Regulating ones own fertility and pregnancy has long been an essential part of women’s health and wellbeing.
However, even with multiple forms of birth control now available, there is not global, equal, independent access to them.
Dr Tracy Morison of Massey University in New Zealand researches attitudes, accessibility and issues of justice around Long Acting Reversible Contraceptives in New Zealand, and the place of reproductive health for women around the globe.
Read the original article: https://doi.org/10.1080/03630242.2021.1927284
Image Source: Adobe Stock Images / JPC Prod
The following transcript is automatically generated
00:00:05 Will Mountford
Hello. I’m Will. Welcome to researchpod.
00:00:08 Will Mountford
Even before the invention of the oral contraceptive pill in the 1950s, the ability to influence one’s own fertility and pregnancy has been an essential part of Women’s Health and well-being.
00:00:19 Will Mountford
With multiple forms of birth control now available, there are more ways than ever for women to take that control for themselves.
00:00:26 Will Mountford
If they are able, however, the existence of birth control options is not the same as their availability, and even further from equal independent access. Doctor Tracy Morison of Massey University in New Zealand joins us today to discuss her research into attitudes, accessibility and issues of justice around long acting reversible contraceptives in New Zealand and the place of reproductive health for women around the globe.
00:00:55 Will Mountford
Doctor Morison. Hello.
00:00:57 Tracy Morison
00:00:58 Will Mountford
To help introduce all our listeners to yourself and to your work, can you tell us a bit about your background, kind of the personal and academic stuff and what’s led you to the position that you hold today?
00:01:10 Tracy Morison
Yes, absolutely. So I work at Massey University in Aotearoa, New Zealand at the moment. I trained as a research psychologist at Rhodes University in South Africa, where I earned my doctorate in 2010. The main goal of my work is to identify structural and systemic.
00:01:33 Tracy Morison
Items so beyond the individual that need to be fixed to support people sexual and reproductive rights and justice. So really it’s about seeing what is stopping people from being able to make the choices that they want and their sexual and reproductive lives. In terms of the social context.
00:01:55 Will Mountford
And why is it out of all of biology, sociology, psychology, health, everything. Why is it you doing this?
00:02:06 Tracy Morison
I mean, as I said, I’m interested in particularly what allows people to make the decisions that they want to make about their sexual reproductive health. So the broad background of my research is reproductive justice. And I became interested in contraception because it’s quite paradoxical in some ways. So it’s a technology that can be hugely.
00:02:27 Tracy Morison
Empowering. And we know that having birth control helped women to sort of take charge of their lives and to do things that they otherwise wouldn’t have been able but it’s also a technology that can be used in.
00:02:40 Tracy Morison
Oppressive ways. So coming from South Africa, I was of course aware of the ways that the apartheid government, for instance, tried to stop what they called white race suicide by targeting black women with long acting contraception and even sterilization.
00:02:58 Tracy Morison
Often in very cohesive way.
00:03:01 Tracy Morison
LARC has been presented as the solution to all of these social problems and like poverty, welfare dependency. But the problem is that it paints certain groups potentially as the problem, and it’s not really looking at what needs to change in society potentially can marginalized people whose fertility.
00:03:21 Tracy Morison
Has historically been devalued, so young women, Maori woman and researchers in other countries have called this kind of targeted use and promotion of locks a form of soft sterilisation. That’s the worry, I guess, is that as much as what contraception and lark in particular has benefits? And it can be empowering.
00:03:41 Tracy Morison
It can also be used in these kinds of oppressive ways that are often more about ideas of what makes the society run, or what makes society good, rather than the people themselves.
00:03:53 Will Mountford
Right. So with reproductive freedom as kind of the core concern and the motivation here, what drew you to the issue of larks in particular?
00:04:02 Tracy Morison
What I was really interested in is this issue of agency. The title of my project is balancing access and agency.
00:04:12 Tracy Morison
And once women have access to contraceptives, then they actually need to be able to make choices about them freely and according to what they feel they need or what their preferences are.
00:04:27 Tracy Morison
But we don’t really know if that is the case here in New Zealand and like most other places in the world, really, because the focus has been on improving access.
00:04:38 Tracy Morison
So what my work really is doing is looking at that neglected piece of the puzzle, which is agency.
00:04:44 Tracy Morison
The focal point of my research is what I call contraceptive agency. So.
00:04:49 Tracy Morison
To what extent can people freely and independently make choices about contraception based on what they feel they need and want and their unique circumstances.
