I’ve contributed two chapters and I have excerpted the introduction of each chapter below:
8. Navigating the ethical in cultural safety
Caring is an ethical activity with a deep moral commitment that relies on a trusting relationship (Holstein & Mitzen, 2001). Health professionals are expected to be caring, skilful, and knowledgeable providers of appropriate and effective care to vulnerable people. Through universal services they are expected to meet the needs of both individual clients and broader communities, which are activities requiring sensitivity and responsiveness. In an increasingly complex globalised world, ethical reflection is required so that practitioners can recognise plurality: in illness explanations; in treatment systems; in the varying roles of family/whanau or community in decision making; and in the range of values around interventions and outcomes. To work effectively in multiple contexts, practitioners must be able to morally locate their practice in both historical legacies of their institutional world and the diversifying community environment. This chapter examines the frameworks that health professionals can use for cross-cultural interactions.I then explore how they can select the most appropriate one depending on the person or group being cared for.
13. Culturally safe care for ethnically and religiously diverse communities
Cultural safety is borne from a specific challenge from indigenous nurses to Western healthcare systems.It is increasingly being developed by scholars and practitioners as a methodological imperative toward universal health care in a culturally diverse world. The extension of cultural safety, outside an indigenous context, reflects two issues: a theoretical concern with the culture of healthcare systems and the pragmatic challenges of competently caring for ethnically and religiously diverse communities. As discussed throughout this book, the term ‘culture’ covers an enormous domain and a precise definition is not straightforward. For the Nursing Council of New Zealand (‘the Nursing Council’) (2009), for example, ‘culture includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience; religious or spiritual belief; and disability’.
In an attempt at a precise two-page definition, Gayatri Chakravorty Spivak (2006, p. 359), captures the reflexive orientation required to grasp how the term ‘culture’ works:
Every definition or description of culture comes from the cultural assumptions of the investigator. Euro-US academic culture… is so widespread and powerful that it is thought of as transparent and capable of reporting on all cultures. […] Cultural information should be received proactively, as always open-ended, always susceptible to a changed understanding. […] Culture is a package of largely unacknowledged assumptions, loosely held by a loosely outlined group of people, mapping negotiations between the sacred and the profane, and the relationship between the sexes.
Spivak’s discussion of the sacred and the profane links culture to the more formal institution of religion, which has historically provided the main discourse for discussion of cultural difference. Particularly important for cultural safety is her discussion of Euro-US academic culture, a ‘culture of no culture’, which has a specific lineage in the sciences of European Protestantantism. Through much of the 19th century, for example, compatibility with Christianity was largely assumed and required in scientific and medical knowledge, even as scientists began to remove explicit Christian references from their literature. This historical perspective helps us see how the technoscientific world of the healthcare system, and those of us in secular education, are working in the legacy of white Christian ideals, where the presence of other cultures becomes a ‘problem’ requiring ‘solutions’. Cultural safety, however, attempts to locate the problem where change can be achieved in the healthcare system itself.
Other contributors include: Irihapeti Ramsden, Liz Banks, Maureen Kelly, Elaine Papps, Rachel Vernon, Denise Wilson, Riripeti Haretuku, Deb Spence, Robin Kearns, Isabel Dyck, Ruth Crawford, Fran Richardson, Rosemary McEldowney, Thelma Puckey, Katarina Jean Te Huia, Liz Kiata, Ngaire Kerse, Sallie Greenwood and Huhana Hickey.
Those who know me or follow my work will know that I am deeply interested in eating and thinking about food. I’m interested in how food structures our days and our lives,it nourishes and sustains us, reminds us of people, events, history, all in a mouthful.
A special birthday cake, made for a surfer on his special birthday.
I’ve written elsewhere about how migrants perform identity through food preparation and consumption. I’ve also written about consumptive multiculturalism. I’m also interested in the provision of food in (monocultural) institutional contexts such as health where people are racialised by the foods that they eat and how the processes of hospitalisation strip people of their cultural and social identities and often lead people into being unable to access culturally appropriate food. This presentation brings those ideas together.
Food, its preparation and ingestion, constitutes a source of physical, emotional, spiritual and cultural nourishment. Food structures both daily life and major life transitions, including the transition to parenthood, where food is prepared and consumed that recognises the unique status of the mother. However, the reductive focus of hospitals where efficiency, economy and a focus on nutrients dominate and where birth is viewed as a normal event can mean that there is a mismatch between the cultural and religious dietary needs of migrant mothers with the food that is available from Western instititutional environments. In this paper I outline a research study, which examined the transition to parenthood among new migrant groups in New Zealand. Based on a number of focus groups with mothers and fathers, the data were analysed using a postcolonial feminist lens and drew upon Foucauldian concepts to examine the transition to parenthood. The findings show that Asian new migrant parents construct the postnatal body as vulnerable, requiring specific kinds of foods to facilitate recovery from the trials of pregnancy and delivery and optimize long term recovery from pregnancy. This discourse of risk contrasts with the dominant discourse of birth as normal, and signals the limitations of a universal diet for all postnatal mothers, where consuming the wrong food can pose a threat to good maternal health. Paying attention to what nutrition and nurturing might mean for different cultural groups during the perinatal period can contribute to long term maternal well-being and cultural safety. Health practitioners need to understand the meanings and significance attached to specific foods and eating practices in the perinatal period. I propose that institutional arrangements become responsive to dietary needs and practices by providing facilities and resources to facilitate food preparation.
I’m hoping that the written form of the paper becomes part of an edited book about mothers and food. Fingers crossed, it’s under review at the moment.
In August 2014 there was a wonderful story of how “people power” had freed a man in Perth, whose leg had become caught in the gap between a platform and train on his morning commute. You can watch the video here. What struck me about this story was that people taking part in their “regular” commute noticed something out of the ordinary and used their combined energy to free the man. Someone alerted the driver to make sure that the train didn’t move, staff then asked passengers to help and in tandem they rocked the train backwards from the platform so it tilted and his leg could be freed. It made me think about the gaps people are stuck in, that exist all around us, that have become so routine, that we are habituated to, and fail to notice.
