The early bird

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It’s difficult to make an argument against timely antenatal care. All the available research indicates that timely antenatal care leads to better health for mothers, fewer interventions in late pregnancy and positive child health outcomes.  In the case of pregnancy and birth, the early bird achieves greater outcomes. Accordingly, the Australian Antenatal Guidelines recommend that the first antenatal visit occur within the first ten weeks of pregnancy. Wise advice.

However, in Australia there is a group of women that miss out on care within the first 14 weeks of pregnancy. Of the women who gave birth in Australia in 2013, 43% of overseas-born women and 35% of Australian-born women did not see a doctor for their pregnancy before 14 weeks. By 20 weeks, these figures decrease to 18% and 14% respectively: better numbers but concerning nonetheless.

What is behind these numbers? What prevents women from seeing their doctors within the first 10 weeks of pregnancy? Cost is a factor. The public health system offers free care to Australian permanent residents, but there are many immigrant women on temporary visas who pay their own way if they become pregnant during the first twelve months on arrival, and therefore fall within the 12 month health insurance waiting period.

Accessibility is another factor. While the health system might be self-explanatory to those who are familiar with its idiosyncrasies, for people born overseas, the health system can be a labyrinth. It takes time to decipher the system and evaluate the right entry point, for different reasons and at particular points in time.

Language barriers also get in the way, as do time constraints. The multiple demands on women’s time and energy lead to a need to prioritise and women’s health doesn’t always make it to the top of the list. During the course of our health education work we met a newly arrived woman who was in her eight month of pregnancy and who had not yet booked in to the hospital. The woman had a range of other pressing priorities: she needed to earn an income, find a stable home, and arrange for her husband to join her in Australia. Fortunately we were able to link her with a hospital that then arranged supports for her other issues.

Every woman giving birth in Australia should have the opportunity to access timely and appropriate antenatal care. Health services can play their part by acknowledging that their service starts long before a woman approaches them for care. There are proven strategies that health services can employ to reach out more widely, including promotion in ethnic media,  and the use of interpreting services and bilingual workers. Even when written information is provided in-language, women still need the opportunity to discuss the options available to them in ways that are culturally responsive and relevant to their needs.

Partnerships with organisations like MCWH, or ethno specific and settlement services help in creating a smoother pathway from the community to the health system. There is no doubt that timely care benefits mothers and babies, and makes the job of health professionals more effective. Further sustained investment into early intervention will make it easier for all women to take action on their health at the time it matters most.

International students’ rights: it’s time for change

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It’s a little known fact but an important one: there are more people arriving into Australia as temporary migrants than there are recently arrived permanent migrants. As of December 2015 there were over 1 million people living in Australia on temporary visas, compared to about 190,000 migrants who settled in the country as part of the 2014-2015 Migration Program.

Statistics also show that more than 40% of new permanent migrants are not so ‘foreign’, ‘international’, or ‘temporary’ at all and have already been in the country under some type (or in many cases, other types) of visas for several years. Many have successfully overcome the challenges of precariousness in order to secure permanency and stability. But at what cost? The answers are strikingly clear if we take the case of international students.

Since last recorded (December last year), there were about 352,000 immigrants on student and temporary graduate visas. That’s almost twice that of our total yearly permanent migrant intake. You would think that, given their numbers, they must by living it up in Australia: enjoying all the privileges, advantages and benefits of a student on an international holiday. Not so. Despite the negative stereotypes of cashed up international students stealing jobs, there is actually more evidence that shows temporary residency status can impact negatively on international students’ health and wellbeing.

While all students face the mounting expenses related to education, as well as the general cost of living, international students also face exploitation in employment and accommodation, and experience social isolation, racism and discrimination. International student’s situation is only worsened by their temporary visa status, which limits their access and entitlement to services and support.

It’s now four years since the Australian Human Rights Commission (AHRC) first articulated the human rights of international students and more than five years since MCWH first identified the challenges female international students face in relation to accessing equitable pregnancy-related care. During this time, after four changes of prime minister, the precarious situation for international students, particularly those who find themselves pregnant in the first 12 months of arrival, remains unchanged.

Why are we struggling to uphold international students’ human rights? A recent review of the AHRC’s Principles to promote and protect the human rights of International Students suggested that the challenge can arise because human rights principles are seen to be too broad to advocate for change.