00:04:58 Tracy Morison
So yeah, that’s what drew me into it. And I suppose what was also quite prominent during. So for example, that welfare reform, we welfare beneficiaries were targeted is that often these kinds of policies and practices are presented as being for women’s good or as empowering. And that’s what politicians were saying.
00:05:20 Tracy Morison
That that often masks biases or coercive practices like welfare sanctions, for example. So a lot of the research has focused on increasing access to contraception, you know, allowing them to easily access contraception.
00:05:35 Tracy Morison
But they’ve missed the piece about whether once women are in those clinics or in those spaces, whether they can make their decisions freely, particularly if they are from at risk groups who are targeted, it has social justice implications, really.
00:05:56 Will Mountford
Before we get on to all of those implications, can we start with just a bit on why everyone has been using and so keen on LARCs for so long and what’s kind of the main selling point for them?
00:06:05 Tracy Morison
LARCS are great. There’s a new generation of LARCs that have come up.
00:06:10 Tracy Morison
So there’s been some really hard marketing that’s happened of these new generation LARCs as they called.
00:06:15 Tracy Morison
And they are very effective. They are safe and they work for a long period of time. So they offer the user great reliability.
00:06:26 Tracy Morison
And because of all of those things, that makes them cost effective in the long term. So there might be an initial outlay of expenses if that’s subsidised, then it makes it more obviously attainable for people. I say women often because those are the biggest group of contraceptive users, but of course they’re not the only group who use contraception, but I’ve focused on women in my study.
00:06:50 Tracy Morison
So other advantages in addition to their effectiveness, in addition to their reliability and cost saving is that they of course are what
00:07:00 Tracy Morison
This is the big marketing headline that they fit and forget, right. They are discrete and like taking a pill or using barrier methods you.
00:07:09 Tracy Morison
Can use them without anyone knowing . So there’s various advantages for women in different kinds of circumstances from a public health perspective, the cost effectiveness of sustained lab use and negligible user failure.
00:07:27 Tracy Morison
Makes it incredibly popular and very desirable, so larks have been celebrated for their potential to reduce unwanted pregnancy at the population level and really seen as a way of addressing, I guess, health costs on one hand that are associated with, say, repeat, abortion.
00:07:46 Tracy Morison
With teen births but also social issues like poverty and social marginalization that are assumed to be associated with unintended pregnancy, which is a big and broad top.
00:08:02 Tracy Morison
So because of all of this kind of superb effectiveness, they say of luck and it’s cost saving nature, it’s been promoted in public health as the kind of top tier or first line method. So what this means is that contraceptive providers should take a lock first approach.
00:08:21 Tracy Morison
When they’re counselling their patients, particularly if that patient is in one of the.
00:08:27 Tracy Morison
Sort of target groups, or what they often refer to as At Risk.
00:08:31 Will Mountford
You mentioned a LARC first approach there. What is that and what are some of the downsides to it?
00:08:37 Tracy Morison
So what that means is they need to present like to every patient, but particularly at risk patients as the optimum method, the best method and in some ways I guess you can say if efficacy is your only or first concern, then yes, it is the best method. But research shows that that’s not.
00:08:57 Tracy Morison
Always the concern of patients or women themselves.
00:09:01 Tracy Morison
And I suppose the troubling thing with the lock first approach and that has led to criticisms of it. And this is kind of the piece where my interest in the work comes in is that it was really developed this low price counselling approach was developed to increase lock is among target populations so specifically at risk women.
00:09:24 Will Mountford
And that was something from your own studies, right?
00:09:26 Tracy Morison
In my research, this kind of played out as providers talking about really persuading patients to use like methods. So they spoke about selling lark or pushing lark. And that’s in a way, kind of how that lock first approach is interpreted.
00:09:46 Tracy Morison
So I guess if you’re talking about the benefits and like to individual users, it is really great. It allows them to meet their reproductive goals because they can plan.
00:09:56 Tracy Morison
And their pregnancies with great accuracy and reliability. But it also limits their own personal control, because of course, locks have to be fitted or administered by a healthcare provider. So they are what is known as potentially imposable, meaning that they can be, I guess.
00:10:17 Tracy Morison
Not removed or as I said. So you talk about that reversible piece. If you’re offering someone something, if it’s going to be a truly free and informed decision, they need to be able to stop it when they want to.