One of the biggest gaps is in the health outcomes between Indigenous and non-indigenous people in settler nations. Oxfam notes that Australia equals Nepal for the world’s greatest life expectancy gap between Indigenous and non-Indigenous people. This is despite Australians enjoying one of the highest life expectancies of any country in the world. Indigenous Australians (who numbered 669,900 people in 2011, ie 3% of the total population) live 10-17 years less than other Australians. In the 35–44 age group, Indigenous people die at about 5 times the rate of non-Indigenous people. Babies born to Aboriginal mothers die at more than twice the rate of other Australian babies, and Aboriginal and Torres Strait Islander people experience higher rates of preventable illness such as heart disease, kidney disease and diabetes.
One of the most galvanising visions for addressing the health and social disparities between Indigenous and non-indigenous people is The Close the Gap campaign aiming to close the health and life expectancy gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians within a generation. By 2030 any Aboriginal or Torres Strait Islander child born in Australia will have the same opportunity as other Australian children to live a long, healthy and happy life.
Nurses play an important role in creating a more equitable society and have been forerunners in the field of cultural safety and competence. For the gap to close, nurses need an understanding of health that includes social, economic, environmental and historical relations. Cultural safety from Aotearoa New Zealand has been an invaluable tool for me as nurse for analysing this set of relations. However, as a newcomer to Australia, I have a lot to learn about what cultural competency means here and how I fulfil my responsibilities as a nurse educator to Aboriginal and Torres Strait Islander peoples. To that end, this blog piece focuses on some of the frameworks in nursing that might enable nurses to close the gap. I am particularly interested in frameworks that enable nurses to widen the lens of care beyond the individual and consider service users in the context of their families and communities and broader social and structural inequities. I’m also interested in policy frameworks that can support practice.
A social determinants of health approach takes into account “the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics” (WHO, 2010). A health equity lens has also been invaluable to my own practice, it refers to the absence of systematic disparities in health (or in the major social determinants of health) between groups with different social advantage/disadvantage. Social inequalities refer to “relatively long-lasting differences among individuals or groups of people that have implications for individual lives” (McMullin, 2010, p.7). While an inequity, refers to an unjust distribution of resources and services. “equity means social justice” (see, Braverman 2003). The term “social and structural inequities,” refers to unfair and avoidable ways in which members of different groups in society are treated and/or their ability to access services.
PRINCIPLE FOUR Cultural safety has a close focus on:
4.1 understanding the impact of the nurse as a bearer of his/her own culture, history, attitudes and life experiences and the response other people make to these factors
4.2 challenging nurses to examine their practice carefully, recognising the power relationship in nursing is biased toward the provider of the health and disability service
4.3 balancing the power relationships in the practice of nursing so that every consumer receives an effective service
4.4 preparing nurses to resolve any tension between the cultures of nursing and the people using the services
4.5 understanding that such power imbalances can be examined, negotiated and changed to provide equitable, effective, efficient and acceptable service delivery, which minimises risk to people who might otherwise be alienated from the service.
The Australian Code of Ethics for nurses and midwives in Australia also pays attention to the role of nurses in having a moral responsibility to protect and safe guard human rights as means to improving health outcomes and having concern for the structural and historical:
The nursing profession recognises the universal human rights of people and the moral responsibility to safeguard the inherent dignity and equal worth of everyone. This includes recognising, respecting and, where possible, protecting the wide range of civil, cultural, economic, political and social rights that apply to all human beings.
The nursing profession acknowledges and accepts the critical relationship between health and human rights and ‘the powerful contribution that human rights can make in improving health outcomes’. Accordingly, the profession recognises that accepting the principles and standards of human rights in health care domains involves recognising, respecting, actively promoting and safeguarding the right of all people to the highest attainable standard of health as a fundamental human right, and that ‘violations or lack of attention to human rights can have serious health consequences’.
In recognising the linkages and operational relationships that exist between health and human rights, the nursing profession respects the human rights of Australia’s Aboriginal and Torres Strait Islander peoples as the traditional owners of this land, who have ownership of and live a distinct and viable culture that shapes their world view and influences their daily decision making. Nurses recognise that the process of reconciliation between Aboriginal and Torres Strait Islander and non-indigenous Australians is rightly shared and owned across the Australian community. For Aboriginal and Torres Strait Islander people, while physical, emotional, spiritual and cultural wellbeing are distinct, they also form the expected whole of the Aboriginal and Torres Strait Islander model of care.
The Code stops short of using words like colonisation and racism, but the National Aboriginal Community Controlled Health Organisation background paper “Creating the Cultural Safety Training Standards and Assessment Paper” (2011, p. 9) points out that awareness and sensitivity training, result in individuals becoming more aware of cultural, social and historical factors and engaging in self-reflection however if there isn’t an institutional response and the responsibilities for institutional racism remain individualised:
Even if racism is named, the focus is on individual acts of racial prejudice and racial discrimination. While historic overviews may be provided, the focus is again on the individual impact of colonization in this country, rather than the inherent embedding of colonizing practices in contemporary health and human service institutions
The focus is on the individual and personal, rather than the historical and institutional nature of such individual and personal contexts.
The concept of cultural respect (Aboriginal Cultural Security: Background Paper, Health Department of Western Australia) comes the closest to embedding the health care system with policies and practices to help improve the health care outcomes of Aboriginal and Torres Strait Islander peoples. Having a cultural respect framework means that there is an acknowledgement that:
the health and cultural wellbeing of Aboriginal and Torres Strait Islander peoples within mainstream health care settings warrant special attention. Cultural Respect is the: recognition, protection and continual advancement of the inherent rights, cultures and tradition of Aboriginal and Torres Strait Islander Peoples. …. [it] is about shared respect ….[and] is achieved when the health system is a safe environment for Aboriginal and Torres Strait Islander peoples and where cultural differences are respected. It is commitment to the principle that the construct and provision of services offered by the Australian health care system will not compromise the legitimate cultural rights, values and expectations of Aboriginal and Torres Strait Islander peoples. The goal is to uphold the rights of Aboriginal and Torres Strait Islander peoples to maintain, protect and develop their culture and achieve equitable health outcomes.
