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New calls for wider implementation of Birthing on Country

Last week I was joined by Congress of Aboriginal & Torres Strait Islander Nurses and Midwives (CATSINaM) members in presenting to a Parliamentary Friends of Close the Gap meeting, attended by Senator Malarndirri McCarthy and Rachael Seaworth, the Member for Cowan, the Hon Dr Anne Aly, and Waminda Health.

In my presentation, I asked all MPs present to support CATSINaM’s call for a Senate Select Committee to investigate the barriers to wider implementation of Birthing on Country.

This inquiry should make recommendations for all who need to be involved in filling this gap in services for Aboriginal and Torres Strait Islander women and their families. This included governments, health and medical professionals and organisation, educators and training organisations.

The inquiry could draw upon the national and international evidence that demonstrates the wide-ranging benefits of Birthing on Country. We need such an inquiry to systematically identify the barriers that are holding back wider implementation of Birthing on Country and to make recommendations for solutions.

And we need this to happen ASAP –- to address what is a health emergency: every day, more of our babies are being born into health services and systems that are unsafe, undermining their chances of healthy futures.

Birthing on country is a culturally safe experience for women and families and could reduce the number of babies being born too early and dying in their first months. We could make a difference to every stage of life -– reducing chronic disease, strengthening culture and identity.

Birthing on Country services encompass some, or all, of the following elements:

  • They  are community  based and governed
  • Provide  for inclusion  of traditional practices
  • Involve  connections  with land and country
  • Incorporate  a holistic definition  of health
  • Value  Aboriginal  and/or Torres  Strait Islander knowledge as  well as other ways of knowing  and learning

And, most importantly, Birthing on Country is about providing care to women and their families which is culturally safe.

Birthing on country is a culturally safe experience for women and families and could reduce the number of babies being born too early and dying in their first months.

What is cultural safety?

Cultural safety is quite different from cultural awareness training. Cultural awareness training is a comfortable exercise for members of the dominant society to examine our cultures as Indigenous peoples and others us. The gaze is outward. And this type of training is comfortable. It is also often based on a simplistic notion that all Aboriginal people are the same.

By contrast, cultural safety’s gaze is inward and it encourages members of the dominant society to get uncomfortable and examine themselves and their own worldviews, assumptions, beliefs and how they are formed intergenerationally.

And particularly in health, how these may be harmful for their Indigenous colleagues and clients. Importantly, whether a health service is culturally safe is not judged by the provider of the service, but by the recipient of care.

Cultural safety represents a key philosophical shift from providing care regardless of difference… to care that takes account of peoples’ unique needs — and is regardful of difference. This is a critical shift from the thinking that health professionals should treat everyone the same, as I have written about previously.

Cultural safety unpacks the concept of the dominant culture. When you are a member of the dominant culture, your identity is constantly affirmed and reinforced, in ways that you probably don’t even realise.

But for those of us living outside of this dominant culture, it can be challenging. A perfect example of this is in the dominant culture design and distribution of maternity services.

Unfortunately, there is no shortage of examples of barriers or how the system is not only failing to support us  but is inflicting harm and trauma. Professor Sue Kildea related a story to me involving a hospital discharging a new mother and put her on the long bus-ride home to her community. But they didn’t ring to tell anyone she was coming. They did not provide care based on a needs analysis.

So when this new mother, with a new baby, arrived into town at 3am, there was no-one there to meet her. She didn’t have a mobile phone, she had no means of contacting anyone to pick her up.

What could she do? At 3am?

She walked for an hour, with her new baby, to get home.

We know these are not isolated stories.

A culturally safe system is one in which the wider health workforce understands the complicity of the health system — and their profession — in harmful practices and policies and proactively works to redress this.

A culturally safe system is one where Indigenous families feel they belong, it is one that affirms their identities, they see themselves across all facets of society, the workforce, a part of governance structures, policies and practices and are affirmed that this system respects and values their cultural knowledges and practices.

A culturally safe system is one in which the wider health workforce understands the complicity of the health system — and their profession — in harmful practices and policies and proactively works to redress this.

Midwives and other health professionals were part of enacting government policies like the Stolen Generations and medical experimentation that did so much to undermine the sense of belonging and trust for Indigenous people.

The importance of Birthing on Country and embedding cultural safety more widely across the health system was a key theme at the annual CATSINaM 20th anniversary celebrations and professional development conference, which was successfully held with close to 300 delegates, in Adelaide from 17-19 September.

We can sometimes get the impression from media coverage that our politicians are not interested in working together. But I was pleased at the meeting this week to see genuine cross-party interest in engaging with our work and in respectful dialogue across party lines.

The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) would like to thank Federal Members of Parliament for showing respect and support for our work in this space. It is encouraging to observe the MPs’ meaningful engagement with issues such as cultural safety and the importance of increasing and supporting the Indigenous health workforce. However we are now calling on all serving MP’s to support a wider implementation of Birthing on Country.

My dream is that in the not too distant future, all Indigenous babies will be born in places and amongst people who respect and value their cultural identity, ensuring they start life with a strong sense of belonging and connection to their culture and identity. This can only be achieved by working with, listening to and respecting Indigenous peoples and our culture.

(To read more on the CATSINaM positioning statement, click here https://www.catsinam.org.au/static/uploads/files/birthing-on-country-position-statement-endorsed-march-2016-wfaxpyhvmxrw.pdf)

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