Health services specific to women began in Melbourne with the opening of the Lying-in Hospital, later the Royal Women's Hospital, in 1856. In addition to providing public maternity facilities the hospital included infirmary wards where generations of medical students were able to develop experience in treating diseases of the female reproductive system.
The determinants of women's health are both social and biological. In the 19th and early 20th century diseases associated with poverty took a particular toll on women. Socialised to put their own needs behind those of their family, wives often denied themselves food in order that the male breadwinner would stay strong, and delayed seeking treatment because they were reluctant to leave their children. The types of employment open to uneducated women exacerbated their tendency to ill health, and working long hours in overcrowded and poorly ventilated conditions made them particularly susceptible to tuberculosis, the greatest killer of women in their child-bearing years.
Poverty also had a negative impact on women's reproductive lives. Malnutrition in childhood predisposed women to difficult births, the legacy of which often created chronic illness in later life. Too frequent child-bearing had a similarly debilitating effect. Although there is evidence of women sharing information on a family or neighbourhood level, there was no formal education about sex and reproduction until the 1890s when woman's suffrage activist, Brettena Smyth (1840-98), began to offer lectures on 'Women's diseases: their Cause, Cure and Prevention' as an adjunct to her North Melbourne drapery. The store also sold contraceptives. The opening of a clinic staffed exclusively by women at what would become the Queen Victoria Medical Centre provided a place where women could discuss conditions they found embarrassing to raise with male doctors. Antenatal care was introduced at the Women's Hospital in 1917 but involved only two visits during pregnancy, rising to five by the 1940s. Concerns about a high maternal death rate saw maternal health services added to the infant welfare centres developed by municipal councils between the wars. Outside these spaces, silence perpetuated ignorance. The impact of venereal diseases, discussed only in sometimes alarming euphemisms, left women with chronic pelvic inflammatory disease and created complications with subsequent pregnancies. The desire to avoid excessive child-bearing ensured that abortion, as the contraceptive of last resort, took a heavy toll until the advent of penicillin, and continued to claim women's lives until 1970.
The availability of effective contraception and the decriminalisation of abortion since the 1960s have radically improved women's health, creating an environment in which infertility has replaced excess fertility as a major concern. Medical research has placed Monash Medical Centre in the forefront of the development of the new reproductive technology designed to address this problem. Cancers specific to women provide another focus for research, and are the subject of government-funded screening programs aimed at early detection of what have become major causes of death now that most women survive their child-bearing years.