The framework includes the following dimensions:
Knowledge and awareness, where the focus is on understandings and awareness of history, experience, cultures and rights of Aboriginal and Torres Strait Islander peoples.
A focus on changed behaviour and practice to that which is culturally appropriate. Education and training and robust performance management processes are strategies to encourage good practice and culturally appropriate behavior.
Strong relationships between Aboriginal and Torres Strait Islander peoples and communities, and the health agencies providing services to them. Here the focus is on the business practices of the organization to ensure they uphold and secure the cultural rights of Aboriginal and Torres Strait Islander peoples.
Equity of outcomes for individuals and communities. Strategies include ensuring feedback on relevant key performance indicators and targets at all levels.
What I like about this framework is that it goes beyond attitudes and knowledge-based to also demand changed behaviour and action that leads to culturally safe healthcare for Aboriginal and Torres Strait Islander peoples. Central to cultural respect is the need for organisations to engage with and seek advice from local Aboriginal or Torres Strait Islander communities.
Another new term is the notion of cultural security (developed by the Department of Health, Western Australian Health, 2003, Aboriginal Cultural Security: A background paper, page 10) which focuses on behavior: the practice, skills and behaviour of both professionals as individuals and the health system:
commitment to the principle that the construct and provision of services offered by the health system will not compromise the legitimate cultural rights, values and expectations of Aboriginal people. It is a recognition, appreciation and response to the impact of cultural diversity on the utilisation and provision of effective clinical care, public health and health system administration
Defined by the Victorian Health Department as: The capacity to respond to the healthcare issues of diverse communities. This term broadly considers diversity rather than the unique needs of Aboriginal and Torres Strait Islander peoples which are a consequence of colonialism and racism.
The term ‘Cultural competence’ originates from Transcultural Nursing developed by Madeleine Leininger. Borrowing from anthropology, the aim was to develop a model that encouraged nurses to study and understand cultures other than their own. You can read my paper on the complementariness of cultural safety and competence here. Wellness for all: the possibilities of cultural safety and cultural competence in New Zealand. Betancourt, et al., 2002, p. v define it as:
the ability of systems to provide care to patients with diverse values, beliefs and behaviours, including tailoring delivery to meet patients’ social, cultural and linguistic needs
Government interventions to address health inequities are being deployed in tandem with neoliberalism and economic globalisation, which push back responsibility to individuals. Now, more than ever, attention needs to be paid to power relations and structures that contribute to inequality in society and injustice within nursing, using approaches that consider equity and the social determinants of health. I personally am looking forward to the day when we don’t need this sign, because there isn’t a gap.
What you can do:
Support the Close the Gap campaign
Dr Tom Calma’s (Aboriginal and Torres Strait Islander Commissioner ) Social Justice Report 2005 instigated a human rights-based approach Campaign to close the gap in life expectancy between Indigenous and non-Indigenous Australians (up to 17 years less than other Australians at the time). This report called on all Australian governments to commit to achieving equality of health status and life expectancy within a generation (by 2030).
A coalition drawn from Indigenous and non-Indigenous health and human rights organisations formed the Close the Gap Campaign, which was launched in April 2007 by Catherine Freeman and Ian Thorpe, the Campaign’s Patrons. The CTG Campaign is currently Co-Chaired by the Aboriginal and Torres Strait Islander Social Justice Commissioner Mick Gooda and Co- Chair of the National Congress of Australia’s First Peoples, Kirstie Parker. The Campaign Steering Committee is comprised of 32 health and human rights organisations. The members of the Campaign Steering Committee have worked collaboratively for approximately nine years to address Aboriginal and Torres Strait Islander health inequality through two primary mechanisms: attempting to gain public support of the issue and demanding government action to address it.
Some useful videos
Aboriginal and Torres Strait Islander health videos:
http://blogs.crikey.com.au/croakey/2013/08/04/youtube-an-excellent-resource-for-aboriginal-and-torres-strait-islander-health/Cultural competence video:
https://www.youtube.com/watch?v=JpzLzgeL2sADr Tom Calma – Cultural Competency
White privilege: Unpacking the invisible knapsack
http://amptoons.com/blog/files/mcintosh.htmlWhat kind of Asian are you?
https://www.youtube.com/watch?v=DWynJkN5HbQReverse racism, Aamer Rahman:
Aboriginal and Torres Strait Islander peoples are the first inhabitants of Australia. Aboriginal people are extremely heterogenous groups differing in language and tradition. Torres Strait Islander peoples come from the islands of the Torres Strait, between the tip of Cape York in Queensland and Papua New Guinea but who may live on mainland Australia. The term ‘Indigenous’ is often used to refer to both Aboriginal and Torres Strait Islander peoples. In the spirit of being both relational and political then I’d like to share with you my learning about cultural competency and Aboriginal and Torres Strait Islander health care.
Risk management and life planning are a feature of contemporary parenting, which enable children to be shaped into responsible citizens, who are successful and do not unduly burden the state (Shirani et al. 2012). This neoliberal project of intensive parenting and parental responsibility (typically gendered as maternal) involves child centredness and detailed knowledge of child development (Hays 1998). Simultaneously, contemporary masculinities are increasingly being situated beyond the traditional Western binary of the active home-caring mother and passive breadwinning father. Following Connell (1995), the plural word masculinities refers to the many definitions and practices of masculinity (See e.g. Archer 2001, Cleaver 2002, Finn & Henwood 2009, Haggis & Schech 2009, Walsh 2011). Broader and more inclusive repertoires of fathering emerge from diverse family practices and formations including queer/homoparental families; cohabitation; new technologies; changing domestic labour arrangements; the changing organization of childcare and growing involvement of fathers; and social policy initiatives including parental leave and family-friendly employment practices (Draper 2003).
These rapid societal changes have ushered in new forms of participatory fathering and family involvement for men in the Western world. However, the pressure to integrate traditional breadwinner and authority figure roles with contemporary demands for involvement in all aspects of the perinatal period has not been matched by reduced work pressures or the provision of active societal support and preparation (Barclay & Lupton 1999). As a result, men often feel isolated, excluded, uninformed and unable to obtain resources and support in the perinatal period placing pressure on relationships, challenging feelings of competence and requiring negotiation of competing demands (Deave & Johnson 2008). Furthermore, men have gender- specific risk factors for perinatal distress including their more limited support networks; dependence on partners for support; additional exposure to financial and work stresses; a more idealized view of pregnancy, childbirth and parent- hood stemming from a lack of exposure to contemporary models of parenting; and lastly being less keen to seek help with emotional problems (Condon et al. 2004). All of these factors are compounded by practitioners and services oriented towards mothers and babies marginalizing fathers (Deave & Johnson 2008, Lohan et al. 2013).
Published online before print on February 28, 2014.
Purpose: To critically analyze the power relations underpinning New Zealand maternity, through analysis of discourses used by Korean migrant mothers. Design: Data from a focus group with Korean new mothers was subjected to a secondary analysis using a discourse analysis drawing on postcolonial feminist and Foucauldian theoretical ideas. Results: Korean mothers in the study framed the maternal body as an at-risk body, which meant that they struggled to fit into the local discursive landscape of maternity as empowering. They described feeling silenced, unrecognized, and uncared for. Discussion and Conclusions: The Korean mothers’ culturally different beliefs and practices were not incorporated into their care. They were interpellated into understanding themselves as problematic and othered, evidenced in their take up of marginalized discourses. Implications for practice: Providing culturally safe services in maternity requires considering their affects on culturally different women and expanding the discourses that are available.
Keywords: focus group interview, cultural safety, Korean women, maternal, postcolonial, Foucault.
A feature of contemporary maternity is the notion that birth can be empowering for women if they take charge of the experience by being informed consumers. However, maternity is not necessarily empowering for all mothers. In this article, I suggest that the discourses of the Pākehā maternity system discipline and normalize culturally different women by rendering their mothering practices as deviant and patho- logical. Using the example of Korean migrant mothers, I begin the article by contextualizing maternity care in New Zealand and outlining Korean migration to New Zealand. The research project is then detailed, followed by the findings, which show the ways in which Korean mothers are interpellated as others in maternity services in New Zealand. I conclude the article with a brief discussion on the implications for nursing and midwifery with a particular focus on cultural safety.
As a child I was enchanted by the idea of princesses and fairy godmothers and obsessed with the story of Sleeping Beauty. I even directed classmates in a play version of it in the playground of my Nairobi primary school. In case you aren’t familiar with the story, three good fairies arrive to bless the infant princess. Using their magic wands, one gives her the gift of beauty and the second the gift of song, but before the third can give her blessing, an evil fairy appears and curses the princess because she wasn’t invited to the christening ceremony. The curse is that the princess will die when she touches a spinning wheel’s spindle before sunset on her sixteenth birthday. Luckily the third fairy who was interrupted from her wish making uses her blessing to weaken the curse so that instead of death, the princess will fall into a deep sleep until she is awakened by a kiss.
Since the Royal baby was born, there has been a lot of fanfare with landmarks in London and all over the world lit up to celebrate the birth of the Royal baby. Many in both red and blue leading up to the birth and then blue upon confirmation of the baby’s gender. Former colonies have also got in on the act with almost 40 buildings in New Zealand partaking in the lighting frenzy. This baby has certainly had the Royal treatment in the media:
Daily mail Royal delivery
Led to creative gestures like this one from the crew of the HMS Lancaster based in the Caribbean:
Crew of HMS Lancaster
I’ve loved the idea of being able to bestow wishes, fancying myself as a fairy godmother even if I haven’t had a magic wand. Working on a postnatal ward in the 90s, I would wish every infant and their family a wonderful new life. The birth of the Royal baby has rekindled my desire for godmothership, so this is what I wish for every infant, mother, and family:
I wish the arrival of every infant in the world was greeted with the same sense of anticipation and enthusiasm as the Royal arrival.
I wish every mother, infant and family could receive the same “care” as the Royals will.
I wish “we” cared as much about maternal and infant mortality around the world.
I wish “we” cared as much about “other” mothers who aren’t supported in their mothering and against whom active measures are taken to regulate and surveil their bodies merely because of the accident of their own circumstances.
I wish we could remember the resources that have been extracted globally to maintain the Royal Family in the lifestyle they are accustomed to and that these could be redistributed.
However, all babies are not created equal and neither are all mothers. Regulating the reproduction of those considered to be a burden on society has been a way to secure and control the well-being of the population, leading to the surveillance and management of women’s bodies. The quality and quantity of the populations been an enduring concern of governments, a concern which has seen two kinds of policies, the ones that encourage some mothers to procreate (pronatalist) and others that discourage or even coerce other mothers from reproducing (antinatalist).
Our recent colonial history is emblematic of these concerns, reflecting a shift from Malthusian anxiety about over-population and the inability of the environment to support growth to a concern with the quality of the population. In white settler nations pronatalist movements often had nationalist overtones, equating international prominence with demographic strength, requiring both productive and reproductive capacity. For example in the United States, Republican motherhood was a site of civic virtue, demonstrated through bearing arms if you were a man and producing and rearing sons if you were a woman. These sons would embody republican virtues, even if as a woman you were excluded from citizenship.
18th-Century American Mothers & Their Children By Charles Willson Peale
Fears of ‘race suicide’ arose in early 20th Century Australia, New Zealand and the United States and made motherhood a political duty for white women in the interests of the nation and the health of the race. Reproducing white citizens in the colonies was a patriotic duty for women superseding involvement in public affairs. The concern about ‘race suicide’ was attributed to middle class women neglecting their duties by not having children while ‘other’ women (migrant, indigenous or working class) had too many in white settler societies. Anglo-Saxon middle class’ individualised mothering contrasted with shared child rearing that was more common in other societies. This resulted in women from those communities, for example immigrant and indigenous women, being labelled as bad mothers. Evolutionary theory played a role in demarcating good and bad mothering: Anglo-Saxon and Northern European women were positioned on the top of the hierarchy of the ‘races’ and were the only women capable of being good mothers irrespective of what other mothers did. Such women bore the responsibility for ensuring the well-being of their families, the future of the nation and the progress of the race. Anglo-Saxon mothers were thus both exalted and pressured.
