Throughout Australia, culturally and linguistically diverse (CALD) women experience worse reproductive health outcomes than their peers. The roadblocks surrounding reproductive care are complex and hard to shift – not just for the CALD women trying to access care, but for those trying to provide it.
Ahead, we look at some of the challenges you may be facing in this space, and ways to make a meaningful difference.
Australia is one of the most multicultural countries worldwide. Almost half of our population are migrants or have parents who were born overseas, while 21% speak a language other than English.
Despite our vibrant nation, our health system struggles to cater for such diversity. When it comes to reproductive healthcare in particular, CALD women have very different experiences to that of their non-Indigenous, Australian-born peers.
Studies, while limited, show that CALD women are more likely to experience teen pregnancy, stillbirths and pregnancy complications. Many migrant and refugee women also have inadequate knowledge of STIs, menstruation, menopause and the importance of cervical screening .
“As healthcare professionals, we have a responsibility to do better in the care we provide to change these [findings]”, says Dr Marrwah Ahmadzai, an obstetrics and gynaecology registrar at Canberra Health Services, Australian of the Year Award finalist, and an advocate for providing culturally inclusive healthcare. Though, she admits this can be an uphill battle at times.
According to Dr Ahmadzai, the barriers stopping many CALD women from accessing comprehensive reproductive care are “complex and multifactorial”.
“Many factors may contribute which are not only at an individual patient level but also at a healthcare practitioner and systems level.”
For starters, our health system can be difficult to navigate and the cost of healthcare can be “a major disincentive”, particularly for CALD women without access to Medicare or private health insurance, she says.
Cultural and religious factors can also play a role. For example, research shows that 23% of culturally diverse women in Australia are “too embarrassed” to access sexual and reproductive health services, while 12% cite “shame if anyone sees me” as a barrier. Dr Ahmadzai explains that in some groups, discussing reproductive health issues is taboo, while contraception use may be forbidden or frowned upon.
There are also often language barriers to overcome. “Although interpreters are available…they are under-utilised”, she says. “It can take time to find an interpreter if it is not pre-arranged [and] sometimes patients decline interpreters even if they are offered.” It could be that the patient knows the interpreter and feels uncomfortable discussing sensitive issues through one, explains Dr Ahmadzai.
For healthcare workers, the process isn’t smooth sailing either.
Piergiorgio Moro, co-ordinator of the Multicultural Health Support Service (MHSS) – a program of the Centre for Culture, Ethnicity & Health – says he has met countless health professionals determined to provide quality care to CALD communities. “They work a lot of overtime and it’s not fair”, he says.
Dr Ahmadzai agrees that “time constraints and limited access to culturally safe resources may be barriers that health professionals face”.
It’s why Mr Moro recommends GPs do the best they can in the time they have available. Making a meaningful connection with your patient means she is more likely to re-engage with the health system later, he says.
Women’s reproductive healthcare has many facets. It includes abortion access, contraception/LARC access, heavy bleeding management, hysterectomy, cervical screening tests, STI testing and management, infertility management, prenatal counselling, antenatal care, post-partum care, gynaecological cancer care and menopausal management.
For health professionals, it’s important to feel confident and supported when providing reproductive care. Being able to direct CALD patients to the right in-language information can also make a difference. Below are some services and resources you may find useful:
If you have CALD patients, Dr Ahmadzai and Mr Moro offer these tips for a meaningful connection: