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Book review: This Bridge called my back

I have been a long-time fan of the New Zealand Mental Health Foundation. Starting in 1996 I did some workshops in Northland and around for the community about Depression, while I worked in perinatal mental health. Later, I co-produced a brochure about perinatal mental health for them. So, when the fabulous Kim Higginson asked me if I would feature in a new section on their website, I had to say yes! In My Kete features book reviews and stories from people in the mental health sector sharing what they have found most helpful in their own work and lives. The word/kupu “kete” symbolises the sharing of knowledge and prosperity.

Ceramic kete gifted to me with found sulphur crested cockatoo feathers

Long before social media, my family would eagerly watch the 6pm news. As new migrants to Aotearoa, we would watch with anticipation for even a tiny glimpse of the places we had left behind, that we were connected to. Goa, our turangawaewae, the home of our ancestors, or Tanzania or Kenya, where we had all been born and lived. But it was the seventies, and the closest we ever came was hearing about the famines in Ethiopia and civil war in Angola, until the Montreal Olympics of 1976. We couldn’t wait for the Kenyan and Tanzanian runners like Filbert Bayi to absolutely smash all the other athletes. We knew they were the best!

Our anticipation was thwarted by bigger events. The New Zealand All Blacks had been playing rugby in apartheid South Africa despite the United Nations’ calls for a sporting embargo. 28 African countries led by Tanzania decided to boycott the games after they had asked the International Olympic Committee (IOC) to exclude New Zealand from the Games and were refused. The United Nations secretary-general said he recognised the “deep and genuine concerns” felt by African countries but, “at the same time I wish to point out that the Olympic Games have become an occasion of special significance in mankind’s search for brotherhood and understanding.”

The story about the Olympics shows how keen I was to see anything of my world reflected to me through the collective sphere or mass media. But this was rare, and when I did see something, it was often a globalised reflection of famine, disease or deficit. So I turned to literature. I was a frequent visitor to Titirangi Library in West Auckland, where I discovered Ms Magazine and read every issue I could get my hands on. Through authors like Germaine Greer and Andre Dworkin, I read that white feminism was good and brown women were oppressed by their cultures. I struggled to reconcile this idea of brown men as bad. The men I knew in my community (who were very few in NZ in those days), were also struggling with racism, economic disadvantage and white supremacy. My Dad worked two jobs (as a teacher and then as a cleaner) so that my mother could study to become a teacher. He then came home and did the cooking, while my three sisters and I administered the household so that my mother could study, and our collective free time could be spent on family outings.

Reading This Bridge Called My Back was life changing. For the first time, I saw women of colour foregrounded. They were powerful, knowing, wise, and full-bodied; not deficient, in need of rescuing or pathological. I saw them navigating complicated worlds that were not built for them. I saw collective struggles and collective joy. These stories resonated with me so much I developed a desire for collective solidarities, which led to conference organising (for refugees and Indian social service professionals) and connecting and bringing diverse voices together (the Aotearoa Ethnic Network). I moved beyond exploring gender and incorporated other axes of difference including race, class and sexuality into my academic life. I still carry this work with me as I think about race and health as a researcher. I remain indebted to the solidarities that were brought together in this anthology, for giving me hope and pride in my differences, while also reminding me to always think about who and what is missing from the room, whose voices are not heard and how this can be remedied.

Book Details
Moraga, Cherríe., & Anzaldúa, G. E. (eds.). (1981). First edition. This bridge called my back: Writings by radical women of color. Persephone Press. ISBN 978-0930436100
Moraga, Cherríe., & Anzaldúa, G. E. (eds.). (2021). This bridge called my back: Writings by radical women of color. Fortieth Anniversary Edition. Suny Press. ISBN: 9781438488288

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Mouthing off about oral health

I have had several tooth adventures. The time I rather enthusiastically pushed my middle sister on her bicycle and she fell over the handlebars breaking a tooth (or was that the time I helped her break her collar-bone?). My own dental fluorosis (a developmental disturbance of enamel that results from ingesting high amounts of fluoride during tooth mineralization) and my mother’s sobering experience of periodontal disease. Not to mention my parents’ adventures in dental tourism, but I’ll save those for another time.

Apart from the personal injunction to clean and floss my teeth, I didn’t think too much about oral health as a mental health clinician until I’d left clinical practice for education, when I found myself at AUT University in a faculty committed to inter-professional education and practice, where “current or future health professionals to learn with, from, and about one another in order to improve collaboration and the quality of care.”

 

We had learned about oral health as undergraduate nurses, particularly about post-operative oral health care and oral health for older people. But even when working in acute mental health units, community mental health and maternity, I hate to admit, oral health wasn’t on my mind. Unsurprisingly, evidence shows that even though oral health is a major determinant of general health, self esteem and quality of life, it often has a low priority in the context of mental illness (Matevosyan 2010).

As the programme leader of health promotion at AUT, a colleague in the oral health team asked me to talk to her students about the connections between mental health and oral health and that’s when my journey really began. I also had the pleasure of getting my teeth cleaned and checked at the on site Akoranga Integrated Health at AUT whose services were provided by final year and post graduate health science students under close supervision of a qualified clinical team.

It made me think about how oral health care is performed in a highly sensual area of the body. I learned that oral tissues develop by week 7 and the foetus can be seen sucking their thumb. It made me think about how suckling and maternal bonding are critical after birth. It made me think about how we use our mouths to express ourselves and to smile or show anger or shyness, literally 65% of of our communication. It made me think about kissing in intimate relationships and therefore also about how it’s not at all surprising that our mouths also represent vulnerability and that people might consequently suffer from fear and anxiety around oral health treatment. This can range from slight feelings of unease during routine procedures to feelings of extreme anxiety long before treatment is happening (odontophobia). Reportedly, 5-20% of the adult population reports fear or anxiety of oral health care, which can lead to avoidance of dental treatment and common triggers can include local anaesthetic injection and the dental drill.

Poor oral health has a detrimental effect on one’s quality of life. Loss of teeth impairs eating, leading to reduced nutritional status and diet-related ill health. A quarter of Australians report that they avoid eating some foods as a consequence of the pain and discomfort caused by their poor dental health. Nearly one-third found it uncomfortable to eat in general. Oral disease creates pain, suffering, disfigurement and disability. Almost one-quarter of Australian adults report feeling self-conscious or embarrassed because of oral health problems, impacting on enjoyment of life, impairing social life or leading to isolation with compromised interpersonal relationships

People with severe mental illness are more likely to require oral health care and have 2.7 times the general population’s likelihood of losing all their teeth (Kisely 2016). Women with mental illness have a higher DMFT index (the mean number of decayed, missing, and filled teeth) (Matevosyan 2010). In particular, oral hygiene may be compromised. For people who experience mood disorders, depressive phases can leave person feeling worthless, sad and lacking in energy, where maintaining a healthy diet and oral hygiene become a low priority. The increased energy of manic episodes can mean energy is diffused, concentration difficulties and poor judgement. People who experience mental ill health and who self-medicate with recreational drugs and alcohol can further exacerbate poor oral health. Furthermore, drug side effects can compromise good oral health by increasing plaque and calculus formation (Slack-Smith et al. 2016). It is important for mental health support staff to provide information regarding oral health, in particular education about xerostomic (dry mouth) effects of drug treatment and strategies for managing these effects including maintaining oral hygiene, offering artificial saliva products, mouthwashes and topical fluoride applications.