We can rise to this challenge. MCWH’s advocacy position on advancing the rights of international students to pregnancy-related care is practicable and specific: remove the 12 month waiting period for pregnancy-related care from the terms of the Overseas Student Health Cover Deed, so that international students can access equitable and affordable sexual and reproductive health care whenever it is needed. It’s not the only step, but a first step to eliminating discrimination against female international students and their partners.

Research Project: Contraceptive Technologies and Reproductive Choice Among Immigrant Women


Professor Lenore Manderson (front, left); Associate Professor Andrea Whittaker (front, right) and Ms Azam Naghavi (back, right) from Monash University with the MCWH bilingual educator interview team.

Professor Lenore Manderson (front, left); Associate Professor Andrea Whittaker (front, right) and Ms Azam Naghavi (back, right) from Monash University with the MCWH bilingual educator interview team.

Last week researchers from Monash University conducted an interview training workshop with a group of MCWH bilingual health educators.  Our bilingual health educators were trained to conduct research interviews for the Contraceptive Technologies and Reproductive Choice Among Immigrant Women ProjectThe research will identify how immigrant and refugee women access information and advice about contraceptives; their use of sexual and reproductive health services; and how providers ensure women’s informed choice.  The research team will interview 70 women from at least four different countries, including India, China, Afghanistan and Sudan.  The Project is being conducted in partnership with Monash University, the Centre for Culture, Ethnicity and Health and Family Planning Australia Alliance.

The research project is funded by an Australian Research Council Linkage Grant 2013-14.


WRAP #17: The festive edition with music, Mary and 60 seconds with Alice Pung

Well we’ve made it people!

It’s been a fantastic year which has passed at break-neck speed and for many of us, there will soon be an opportunity for a small pause. Even for those of us who will still be toiling through December and January, there is something about the end of the old year and the approach of the new that makes you want to sing. Or scream. Or sigh. In all cases, there is an urge to use your voice.

We’d like to use ours to sing the praises of the wonderful women at MCWH, who cheer us on each month and make work fun. We’d also like to say to each of you: thank you for supporting us, staying in touch and sharing our stories with others. Thanks to those especially who came along to our AGM and birthday party … it was a wonderful event. And finally, we’d like to start your 2014 calendar with a brilliant February event that we are hosting with Women’s Health in the North, Mercy Health and North Yarra Community Health.

It’s called Voices of Change and if you want to hear a host of incredible women sharing stories of strength and success in relation to their work with FGM/C then get your ticket now!

Now for a light WRAP on music, Mary and 60 seconds with Alice Pung.

We’ll be taking a quick break from WRAPing in January (after too much wrapping in December ha ha) so we wish you all a wonderful and safe summer.

Until next time,
The WRAP Team.


Creole choir of Cuba performing at WOMAD 2011 courtesy of Stuart Madeley on flickr

A universal language

While merrily decking our office halls with boughs of holly, it occurred to us that even Christmas carols are not immune to gender analysis: where are the little drummer girls? Has Frosty always been a snow man? And why is it mummy kissing Santa Clause underneath the mistletoe? Like all products of culture, music—for better or worse—usually reflects the time and place from which it originates.

Singing along to ‘White Christmas’ may not be for everyone then, but chances are many of us will be breaking out our Bollywood moves, miming the macarena or hip-swaying to makossa because it makes us feel relaxed and joyous. Alive. Whatever your taste or persuasion, the power of music and song to unite, transform and uplift is the reason for its enduring appeal. Like some magical elixir, it somehow appeals to our better selves.

When we asked Ee’da Ibrahim what multiculturalism means to her she responded with a musical  metaphor: “It’s like a symphony of music, of sound—a beautiful orchestra where every single sound and instrument contributes overall to the beauty of the music.”  It’s a sentiment also found in the work of ‘Kween G’, a Sydney hip-hop MC and radio presenter who migrated to Australia from Uganda at the age of four. For Kween G, teaching hip-hop to indigenous youth in the Northern Territory is a way of transcending language and helping others to both preserve and transform their unique culture.

