International Women’s Day Address – Dr Danielle McMullen

St Hilda’s College was honoured to host AMA President, Dr Danille McMullen for this year’s International Women’s Day event. With permission, here is the speech that Danielle delivered to those in attendance.

Thank you so much for having me.

I’d like to acknowledge the traditional owners – Wurundjeri Woi-wurrung people & Bunurong people; who never ceded their land, but generously welcome us onto it.

When James asked me to do this talk, I was very excited – of course, to speak to all of you about an issue I care a lot about, but also because it’s a sign of the enduring connection of colleges.

James and I went to college together, up at UNSW in Sydney. I wish I had some embarrassing stories to share, but I must admit he was pretty responsible even back then. We studied in different disciplines, but Baxter was what united us…and now, nearly 20 years later (gee that makes me feel old!!), being able to get together again at a college is something pretty special.

Advocacy is a skill, and I’ve been in training since those college days. As House President, we fought for better common room facilities, better parking, and better catering – in fact, my first experience of being in a procurement process was tendering for the new catering company. Little did I know, that I’d now be overseeing contracts worth 10s and hundreds of millions of dollars in my role on the Australian Digital Health Agency Board, looking after My Health Record and the county’s digital health infrastructure assets. So, don’t underestimate the value of some local advocacy practice!

A bit about me. I studied medicine at UNSW and did my early training at St Vincent’s Hospital in Sydney, where the Sisters of Charity nuns demonstrated what powerful women who are in charge of culture can achieve. Now, I’m not religious, but the strong commitment to their mission & values was palpable. We were a big city hospital with a small-town vibe, and we put the care of pretty vulnerable communities front and centre.

I particularly loved my time in geriatrics at St Vincent’s, but found myself increasingly drawn to general practice.

GP is a fantastic career – we have the flexibility to work how we want to, and the huge honour of building relationships with generations of families. The luxury of time, and really getting to know patients to build the care plan that is right for them. General Practice is taking all the ingredients of healthcare – both the art and the science, and creating a new exciting blend every day.

But there are of course pressures – and we need someone to look after the whole system so that doctors can get on with doctoring.

From my internship in 2011, I was involved with the Australian Medical Association – first as a doctor in training, eventually as the president in NSW throughout the COVID pandemic, and then lifting to the national stage first as vice president where I focused on much-needed general practice reforms, and now find myself as the third ever female president of the national AMA (an organisation that dates back to 1880).

The AMA is the largest, voluntary membership association of doctors. We represent all doctors, of all specialties and stages of career, right around the country. We help them in their workplaces with things like pay and conditions, but also help be their voice to build a better system.

So, not only are we trying to represent doctors, but also patients and the broader community in building a healthcare system that meets the needs of the future – we’ve given ourselves a massive task, but gee is it an interesting time to be involved.

I never thought that I’d go from speaking up with a handful of students, to speaking on behalf of an entire profession, and often our patients. But speak up, we must.

Doctors do hold a pretty respected voice in the community and that brings a responsibility to work to make things better for our patients.

With a federal election looming, I’m in the front seat as Federal President; the front seat to the intersecting challenges we face across general practice, private healthcare and public healthcare.

It’s where I actually get to be at the table fighting for the future we want to see:

• Where our primary care system centres around patients in GP-led, primary care teams.
• Where we have a balance of private and public healthcare so that we can achieve equity but not end up like the NHS where waitlists are entirely unmanageable, or the USA where managed care and insurance companies have taken over the clinical relationship.
• A future where the principle of patient centredness is key – where your healthcare is designed for you

So, my greatest privilege as President is to be the voice of my profession, and to champion the role of doctors, particularly to support our most vulnerable patients.

Part of that is speaking about women’s health. For too long it’s taken a back seat at a systems and individual level.

Women’s rights are at a critical point worldwide. While significant progress has been made, gender inequity remains deeply entrenched in many aspects of life. Around the world, and even here in Australia, women continue to face barriers to healthcare, economic opportunities, and personal safety.

According to the UN Women’s 2024 Gender Snapshot report, the world is considerably off track in achieving the UN’s Sustainable Development Goals by 2030, due to social norms that continue to perpetuate discrimination and prevent women from gaining an equal footing.

In Afghanistan, the Taliban have imposed horrific restrictions on women and girls, banning them from attending secondary schools and universities, working in many jobs, and even moving freely outside their homes.

But even in developed countries, like Poland, women are suffering under restrictive termination of pregnancy laws. And in the US, legal abortion has been reversed in many states after the US Supreme Court overturned Roe v Wade.

Around the world, many hard-won rights are being rolled back.

Even in wealthy nations, the gender pay-gap, workplace discrimination, and the burden of unpaid caregiving continue to limit women’s financial independence.

Gender-based violence is a terrifying reality for millions, with laws failing to protect victims or hold perpetrators accountable.

This is not just happening “somewhere else”. Here in Australia, women’s safety, autonomy, and healthcare rights are still major concerns. Domestic violence remains at critical levels, Aboriginal and Torres Strait Islander women face shocking rates of health disparities, and reproductive healthcare is still inaccessible to many, especially in rural and remote areas.

In my time as NSW AMA president, I successfully fought for abortion law reform. It wasn’t easy. We made the walks into Parliament House, flanked by protesters accusing us of murder. We did that to sit with politicians and explain over and over what it was like to see women with unplanned pregnancies and try to support them through their difficulties accessing care, or even accessing choice.

