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Monday, 3 March 2014
Page: 1394


Dr STONE (Murray) (19:23): With International Women's Day just past I rise to speak on an issue of national significance but which may come as a disturbing surprise for many Australians. Given our tragic history in Australia, when many Indigenous families suffered long separations or the permanent loss of their children and many were restricted in their rights to live where they chose and partner whom they wished, it is deeply concerning to find that the rights and preferences of some Indigenous women who are about to give birth are not always respected, even when medical risk is minimal or can be virtually eliminated. This is about the failure of state and Northern Territory governments in particular to deal with the remote area needs of Indigenous mothers.

While most Australian women await the imminent birth of their babies comforted by the support of their partners, their mothers, other close or extended family or their friends, Aboriginal women living in remote parts of Australia cannot await a birth in those circumstances. At 36 weeks into her pregnancy, no matter what her state of health or how many healthy babies she has already delivered, the remote Indigenous woman is expected to board a bus or plane and go to await the birth somewhere near a hospital that still delivers babies. She may be accommodated in a young working men's hostel, as in Western Australia, or in a caravan park, sharing an ablutions block some distance from where her caravan is, and in the freezing cold in winter. Or she may be in a crowded dormitory. She will rarely be escorted or have a support person with her, and she will quite often have left her other children, if this is not her first birth. She will have left the significant others in her life and her other family commitments for the four or five weeks awaiting the birth. So the pregnant women must leave other children, including toddlers. You can imagine the bonding issues and confusion for a younger child when their mother reappears after four or five weeks with a brand-new baby taking up a great deal of the mother's time.

Not only has the pregnant mother had to make complex arrangements with others in her community to care for her other children, her partner is not able to support her emotionally or in any other way in her final critical weeks. He cannot attend the birth, even if that has been his or his partner's wish. The pregnant woman is also without the support of her own mother or others who in her community can give her care, especially in the final stages of her pregnancy. As Mrs Maher, one of the participants in the roundtable I will describe in a minute, said: 'Is it any wonder that they do not want to leave?'

On 30 May 2013 members of the House of Representatives Aboriginal and Torres Strait Islander Affairs Standing Committee decided to hold a roundtable discussion here in Parliament House where a number of the midwives and other medical service providers, both Indigenous and non-Indigenous, could give us their views and share their knowledge about the issues surrounding the birth experiences of remote Aboriginal women. At least one of these women had been living in a remote settlement herself when she first gave birth, and she was forcibly relocated.

The participants at the roundtable conducted in May last year included Ms Karen Atkinson, a midwife and member of the Congress of Aboriginal and Torres Strait Islander Nurses; Mrs Millie Hills, the project manager for the Kimberley Aboriginal Medical Services Council; Mrs Anne Maree Maher, President of the Congress of Aboriginal and Torres Strait Islander Nurses; Mrs Rachel Sargeant, team leader, Child and Maternal Health, Apunipima Cape York Health Council; Mrs Meleseini Tai-Roche, Coordinator, Regional Maternal and Child Health, Kimberley Aboriginal Medical Services Council; and Miss Danielle Weise, community midwife and child health nurse, Apunipima Cape York Health Council. The transcript of this roundtable can be found in the official committee Hansard reports of 30 May last year. The committee secretariat has just rechecked with these participants a week or so ago to make sure that I am not reporting on something that has recently changed. I wish I was, but in fact the conditions I am about to refer to and describe have not changed. The situation is the same for these remote Indigenous women. It is a sad situation.

I quote from these midwives and the other remote area health professionals who participated. Mrs Sargeant is speaking. She begins by introducing herself. She then explains :

We look after 12 communities at Cape York. That averages about 160 births a year. We provide midwifery and child health services. All our child health nurses are midwives as well, so they will often do a dual role which is great for continuity. They are fly in, fly out. All of our registered nurses are midwives or have partnerships with specially trained maternal and child health workers who are community based. So they lead the way; it is a health worker led program that we provide, taking a lot of cultural guidance and appropriate management from there.

The committee then asked where the communities' babies were actually born. Mrs Sargeant replied:

In Cairns base [hospital]—there is no other option—at the main delivery suite at that facility … Currently there are no other options. If ladies dare not come down they are considered to be absconding and threatened with the Department of Child Safety. This is at 36 weeks—a good month before their due date, and often they may go over.

The committee chair asked what they were threatened with. Mrs Sargeant then explained:

They are threatened with the Department of Child Safety becoming involved with their management because if they do not leave their home at 36 weeks into the pregnancy they are 'deemed as not responsible'.

The chair asked for clarification—if in fact the Queensland child safety department can actually activate official interest in the still-to-be-born. Miss Weise, a midwife from the Kowanyama community of 1,100 people, answered:

It is an unborn risk notification.

Mrs Sargeant explained:

… if they do not comply with this recommended schedule and policy of management of their antenatal care and leave their community, friends and family and live down in Cairns, they are threatened with the Department of Child Safety. It depends on a lot of other circumstances, but that threat is used regularly for ladies …

Miss Weise stated:

It is not a government policy—it is just a threat. It is there and it is used.

Mrs Sargeant added:

It is standard practice.

The women who are sent to Cairns stay in a cheap hotel room if the much better 20-bed hostel at Edmonton is full, but this hostel is for Indigenous women only, so the women's partners cannot stay, nor their children. The women are paid a $33-a-night subsidy, and so finding the rest of the cost is often very problematic. Mrs Sargeant noted that, in relation to accommodation at the hostel:

This is very difficult when you have different clans in the same room and it is completely inappropriate.