There are organisational and professional barriers to better oral health in mental health care. Mental health nurses do not routinely assess oral health or hygiene and lack oral health knowledge or have comprehensive protocols to follow. As Slack-Smith et al. (2016) note there are few structural and systemic supports in care environments with multiple competing demands. Research shows that dentists are more likely to extract teeth than carry out complex preventative or restorative care in this population. Mental health clinicians are reluctant to discuss oral health and in turn oral health practitioners are not always prepared for providing care to patients with mental health disorders.

Which brings me to the topic of this blog post. Until the 17th century, medical care and dental care were integrated, however, dentistry emerged as a distinct discipline, separate from doctors, alchemists and barbers who had had teeth removal in their scope of practice (Kisely 2016).

Cox, S.; A Country Toothdrawer; Wellcome Library; http://www.artuk.org/artworks/a-country-toothdrawer-125814

Cox, S.; A Country Toothdrawer; Wellcome Library; http://www.artuk.org/artworks/a-country-toothdrawer-125814

I spent the weekend at the Putting the Mouth Back into the Body conference, an innovative, multidisciplinary health conference hosted by North Richmond Community Health. It got me thinking about the place of the mouth in the body and developed my learning further. The scientific method and the mechanistic model of the body central to the western biomedical conception of the body, have led us to see the body in parts which can be attended to separately from each other. And yet we know what affects one part of the body affects other parts. There’ll be an official outcomes report produced from the conference, but I thought I’d capture some of my own reflections and learning in this blog post.

Equity and the social determinants of dental disease

Tooth decay is Australia’s most prevalent health problem with edentulism (loss of all natural teeth) the third-most prevalent health problem. Gum disease is the fifth-most prevalent health problem. Tooth decay is five times more prevalent than asthma in children. Oral conditions including tooth decay, gum disease, oral cancer and oral trauma create a ‘burden’ due to their direct effect on people’s quality of life and the indirect impact on the economy. There are also significant financial and public health implications of poor oral health and hygiene. Hon. Mary-Anne Thomas MP, Parliamentary Secretary for Health and Parliamentary Secretary for Carers spoke about the impact of oral health on employment. She reinforced research findings which show that people with straight teeth as 45 per cent more likely to get a job than those with crooked teeth, when competing with someone with a similar skill set and experience. People with straight teeth were seen as 58 per cent more likely to be successful and 58 per cent more likely to be wealthy. Dental health is excluded from the Australian Government’s health scheme Medicare, which means that there is significant suffering by those who cannot afford the cost of private dental care for example low-income and marginalised groups. Dental care only constitutes 6% of national health spending and comprehensive reform could be effected with the addition of less than 2 percentage points to this says a Brotherhood of St Lawrence report (End the decay: the cost of poor dental health and what should be done about it by Bronwyn Richardson and Jeff Richardson (2011)). The socially
disadvantaged also experience more inequalities in Early Childhood Caries (ECC) rates. Research has also shown that children from refugee families have poorer oral health than the wider population. A study by my colleagues at North Richmond Community Health and University of Melbourne found that low dental service use by migrant preschool children. The study recommended that health services  consider organizational cultural competence, outreach and increased engagement with the migrant community (Christian, Young et al., 2015).

The interactions between oral health and general health 

Professor Joerg Eberhard spoke about the interactions between oral and general health through the lifespan. His talk also demonstrated the importance of oral hygiene, not only to prevent cavities and gum disease but impact on pregnancy, diabetes and cardiovascular health. 50 to 70 per cent of the population have gingivitis and severe gum disease (periodontitis) which develop in response to bacterial accumulation have adverse effects for general health. He showed participants the interactions of oral health and general health with a focus on diabetes mellitus, cardiovascular disease and neurodegenerative diseases. Most strikingly, Eberhard’s research published in The International Journal of Cardiology in 2014, showed periodontitis could undermine the major benefits of physical activity. If you are interested in the link between oral health and non-communicable diseases, this Sydney Morning Herald article provides a great summary.

Key points:

  • What effects the body also affects the mouth, in fact this is bidirectional.
  • Early experiences impact lifelong health eg sugar preference, early cavities, diet.

Sugar is a significant culprit

I learned a lot about sugar from Jane Martin the Exective Manager of the Obesity Policy Coalition and Clinical Associate Professor Matthew Hopcraft an Australian dentist, public health academic and television cook. 52% of Australians exceed the WHO recommendations for sugar intake, and half of our free sugars come from beverages. Sugar intake profoundly impacts cavities and our contemporary modes of industrial food production are to blame. We also need to challenge the subtle marketing of energy dense nutrient poor products eg the ubiquity of fizzy drink vending machines. To that end both Universities in the United States and health services worldwide (see NHS England) are taking the initiative to phase out the sale and promotion of sugary drinks at their sites. At the University of Sydney a group of students, researchers and academics are taking this step through the Sydney University Healthy Beverage Initiative. Check out this fabulous social marketing campaign with indigenous communities in Australia by Rethink Sugary Drink. Sugar-free Smiles advocate for public health policies and regulatory initiatives to reduce sugar consumption and improve the oral health of all Australians. There’s also the Sugar by half campaign.

sugary-drinks

Key points:

  • We need to think about what we are eating.
  • Oral health promotion and oral health literacy are important.
  • We need to think about the addition of sugar in foods that are ostensibly good for us (cereal and yoghurt for breakfast for example).

The case for working collaboratively: The example of pharmacists

Dr Meng-Wong Taing (Wong) from the University of Queensland persuasively argued how other professionals can have a major role in promoting both oral health and helping to lower the risk of suffering other serious conditions, such as diabetes or cardiovascular disease. Wong cited recent research findings describing the role of Australian community pharmacists in oral healthcare that show 93 per cent of all community pharmacists surveyed believed delivering oral health advice was within their roles as pharmacists. People in lower socio-economic areas often can’t afford to see a dentist and so pharmacies are the first port of call for people experiencing oral health issues. The 2013 ‘National Dental Telephone Interview Survey’, which found the overall proportion of people aged five and over who avoided or delayed visiting a dentist due to cost was 31.7 per cent, ranging from 10.7 per cent for children aged five-14 to 44.9 per cent for people aged 25-44.

Wong’s presentation and those of other speakers over the two days showed the importance of Interprofessional Collaboration (IPC)

IPC occurs when “multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers, and communities to deliver the highest quality of care across settings” (WHO 2010, p. 13).

Key points:

  • How do we get oral health in health professional curricula? Particularly given the emphasis on the technocratic and acute at the expense of health promotion and public health.
  • How can we focus on oral health from a broader social determinants perspective?
  • Let’s improve access to services and oral health outcomes.
  • Let’s develop inter-professional approaches to undergraduate education.
  • Let’s develop collaborative approaches and avoiding the ‘siloing’ of oral health.
  • Let’s encouraging partnerships between oral health professionals and other health professionals, community groups and advocacy groups.
  • Rather than developing better systems, let’s have better relationships that are consumer centred (see above and AUT’s Interprofessional Education and Collaborative Practice (IPECP) website.

Perhaps the best news of the two days for me is that milk, cheese and yoghurt and presumably paneer, contain calcium, casein and phosphorus that create a protective protein film over the enamel surface of the tooth thereby reducing both the risk of tooth decay and the repair of teeth after acid attacks. This information validates my enjoyment of sparkling wine (low sugar but acidic) and cheese. Cheers.

