If I take you back to my original slide that talked about what our goals were, to undertake research to inform policy, increase health literacy and improve clinical practice, then I feel quite proud, really, to be able to say that we're achieving on all of those fronts.

I guess that's why our second CRE was funded. It's a very exciting space to be working in. It's very exciting to have the support of government and the interest of government in the work that you're doing. Our time is now, we want to take advantage of the current political environment and the current public discourse, as Steve put it to really try and make some, some big gains in this space to ensure that women's reproductive, sexual reproductive needs are met.

If I can talk about our potential vision for the future, we'd really like to see that unplanned pregnancies are reduced and every child is a wanted child. We want to see equitable access to abortion across the country at all gestations. We want women to have a true choice of medical or surgical abortion. We would like those services to be available at no cost to the patient, so that cost is not a barrier. We want women to be knowledgeable about their options, both medical or surgical abortion and contraception, and empowered to access the service and the contraception of their choice. We want health professionals trained and supported to provide high quality services.

We've got a lot of work still to do and I look forward to doing it with the help of fantastic colleagues around the country and around the world. And with that, I'll stop and happy to take any questions. Thank you.

48:04 Professor Steve Wesselingh
Thanks very much. Just trying to get my video back up, that's better. That was just fantastic. So, so good and really, the reason I think it's so good was that it's such a great example of going from research and discovery all the way to policy, and it's the policy that then has this enormous impact on the population. For NHMRC to be able to fund that sort of activity is so good.

Danielle, that was an outstanding, I was going to say piece of work, but a whole lot of work. It was really terrific.

I don't have any questions on the chat yet, so I'm encouraging people to ask questions, but I want to go to that point I just made about policy.

MS-2 Step was great research, but it was also that ability to get policy and policy change, and obviously you've become very good at that.

How do you do it through SPHERE? Are you teaching? How do you teach people to understand, firstly, the power of policy change, but secondly, the process of doing the research and then advocating and working towards policy change, because it's not something we as medical researchers, or even we as doctors get taught. We might get taught how to do good research, but we don't get taught how to advocate for policy. Do you want to just comment on that?

49:37 Professor Danielle Mazza AM
Yeah, that's been, I think the biggest learning for me in the last 10 years is how you actually go about that, and I think you have to be a little bit fearless actually to reach out and actually show people what the policy relevance is of the work that you're doing.

50:00
But it's not just at the end, it's not just when you have your results, Steve, it's actually in the design of your grant applications, where you know you've really got to be in touch with what are the key issues and challenges in the space, and what is the policy work that's currently going on.

I think it helps to be a clinician, actually, on the ground, where you see what the challenges are in health service delivery, and you can slant your grant towards answering the questions that the policy makers want the answers to.

50:47
What policy work is going on in the department? What are they focused on? What are the politicians talking about? You know, we hear our politicians are talking about cost of living. They're talking about access to services. They're talking about, extending scope, equity in rural and for rural and regional and priority populations. Designing your applications and your trials and your research questions actually address those kinds of issues, so that you've got something to go and talk to them about.

I think the other thing for me that's been very useful is looking to see what international examples there are of what's worked and to bring back those ideas, particularly from a health service system point of view. All of the countries are grappling with similar issues, but are trying out different things. What have they tried? What can we try here? What can we learn from, for example, from the work that was happening in Canada?

51:57 Professor Steve Wesselingh
Fantastic. Thank you.

I just got a couple of questions appearing. I just have to have a look at them.

There's one here. Great presentation, understandably, a focus on female contraception and behaviors, but men are obviously equal contributors to unplanned pregnancies. From your research perspective, how might you or are you engaging with men in this space? Yeah, we are partly to blame.

52:45 Professor Danielle Mazza AM
We are unashamedly focused on women's sexual and reproductive health. But agree, men have a clear role and I guess one of the areas of focus that we have for men is in the area of pre conception care and what the role is of men in pre conception care and pregnancy planning.