Market Court, Kensington High Street, London
It has always been easier to focus on the management of mothers rather than politically challenging public health issues. Schemes to address maternal malpractice such as health visitors (whose job it was to keep surveillance and intervene to educate women) were initiated to ensure that the British working class mother was subjected to the imperatives of the infant welfare movement and became a ‘responsible’ mother. A proliferation of organisations to promote public health and domestic hygiene among the working class thrived, assisted by upper or middle class women. This class-based maternalism in Europe and North America reflected a race-based maternalism in the colonies, where Europeans challenged and transformed indigenous mothering in the name of “civilisation, modernity and scientific medicine” (Jolly, 1998, p.1). Similarly, in colonised countries the ‘cleaning up’ of birth was achieved through both surveillance and improved hygiene and sanitation. Sadly, interventions have involved the removal of children, most notably in the Stolen Generation in Australia, where Aboriginal – and some Torres Strait Islander – children were forcibly removed from their families by Australian Federal, State and Territory government agencies, and church missions, from the late 1800s to the 1970s and children sent either to institutions or adopted by non-Indigenous families.
A grassroots campaign calling for a national apology led to the first national Sorry Day on 26 May 1998 marked by ceremonies, rallies and meetings. Sadly, Australian Greens leader Bob Brown’s move to amend the sorry motion by offering “just compensation to all those who suffered loss” – was voted out by all the non-Green Australian Senators.
Australia Day 2008. The ‘Sorry’ writing was commissioned by a private person. Photo: Michael Davies, Flickr
Forced sterilisations without consent occurred as recently as between 2006 and 2010 where prison doctors sterilized 150 California women. The targets of Golden State prisons were people with a mental illness or who were poor. The practice was eventually banned in 1979, but even by 1933, California had subjected more people to forceful sterilization than all other U.S. states combined. This eugenic programme spread to Nazi Germany where extreme anti-natal racial hygiene doctrines were implemented against ‘unfit mothers’. Anti-natalist ideologies have often occurred concurrently with pronatalist ones. Women with mental or physical impairments or ethnically ‘other’ women such as Jews, Gypsies and Slavs were forcibly sterilised and abortions conducted, while Hitler simultaneously supported initiatives for the growth of a strong German Nazi Volk through a virtuous German motherhood. Breastfeeding in Nazi Germany was obligatory and women were awarded the Mutterkreuz medal (Honour of the German Mother (Ehrenkreuz der deutschen Mutter) for rearing four or more children.
So how will the other children born in the UK on 22 July 2013 fare? Emily Harle in The new Prince and his 2,000 birthday buddies paints a bleak picture. To summarise, 226 children of the 2,000 will live in overcrowded, temporary or run down housing, 11 will be homeless. 540 children will live in poverty. 8 children will die before their first birthdays and poor housing and low quality healthcare will be contributing factors.13 children will be taken into care during their childhood and have around five different sets of carers and nine of them will leave school with no qualifications. 120 will have a disability and 40 will have difficulty accessing services, support and activities that their able-bodied friends can. 25 of the 2,000 will be young carers who look after ill or disabled family members. Eleven of the children born on the same day will suffer from severe depression during their childhood, and 500 will experience mental illness during their lives, half of whom will have reported that the problem began before they were 18.
Seumas Milne contends that the monarchy embodies inequality and fosters a “phonily apolitical conservatism”. The hypocrisy at the heart of the celebration of the monarchy is seen in the British government’s preaching of democracy globally, whilst supporting an undemocratic system at home through an unelected head of state and an appointed second chamber giving the monarchy significant unaccountable powers and influence aside from the more visible deferential culture and invented traditions.
The festivities to mark the Royal baby’s arrival are likely to continue for some time but let’s not forget the ‘other’ mothers, infants and families for whom there are no celebrations and for whom there will never be. Let us not forget that not all lives are equal, there are those whose lives are valued and those who aren’t. Most of all, let’s do something about it.
Niagara Falls turns blue to celebrate the arrival of the royal baby.
I’ve just had the first paper from my PhD published: DeSouza, R. (2013), Regulating migrant maternity: Nursing and midwifery’s emancipatory aims and assimilatory practices. Nursing Inquiry. doi: 10.1111/nin.12020
In contemporary Western societies, birthing is framed as transformative for mothers; however, it is also a site for the regulation of women and the exercise of power relations by health professionals. Nursing scholarship often frames migrant mothers as a problem, yet nurses are imbricated within systems of scrutiny and regulation that are unevenly imposed on ‘other’ mothers. Discourses deployed by New Zealand Plunket nurses (who provide a universal ‘well child’ health service) to frame their understandings of migrant mothers were analysed using discourse analysis and concepts of power drawn from the work of French philosopher Michel Foucault, read through a postcolonial feminist perspective. This research shows how Plunket nurses draw on liberal feminist discourses, which have emancipatory aims but reflect assimilatory practices, paradoxically disempowering women who do not subscribe to ideals of individual autonomy. Consequently, the migrant mother, her family and new baby are brought into a neoliberal project of maternal improvement through surveillance. This project – enacted differentially but consistently among nurses – attempts to alter maternal and familial relationships by ‘improving’ mothering. Feminist critiques of patriarchy in maternity must be supplemented by a critique of the implicitly western subject of maternity to make empowerment a possibility for all mothers.
I am a member of the Perinatal Mental Health New Zealand Trust (PMHNZ) whose vision is to : “improve outcomes for families and whanau affected by mental illness related to pregnancy, childbirth and early parenthood”. They produce a quarterly newsletter that includes information about research, training, workshops and courses, innovative projects and services, topics for discussion and stories. It was a privilege to share my research with other members in the February newsletter (pdf) and on this Women’s day it seems apt to share it with a broader audience.
