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HEALTH RELATED INEQUALITIES IN AUSTRALIA | REPRODUCTIVE HEALTH AMONG ABORIGINAL AND NON-ABORIGINAL WOMEN IN AUSTRALIA
June, 2020
Aboriginal Women of Australia face challenges of inequality contrary to those whom are non-Aboriginal due to intersectional and institutional complexity, these cultural and social disadvantages create barriers greatly effecting their access to Reproductive and Maternal Health Care. The following essay aims to explore the axes of inequality experienced by Aboriginal Women in Australia in relation to Reproductive and maternal Health care will be explored and analysed. This paper will specifically examine the effectiveness of the Government campaign ‘Closing the Gap’ while considering intersectional and institutional complexity. The word count for this paper allows for a scope of general discussion to explore the aforementioned topics but may not allow for the elaborate discourse of specific areas, for this reason some concepts may be recognised but not explored in detail.
The heterogeneity of Aboriginal Australian Women is inclusive of the diversity of Aboriginal Nations, each possessing their own language and traditions. Aboriginal’s across Australian Regions face similar albeit sometimes different health concerns, additionally, those same health concerns may present in different degrees of severity or symptoms (Couzos & Murray 2008, p xiv). For the sake of this essay, the growing health concerns and inequalities faced by Aboriginal Australian Women in reproductive and maternal health are explored with a sociological scope that includes a feminist and intersectional lens. ‘Transferability’ and ‘generalisability’ is the implication that research findings in a singular populace can also be pertained to another (Couzos & Murray 2008, p xivi), these factors would include race or ethnicity related to expected outcomes (2008, p xivi). Generalisability would then include; age, sex, degree of biomedical risk, diagnostic skill of practitioner, health resources, client adherence and socioeconomic status (Couzos & Murray 2008, p xivii). A problematic example of this involves many of the statistics included in the proceeding document which include identities of both Aboriginal Australians and Torres Strait Islander peoples. These are independent and distinguished identities. However, for the purpose of this essay the statistics are relevant to Aboriginal Australian People’s only and Torres Strait Islander people are not included in the body of discussion.
Recent statistics show that Indigenous Australian’s are participating in higher levels of education, establishing greater numbers of home ownership, reducing rates of homelessness and slowly improving mortality rates, however; health disparities between Aboriginal and non-aboriginal communities remain prevalent (Australian Government 2020). Many targets for improvement of Aboriginal Health Disparities remain unattained. ‘Aboriginal Women collectively have the poorest health of any other group of women in Society (Frederick, 2007 p93).’ In fact, some of the most recent reports emphasise the apparent disparities which burden the perinatal outcomes of Aboriginal mothers and babies compared to that of non-indigenous mothers and babies. Examples include; increased maternal mortality with approximately 13.8 deaths compared to 6.6 deaths per 100, 000 women post-natal between 2008 and 2012 (Humphrey et al 2015), low birth weights calculating to 118 for Indigenous instead of 62 per 1, 000 for their non-indigenous counterparts, as well as perinatal deaths accounting to 14 per 1,000 for Indigenous Women and 9 per 1, 000 for Non-Indigenous Women (AIHW 2016).
Improvement of female related health disparities continues to remain unresolved in the healthcare system. But furthermore, particularly for that of Indigenous Women. Intersectionality creates a holistic and dynamic approach to recognition of issues reflective of specific, unique or marginalized groups. As Norris, Murphy-Erby and Zajieck (2007, p. 334) explain, perspective of Intersectionality improves a definitive focus on the interaction of inequalities – class, race, gender, sexuality and age – and the way they shape people’s lived experiences. For instance, when considering the intersectionality of poverty, it’s effects are affectedly enhanced by the mirroring of race-ethnicity and gender (Norris, Murphy-Erby and Zajieck 2007, 334). Not dissimilarly, the effects on a Women’s health will be significantly rendered by race/ethnicity. Norris, Murphy-Erby and Zajieck (2007, p. 334) highlight the scrutiny of White Feminists unknowingly homogenising female issues. Alleviated from these issues, some Feminists are non-inclusive of the intersectionality framework required for understanding the concerns featured in the lives of non-white women. An intersectional framework allows sociologists – alongside other scholars and professionals – to explore how axes of inequality and social determinants of Health greatly effect a persons’ life course (Norris, Murphy-Erby and Zajieck (2007, p 336). Through movements such as Aboriginal Women’s Activism a light shone on the obvious health disparities effecting Indigenous Women of Australia (Frederick 2007, p94). Frederick (2007, p95) that Aboriginal Women should no longer be disempowered and marginalized.