Youth has always been a time of change and, if you happen to be different to your peers by virtue of your skin colour, sexuality, culture and/or socio-economic circumstances, then music can be both a leveller and a life-raft. One young girl, a member of the ‘Recycled Orchestra’, puts it this way, “My life would be worthless without music.” This young girl lives in Cuerta, Paraguay, a city essentially built on top of a landfill. Much closer to home, the ‘With One Voice’ choir has membership from a range of immigrant communities and has led to networks and friendships being developed amongst and beyond the group. Choir members have literally been singing all the way to improved wellbeing.

You don’t have to believe in Santa to harness the magic of the season: go Gangnam Style, shimmy those tassels, sing your best karaoke— it’s the silly season after all—and remember that you are also participating in an enduring, life-changing art form. Share it widely and passionately.


Nativity play courtesy of CK Koay on flickr.

…but what about young Mary?

Christmas Day is arguably the largest birthday celebration of the year, which makes Jesus the most well-known birthday celebrant, at least in the Western world. Yet, despite knowing in detail the exploits of his father (the big G), few know as much about his mother, ‘The Virgin Mary’ (Jesus was an ‘immaculate conception’ so the story goes) beyond the fact that she was engaged to a carpenter and gave birth in a stable surrounded by three wise men.

Less well known is the fact that Mary was also a teenager when she gave birth (in some accounts, she may have been as young as 13). Of course, circa 6 B.C. was a very different time, people died young and it was common for girls to marry and bear children at a young age. Nevertheless, Mary of Nazareth was young, poor and female. Thousands of years and much research have shown that these qualities alone make it more difficult to achieve good health, let alone manage an adolescent pregnancy.

For the millions of young girls each year who experience an unplanned or unintended pregnancy, opportunities for education are reduced and vulnerability to poverty and social exclusion are heightened. Although the majority of adolescent pregnancies (19%) and adolescent births (95%) occur in less industrialised countries, the causes and consequences of adolescent pregnancy cut across regions. You are more likely to become pregnant if you are poor; poorly educated; culturally marginalised; and/or have limited or lack access to appropriate sexual and reproductive health care.

According to the latest UNFPA ‘Motherhood in Childhood’ Report’, adolescent pregnancy is both a cause and consequence of rights violations. Regardless of the circumstances or reasons, when a girl falls pregnant it often stems from lack of choice and opportunity and is a reflection of powerlessness (and in many cases, is a result of violence and coercion). It can also significantly diminish a young woman’s choices throughout her life.

Prevention of unplanned and unintended pregnancy should therefore focus on ensuring girls can exercise their rights to health, education and autonomy in the first place. A broad-based human rights approach requires that we shift the focus away from targeting prevention at girls and instead, invest in building their capacity to make transformative decisions.

Australian birth data suggests that some overseas-born adolescents have a higher fertility rate than their Australian-born peers.  Exactly why this is the case needs further investigation.  Girls and adolescents from immigrant and refugee backgrounds do need access to culturally relevant sexual and reproductive health information and education. However, it’s never just purely and simply about ‘their culture’. The complex interplay of forces in young girls’ lives needs consideration. It’s essential that we speak with and listen first to what they have to say.

60 seconds with Alice Pung

Alice Pung

writer, editor and lawyer

If you were a super-heroine, what powers would you like to have?
I would like the power of invisibility so I could be a silent witness and eavesdropper in places where I am not supposed to be – this would be an invaluable power for a writer!

 What’s the most interesting job you’ve had?
Teaching older people in Alaska to tell their stories in writing workshops

If you could give one piece of advice to someone new to Australian culture, what would it be?
Try and learn as much English as you can. It opens up the new world for you, and will keep you connected to your children as they grow up in this country.

If you could invite anyone (dead or living) to dinner tonight, who would it be?
Aung San Suu Kyi

Tell me about an amazing woman you know.
My grandmother was essentially a single mother with ten kids in Cambodia (because she was the second wife of my granddad – back then, Chinese men could have multiple wives). She started a plastic bag factory until the Khmer Rouge took over, and she came to Australia at the age of 72, as the oldest surviving member of her work collective in the Killing Fields. She had a lot of time and love for us, and an innate sense of dignity. Even after she had a stroke, and was in a wheelchair, she would not have a photograph taken without her lipstick on. I do not see that as vanity, but as a sign of enormous self-respect. She did not want to be ‘young’, she just didn’t want people to see her as decrepit.