Mrs Maher also reported her experience of working in rural New South Wales. She said:

I have worked also in Walgett, New South Wales, which does not seem very remote to most people but women are not allowed to birth in Walgett. They have to catch a bus at their own expense to Dubbo, which is three hours away—again, at 36 weeks. There is no accommodation supplied; they have to find their own accommodation. They have their baby at Dubbo hospital and then a day or two afterwards, because they want to come home, they get on a bus and come home.

On day 3, their milk comes in. They have got no support—no midwife—and they do not know what to do. All their mothers bottle-fed—the whole generation of mothers before—so not only is it about where you birth, it is about the support you get before and after. There were seven midwives from Canberra who would fly in fly out to Walgett. Walgett is not remote, but they could not get anyone to work there.

Mrs Tai-Roche works in remote East Kimberley. She reported:

Mine are very, very similar issues.

In her words:

The birth journey for Kimberley women varies depending on where they are geographically … What it looks like for really remote communities and particularly for East Kimberley women, is a Greyhound bus—usually a mail plane and a Greyhound bus—at 36 to 38 weeks.

And she said that journey:

… can take two days in and out … women are out—

of hospital—

… two to three days post birth and back onto a Greyhound bus.

Unless the woman is under 18 or particularly unwell or is high risk, there is typically no funding for an escort to accompany her on the bus or plane journey, or to stay with her while she awaits the birth.

Obviously, all women need a safe place to give birth, with appropriate facilities and expert care should there be an emergency, and many remote Indigenous women and their babies do need special medical care, given the state of their health; that is widely and broadly acknowledged. However, we are concerned that, for these women, there are no options even when their state of health is fine, when there are other options and when they have previously had healthy babies.

Ms Atkinson gave examples of the practice in Flinders Medical Centre where pregnant women with rheumatic fever heart disease go to give birth. She stated:

Flinders Medical Centre will not accept a client that is retrieved without an escort, so they all have to have an escort.

She felt that that was a very appropriate thing to do, and of course we would all agree, but she went on to say:

The main thing with ladies … from the Top End is that they would arrive with next to nothing and it is freezing … They have no money, they have got no Medicare card … They might have their Basics Card with them, which is totally useless in Adelaide because there is only Target in the city and all the Caltex servos that take that Basics Card …

Mrs Sargeant told the committee about the close relationship that develops between midwives and health workers and the pregnant women in remote communities. However:

When the ladies get flown out at 36 weeks, they get put into a system which is so different …

No-one might speak their language. They are in:

… a hospitalised, once a week, ante-natal, really busy clinic, where they do not know the midwife and they will see somebody different every time they go who may not be aware of the often very complex social situations and family situations that the midwives and health workers looking after them in the communities are very aware of and can manage their care around. Again, it is a very daunting experience.

Following that roundtable discussion, we in the Standing Committee on Aboriginal and Torres Strait Islander Affairs put together some targeted recommendations to the Commonwealth government. I want to refer to these now because I think this is a very significant issue. It is one we must deal with urgently and it is one that the states and territories are not dealing with as they should.

The recommendations are: the Commonwealth recognise as distressing and damaging the practice of requiring that Indigenous women in remote areas with normal pregnancies relocate alone to an urban area near a hospital weeks before the birth; the Commonwealth works with states and territories to change this policy of mandated removal by providing greater support and resourcing for the provision of more child health nurses and midwives in remote Indigenous communities; the Commonwealth support improved access to safe and appropriate accommodation for Indigenous mothers and their families if they must be away from their home communities to give birth, including providing for their other children and partners; the Commonwealth provide more culturally appropriate support for mothers if they must be away from their home communities to give birth, including a skilled case manager who can communicate in the mother's language and maintain contact after the birth; the Commonwealth ensure there are resources to improve breastfeeding support for Indigenous mothers, given that women in remote areas are frequently discharged from the hospital before their breastfeeding is established; appropriate and safe transport should be provided to women and their babies who have to leave or return to their home country; and the Commonwealth work with the states and territories to introduce an acknowledgement of a child's home country on all Indigenous children's birth certificates when the mother would normally reside in the home country but has needed to leave to give birth. This last is obviously a very important matter for Indigenous children when later in their lives they want to register for or prove their traditional ownership status in relation to certain country. I want to stress that these are recommendations from the committee and have no status other than as recommendations, but we have passed them to the minister and I know he will consider them. We have also asked the minister to discuss them with the appropriate state and territory ministers who have responsibility in this area.

Finally, I want to say that, if anyone is in any doubt about the history of women being separated from their babies in the Australian Indigenous community, I want to refer them to 1913, 23 July, and the South Australian parliamentary proceedings and the progress report of a royal commission on the Aborigines in Australia. This is from a documentary history that I compiled in the 1970s. This parliamentary proceeding talks about removing children—in particular, half-caste children—from their mothers.

The Hon. J Jelley asks Mr EC Stirling, 'What would be a suitable age to remove them?'—meaning the children—and the answer is:

I think when they are about 2 or 3 years of age.

The chairman says:

You would not recommend that they be taken away when they are absolute infants ?—No ; because then you would have the burden of them that all children are at such a young age. When they are a couple of years of age they do not require so much attention and they are young enough to be attractive.

And he says:

Do you think that their experience of two years with the black mother would seriously interfere with them ?

Mr Stirling's answer is:

No. There would not be time for them to establish habits and customs. I am quite aware that you are depriving the mothers of their children, and the mothers are very fond of their children; but I think it must be the rising generation who have to be considered. They are people who are going to live on.

I want to say that we have not come much further from sentiments like that in parliament if we are still having women with perfectly normal pregnancies forced to leave their home country, away from their partners, their mothers, their sisters and their other children, at 36 weeks into their pregnancies. They then have to spend the next four to six weeks in totally alien and, to them, often hostile surroundings. It is not good enough in 21st century Australia. We need to do much better. So I urgently commend those recommendations we made to the minister, and I hope they will receive state and territory support.