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“I had to keep my options open”: White mothers and neoliberal maternity

Unpublished manuscript that never found an appropriate institutional home, but sharing for those who might be interested. Cite as: DeSouza, R., & Butt, D. (2016, June 11). “I had to keep my options open”: White mothers and neoliberal maternity. [Web log post]. Retrieved from: http://ruthdesouza.dreamhosters.com/2016/06/11/i-had-to-keep-my-options-open-white-mothers-and-neoliberal-maternity/

Where patriarchal healthcare institutions saw birth as a process controlled by male doctors and supported by female nurses, contemporary midwifery draws from liberal feminism the concept of “choice” as the marker of maternal agency. However, critiques of neoliberalism locate “informed choice”, “empowerment” and “partnership” as discursive markers of specific capitalist subjectivities that are unevenly distributed among class, race, and sex. The ideology of reproduction as choice aligns with Foucault’s notion of “governmentality”, where the managerial state promotes middle-class discourses of responsibilisation, transformation and empowerment to regulate and maximise the efforts of individuals within the social body. Previous research has shown how maternal care nurses and midwives are instrumental in reproducing these discourses, reflecting white middle-class ideals of the individual service user. This study explored these themes through a secondary discourse analysis on focus groups with white migrant mothers in Aotearoa New Zealand. While migrant mothers noted differences between the New Zealand context and their home nation, unlike ‘other’ migrant mothers they generally adhered to neoliberal requirements to make choices aligned with the expectations of the state. The mothers espoused ideals of natural birth that sat in tension with their notions of informed consumption, reflecting technoscientific discourses that have informationalised the maternal body and interpellated mothers into neoliberal ideologies. The paper argues that attention to the restricted discourses of choice as empowerment illuminates how settler-colonial maternal healthcare systems are limited in their universality, failing to escape cultural and class-based assumptions that empower some mothers at the expense of others. The paper concludes that critical healthcare analysis and methodologies such as cultural safety provide tools for the transformation of these discourses.

Keywords 
Maternity, whiteness, neoliberalism, Foucault, cultural safety.

Introduction

Midwifery discourses have advanced a feminist vision of women’s empowerment where women usurp patriarchal control of maternity institutions and increase their own power by becoming informed. However, the intrapersonal strategies of information accumulation and behaviour modification can leave structures of power intact and fulfil neoliberal ends. Facilitating a non-authoritarian, woman-centred ethic of care through liberal feminist values (such as individual choice and autonomy) allows mothers to choose to be healthy and productive, while also leading to a reduction in demands on the state as women govern themselves and each other (Collins, 2009). Although midwifery has positioned itself outside dominant norms as an anti-authoritarian discourse, these ‘choices’ are made within a neoliberal consumerist context of health care (Spoel, 2007). Midwifery is simultaneously constructed by these norms and reproduces them, masking new forms of social regulation shaping health care delivery in the process (Skinner, 1999; Spoel, 2006; O’Connell and Downe 2009). Consequently, the emancipatory promise of liberal feminism has disturbingly converged with the economic ‘freedoms’ of neoliberalism, in a discursive formation structured by whiteness. Where previous work established this formation in the discourses of maternal and child health nurses, this paper diagnoses neoliberal discourses employed by white informed consumers.
The dominance of whiteness in Western healthcare systems has been well established (see e.g. Allen, 2006). The liberal theoretical paradigm is deeply embedded in nursing, where those employed in care are rarely able to see how it structures their professional culture, in turn making it difficult to understand how adherence to seemingly neutral and egalitarian values (to white norms) can be oppressive. Whiteness here does not refer only to the visible phenotype of individuals, but to “a cultural disposition and ideology held in place by specific political, social, moral, aesthetic, epistemic, metaphysical, economic, legal, and historical conditions, crafted to preserve white identity and relations of white supremacy” (Bailey & Zita, 2007: vii). Although it is a scientific and cultural fiction like other racial identities, it has a real social impact on the distribution of resources due to a “possessive investment in whiteness” among white individuals (Lipsitz, 2006). A combination of public policy and private prejudice operate simultaneously to create this investment and perpetuate racialised hierarchies that structure access to resources, power and opportunity. Lipsitz contends that white supremacy is less a direct expression of contempt (as usually described by whites who distance themselves from the term), and more a system that protects white privilege and prevents communities of colour from accumulating assets and upward mobility. Complicating any direct identitarianism, Lipsitz contends that non-white people can become agents of white supremacy as well as passive consumers in its hierarchies— not all white people are equally complicit with white supremacy. White dominance and neoliberalism are two powerful and interrelated concepts that describe the systemic and structural forms that produce and reproduce ideal subjectivities. It is this relationship between subjective experience and institutional rationality that this paper seeks to illuminate.
Liberalism and neoliberal maternity
The revalorisation of liberal precepts into the global structures of institutional power termed neoliberalism has been most thoroughly documented by Michel Foucault. Foucault’s analysis of governmentality as “both a political discourse about the nature of rule and a set of practices that facilitate the governing of individuals from a distance” (Larner, 2006: 6) has particular resonance in health and in maternity. The birth of a future citizen is an event with great emotional, biological, cultural and social significance; and consequently the rites and routines that organize birth reflect core cultural values (Fox & Worts, 1999; Reiger, 2008). Maternal and infant public health has been shaped by state concern about the quantity and quality of population in the context of imperial rivalry, both in the centre of empire and the outer edge of white settlement (Lewis, 1988). The “health of the race” and infant health have been a central focus for doctors and politicians, with babies viewed as valuable assets in the struggle for imperial supremacy (Lewis, 1988). While such explicitly racial discourses are today less prevalent, maternity discourses and practices still reflect and reproduce historical and cultural visions of what it is to be a citizen (Georges, 2008). Good mothering and good governing are intimately linked. Foucauldian analysis in health has shown how institutions produce subjects as citizens, where health professionals are not simply individual agents constrained by institutions but develop their values, beliefs and skills within parameters guided (but not fully determined by) those institutions. Healthcare professionals such as nurses and midwives manage key processes through which hegemonic social subjects are reproduced, and thus reflect transformations in ideologies of the public and the citizenry (Fox & Worts, 1999). Maternal health is therefore a rich site to track shifts in public health from a sovereign technique of population management to a global industry in a neoliberal economic system.

Foucault’s analysis in The Birth of Biopolitics identified neoliberalism as the development of a “general regulation of society by the market” (Foucault, 2008: 145). It involves the enforcement of competition (rather than exchange) as the principle of the market in a game which one is not allowed to drop out of, “a sort of inverted social-contract” (Foucault, 2008: 201). Neoliberal economics becomes “no longer the analysis of the historical logic of processes; it is the analysis of the internal rationality, the strategic programming of individuals’ activity” (Foucault, 2008: 222). In this game, economics is redefined as a behavioural science governed by the “relationship between ends and scarce means which have mutually exclusive uses” (Foucault, 2008: 222). This “competitive ratio” is naturalised, and the neoliberal subject “accepts reality” by responding to “systematic modifications artificially introduced into the environment” — becoming “eminently governable” (Foucault, 2008: 270). Through the extension of market values to all institutions and social action, good neoliberal citizens are constructed as choice-making subjects, who take responsibility for maximising their healthy productivity and minimising risks to their health, reducing collective health demands upon the state.
Historically, women’s freedom during pregnancy was constrained by structural or physical factors to ensure the safety of mother and foetus. Improvements in health have led to the emergence of more subtle kinds of governmental regulation, where normalising strategies focussing on individual ‘lifestyle’ have developed in tandem with the new public health and risk discourses (Petersen & Lupton, 1996). Self-regulation through the internalisation of scientific knowledges and medical technologies and the corresponding modification of behaviour have become central to a type of ideal neoliberal subjectivity variously identified as the healthy citizen (Petersen & Lupton, 1996), the active consumer (Fox, Heffernan, & Nicolson, 2009) and the reflexive project of the self (Giddens, 1991).