Arabena (2016) states Aboriginal women are regarded by health practitioners as ‘vectors for disease,’ or ‘vehicles for health gain,’ and this is particularly apparent through pregnancy; they are then reinforced positively or negatively according to these practices. 9 per cent fewer Aboriginal women present to their perinatal examinations post child birth than that of non-Aboriginal women (AIHW 2016). Aboriginal Australian’s are already so permissible to a wide sum of health concerns, more so than their non-indigenous counterparts. ‘Indigenous people face barriers in accessing health services, in particular primary health care (ABS, 2008).’ Which greatly affects rates of; diabetes, cardiovascular disease, respiratory disease, kidney disease, poorer mental health, and weight-centred health concerns (Department of Health 2019), in addition to life style factors such as poorer nutrition, alcohol intake, smoking and psychological distress (2019). All of which greatly attribute to the overall reproductive and perinatal health. We might then consider the intersection of socioeconomic factors more likely subject to Aboriginal than non-Aboriginal women such as lower income, higher unemployment, lower education levels, inadequate infrastructure and higher rates of incarceration (Department of Health 2019). ‘Indigenous women and their children need health equity and social equality (Arabena 2016).’ Achieving this requires replacing current structural and systemic barriers with services of equitable availability, whilst reframing our relationships to work collectively to embrace human rights for all Australian’s (Arabena 2016). Aboriginal Australian women became disempowered as a result of colonization (Frederick 2007, p 94). We use the word ‘re-empowerment’ to discuss the health improvement of Australian Aboriginal Women by the integration and reconciliation of women specific issues as we must acknowledge that they were not subject to such poor health before colonisation. Our health care system does a poor job of acknowledging the backgrounds of patients in order to understand their key social determinants of health. Treatment should come from someone who will consider background as a contribution to the social determinants of health, which may or may not relate to their current state of well-being, overall health or perception of health (2007, p 96).
Closing the Gap is a national campaign which has been the Australian Government’s response to the institutional disadvantage of Australian Indigenous people (Arabena 2016). Its essence is the elimination of apparent health disparities, inequalities and equity gaps within the Australian health care system. It aims to solve the discrepancy in life expectancy and health outcomes (Arabena 2016). Working together is the strategy of quality health solutions; locally driven and controlled the proposal for improving Indigenous assistance for resolution provides pathways of self-determination and sustainability outcomes (Arabena 2016). The importance of cultural preservation is also outlined. Approaches must match the holistic health concepts of the First Nations people and acknowledge individual well-being as well as products of social, cultural and emotional wellbeing in the community (Arabena 2016). According to the most recent Closing the Gap Prime Minister Report (Australian Government 2020) the target aim for Child Mortality rates has not been met. The Government states that Improving and maintaining lower child mortality requires a continued focus on preventative care as well as child and maternal health services (2020). The need to address issues facing socio-economic status, education, smoking during pregnancy, infant breast feeding, adequate diet and exercise is mentioned. Additionally, disparities of reproductive health care for Aboriginal Women is not a part of the program. Albeit the placement of policies, there appears to be little practice or execution of improvement.
Traditionally, Aboriginal cultures birth and rear children in practices which are primarily associated with the land and the plants; providing fundamental ritual elements and procure cultural aspects at these life stages (Dudgeon & Walker 2009). Post-colonisation and modernisation has radically shifted many Aboriginal Australian’s from their traditional practices due to displacement to suburban areas or cities and the expectation to practice westernised medicine as well as birthing in hospitals. As explored in Frederick (2007, p. 95), Aboriginal Australian women feel they are living as colonised people who continue to be subjected to racism and kept impoverished by policies and behaviours which have their origins in history. Arabena (2016) explains that Aboriginal Women feel a combination of pain, humiliation and frustration when it comes to ideals generated from health campaigns created by non-Indigenous health workers. This therefore, creates many barriers when presenting medical conditions - including pregnancy or perinatal concerns - to health professionals by exposing their bodies. Arabena explains that ideas of not wanting to share personal care and healing practices with non-Aboriginal medical professionals creates a huge breach in the grade of care received by Aboriginal women (2016). Cultural respect therefore cannot be obtained. Defined as ‘recognition, protection and continued advancement of the inherent rights, cultures and traditions of Aboriginal and Torres Strait Islander peoples’ (AHMAC 2009), cultural respect is an essential aspect of receiving appropriate attitudes of care from health-care providers and medical professionals.
While programs such as Closing the Gap exist - and it has rounded some success in reaching goals – many targets have not yet been met. Namely, these strategies do not evoke culturally safe environments. Practices are hindered by forms of intersectional complexity and maintained through institutions such as cultural, economic and racial marginalization of Aboriginal peoples. The current policies in place have not been approved by Indigenous communities’, meanwhile their intervention would do a great deal to reduce barriers. The health care system fails to implement education about Indigenous Australians to improve the consideration of background when treating patients as these are contributing factors to social determinants of health. Additionally, an unspoken expectation of agency such as self-determination in Australia exhibits a negative link to Aboriginal Women’s personal motivation to improve their own health. Therefore, Aboriginal Australian women still face great inequality of reproductive and maternal health care based on intersectional and institutional complexity that creates barriers to access, prevention and treatment of care. Proposal of a three-tiered approach to improving health equality among Aboriginal women in Australia could include;
Compulsory education and training for General Practitioners and Specialists in Australia as a part of National Health incentives. Integrated understanding of Indigenous culture must be included as part of the AHPRA if we are to overcome the disparity placed on indigenous women for their access to appropriate, low-barrier, low-risk reproductive health care.
Improved initiates to increase medical education among Aboriginal Australian’s will reduce risk associated with judgement that prevent Indigenous Australian’s from visiting General Practitioners and seeking medical help when needed. Harmonising culture and health is possible through this transaction.
Having Government funding medical practitioner aid travel to rural and remote areas of Australia for improved access to medical advice, treatment plans and diagnoses.
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