Name a book or film that changed your life?
I have Never Forgotten You: The Story of Simon Weisenthal. He was a holocaust survivor that spent most of his life bringing war criminals of the Nazi regime to justice. It was not work that he enjoyed doing, and he suffered greatly for his work, which he did up till his death in his nineties. But through his life’s work, he was instrumental in helping Europe heal its wounds.

What are you reading right now? (e.g. blogs, books, magazines, or anything else!)
I just read an incredible profile of a homeless 11 year old girl, Dasani, in New York City, written by Andrea Elliot, who spent over a year following Dasani around. It was a story of great resilience, empathy and hope; and also longform journalism at its finest.

Do you have a song/music that inspires and motivates you?
All the songs of Michael Jackson, from his childhood years. He had such an angelic voice.

Is there a favourite cultural tradition that you like to follow?
I love coming back to my parent’s house for Chinese New Year. It is very important to my mother, because when she arrived here, she lost the one thing she had looked forward to every year – in Southeast Asia, new year is as big, if not bigger, than Christmas, and it signifies family time and new hope and new beginnings.

What does multiculturalism mean to you?
Multiculturalism means that we are collectively enriched by our individual cultures.

Do you think Australia is multicultural?
In urban areas, there is a very unselfconscious multiculturalism happening because different groups, by circumstance, live together. So multiculturalism is not a ‘big deal’ like the media makes it out to be, it is just a nice pre-existing reality. It only becomes a problem when the media decides to point this out. Then, the people in communities that do not have such diversity, are usually the ones who are most vocal about it.

Finish this sentence: “We need feminism because…”
… if you didn’t have it, you are denying the rights of fifty percent of the human inhabitants on this planet, who have just a tiny fraction of the world’s resources, and yet are responsible for the birth, growth and usually, education, of the entire human race.

Media Release: International seminar highlights invisibility of abortion as a federal election issue

Variation in abortion law among the states is not the only issue at stake for women in Australia.

Today MCWH will host a visit by Dr Anu Kumar, Executive Vice-President of Ipas, a global nongovernment organisation dedicated to ending preventable death and disability from unsafe abortion.

Dr Kumar’s visit marks the beginning of MCWH’s partnership with researchers from the Social Sciences and Health Research Unit, Monash University on a research project investigating the contraceptive and reproductive choices of immigrant and refugee women.

Executive Director of MCWH, Dr Adele Murdolo said that while abortion law continues to be a matter for the states, both state and federal governments need to ensure that abortion is accessible and available to all women.

Twenty six per cent of the world’s population still live in countries where abortion is generally prohibited, so in that regard Australian women are in the fortunate position of living in a country where induced abortion is legally available. However, access to abortion is still restricted to different groups of women in various ways. It is already well-known that immigrant and refugee women have limited to access to sexual and reproductive health for a range of reasons including visa status, economic reasons and lack of access to culturally sensitive programs.

A recent report has found that living in a rural or regional area can also severely restrict your access to abortion because of the lack of services in certain regions. There’s a triple disadvantage then if you’re an immigrant or refugee woman living in one of these regions.

In many respects there are overlaps with the human rights work being done at an international level. In Australia, immigrant and refugee women’s access to abortion is still determined by such things as visa status and other policies, which can indirectly impact on women’s right to free choice.

Women’s rights aren’t just a matter for the law, although legal reforms are crucial – we’d like to see government make the necessary policy changes, and fund appropriate services, to improve women’s access to abortion.

Position Paper on International Student Access to Pregnancy-Related Care

Through the On Your Own research project we undertook in 2011 with international students in Melbourne, we found that the minimum requirements of the Overseas Student Health Cover (OSHC) Deed pose significant obstacles to female international students who fall pregnant unintentionally. Through further consultation with services and students across Australia, we have found that this is an issue that affects international students nation-wide and has already led to detrimental health outcomes for some women. Our new position paper outlines the reasons why the OSHC deed needs to be changed, and points to wider issues for international student health. We believe that the issue creates further ambiguity about the rights of international students to access health services and could potentially contribute to misunderstandings in health service delivery settings.

Our position has been endorsed by over 20 organisations and we encourage you to read it, talk about it and pass it on.

You can read and download the paper here.