Mothers are incited to take up the advice and guidance of experts; are incorporated into relations of surveillance and discipline; and are required to monitor and adapt their behaviour against normative discourses. Ideal neoliberal maternal subjects are scientifically literate, meet normative standards, and consume specialty objects and expert advice (Avishai, 2007). They invest in “intensive motherhood”, a pervasive ideology in Western culture that is: “child-centered, expert-guided, emotionally absorbing, labour intensive, financially expensive” Hays (1998: 46).
As Simon and Dippo (1986: 198) note, a historical and material perspective is required to understand the “nonarbitrary specificity” of power relations in the present, “for while the production and reproduction of social forms is a result of what people do, it can never be understood in terms of what they intend.” To that end, contemporary maternal speech must be linked to the historical conditions of its emergence. The history of midwifery development provides structural clues to the emergence of dominant discursive formations of maternity in New Zealand that enable, constrain and contest the narrated experience of migrant mothers.
Midwifery in New Zealand: erosion, erasure and re-emergence

Midwifery’s emergence as an autonomous feminist profession in New Zealand has been shaped by the desire for professional recognition among midwives and feminist aspirations for the control of birth to be returned to women, (Stojanovic, 2008). Midwifery training began in 1904 with the advent of the Midwives Act, prior to which trained midwives were imported from Britain. Free midwifery services became available to all women from 1938, either in their homes or in maternity hospitals (Pairman, 2006). The trends of medicalisation, hospitalisation and nursification eroded the autonomy of midwifery between 1904 and the 1970s (Stojanovic, 2008). For Māori, the Tohunga Suppression Act (General Assembly of New Zealand, 1907) curtailed the active involvement of tohunga (traditional knowledge specialists) in childbirth, and the expertise of Māori birth attendants or tāpuhi remained suppressed as midwives were trained in New Zealand. With fewer tāpuhi assisting birthing women in their homes, childbirth became relocated into state-owned maternity hospitals, which in the colonial view were thought to be safer and cleaner than Māori homes (Simmonds, 2011), even though Māori maternal mortality rose to three times that of non-Māori by the 1960s. Interventions to reduce infant mortality coupled with demands from women for pain-free childbirth increased the medicalisation of birth, leading to doctors supervising midwifery births and holding legal responsibility (Pairman, 2006). Nursification saw the merging of midwifery into nursing, the erasure of the word ‘midwife’ from legislation and the redefinition of the scope of midwifery practice within nursing (Stojanovic, 2008).
Autonomous midwifery practice (differentiated in scope from nursing) re-emerged through mutually beneficial political lobbying by consumers and midwives forcing legislative changes in the late 1980s. Spurred by decades of feminist struggle, maternity consumer activists saw autonomous midwifery practice as a mechanism for gaining increased control over their own birthing (Pairman, 2006). This pressure eventually led to the passing of the Nurses Amendment Act in 1990 which provided New Zealand women with the option of a caregiver (Lead Maternity Carer or LMC) who could either co-ordinate or provide the care they required from early pregnancy to six weeks postpartum (Pairman, 2006). Consequently, 75.3% of New Zealand women were registered with a midwife to provide lead maternity care in 2007 (Ministry of Health, 2007). Hence, partnership with women became a central tenet of New Zealand midwifery and to its claim as protector of the health of women from an intervening medical corpus (Reiger, 2008). The discourse of ‘partnership’ positions women as ‘naturally’ equipped and capable of carrying and delivering babies without physician monitoring or intervention in hospitals (Macdonald, 2006). The social model of this discourse locates risk not within the female body as under the medical model, but from power relations in the social world including poor support for women. In response, midwives have the capacity to nurture and empower the autonomous woman so that she is capable of birth without intervention (Lane, 2012). The study discussed here consisted of focus groups with mothers and maternal care professionals to evaluate the effects of these discourses and institutional arrangements on different groups of migrant women.
Study Design

The focus groups for this project were undertaken with the assistance of The Royal New Zealand Plunket Society (Plunket), and consisted of focus groups with five ethno-cultural groupings of new migrant mothers (including white mothers) about their maternity experiences (DeSouza, 2006; DeSouza, 2011). Ten first time mothers aged between 29-40 years, who had been living in New Zealand for between two and ten years took part in the white focus group. The women self-identified as ‘white’ and had migrated from South Africa (Jane and Charlotte), England (Nancy, Annette, Olive, Sarah, Carol), the US (Joan and Mary) and Scotland (Georgina). Four had post-graduate qualifications; four had under-graduate qualifications and one a trade certificate. Their occupations included: teacher, scientist, project manager, account manager, project manager, lecturer. Reasons for migrating included the New Zealand lifestyle and their husband’s careers. The group are not intended to be representative of all white female migrants, although the demographic bias of white migrants to New Zealand skews toward the upper-middle class. Of interest here are the range of available subject positions in the discourses represented and what implications those subject positions hold. Discourse analysis can aid understanding of the relationship between “subjectification (the condition of being a subject) and subjectivity (the lived experience of being a subject)” (Walkerdine, 2001: 20). In this case, the focus is on discourses of knowledgeable consumption, natural birth, and intensive motherhood.
Knowledgeable antenatal consumers

Mary invokes liberal feminist/woman centred tenets of choice, freedom and autonomy when she speaks about becoming pregnant through assisted reproductive technologies:

Mary: Artificial insemination… was something that was incredibly easy in New Zealand whereas in the States it would’ve been a lot more difficult and more expensive. For us moving to New Zealand was partly a life-style choice, we had a known donor and we found that we went to a fertility class and it was just incredible how helpful and inclusive they are and everything was really easy to do… more information is always good for us and we found that there was plenty of information for us. It’s like I said before we’ve been planning this for over five years so that was, their resources were there for us.

Mary’s excerpt reflects the liberal feminist ideal of a planned pregnancy and the control of reproductive processes (even in the context of assisted fertility), to which the democratisation of knowledge, its acquisition and demystification are fundamental. Mary positions herself as a responsible health consumer who makes choices (including migrating), within a caring and available system. She actively searches for and chooses the appropriate information, products and services from a saturated global market. Migration is a space where she can realise possibilities for mobility and self-actualisation, imbricating maternity in local and global patterns of consumption. Annette also positions herself as a knowledgeable and responsible consumer, who can both evaluate and challenge expert knowledges:

Annette: Although our doctor suggested certain paths that we could take I wasn’t necessarily in total agreement with what he wanted so I was trying to combine his knowledge with the information that I was reading as well.

Annette’s capacity to act and make choices is evident in her avoidance of informal and embodied knowledge in favour of formal knowledge:

Annette: When I found that I was pregnant the first thing I did was I bought a book named New Zealand Pregnancy Guide… although we have a lot of friends here I didn’t feel that I was in a position where I wanted to talk to anybody about the pregnancy because it was so early and I felt that the more people that I talked to and asked for their advice then if I did miscarry I’d have to tell everybody that I’d miscarried. So I was in that situation of having to try and discover a lot of information out by myself initially and I found that was a little bit overwhelming at times. But that book was particularly useful and then I phoned I think the Ministry of Health and got a list of midwives. And then to be quite honest it was absolutely useless, because I just looked at this list and I’m going, ‘well where do I start’? So you are in this catch 22 thinking ‘do I phone this person? Would they come to me because we’re on the other side of town?’ I didn’t have any recommendations. It was literally a list and it meant nothing to me.