At that time, I was working right next to a university and, as you all know, it’s a really tough time of life – you don’t have much money, you’re often living away from family, and an unplanned pregnancy can be a really life-changing thing.

And through that advocacy, we won! Finally, in 2019, termination of pregnancy was no longer in the Crimes Act. Women and their doctors could freely discuss all options. And we could finally turn our attention to building better access.

Yet now, just a few short years later, we still have terrible access, especially in public sector. And we watch with apprehension the winding back of termination provisions in the USA, and even increasing political debates in our own country – most recently in NT and QLD. Clearly, the fight isn’t over.

Fortunately, the medical community in Australia is refusing to stay silent, and the AMA is leading the charge by being a strong advocate for women’s reproductive rights and equitable access to health services. I again have an opportunity and platform to speak up for women.

Beyond reproductive choice, I will spend my term fighting for stronger maternal healthcare.

We have an incredible record of pregnancy safety here in Australia. Maternal mortality is among the lowest in the world with 4.8 deaths per 100,000 women giving birth (in 1975 it was 12.7). In parts of central Africa, that number is still over 1000.

We need to protect that safety we’ve built. Women in Australia can be assured of access to a doctor throughout their pregnancy. Particularly as we see women be older when having babies, and with growing rates of chronic disease such as diabetes, overweight and obesity which can have significant impacts on pregnancy risk. We need to support team-based models of care, yes. But those teams must include a doctor with significant expertise in obstetric care. Sounds logical, you say – but I can assure you…there are pressures to remove this.

And we still see other disparities:

• The involvement of women, particularly pregnant women, in medical research really lags – instead of a paternalistic approach, we should engage women to make informed choices about their participation

• In day-to-day practice the gendered nature of medicine is still apparent; the Medicare rebate for an ultrasound of the scrotum is more than ultrasound of the pelvis, or the breast, or a mammogram… Last I checked, the scrotum is pretty easy to get to, not that complex an organ.

• We’re also seeing risks in system redesign masquerading as supports. Things like the disconnected prescribing by pharmacists of antibiotics for UTI, and the pill. Now on the face of it, this might sound appealing.

But, why should women’s health issues not deserve the care of a doctor like everything else? Rather than slice up our healthcare system, let’s improve access to doctors by making sure complex care gets a fair rebate, and also by working in teams. Truly collaborative care can improve access without the risks of current suggestions.

It may surprise some of you to hear there is still a gender pay gap in medicine, particularly in general practice. How does that occur? Because of systemic factors – Medicare rebates that get lower the longer you spend in a visit…and the tendency for women to bear the burden of longer consultations, complex care and mental health presentations.

The issues I’ve just outlined of fragmented care risking patient safety, the gender pay gap, and the undervaluing of complex care are all things we hope to address through our feature campaign to Modernise Medicare (modernisemedicare.com.au).

Our ask is to redesign Medicare in general practice so that no matter how long you need to spend with the GP, Medicare gives you a fair rebate.

Right now, and even more so after the recent announcement, Medicare really disincentivises consultations longer than 10min. Australians deserve time with their GP. So, my one little plug in this whole speech will be to ask you to visit modernisemedicare.com.au and have your say.

But, it’s not all doom & gloom and fighting an endless battle – We have seen some wins!

I was very pleased to see Labor announce a suite of new measures for women’s health in February. This included a significant Medicare funding boost for long-acting reversible contraceptives (LARCs), and the listing of new oral contraceptive pills and menopausal hormone therapies on the Pharmaceutical Benefits Scheme – reducing costs by hundreds of dollars per year.

This took a lot of work by a lot of people, but I distinctly remember the moment a couple of years ago when I was in a meeting with the Minister for Health & Aged Care, Mark Butler – on other issues completely. “While I’ve got you…tell me about contraceptives”.

It was a good discussion then, and on a few other occasions. It provide a chance to spell out the barriers. And most of them have been resolved.

I am really looking forward to November when, for the first time in my career, I’ll be able to insert an IUD for my patients with no out-of-pocket cost – saving them each close to $200.

The AMA is also playing a critical role in addressing domestic and family violence.

Understanding that healthcare professionals are often the first point of contact for women in danger, the AMA has developed guidelines and resources to help doctors support victims and connect them with life-saving services. Some of these I helped develop as a doctor in training in NSW.

While the challenges are real, there are also incredible stories of progress and resilience.

Thanks to tireless advocacy from individual doctors and organisations like the AMA, more women are gaining access to healthcare services that empower them to take control of their lives. We work with the Advancing Women in Healthcare Leadership group from Monash to help to break down the many barriers women face in achieving leadership positions in health.

As AMA president, I take the responsibility put in me very seriously. We do have access at the AMA – to departments, and ministers – to influence the decisions that define the system we work in, including the health of women. We don’t always get wins, but we certainly get a lot of them, and we always get a say.

For those of you interested in making the world a better place – remember we can’t change it overnight but every little step forward helps. Advocacy is the long game – there are some tangible things and a whole lot of building the system, preventing the worse option

So, I’d encourage you to keep speaking up, saying yes to the opportunities, and congratulating yourself on any forward momentum, no matter how slow it may seem

If we want a future where every woman and girl can thrive, we must keep fighting, keep pushing, and keep demanding better. Because no matter where we live, women’s rights are worth defending.

When women and girls have full access to healthcare, education, and economic opportunities, entire societies benefit. Countries with gender equality see stronger economies, healthier populations, and lower rates of violence. This isn’t just about fairness — it’s about building a better world for everyone.