00:10:28 Tracy Morison
So lots are potentially imposable and I guess focusing on locks as this kind of silver bullet solution to an unintended pregnancy and all these associated social problems kind of overlooks the underlying social dynamics that really lead to unintended pregnancy in the first place.
00:10:52 Will Mountford
In the communities that you’ve been working with and conducting this research alongside to look at things in the reverse.
00:10:59 Will Mountford
Why not get pregnant? Why not have a kid at whatever age?
00:11:03 Tracy Morison
So I mean the question of why not have a child at a younger age or whatever is a good one because the idea that we have of family planning, that really informs public health is a very much a kind of middle class Western ideal that you should plan and space.
00:11:19 Tracy Morison
It’s, you know, you’re financially secure and in a monogamous relationship and have all these milestones before you have a child, which for some people might never be attainable. So you really are saying that to whom people should actually not reproduce. And if they had the support of the state and social support then.
00:11:39 Tracy Morison
They would be able to care for their children adequately.
00:11:41 Tracy Morison
I guess what we are doing though, when we use those kinds of norms and values to inform policies and inform our practice and contraceptive cares that we’re imposing those norms on people that that might not be meaningful for or might not be attainable for. If we take Maori as an example, it is culturally normative to.
00:12:02 Tracy Morison
Have your children at a young age. It’s valued. It’s seen as totally acceptable, and that’s what more you have always done and will do. And the research shows that when young married parents are supported
00:12:16 Tracy Morison
they thrive, traditionally marry, have raised their children community. They’ve had support from, you know, the wider community. They don’t have that nuclear family model. And this idea that you should postpone childbearing and for a certain age is a western imposition.
00:12:33 Will Mountford
What does this mean for contraceptive programs as a whole, then?
00:12:37 Tracy Morison
So what I’m arguing is that a patient centered approach to contraception and contraceptive counselling would say.
00:12:44 Tracy Morison
What are the cultural values and norms that a person brings to their reproductive lives. What do they want and how do we support that? Of course there are bigger discussions around, you know, social support.
00:12:57 Tracy Morison
Social welfare and making sure that parents young parents are supported to be able to be young parents.
00:13:04 Tracy Morison
But to be led by, I guess what’s meaningful and important to the patient rather than what we assume is the correct or the right or the normal way of doing things.
00:13:19 Will Mountford
So could you tell me more about the research that we’re discussing in detail today? What’s the current landscape in New Zealand? How are patients represented in that landscape?
00:13:29 Tracy Morison
Yeah. So the study is a small qualitative study and it really is aimed at kind of teasing out the nuances and gaining greater depth. So you can’t generalize the findings, but you can connect them to other research findings.
00:13:48 Tracy Morison
And they certainly do resonate with what international research is showing and the findings of the study echo the international findings and suggest that more needs to be done to ensure that lock services on New Zealand are of high quality and fair for everyone. So so I interviewed 37 women of a range of ethnicities and ages.
00:14:16 Tracy Morison
And I interviewed 22 healthcare providers and the interviews focused on how decisions are made about using lock and how much say or agency women have in the decision making process and whether there’s anything preventing them from being able to.
00:14:33 Tracy Morison
Make the choices that suit their needs, differences and circumstances.
00:14:38 Will Mountford
So how much say did the participants who engaged in your study have when it came to their own decision making? What was their kind of feedback on that?
00:14:46 Tracy Morison
All the participants want to chair decision making, which is where the patient and contraceptive provider work together to make decisions, and both have a say in the decision making process. But this appeared to be.
00:14:58 Tracy Morison
Relatively uncommon, in fact, many of the participants said they felt lucky. Well, some of them said they felt lucky if they got that kind of care. So the most common approach to decision making is a top down approach where the contraceptive providers in charge and they make most of the decisions with the patients having little input.
00:15:17 Will Mountford
And what about the providers?
00:15:18 Tracy Morison
Well, they all said that they believe that patients should have the right to choose, but then at the same time they describe situations where they possibly inadvertently limit the control and the decisions.
00:15:30 Tracy Morison
Of their patients when they’re counselling them. So for example, they spoke about, as I mentioned, pushing LARP or selling lark and really directing the.
00:15:39 Tracy Morison
Patients along a particular kind.
00:15:41 Tracy Morrson
Of path and what the findings really show is that these disempowering actions are, you know, pushing or persuading patients often getting behind good intentions and that providers might not even realize that they’re doing it.