One of my favourite stories that I would tell when we ran workshops in the nineties about postnatal depression was by Jack Kornfield. I would share this story and half the room would be in tears.
“There is a tribe in East Africa in which the art of true intimacy is fostered even before birth. In this tribe, the birth date of a child is not counted from the day of its physical birth nor even the day of conception as in other village cultures. For this tribe the birth date comes the first time the child is a thought in its mother’s mind. Aware of her intention to conceive a child with a particular father, the mother then goes off to sit alone under a tree. There she sits and listens until she can hear the song of the child that she hopes to conceive. Once she has heard it, she returns to her village and teaches it to the father so that they can sing it together as they make love, inviting the child to join them. After the child is conceived, she sings it to the baby in her womb. Then she teaches it to the old women and midwives of the village, so that throughout the labor and at the miraculous moment of birth itself, the child is greeted with its song. After the birth all the villagers learn the song of their new member and sing it to the child when it falls or hurts itself. It is sung in times of triumph, or in rituals and initiations. This song becomes a part of the marriage ceremony when the child is grown, and at the end of life, his or her loved ones will gather around the deathbed and sing this song for the last time.” A Path with Heart (1993, p. 334).
For me the message in this story reflects the importance of love, being loved by a community and the importance of acknowledgement. Painfully, however, it highlights the ways in which women’s experiences of maternity can be just the opposite. That is, they can feel isolated, disrespected and invisible. As a clinician, I’ve learned that there are ways in which we, and the system that we work in can make this most magnificent, sacred and profound time in a woman and her family’s life also one that is painful, one that leaves long lasting scars. Health professionals can cause harm even especially when we think we are doing good. As an academic for 13 years prior to which I worked as a clinician for 10 years, I am deeply interested in the issue of power and how professional frameworks of care can undermine women’s personal experiences.
This song has been the background soundtrack to my recently completed PhD. I used data from a study funded by the Families Commission and assisted by Plunket, where I talked to 40 migrant women about their experiences of becoming mothers in New Zealand. I also talked to Plunket nurses about their experiences of caring for women from ethnic migrant backgrounds.
My motivation for doing research was prompted by my clinical experiences. Several years ago I decided to make a move from working in mental health to working in maternity. As someone who had worked as a community mental health nurse I took a lot of concepts about my work in mental health into this new setting, for example, I believed that care should be client centred and driven, that services should fit around consumers of services and that taking time to be with people was important. What I found in the institutionalised setting of hospital maternity care and later community care was that some of the routine procedures that are administered in hospitals and in the community with good intentions had negative impacts and were oppressive especially for women who did not tidily fit into the mould for the factory style model that was in place then. The conveyor belt metaphor is apt given that women who were the wrong fit were viewed as a problem, as only a single way of becoming a mother was acceptable. I saw that staff were frustrated at the extra demands or complexity of working with ‘diverse’ women, they lacked resources like time and knowledge. In turn, I could see that women who valued particular kinds of social support, acknowledgement and rituals were not getting their needs met. It seemed like a situation where no one was a winner.
What I found out in my research was that there was a big gap in satisfaction among women who were familiar with the structure of maternity services in the west and women whose lives had been shaped by growing up in other cultural contexts. Fundamentally there was a schism in the ways in which birth was understood. To be simplistic, western modes of being a mother valued independence, autonomy, taking up expert knowledge and using it and being an active consumer. By that I mean the individualising of responsibility for maternity on the mother, to take up scientific knowledge through reading self help books and for the role of the partner to be a birth coach and the goal of birth to be “natural”.
This dominant Pakeha middle class model of being a mother clashed with other understandings of motherhood, where responsibility was more collectivised, so that embodied knowledge from cultural authority figures (mother and mothers in law) protected mothers and where a range of rituals and supports were available for the mother (including some which were also not necessarily helpful). Women who became mothers in New Zealand had to negotiate these two different models of maternity and come to terms with what they negotiated. However, in the context of an assimilatory maternal health system it was very difficult for women to maintain traditions that were important to them. For example many women were not supported if they wanted to bring in traditional foods with them or have support from grandmothers. Many of these encounters left migrant mothers feeling disempowered. Another important clash was the different philosophies and roles of professionals and mother in the context of midwifery models and medical models. Some women viewed birth as a risky process and wanted the reassurance of visualising technologies. The view of birth as a risky process clashed with midwifery models of birth as a natural process that women are physically prepared for but need encouragement and support with.
Conclusion How can we support all kinds of women with different values, beliefs and rituals around birth, to feel loved, nurtured, safe and supported? How can we give women who might be separated from their loved ones, support to access those values, beliefs and that will allow them to manage the transition into motherhood? Returning to the metaphor of singing, and the power of connection it engenders, how can we connect and support people who are singing different kinds of songs? Can we adjust our tone so that we can harmonise? Can new songs and rhythms infuse the songs we already know with new energy and possibility?
Having a baby in New Zealand without your support base http://www.mentalhealth.org.nz/kaixinxingdong/page/486- resources+dragon-babies+parents-stories ￼
When my parents were considering migrating from East Africa, their focus was on the white settler contexts of Australia, New Zealand, Canada and the United States. For a bunch of reasons I won’t go into here, they settled on Aotearoa New Zealand. A part of me always felt like my life would have been better if we’d moved to Canada or the United States, because there would have been a bigger Goan community and more support for my family. I reasoned I might have felt more culturally confident, more capable at speaking Konkani. My visit to Canada in October helped me accept the gift that my parents had given me in migrating to Aotearoa New Zealand. By not being wrapped in the comforting cocoon of an insular diasporic community, I had to figure out my own relationship with my personal and cultural history but also what Ghassan Hage terms, an ethical relationship with colonisation and living on colonised land. Visiting Canada and meeting terrific indigenous people and migrant scholars allowed me to see the contrast between Canada’s genocidal history and its self-representation as a benign, civilised and benevolent nation. The parallels between Aotearoa and Canada of a colonial history supplemented by exploited migrant labour to meet settler ends mirrored the clearly unfair outcomes in measures of health, well-being and prosperity for indigenous peoples that I see in Aotearoa New Zealand as a health professional. For the first time I began to see how the issues I’d been grappling with as a migrant were replicated across seemingly disparate white settler contexts.