Annette’s preference for purchasing a book of expert knowledge about pregnancy in New Zealand—rather than seeing her networks and friends as primary resources—is emblematic of her desire to produce herself as an autonomous, composed, and rational individual, avoiding public judgement upon her possible failure to reproduce. Her unwillingness to expose her pregnancy and potentially complicate social relationships means that she loses out on possible social support, information and referrals, which could enable the transition to parenthood.
Natural birth
The rewards of antenatal preparation are realised when women describe feeling informed and in control of their birth experiences, aligning with midwifery discourses of natural birth (Brubaker & Dillaway, 2009).

Mary: Well I thought we were going to have a very sort of natural birth with no drugs although I was hoping to take drugs if I was in pain. I found the antenatal explanation of how what happens in a C-section very useful as I ended up having a C-section. And the fact that they explained, ‘ok all of these people are going to be there and it’s going to be a person on your right is going to be your doctor and the person with the baby’, and all of that… I had a really negative reaction to all the drugs and when she explained again who was going to be in the room it was exactly the same as what the antenatal person had said.

Mary’s antenatal preparation equips her for an unintended Caesarean, but instead of feeling cheated by the requirement for medical intervention, she surfaces the woman-centred natural birth discourse of feeling in control and informed. Thus birth can be considered ‘natural’ despite medical intervention, as long as the labouring mother chose the intervention (Macdonald, 2006).
Charlotte’s narrative also captures the two competing discourses of birth that Mary situates herself in. On the one hand, Charlotte values having self-control (through being informed and behaving accordingly) and on the other is willing to surrender control—the choice to rescind action is also a choice (Lupton, 1994):

Charlotte: I just have to say to myself you know we’ve even had to go with the flow, and then also those booklets that you receive on feeding, those pamphlets. I did a lot of reading and my midwife gave me a lot of information. The information from those pamphlets helped me a lot and so I felt comfortable, like I’m on the right track now so everything is going well. So I was trying to speak to myself and keep calm (speaks quietly). I was in labour for since the Saturday and I gave birth on Monday morning so (laughter) I had to keep my options open as well about taking drugs so you know things like that.

Charlotte presents herself as a self-efficacious middle class maternal subject, able to internalise information and adapt her behaviour accordingly through self-discipline, self-denial and will power. Disciplining herself by subsuming her own distress and fear, aligns with the needs of the institution for calm consumers, who are more compliant and require less time and support than distraught ones.
Being given the right information at the right time made Charlotte feel supported:

Charlotte: The midwife that delivered my baby is actually from New Zealand but she worked in Cape Town for three years so that was good, that connection. She told me, step by step where and what stage I’m at. I think that’s the biggest support that you really need in the delivery room is to tell you at what stage you are at and what’s happening.

It is significant that Charlotte constructs her midwife as the person who delivers her baby rather than facilitates Charlotte’s ability to birth her baby. She discursively positions her midwife as a translator, who can link what is happening in her body to an identified physiological process. This positioning challenges midwifery discourses of the mother as ‘expert’ as the midwife’s role as a translator reinforces a hierarchy reminiscent of biomedicine.

Jane actively and discursively resists biomedical discourses, until she acquiesces to Entonox:

Jane: I was trying to still keep my energy up by eating and drinking as much water as possible. My choice was that I wanted to stay at home as long as possible, I didn’t want to be in the hospital for too long because when I start thinking of all the other options, and I wanted a natural childbirth, no assistant and also no pain relief. At the end for about 2 ½ hours before baby was delivered I chose Entonox with the gas and that helped. As the pamphlets also say I actually felt distance from the actual experience so if I think back I would’ve actually chosen nothing but I just felt at that stage I needed something and I chose that. So fortunately baby was in the right position, in a good position so I didn’t have to have a Caesarean. I was more scared of the Caesarean than the pain and I wanted a natural childbirth.

Jane positions herself within midwifery discourses of natural birth, disciplining her body so that she avoids hospital as much as she can, and engaging in deliberate bodily maintenance so she can maximise the efficiency of her body and have the energy to labour. She constructs a natural birth as one where she uses pain relief as a last resort.

Nancy disciplines her body through specific breathing techniques learned outside the health system:

Nancy: Yes. At the beginning of my pregnancy I was kind of really worried about actually giving birth. But what really helped me was I went to do yoga in pregnancy and through that they talked a lot about it and they did sort of breathing and just general exercises to help you kind of keep calm and focused. And at the end of it I really wasn’t worried about it at all and I thought I might even be able to get through this without drugs but I didn’t in the end, I gave in, in the last couple of hours.

Nancy positions herself as a good mother to be, taking control and acting to promote her own health and wellbeing through natural breathing. Nancy’s expectation that her body would be able to cope with birth naturally and without medical intervention reflects her incorporation in woman centred/natural birth discourses. Her acceptance of a biomedical intervention in the form of pain relief in the last few hours is presented as a capitulation, and reflects her perception of the control she had in the process and her failure to accomplish a natural process.
Intensive motherhood
The post-partum period is characterised by the demands of intensive mothering. Producing oneself in the discourses of the “good mother” requires taking sole responsibility for the well-being of the infant while being isolated and having minimal support. The post-natal ward represents a space where the rude transition from women-centred discourses to intensive mothering begins. There is a glaring shift from one-to-one attention from midwives, to competition for support and assistance with other new mothers:

Olive: I mean the actual labour and delivering – fantastic. I couldn’t fault them and the staff was superb, the midwife was just brilliant, the obstetrician fantastic. When I got on the ward I found it really hot, I felt really overwhelmed. I was right next to this buzzer and it just went buzzing all the time because everybody wanted help, I found that really quite distressing and I was absolutely knackered.

The clamour of the buzzer and interruptions signal a consequence of being returned to the factory model of maternity. Olive experiences a shift from care described in superlative terms to feeling overwhelmed, distressed and tired. Meanwhile, Nancy recognises that her expectations were primarily oriented to the birth event with no real preparation for the post-partum period:

Nancy: I just want to say in terms of thinking after the birth, and how it was compared to expectations, I didn’t really have any expectations of after the birth, everything was concentrated about the labour and, ‘oh God, it’s going to feel terrible’ and after the birth it just hit me like that and it was hell for six weeks more or less it was just hell… Yes and I wished somebody had actually told me that it was going to be that hard.

Nancy assumes that if she had been given the information, this post-partum period would have been easier for her, reflecting the notion of autonomous rational personhood that with planning and control of one’s circumstances, future success can be ensured (Wall, 2010).

Interviewer: What was the “hell”?

Nancy: Mainly lack of sleep, lack of sleep and just coping with a crying baby, and I had my Mum and I was lucky she was there for the first three weeks and she did the housework, the cooking and stuff. [Group laughter]
Jane: I also think you also just feel like a robot, cleaning the bottles, making a bottle, breast-feeding, in a little corner all the time, just you and the baby.

The mothers in the group identify a conspiracy of sorts. Much of their preparation for the world of parenthood revolved around knowledge acquisition, maintaining good health during their pregnancies and having control during their labour, none of which help in the postnatal period.
In the quotes that follow, the limitations of expert knowledge and self-sufficiency are identified and Nancy identifies the difference support might make for her.

Nancy: It would’ve been different in that I would’ve had a lot more support and for me a lot of my anxieties around that was I didn’t have anyone to talk to, and particularly (baby crying). And yes OK you meet people at your antenatal group but at that time they’re not your closest friends that you can say anything too. And having said that I did, you know… But I think that was it for me was thinking, ‘oh my God, I just need some adult conversation’. And that’s what I struggled with most probably.

Emotional support and having a confidant require time and energy, and an investment, which can be drawn on. The friendships Nancy has made cannot be drawn on for the kind of support she needs. For Georgina, the absence is emotional as well as practical—in the form of having ‘time out’ for errands or for ‘couple time’:

Georgina: Yes you do miss the support network, friends as well. I’ve got a lot of friends back home who have got kids and I think you miss that as well… Not just family but friends who would maybe be a bit more candour than you might take from them or what you feel than you take from close family and things. So I definitely miss that and also, we were just back home and it was just so nice…you know tight as you are, what simple things, like I needed to go out and do couple of things and I knew I was only going to be half an hour or so and to actually have somewhere to leave him and it would take me half the time.

Discussion and Conclusion

Women who identified as ‘white’ in this study constructed themselves within liberal feminist and neoliberal discourses as consumers who were rational unified actors. They were interpellated as competent selectors and consumers of maternity services, and moral value was attached to their ability to engage in self-reliant behaviours. They embraced the neoliberal psychological imperative to improve and transformed themselves, responding positively even in the most difficult of situations (Baker, 2009). These practices reflect women’s engagement in ‘techniques of the self’ that are constitutive of neoliberal subjectivity. The white mothers conform to the ideal of the good mother (to be) by discursively positioning themselves as taking appropriate individual care and responsibility for their pregnancies and maternal care.
The speech of the women reflects three specific discourses of liberal feminist maternity that form the basis of normative midwifery ideologies.
Firstly, the women routinely position themselves as knowledgeable consumers of authoritative maternity information provided by the health system. Critically interrogating the authority of biomedicine by coordinating and evaluating diverse sources of information is central to woman-centred discourses, where acquiring authoritative knowledge both bypasses medical control and is a way to claim empowerment, subjectivity and agency (Edwards, Davies, & Edwards, 2009). Her ‘preparation’ for motherhood through the acquisition of knowledge valorises scientific/professional knowledge rather than the informal and personalised information or social and emotional support that friends and extended family can provide (Marshall & Woollett, 2000). Authoritative professionals transmit information to individual women whose embodied, enculturated understandings and experiences are discounted or devalued. Yet individual women are expected to engage in reflexive techniques and /or practices of subjectification, to be accountable for the choices that are made, and to account for their behaviours to those who are tasked with monitoring and validated for monitoring them (Stapleton & Keenan, 2009). Thus regulatory technologies “construct an autonomous subject whose choices and desires are aligned with the objectives of the state and other social authorities and institutions” (Petersen & Lupton, 1996: 64).
Secondly, natural birth is positioned as a goal, suppressing technical and industrial discourses associated with medicalisation, except as far as they are in control of the mother. The women articulate being informed and having control, autonomy or authority despite experiencing various degrees of obstetric intervention. As middle-class women are more likely to receive the birth and/or medical treatments they desire, pregnancy and childbirth can be framed as contributing to their personal growth (Brubaker, 2007). In this paradigm of actualisation, it is assumed that intentional actions, self-discipline, self-denial and will power will achieve the ‘right’ kind of birth, and that intervention from a public health system is not a default practice but a considered choice of the mother based on information. In other words, a ‘natural birth’ does not happen naturally, but is chosen as an expression of the knowledgeable consumption discussed above.

Finally, the excerpts on intensive motherhood highlight how this responsibility for maternal self-expression and knowledge is a critical instrument of women’s control in the post-partum period. The mother’s needs are marginalised, as mothers take on most of the responsibility for nurturing and developing the sacred child. Pregnant women and their partners are subject to discipline, given that they are held responsible for maximising their own health and that of their foetus‘ and then infant’s body (Collins, 2009). Intensive mothering is intertwined with a neoliberal rationality, where individual responsibility and self-management are fore-grounded and social support is reduced compared with earlier in the perinatal period (Wall, 2001). Neoliberal discourses place individual responsibility for parenting on mothers, shifting the costs and the burden of work from public resources to household resources. The gendered aspects of these discourses are visible in the assumptions of reproductive heteronormativity, where market production separates the private and public spheres with women taking responsibility for childrearing. These discourses assume that households are based on a nuclear family; that caring labour is divided on the basis of gender, and that this labour is elastic and must expand to fit demand. In turn, the domain of the private is subject to surveillance and regulation to account for responsibilisation, or the ways in which public tasks become the responsibility of individuals, the private sector and community (Schinkel & Van Houdt, 2010; Clarke, 2004). In the postpartum, women note that they are treated like a “normal person”, a labouring, productive figure rather than the choice-making perinatal consumer. The responsibilities for infant care and repetitive ‘robotic’ household tasks seem overwhelming, and there is a sense of failure and disillusionment with the system and with providers that cannot be displaced through their well-developed information gathering strategies.
The interplay of the three discourses has significant implications for maternal mental health, as they locate the “specialness” of birth in decisions which are seen to be under the mother’s individual control, when in fact broader class positions are strongly determinant of what services and support are available. The incentives to locate maternal knowledge in an individual relationship with an authoritative caregiver produce dependence on a system that shifts risk and responsiblity onto the individual. These assumptions come to structure the professional habitus of nursing and midwifery professionals, who adopt regulatory behaviours that fail to support women who do not subscribe to white middle-class ideals. Governing occurs through the aspirations of mothers, and while the state appears to be protecting the interests of infants and parents, little in the way of actual resources are provided. These neoliberal discourses of individual responsibility constructed through dependence on knowledge also disempower women who do subscribe to these ideals, as the institutional withdrawal of support in postnatal care cannot be addressed by the skills the knowledgeable consumer has developed.
Conclusion
In recent decades the capacity of liberal feminist frameworks to provide effective support to non-Western women has been questioned, and midwifery has not been exempt. In New Zealand, the discursive emphasis of being ‘with woman’ implied in the etymology of the word midwife is central to indigenous critiques of Pākeha (white/European) midwifery (Kenney, 2011). Kenney notes that the Pākeha liberal feminist agenda privileges the individual while neglecting the familial context of pregnancy and birth. In contrast, the Māori word for midwife ‘kaiwhakawhānau’ emphasises the facilitation, creation and development of whānau (family). This discursive contrast between Māori models of midwifery has heightened significance in the context of the under-representation of Māori midwives (6.4%) when Māori births comprise approximately 28% of total births and in the context of and inequalities in birth outcomes between Māori and non-Māori (New Zealand Health Information Service 2010 cited in Kenney 2011; Ratima& Crengle, 2012). Midwifery as a profession has attempted to redress these injustices by incorporating Māori cultural principles and values (Ngā Turanga Kaupapa) in midwifery practice competencies (Kenney, 2011), and the development of cultural safety has become a central, if contested tenet of nursing education in New Zealand (Ramsden 1997; DeSouza 2008).
A consistent aim of cultural safety training in nursing has been to deconstruct the implicit racism of the healthcare system, by asking practitioners to reflect on one’s practice, values and cultural assumptions (Browne et al., 2009). In other words, it asks all of us involved in the health system to understand our own position as culture-bearers. Yet, the assumptions of white culture are hard to identify as the norms and commitments of whiteness are naturalised by their ubiquity and dominance. This culture not only shapes practitioner values but also shapes the dominant voices of those consumers who receive and evaluate care, while marginalising women outside these cultural assumptions. Operationalising critical feminist and postcolonial critiques through cultural safety can help nurses understand how the discourses they use are shaped by wider social discourses, which can then be critically interrogated (Browne, 2005). This analysis has aimed to contribute to this project by identifying three norms of white maternity that are normalised in alignment with neoliberal principles: the knowledgeable consumer, natural birth and intensive motherhood. These norms contrast to the discourses that have been identified in the literature on migrant maternity, which generally reflect less of an individualised focus on choosing the experience of birth and more on the presence or exclusion of wider family and social supports. Given the shock and isolation many women experience in the transition from impending mother to intensive mothering, critically advocating for those diverse structures of support can potentially benefit all mothers.
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Acknowledgements

Many thanks to Debbie Payne, David Allen, Ray Nairn and Tim McCreanor for their helpful conversations and feedback.

