National conversations on gender bias and discrimination in the healthcare system have swept the country, with many asking: what does it mean to have your needs left unaddressed by a system that is meant to care for all? For migrant and refugee women and gender-diverse people, having to navigate the terrain of racial and gender bias is an all-too-familiar reality.
Racial and gendered biases can manifest in different ways in our lives. It can be when you are overlooked for a job because your name is considered “too ethnic”. It can also be built into our systems and policies, for example, not having your overseas qualifications recognised in Australia. Racial bias is the expectation that when you enter a healthcare clinic, you should be fluent in English or that the accent in your voice is a reflection of your abilities or intelligence. It can be when your doctor assumes you are in a heterosexual relationship or that you want kids because you have a uterus. It’s your pronouns being consistently ignored or misused, as was the case with Ash, who didn’t end up using her referral for a speech pathologist due to being constantly misgendered by healthcare professionals.
Healthcare bias can make people feel dismissed and disrespected and not in control over their health and wellbeing. Take for example the NSW Birth Trauma Inquiry, where over 4000 submissions were received, describing instances of obstetric violence, abuse and gender and racial bias. Migrant woman Elahe shared her story of being ignored and forced to undergo an induction when she was 41 weeks pregnant, without fully understanding why the procedure was happening in the first place. While these are just some examples of how bias occurs within Australia’s healthcare system, Elahe’s and Ash’s stories remind us that bias isn’t just an abstraction, it is a lived reality with profound consequences on our health and wellbeing.
Bias exists because those in positions of power (usually white, cis and male) have designed and shaped a world – our social, political, health, and economic systems – in ways that reflect their own interests and perspectives. In doing so, this has created a universal assumption that everyone experiences reality the same way. As Caroline Criado Perez explains in her book, Invisible Women: Exposing Data Bias in a World Designed for Men: “…Whiteness and maleness are implicit. They are unquestioned. They are the default. And this reality is inescapable for anyone whose identity does not go without saying, for anyone whose needs and perspective are routinely forgotten. For anyone who is used to jarring up against a world that has not been designed around them.”
It is clear that our healthcare system in Australia has not been designed to respond to the needs of migrant and refugee women and gender diverse communities. For example, at a policy and programming level, migrant and refugee populations are either overlooked, considered ‘hard to reach’, or regarded as a homogenous group under the umbrella of ‘CALD or culturally and linguistically diverse’. It’s routinely forgotten that as migrant and refugee women and gender diverse people, we can also be part of LGBTQIA+ communities, live with disabilities, and face precarious visa statuses.
To tackle the current disparities in our healthcare system, we need to go beyond acknowledging our own personal biases and take meaningful action. In practice, this means recognising and addressing where the gaps are, such as the disproportionate research gap that centres migrant and refugee people’s lived experience.
Our national research project, End All Bias, is building upon the Federal Government’s #EndGenderBias survey and seeks to bridge this gap by making a valuable contribution to the conversation on gender bias and racial discrimination in Australia’s healthcare system, centring migrants and refugees as co-producers of knowledge and evidence. At the heart of this work will be the solutions and visions migrant and refugee women and gender diverse people have for shaping a healthcare system that is more responsive to their needs.
When we flip the script and ensure those most affected by bias and discrimination are leading the change, we can transform unequal power relations that have been long-standing and begin to realise an equitable and responsive healthcare system for all.
This article was first published in edition #139 of The WRAP on November 2024.