00:15:56 Tracy Morison
So they believe and they’re motivated by the belief that they want what’s best for their patients. But often that involves what their values are and what their beliefs are about reproduction. So ultimately, you have this kind of scenario where there’s this doctor knows best approach and if you put those two.
00:16:14 Tracy Morison
So I have to sit side by side. You can hear the resonance between what the women were saying and how the doctors were describing what they were doing. So All in all, as I said, there really is the suggestion that there needs to be improvement.
00:16:29 Tracy Morison
And contraceptive care, and that it definitely there’s a lot more work that needs to be done to make it more patient centered.
00:16:37 Will Mountford
A reflective more than a prescriptive approach does seem to be at the core of having any agency and justice in your healthcare. And I think that kind of leads very neatly on to the issues of addressing that from a policy perspective.
00:16:49 Tracy Morison
Yeah, absolutely. So I mean from a policy perspective, I guess it’s important to think about the issue quite holistically. So one of the pieces, obviously of this puzzle is to say we need to make providers aware or train providers around.
00:17:04 Tracy Morison
What it means to… some people call it patient centered care. Some people call it person centered care, which is really being sensitive to and led by the patients needs, desires, preferences, life circumstances and giving space for that person to have a say.
00:17:26 Tracy Morison
To be part of decision making, because often what happens is that top down approach is taken so.
00:17:34 Tracy Morison
That’s really what my research showed both in terms of the the woman’s own experiences as well as how
00:17:42 Tracy Morison
Providers spoke about what they do. It’s that kind of doctor knows best approach. It’s well meaning, but it is often based on their own values, their own assumptions. So we do need to have that kind of values clarification piece where providers are made aware of what is my bias.
00:17:59 Tracy Morison
How do I come to the conversation or the decision making process with?
00:18:04 Will Mountford
Yes, and you’ve suggested some questions that can be used to facilitate that reflection. Based on your findings, we can add links to those in the show notes. But for right now, is there anything that you would like to highlight to the listeners.
00:18:16 Tracy Morison
Choosing contraception and this is, I guess, a important point that healthcare providers often miss that choosing contraception is not a medical decision alone. It is about values and norms and morals and people’s lives.
00:18:29 Tracy Morison
Lives and their futures and hopes and their dreams. It’s a very social choice, so taking, I guess, a broader approach as a contraceptive provider, that it’s not only about efficacy and preventing pregnancy, but there’s more going on for the patient, at least.
00:18:46 Tracy Morison
So it’s about making the services available, but also making sure that they’re delivered in ways that people can freely choose. So are there spaces, for example, that are suitable for contraceptive conversations that are private, that people feel comfortable that they can share, that there can be meaningful interaction.
00:19:08 Tracy Morison
And if we talk about policy here, I guess what makes it quite difficult for that kind of patient centered care to happen is that there are constraints on doctors, time and resources. I mean that.
00:19:21 Tracy Morison
Absolutely leads to something that needs to be addressed is improving resourcing in ways that increase access and agency.
00:19:30 Tracy Morison
And then I guess the final policy piece I think is a big and bold and probably one that wouldn’t be done overnight, but is too cascade, that reproductive justice approach across the reproductive health sector. And what I mean by that is by starting with.
00:19:50 Tracy Morison
All of your policy, all of your guidelines being led by principles of reproductive justice so that that filters down into practice.
00:20:00 Will Mountford
Now I’ve used the phrase a couple of times, but it’s worth spelling it out.
00:20:03 Will Mountford
What is reproductive justice and how does that relate to contraceptive service?
00:20:08 Tracy Morison
Reproductive justice is a way of thinking about and advocating for people’s rights and choices about their reproductive health. So it really goes beyond that traditional focus on legal access to contraception and abortion, and recognizes that just because you.
00:20:29 Tracy Morison
That have access. It doesn’t guarantee you true reproductive freedom. So when we talk about contraceptive care, reproductive justice means making sure that everyone can get the kind of birth control that.
00:20:42 Tracy Morison
They want and need, regardless of their income, race, age, where they live and so on.
00:20:51 Tracy Morison
And really, reproductive justices that people should have the power to make decisions about their bodies and their families. So from the contraceptive providers side, it’s about giving them all the information that they need to choose the right birth control method for them. And it’s also about making sure that.
00:21:11 Tracy Morison
Everybody has equal opportunities to get birth control, even if they don’t have a lot of money or you know if they live in a certain area. So again, it’s that kind of balance between access and agency.