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What is privilege and cultural appropriation? and why is it so difficult to talk about?

On 15 February 2016, I spoke on 612 ABC Brisbane Afternoons with Kelly Higgins-Devine about cultural appropriation and privilege. Our discussion was followed by discussion with guests: Andie Fox – a feminist and writer; Carol Vale a Dunghutti woman; and Indigenous artist, Tony Albert. I’ve used the questions asked during the interview as a base for this blog with thanks to Amanda Dell (producer).

Why has it taken so long for the debate to escape academia to be something we see in the opinion pages of publications now?

Social media and online activism have catapulted questions about identities and politics into our screen lives. Where television allowed us to switch the channel, or the topic skilfully changed at awkward moments in work or family conversations, our devices hold us captive. Simply scrolling through our social media feeds can encourage, enrage or mobilise us into fury or despair. Whether we like it or not, as users of social media we are being interpolated into the complex terrain of identity politics. Merely sharing a link on your social media feed locates you and your politics, in ways that you might never reveal in real time social conversations. ‘Sharing’ can have wide ranging consequences, a casual tweet before a flight resulted in Justine Sacco moving from witty interlocutor to pariah in a matter of hours. The merging of ‘private’ and public lives never being more evident.

How long has the term privilege been around?

The concept of privilege originally developed in relation to analyses of race and gender but has expanded to include social class, ability level, sexuality and other aspects of identity. Interestingly, Jon Greenberg points out that although people of color have fought racism since its inception, the best known White Privilege educators are white (Peggy McIntosh, Tim Wise and Robin DiAngelo). McIntosh’s 1988 paper White Privilege and Male Privilege: A Personal Account of Coming to See Correspondences through Work in Women’s Studies extended a feminist analysis of patriarchal oppression of women to that of people of color in the United States. This was later shortened into the essay White Privilege: Unpacking the Invisible Knapsack (pdf), which has been used extensively in a a range of settings because of it’s helpful list format .

Many people have really strong reactions to these concepts – why is that?

Robin DiAngelo, professor of multicultural education and author of What Does it Mean to Be White? Developing White Racial Literacy developed the term ‘white fragility’ to identify:

a state in which even a minimum amount of racial stress becomes intolerable, triggering a range of defensive moves. These moves include outward display of emotions such as anger, fear and guilt, and behaviors such as argumentation, silence and leaving the stress-inducing situation

DiAngelo suggests that for white people, racism or oppression are viewed as something that bad or immoral people do. The racist is the person who is verbally abusive toward people of color on public transport, or a former racist state like apartheid South Africa. If you see yourself as a ‘good’ person then it is painful to be ‘called out’, and see yourself as a bad person. Iris Marion Young’s work useful. She conceptualises oppression in the Foucauldian sense as:

the disadvantage and injustice some people suffer not because of a tyrannical power coerces them but because of the everyday practices of a well-intentioned liberal society…

Young points out the actions of many people going about their daily lives contribute to the maintenance and reproduction of oppression, even as few would view themselves as agents of oppression. We cannot avoid oppression, as it is structural and woven throughout the system, rather than reflecting a few people’s choices or policies. Its causes are embedded in the unquestioned norms, habits, symbols and assumptions underlying institutional rules and the collective consequences of following those rules (Young, 1990). Seeing oppression as the practices of a well intentioned liberal society removes the focus from individual acts that might repress the actions of others to acknowledging that “powerful norms and hierarchies of both privilege and injustice are built into our everyday practices” (Henderson & Waterstone, 2008, p.52). These hierarchies call for structural rather than individual remedies.

We probably need to start with privilege – what does that term mean?

McIntosh identified how she had obtained unearned privileges in society just by being White and defined white privilege as:

an invisible package of unearned assets which I can count on cashing in each day, but about which I am meant to remain oblivious (p. 1).

Her essay prompted understanding of how one’s success is largely attributable to one’s arbitrarily assigned social location in society, rather than the outcome of individual effort.

“I got myself where I am today. Honestly, it’s not that hard. I think some people are just afraid of a little hard work and standing on their own two feet, on a seashell, on a dolphin, on a nymph-queen that are all holding them up.”

“I got myself where I am today. Honestly, it’s not that hard. I think some people are just afraid of a little hard work and standing on their own two feet, on a seashell, on a dolphin, on a nymph-queen that are all holding them up.”

From: The Birth of Venus: Pulling Yourself Out Of The Sea By Your Own Bootstraps by Mallory Ortberg 

McIntosh suggested that white people benefit from historical and contemporary forms of racism (the inequitable distribution and exercise of power among ethnic groups) and that these discriminate or disadvantage people of color.

How does privilege relate to racism, sexism? Are they the same thing?

It’s useful to view the ‘isms’ in the context of institutional power, a point illustrated by Sian Ferguson:

In a patriarchal society, women do not have institutional power (at least, not based on their gender). In a white supremacist society, people of color don’t have race-based institutional power.

Australian race scholars Paradies and Williams (2008) note that:

The phenomenon of oppression is also intrinsically linked to that of privilege. In addition to disadvantaging minority racial groups in society, racism also results in groups (such as Whites) being privileged and accruing social power. (6)

Consequently, health and social disparities evident in white settler societies such as New Zealand and Australia (also this post about Closing the gap) are individualised or culturalised rather than contextualised historically or socio-economically. Without context  white people are socialized to remain oblivious to their unearned advantages and view them as earned through merit. Increasingly the term privilege is being used outside of social justice settings to the arts. In a critique of the Hottest 100 list in Australia Erin Riley points out that the dominance of straight, white male voices which crowds out women, Indigenous Australians, immigrants and people of diverse sexual and gender identities. These groups are marginalised and the centrality of white men maintained, reducing the opportunity for empathy towards people with other experiences.

Do we all have some sort of privilege?

Yes, depending on the context. The concept of intersectionality by Kimberlé Crenshaw is useful, it suggests that people can be privileged in some ways and not others. For example as a migrant and a woman of color I experience certain disadvantages but as a middle class cis-gendered, able-bodied woman with a PhD and without an accent (only a Kiwi one which is indulged) I experience other advantages that ease my passage through the world You can read more in the essay Explaining White Privilege to a Broke White Person.

How does an awareness of privilege change the way a society works?

Dogs and Lizards: A Parable of Privilege by Sindelókë is a helpful way of trying to understand how easy it is not to see your own privilege and be blind to others’ disadvantages. You might have also seen or heard the phrase ‘check your privilege’ which is a way of asking someone to think about their own privilege and how they might monitor it in a social setting. Exposing color blindness and challenging the assumption of race-neutrality is one mechanism for addressing the issue of privilege and its obverse oppression.  Increasingly in health and social care, emphasis is being placed on critiquing how our own positions contribute to inequality (see my chapter on cultural safety), and developing ethical and moral commitments to addressing racism so that equality and justice can be made possible. As Christine Emba notes “There’s no way to level the playing field unless we first can all see how uneven it is.” One of the ways this can be done is through experiencing exercises like the Privilege Walk which you can watch on video. Jenn Sutherland-Miller in Medium reflects on her experience of it and proposes that:

Instead of privilege being the thing that gives me a leg up, it becomes the thing I use to give others a leg up. Privilege becomes a way create equality and inclusion, to right old wrongs, to demand justice on a daily basis and to create the dialogue that will grow our society forward.