The Idle No More movement which began on Great Turtle Island on December 10, 2012 was initiated by four women Nina Wilson, Sylvia McAdam, Jessica Gordon & Sheelah McLean in response to legislation (Bill C-45) affecting First Nations people and gained momentum with the hunger strike by Attawapiskat First Nation Chief Theresa Spence. Impressively the United Church of Canada has acknowledged it’s complicity in colonization, inequality and abuse, through being one of the bodies that ran Indian Residential Schools. In 1986 they apologized to Aboriginal peoples for confusing “Western ways and culture with the depth and breadth and length and height of the gospel of Christ.” Apologizing to former residential schools students in 1998. Their response to the Idle No More movement has been to fully support Chief Spence’s statement that “Canada is violating the right of Aboriginal peoples to be self-determining and continues to ignore (their) constitutionally protected Aboriginal and treaty rights in their lands, waters, and resources.”
Other activists have also taken note of the commonalities of the struggle, noting how how what is particular, has universal relevance. Naomi Klein notes that
During this season of light and magic, something truly magical is spreading. There are round dances by the dollar stores. There are drums drowning out muzak in shopping malls. There are eagle feathers upstaging the fake Santas. The people whose land our founders stole and whose culture they tried to stamp out are rising up, hungry for justice. Canada’s roots are showing. And these roots will make us all stand stronger.
International support has come from the occupied lands of Palestine and indigenous communities around the globe. In Aotearoa New Zealand a Facebook page has been developed called Aotearoa in Support of Idle No More: Maori women’s group Te Wharepora Hou, a collective of wāhine based in Tāmaki Makaurau Auckland with a commitment to ensure a stronger voice for wāhine have also pledged support. As a migrant occupying a disquieting position in a country working through issues of biculturalism and mutliculturalism in a monocultural context. Diasporic migrant communities and organisations have also backed the Idle No More movement, with South Asian activists and BAYAN-Canada, an alliance of progressive Filipino organizations noting the similarities between migrant experiences and indigenous struggles.
Immigrants in Support of Indigenous Rights via Harsha Walia Photo credit: Cameron Bode
How do we do engage with an indigenous struggle when we do and don’t belong at the same time? Himani Bannerji notes in a Canadian context (but one that readily resonates through various white settler contexts):
So if we problematize the notion of ‘Canada’ through the introjection of the idea of belonging, we are left with the paradox of belonging and non-belonging simultaneously. As a population, we non-whites and women (in particular, non-white women) are living in a specific territory. We are part of its economy, subject to its laws, and members of its civil society. Yet we are not part of its self-definition as ‘Canada’ because we are not ‘Canadians.’ We are pasted over with labels that give us identities that are extraneous to us. And these labels originate in the ideology of the nation, in the Canadian state apparatus, in the media, in the education system, and in the commonsense world of common parlance. We ourselves use them. They are familiar, naturalized names: minorities, immigrants, newcomers, refugees, aliens, illegals, people of color, multicultural communities, and so on. We are sexed into immigrant women, women of color, visible minority women, black/South Asian/Chinese women, ESL (English as a second language) speakers, and many more. The names keep proliferating, as though there were a seething reality, unmanageable and uncontainable in any one name. Concomitant with this mania for naming of ‘others’ is one for the naming of that which is ‘Canadian.’ This ‘Canadian’ core community is defined through the same process that others us. We, with our named and ascribed otherness, face an undifferentiated notion of the ‘Canadian’ as the unwavering beacon of our assimilation.
The experiences of marginalisation that Bannerji elucidates can guide our responses to the Idle No More movement. Gurpreet Singh from Vancouver, notes that South Asian seniors have always referred to the indigenous peoples as Taae Ke (family of elderly uncle). If we see a familiar connection between what we ourselves experience as migrants and extend that empathy to the struggles of indigenous people who have experienced an inter-generational slow genocide, we might be able to see beyond our own oppression and our view that we are too far outside the structures of power to claim a space. Privileged in some ways, disadvantaged in others, our futures are tightly imbricated in this indigenous struggle. Our presence has sometimes diffused indigenous claims and we must consider our complicity in the continuing colonisation of indigenous people. We must put pressure on governments to recognise the rights of indigenous people and their unique place as guardians of the lands we stand upon, our futures depend on it.
At the asset sales March in Auckland in April 2012. Banner by YAFA-Young Asian Feminists Aotearoa. Photo by Sharon Hawke.
So if you really want to hurt me, talk badly about my language. Ethnic identity is twin skin to linguistic identity—I am my language. Until I can take pride in my language, I cannot take pride in myself —Gloria Anzaldua.
Language maintenance and pluralism mean different things to different groups. Multilingualism is an act of survival for linguistic minorities, but read as a deviation, a threat, a sign of defiance and a rejection of fundamental nation-state values by the dominant culture in migrant receiving and white settler contexts. This interpretation of language pluralism is epitomised in the Stormtroopers of Death song Speak English Or Die (1985).
You come into this country You can’t get real jobs Boats and boats and boats of you Go home you fuckin’ slobs Selling hot dogs on the corner Selling papers in the street Pushing, pulling, digging, sweating Where you come from must be beat[CHORUS] You always make us wait You’re the ones we hate You can’t communicate Speak English Or DieYou don’t know what I want You don’t know what I need Why must I repeat myself Can’t you fuckin’ read? Nice fuckin’ accents Why can’t you speak like me What’s that dot on you head, Do you use it to see?
I was reminded of it with the news of a racist incident in Melbourne where a group of French-speaking women travelling on a bus were told by another woman to “speak English or die”. The verbal abuse captured on video shows a second man threatening to cut the woman with a knife. The knives remained in the kitchen in a New Zealand Herald report about the unfair dismissal of a chef who in addition to the sin of not knowing the difference between types of tofu “insisted on listening to Indian music and speaking Hindi” which “affected” customers. This anxiety about the speaking of languages other than English extends to the policy sphere with many states in the US introducing legislative bills to make English the official state language, for example Minnesota in 2011. Even signs in languages in other languages provoke discomfort. Massey University researchers Robin Peace and Ian Goodwin found some New Zealanders responded with “annoyance” or “repugnance” when confronted with a space that did not make immediate, translatable sense.