It's a bit unfortunate at the moment that we don't have male contraceptives available currently in the market to be able to do this kind of implementation research, but when it comes, I'm sure there'll be a great deal of interest and work being done in that area too.

53:21 Professor Steve Wesselingh
Thanks for that. The next question, I noticed this as well, was that in the trial to increase the uptake of LARC the control group also had an increase and Tasman asked, could you comment on why this may have been and how might have impacted on the findings of the study?

53:38 Professor Danielle Mazza AM
Yeah, well, I guess that's why you have a control and an intervention group and when you do these kinds of studies, it's important to recognise that the people that you recruit into the studies are people that have an interest in the area.

When we were recruiting for ACCORd and saying, this is a trial about increasing, LARC uptake in general practice, it was the GPs who had an interest in LARC already that probably put up their hand. It's not unusual to have an increase in the control group, when you've got people who have read, kind of what the trial is about, and having second thoughts about what their control practice actually looks like.

54:28 Professor Steve Wesselingh
Another comment in the chat from Giselle, which is about the benefits of consumer contribution to research, and the importance of targeted design that addresses those issues that governments are discussing. Really want to perhaps you could just comment on the on the role of consumers in the design of your studies and obviously in advocacy as well.

54:43 Professor Danielle Mazza AM
Yeah, so I didn't highlight that so much. I probably should have, should have spoken more about that in my presentation.

But consumers are an essential component of the work that we're doing. We have SPHERE, both a consumer advisory group, and we also have, I guess, consumers, as in terms of health practitioners, who are our consumers as well about the lot of lot of the research and the products that we're designing.

We have advisory circles with different professional groups. We have a rural consumer advisory group. We've just set up one in the area of postpartum contraception for some work that one of my research fellows, Jess Botfield, is leading and every single element of the interventions that we are designing go through a very extensive co design process, and you'll find that in every single grant that we write, co design is in there, because if you don't co design things with the people who it affects or who utilise it, it won't work, especially in primary care.

Our consumers are integral to all of the work that we're doing.

56:36 Professor Steve Wesselingh
Thanks for that, and we're getting close to time so I might ask the last question, and actually it goes back to when we worked together. I remember, I think, the first time I met you, you talked to me about data and GP primary care and GP data. How are we going in regard to that? Because I know it's such a difficult area, because every general practice is separate and how are we going coordinating the data collection across multiple general practices, and perhaps linking it to PBS and MBs and those sorts of things.

56:50 Professor Danielle Mazza AM
Slowly, not fast enough. You know, it remains a challenge. I think one of our investigators on the new SPHERE CRE Luke Grzeskowiak, from South Australia, works very closely with medicine insight, which is a large primary care data set and we're starting to get some papers published in the MJ that are using that data set, and there'll be one on endometriosis, coming out in September, which I think will be very, very useful.

It's critical that we have our work research on primary care data in Australia, because primary care is where this service delivery is happening. We've got to understand what's happening so that we can work to improve it. We need the baseline, and we need to be able to access primary care data to also evaluate our outcomes of our intervention. So needs a lot of investment and a lot of focus and the AIHW are working on that.

58:02 Professor Steve Wesselingh
Absolutely agree. No, fantastic. I might wind up there, because it is 4:00 in Canberra now, and just thank you so much. Just a fabulous example of going all the way from understanding the research question, working with consumers, and then taking the work all the way through to meeting with the health minister, changing policy, and actually then changing the lives of hundreds of 1000's of women across the country.

It's just such a great example and you know, to us at NHMRC, this is exactly what we love to see, and 2, want to highlight the impact of funding health and medical research on people's lives around the country. Thank you so much.

I'd like to thank everyone who's been watching and listening, thank those who brought up the questions. Reminder that the webinar is available online and encourage you to come back next time.

Thank you, Danielle. Fantastic. Thank you. 

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