00:21:26 Tracy Morison
So in a nutshell, really reproductive justice is about making sure that people have freedom and support to make their own decisions about their reproductive health, and treating everybody fairly and giving them access to whatever they feel are the best options for them. And what works best for them.
00:21:45 Will Mountford
I’ll have a good interrupt with just a quick question to kind of come back to the political framing of making that choice provider.
00:21:53 Will Mountford
Are there any peculiarities or similarities in the New Zealand healthcare system that might translate to other healthcare systems across the globe?
00:22:04 Tracy Morison
Yeah, yeah, there certainly are resonances with the international findings. There’s definitely common findings around. Like I said, the doctor knows best approach
00:22:16 Tracy Morison
Such where there’s this kind of medical paternalism. But then, of course, as you say, each unique space, those kind of things will play out in a different way. So what’s great about the New Zealand context is the universal public healthcare, so.
00:22:35 Tracy Morison
Or contraception as government subsidised and all kinds of luck. That’s definitely something that’s good about the New Zealand context and the highlights how funding all the different methods is important. But I guess that also raises the issue of.
00:22:51 Tracy Morison
Of access and women in rural and remote locations might have extra costs because they’d have to travel to go and see a healthcare provider. .
00:23:06 Tracy Morison
Sometimes they need more than one appointment. So yeah, they definitely are. Often women who are in disadvantaged circumstances. Also who would experience more difficulties in actually getting their contraception. And I think that would be true of most places.
00:23:21 Tracy Morison
That you would. You’re sort of hard to reach groups.
00:23:24 Will Mountford
Well, the use of phrase, they’re hard to reach groups, and I think that echoes the targeting of groups that kind of came up in the earlier discussions of how reproductive choices were imposed or made available with intention to reach certain groups. And just to kind of kind of draw that comparison towards the racial divide.
00:23:44 Will Mountford
With the Maori and Pakeha communities.
00:23:47 Tracy Morison
Yeah, those are important points. I mean, it’s a fine line between making contraception accessible to so-called hard to reach groups versus targeting at risk groups. So there’s that delicate balance between access and agency, which is kind of the hinge, I guess that my work rests upon and it’s about making contraception accessible in ways that.
00:24:10 Tracy Morison
Don’t remark. Analyze if that’s a word that re entrench historic I guess injustices, and I mean what you’re raising there of disparities and you know gaps in maternal health outcomes.
00:24:25 Tracy Morison
And reproductive health outcomes in general is. Yeah, it is about that systemic, entrenched and systematic injustices that are kind of baked into the system. And that is why in my work and elsewhere, there’s a lot of work that’s been done in the US and some in the UK.
00:24:45 Tracy Morison
Of sensitizing people to well, especially contraceptive providers, to that kind of way. That unfairness is kind of wired into the way that we do this.
00:24:56 Tracy Morrson
Things. So they talk about this idea of structural competency. So when we’re talking about training healthcare providers to be aware of their assumptions and their biases and and that sort of thing, we also want them to be aware of how the way that society is structured, limits opportunities.
00:25:16 Tracy Morison
Resources and choices for particular kind of people. So when you’re offering counselling and when you’re making, I guess.
00:25:25 Tracy Morison
Clinical decisions about what
00:25:26 Tracy Morison
To offer people that you’re aware of that kind of bigger, broader background.
00:25:37 Will Mountford
It’s worth going back to the goals of reproductive justice and your work saw, neatly summarized in terms of access agency, equality and accountability. How those are all at the core of your research in an academic sense, but also in its social application.
00:25:55 Tracy Morison
Yeah. So the issue really is that if you’re saying that someone needs to pull themselves up by their bootstraps, if you’re saying that someone needs to.
00:26:03 Tracy Morison
Make good decisions and that all they need to do is have access to contraception and then make responsible decisions, manage their reproductive health, look after themselves. You’re missing really important parts of the puzzle, which is the kind of social barriers, social factors that might prevent people from.
00:26:23 Tracy Morison
Being able to do that. So do they have access to the resources that they need? Do they have the knowledge that they need? Are they physically able to go to a clinic?
00:26:34 Tracy Morison
If you think about something like abortion, there’s stigma attached to that that somebody might want to end the pregnancy, but they can’t, so we can’t assume that reproductive choices are made in a vacuum and we have to absolutely widen the lens and look beyond the individual and understand what all the various social factors and.
00:26:54 Tracy Morison
They might be, and that’s exactly what reproductive justice.