What is with this monolingual sense of entitlement over public space and deep rage that is provoked by people speaking (or singing as the Frenchwomen were) in their own language?
I think it has a lot to do with how “we” might imagine “ourselves”. Language is a glue that coheres people, identities and values. Hearing a different language represents a threat to the power relations of the dominant group.
Immigrants are not supposed to be heard…. Immigrant culture and language—assumed to have little prestige or usefulness in comparison with the dominant American culture and the English language—are supposed to fade away quickly as assimilation runs its course—Castro, 1992.
The anxiety (Xenoglossophobia) generated in hearing a language that is out-of-place, reflects an anxiety about broader demographic changes that have resulted in the browning of our societies. Having a monoglot ideology though means that linguistic diversity is denied and prohibited. If English is the only language that can be heard, then this effectively silences other languages, cultures and ideas.
Assimilationist and genocidal approaches to linguistic plurality have been central to settler capitalist histories requiring the coercive adoption of majority languages in the interests of economic development. Monolingualism was fundamental to economic growth and supporting language minority rights was viewed as a threat to the nation-state because of having an unassimilated ‘other’ (Phillipson, Rannut, & Skutnabb-Kangas, 1994, p. 4). Colonisation and migration led many to abandon their own languages in order to access the social and political benefits of incorporation and assimilation or risk being stigmatised. My experience of trying to reclaim my own language is relevant here. The Portuguese colonisation of Goa led to the Konkani language being marginalised through the enforcement of Portuguese. This linguistic displacement made Konkani the lingua de criados (language of the servants) as Hindu and Catholic elites turned to Marathi and Portuguese respectively. Ironically Konkani is now the ‘cement’ that binds all Goans across caste, religion and class and in 1987 Konkani was made an official language of Goa. Ironically, contemporary iterations of [neo]colonial and [neo]liberal agendas require the appropriation of languages in the interests of global capital, as seen by the push for Chinese language learning in Australia, with monolinguists questioning the global relevance of indigenous languages. Setting up a familiar dynamic of competing indigenous and migrant others. Interestingly the National Statement on Language Policy published by The Human Rights Commission reflects these tensions:
Human Rights and Responsibilities
The right to learn and use one’s own language is an internationally recognised human right. Human rights treaties and declarations specifically refer to rights and responsibilities in relation to indigenous languages, minority languages, learning and using one’s mother tongue, the value of learning international languages, and access to interpretation and translation services. The New Zealand Bill of Rights Act provides that ‘a person who belongs to an ethnic, religious, or linguistic minority in New Zealand shall not be denied the right, in community with other members of that minority, to enjoy the culture, to profess and practise the religion, or to use the language of that minority’.
New Zealand has a particular responsibility under the Treaty of Waitangi and international law to protect and promote te reo Mäori as the indigenous language of New Zealand. It also has a special responsibility to protect and promote other languages that are indigenous to the New Zealand realm: Vagahau Niue, Gagana Tokelau, Cook Island Mäori, and New Zealand Sign Language. It has a regional responsibility as a Pacific nation to promote and protect other Pacific languages, particularly where significant proportions of their communities live in New Zealand.
A significant and growing proportion of New Zealand’s trade is with Asia and learning the languages of our key trading partners is an economic imperative.
get the right job and contribute to future prosperity
speak and understand New Zealand English
know how to access information and services
feel proud and confident
understand and contribute to New Zealand society.
But there is no emphasis on language maintenance.
Aotearoa New Zealand and linguistic pluralism
Aotearoa New Zealand has two official languages: Te Reo Māori and New Zealand Sign Language (NZSL). English is a de facto official language as it is widely used in Aotearoa, English is spoken by 95.9 percent of people, after which the most common language in which people are proficient in is Māori, spoken by 4.1 percent (157,110 people). 24,090 people report being able to use New Zealand Sign Language and 6,057 people can communicate in all three official languages. Between 2001 and 2006, the numbers of people in New Zealand who spoke Hindi almost doubled, from 22,749 to 44,589, the number of people able to speak Northern Chinese (Mandarin) increased from 26,514 to 41,391, the number of people able to speak Korean increased from 15,873 to 26,967, and the number of people able to speak Afrikaans increased from 12,783 to 21,123. The number of multilingual people increased by 19.5 percent between the 2001 and 2006 Censuses to reach 671,658 people, a 43.3 percent increase from 468,711 people in 1996. Where you were born has a big impact on whether you speak two or more languages, overseas-born residents are more likely than New Zealand-born usual residents to be able to speak two or more languages. 35 percent of overseas-born children (aged 0 to 14 years) speak two or more languages, compared with 11.5 percent of New Zealand-born children. As do working-age people aged between 15 to 64 years, of whom almost half 48.5 percent were multilingual, compared with 10.0 percent of New Zealand-born people. In 2006, 2.2 percent of people could not speak English. Of these, the majority were born overseas (80.3 percent).
Being fluent in three languages but not in Konkani when I arrived in New Zealand (and now not being able to speak at all in Maragoli and poorly in Swahili) has taught me that languages open up different ways of thinking and of understanding the world, but fluency isn’t passive. It must be nurtured in the context of a community. The last New Zealand Census identified that there were 588 Konkani speakers in Aotearoa, an increase from 210 in 2001. This rise gives me great heart and hope for the possibility that I might be able to reclaim my own language (amchi bas). Learning other languages has taught me to empathise and to advocate. Perhaps more than anything this is what learning another language or reclaiming our own language offers us, a chance to connect with ourselves and others in ways that are truly meaningful, but that too must be fostered.
If you talk to a [wo]man in a language [s]he understands, that goes to [her]/his head. If you talk to [her]/him in [her]/his language, that goes to [her]/his heart—Nelson Mandela