industry & reform
Renae Coleman is a proud Darug woman and midwifery activist . Picture : Supplied .
“ Many First Nations women don ’ t feel culturally safe with what the mainstream system offers .
‘ Call it out ’
Claims of inequality and racism in the midwifery sector .
By Eleanor Campbell
A
new report detailing Indigenous patients ’ experiences of hospital care has affirmed the importance of supporting the midwifery workforce , according to UWS researcher and registered midwife Renae Coleman .
Recent insights from the Bureau of Health Information ( BHI ) found that Aboriginal women in NSW had a significantly less positive experience of care than non-Indigenous women .
The survey also found that Aboriginal women giving birth were more likely to report higher levels of respect and improved communication when supported by an Aboriginal health worker .
“ Many First Nations women don ’ t feel culturally safe with what the mainstream system offers ,” said Renae , who is a descendant of the Boorooberongal people of the Darug Nation .
“ Services that offer continuity of care throughout pregnancy , birth and postnatal ; there ’ s just not enough services out there and available .”
Continuity of care is vital to the wellbeing of an expecting mother and her child , with studies showing that having a trusted midwife can significantly reduce medical interventions and preterm birth .
In Australia , Indigenous women face disproportionate rates of adverse health risks during pregnancy and postpartum periods . Access to continuity of care is essential to reducing these disparities .
“ It ’ s difficult to implement this type of care in the fragmented mainstream system , where women see different midwives each time ,” said Renae .
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“ There ’ s also a lot of women that have complex medical histories . Often they get flagged as high risk and they don ’ t get the opportunity to see a midwife . They ’ re moved to the doctor ’ s clinic and they tend to not come back .”
Birthing on Country , described as the ‘ gold standard ’ of care for Aboriginal mothers , calls for the development of the Indigenous maternity workforce to improve women ’ s experiences and overall health outcomes .
According to Renae , acknowledging the individual needs of every Indigenous woman is paramount to the delivery in this type of care .
“ It ’ s all about what the community wants and it ’ s all directed from there .
“ There ’ s that big influence of having an Aboriginal workforce that propels this kind of framework .”
NOT ENOUGH GRADUATES Around one per cent of Australia ’ s healthcare workforce identifies as Indigenous and Torres Strait Islander . In a joint research paper , Renae noted that there was an inadequate number of Indigenous midwifery graduates to redress this gap .
“ Not most , but many of our Aboriginal students have families or care responsibilities that they need to juggle .
“ There ’ s barriers within the health system as well , with experiences of racism .
“ But many of us do overcome that and are able to get through that period , but usually it ’ s with a lot of love and support around them .”
According to a recent AIHW report from April , over 30 per cent of Indigenous Australians indicated they did not access required health services due to discrimination , language barriers or a lack of cultural safety .
Racism entrenched in the health workforce is a major barrier for Aboriginal student midwives , according to Renae .
“ There ’ s also an issue where we ’ re exposed to quite a bit of racism , bias and the blindness that stems from white privilege .”
Kinship and connection to other Aboriginal people , she said , is crucial to supporting students through their learning and development .
“ Sometimes we call it our ‘ sisterhood ’, and it is so important because it can be a very isolating experience going through colonised education systems and colonised healthcare systems .”
Non-Indigenous health practitioners can better support Aboriginal students and co-colleagues by removing the notion that everyone is treated the same , said Renae .
“ I think it ’ s important to them , to speak up when you hear racist comments .
“ It ’ s okay to call it out because for your Aboriginal colleagues or student midwives , it does chip away at them and it ’ s difficult to speak up .
“ And often you see people don ’ t speak up and they end up leaving .”
CLOSING THE GAP Last month Prime Minister Scott Morrison announced a $ 1 billion implementation plan towards closing the gap in Indigenous health , education and justice .
The annual Closing the Gap report showed that only three out of the 17 new targets had made progress , including improving birth weight and preschool attendance .
In the midwifery space , Renae said that working in collaboration with Indigenous women would be pivotal to implementing future policies aimed at achieving equality .
“ I think it ’ d be great if we could try and review policies and procedures , through the lens of Aboriginal women , and better still , asking Aboriginal people to be involved in that process .
“ Ask them to provide their input when making decisions , and actually listen to them , not just invite them to tick boxes .” ■