00:26:56 Tracy Morison
It’s about it’s saying that it’s all good and well to give someone rights on paper, but they have to be able to exercise those rights in practice, the government has to support them. They have to be, for example, social safety Nets. There needs to be welfare, there needs to be supportive environment so that they can live.
00:27:17 Tracy Morison
About those choices that they may have made, choice doesn’t happen in a vacuum.
00:27:21 Will Mountford
And are all these recommendations reflected in your summary sheet document as well? And if they are, can people find that anywhere online?
00:27:28 Tracy Morison
Yeah. So I have a summary of the research aimed at providers as well as patients. So different sort of perspectives, those would be available on my website.
00:27:41 Tracy Morison
Tracymorison.com and of course I have academic publications as.
00:27:47 Will Mountford
Who would you say is going to come away from this with the most to reflect upon internally or the most action to take directly? Where can they go to maybe start making those changes in their practice or in their management of their healthcare? You know, what are some final thoughts and next steps listening to this now?
00:28:07 Tracy Morison
I would like this research to reach people that currently have the balance of power, which is healthcare providers and other decision makers, policy makers.
00:28:18 Tracy Morison
Is what the research has shown is that patients don’t always have a negative experience, but by and large the experience is is of disempowerment. And of course, this is a particular group of participants, but it really does echo what other research is showing in other parts of the world.
00:28:38 Tracy Morison
And other studies here in Aoteoroa, New Zealand. So the kind of balance of power is in the hands of the provider it’s in the hands of the policymakers.
00:28:47 Tracy Morison
Patients are saying they want equitable, patient centered care. They want to be listened to, they want to be part of the decision making. That’s not happening. So I would hope that people who have the power to make those kinds of changes in their own practice, perhaps as a contraceptive provider, perhaps as someone who makes decisions around guide.
00:29:07 Tracy Morison
And would be able to look at these findings, and I guess in relation to what other research is showing in other parts of the world, and think about what that means for our local context. So there’s a lot of, well, there’s a lot of will to have what some people call.
00:29:25 Tracy Morison
Women centered care. Or patient centered care, but I think at the moment that’s at the level of intention or rhetoric, and I think the next step would be finding some pathways to actually get that into practice.
00:29:44 Tracy Morison
So whether that is about consulting with patients around how they’ve experienced their care, whether that is about developing and looking at what training is offered, what does the funding say about what the priorities are and what’s available and what’s important?
00:30:01 Tracy Morison
That’s the kind of next step. I don’t think there’s anything in place at the moment in New Zealand in in any case.
00:30:13 Will Mountford
If things are in a medium place at the moment, what is the best place they can go and how do we avoid them going to the worst place and what is the best place we could be within, you know, a reasonable time frame.
00:30:27 Tracy Morison
At the moment we have, well, certainly in New Zealand. We have a lot of goodwill from contraceptive providers themselves, so they deny is a desire to do the best job that they can and to do right by their patients. All the contraceptive providers that are interviewed expressed those kind of.
00:30:47 Tracy Morison
Desire to help their patients, and I suppose the worry with that kind of approach… If it’s not a kind of reflection on what does helping actually mean and what do we want it to look like in the end, you can actually go down the route of paternalism where you end up telling women what’s good for them, or not good for them.
00:31:10 Tracy Morison
And that’s not patient censored or woman censored at all, which is presumably what clinicians are telling me.
00:31:18 Tracy Morison
They want their practice to look like so things like the lark first approach have to go.
00:31:27 Tracy Morison
Because that is antithetical to patient centered care and what we ultimately want in the end is for people to be able to freely decide what it is that they would like to do.
00:31:45 Tracy Morison
Based on what they feel is important to their life.
00:31:49 Tracy Morison
And the personal circumstances and not what healthcare practitioner might think. So we need to treat patients women as the experts of their own lives. And although the medical practitioner might come with their own expertise and their own training.
00:32:08 Tracy Morison
We don’t want them to think The Doctor knows best.
00:32:12 Tracy Morison
We want them to meet their patients half way. So I I guess the end goal is a lot of the policy talks about voluntary right based care and that isn’t the reality at the moment and moving towards a more patient centered approach would help to ensure.
00:32:30 Tracy Morison
Voluntary rights based care at the moment, healthcare providers are assuming that that’s what’s happening. They’re assuming they’re in a partnership with their patients. That’s what my research showed. That’s what research is showing in the US and the UK, and that’s not the reality.