Is privilege something we can change?

If we move beyond guilt and paralysis we can use our privilege to build solidarity and challenge oppression.  Audra Williams points out that a genuine display of solidarity can require making a personal sacrifice. Citing the example of Aziz Ansari’s Master of None, where in challenging the director of a commercial about the lack of women with speaking roles, he ends up not being in the commercial at all when it is re-written with speaking roles for women. Ultimately privilege does not gets undone through “confession” but through collective work to dismantle oppressive systems as Andrea Smith writes.

Cultural appropriation is a different concept, but an understanding of privilege is important, what is cultural appropriation?

Cultural appropriation is when somebody adopts aspects of a culture that is not their own (Nadra Kareem Little). Usually it is a charge levelled at people from the dominant culture to signal power dynamic, where elements have been taken from a culture of people who have been systematically oppressed by the dominant group. Most critics of the concept are white (see white fragility). Kimberly Chabot Davis proposes that white co-optation or cultural consumption and commodification, can be cross-cultural encounters that can foster empathy and lead to working against privilege among white people. However, an Australian example of bringing diverse people together through appropriation backfired, when the term walkabout was used for a psychedelic dance party. Using a deeply significant word for initiation rites, for a dance party was seen as disrespectful. The bewildered organiser was accused via social media of cultural appropriation and changed the name to Lets Go Walkaround. So, I think that it is always important to ask permission and talk to people from that culture first rather than assuming it is okay to use.

What is the line between cultural appropriation and cultural appreciation?

Maisha Z. Johnson cultural appreciation  or exchange  where mutual sharing is involved.

Can someone from a less privileged culture appropriate from the more privileged culture?

No, marginalized people often have to adopt elements of the dominant culture in order to survive conditions that make life more of a struggle if they don’t.

Does an object or symbol have to have some religious or special cultural significance to be appropriated? 

Appropriation is harmful for a number of reasons including making things ‘cool’ for White people that would be denigrated in People of Color. For example Fatima Farha observes that when Hindu women in the United States wear the bindi, they are often made fun of, or seen as traditional or backward but when someone from the dominant culture wears such items they are called exotic and beautiful. The critique of appropriation extends from clothing to events Nadya Agrawal critiques The Color Run™ where you can:

run with your friends, come together as a community, get showered in colored powder and not have to deal with all that annoying culture that would come if you went to a Holi celebration. There are no prayers for spring or messages of rejuvenation before these runs. You won’t have to drink chai or try Indian food afterward. There is absolutely no way you’ll have to even think about the ancient traditions and culture this brand new craze is derived from. Come uncultured, leave uncultured, that’s the Color Run, promise.

The race ends with something called a “Color Festival” but does not acknowledge Holi. This white-washing (pun intended) eradicates everything Indian from the run including  Holi, Krishna and spring. In essence as Ijeoma Oluo points out cultural appropriation is a symptom, not the cause, of an oppressive and exploitative world order which involves stealing the work of those less privileged. Really valuing people involves valuing their culture and taking the time to acknowledge its historical and social context. Valuing isn’t just appreciation but also considering whether the appropriation of intellectual property results in economic benefits for the people who created it. Kareem Abdul-Jabbar suggests that it is often one way:

One very legitimate point is economic. In general, when blacks create something that is later adopted by white culture, white people tend to make a lot more money from it… It feels an awful lot like slavery to have others profit from your efforts.

 

Loving burritos doesn’t make someone less racist against Latinos. Lusting after Bo Derek in 10 doesn’t make anyone appreciate black culture more… Appreciating an individual item from a culture doesn’t translate into accepting the whole people. While high-priced cornrows on a white celebrity on the red carper at the Oscars is chic, those same cornrows on the little black girl in Watts, Los Angeles, are a symbol of her ghetto lifestyle. A white person looking black gets a fashion spread in a glossy magazine; a black person wearing the same thing gets pulled over by the police. One can understand the frustration.

The appropriative process is also selective, as Greg Tate observes in Everything but the burden, where African American cultural properties including music, food, fashion, hairstyles, dances are sold as American to the rest of the world but with the black presence erased from it. The only thing not stolen is the burden of the denial of human rights and economic opportunity. Appropriation can be ambivalent, as seen in the desire to simultaneously possess and erase black culture. However, in the case of the appropriation of the indigenous in the United States, Andrea Smith declares (somewhat ironically), that the desire to be “Indian” often precludes struggles against genocide, or demands for treaty rights. It does not require being accountable to Indian communities, who might demand an end to the appropriation of spiritual practices.

Go West – Black: Random Coachella attendee, 2014. Red: Bison skull pile, South Dakota, 1870’s.

Go West – Black: Random Coachella attendee, 2014. Red: Bison skull pile, South Dakota, 1870’s by Roger Peet.

Some people believe the cuisines of other cultures have been appropriated – is this an extreme example, or is it something we should consider?

The world of food can be such a potent site of transformation for social justice. I am a committed foodie (“somebody with a strong interest in learning about and eating good food who is not directly employed in the food industry” (Johnston and Baumann, 2010: 61). I am also interested in the politics of food. I live in Melbourne, where food culture has been made vibrant by the waves of migrants who have put pressure on public institutions, to expand and diversify their gastronomic offerings for a wider range of people. However, our consumption can naturalise and make invisible colonial and racialised relations. Thus the violent histories of invasion and starvation by the first white settlers, the convicts whose theft of food had them sent to Australia and absorbed into the cruel colonial project of poisoning, starving and rationing indigenous people remain hidden from view. So although we might love the food we might not care about the cooks at all as Rhoda Roberts Director of the Aboriginal Dreaming festival observed in Elspeth Probyn’s excellent book Carnal Appetites:

In Australia, food and culinary delights are always accepted before the differences and backgrounds of the origin of the aroma are.

Lee’s Ghee is an interesting example of appropriation, she developed an ‘artisanal’ ghee product, something that has been made for centuries in South Asia.

Lee Dares was taking the fashion world by storm working as a model in New York when she realized her real passion was elsewhere. So, she made the courageous decision to quit her glamorous job and take some time to explore what she really wanted to do with her life. Her revelation came after she spent some time learning to make clarified butter, or ghee, on a farm in Northern India. Inspired, she turned to Futurpreneur Canada to help her start her own business, Lee’s Ghee, producing unique and modern flavours of this traditional staple of Southeast Asian cuisine and Ayurvedic medicine.

The saying “We are what we eat” is about not only the nutrients we consume but also to beliefs about our morality. Similarly ‘we’ are also what we don’t eat, so our food practices mark us out as belonging or not belonging to a group.So, food has an exclusionary and inclusionary role with affective consequences that range from curiosity, delight to disgust. For the migrant for example, identity cannot be taken for granted, it must be worked at to be nurtured and maintained. It becomes an active, performative and processual project enacted through consumption. With with every taste, an imagined diasporic group identity is produced, maintained and reinforced. Food preparation represents continuity through the techniques and equipment that are used which affirm family life, and in sharing this food hospitality, love, generosity and appreciation can be expresssed. However, the food that is a salve for the dislocated, lonely, isolated migrant also sets her apart, making her stand out as visibly, gustatorily or olfactorily different. The resource for her well being also marks her as different and a risk. If her food is seen as smelly, distasteful, foreign, violent or abnormal, these characteristics can be transposed to her body and to those bodies that resemble her. Dares attempt to reproduce food that is made in many households and available for sale in many ‘ethnic’ shops and selling it as artisanal, led to accusations of ‘colombusing’ — a term used to describe when white people  claim they have discovered or made something that has a long history in another culture. Also see the critique by Navneet Alang in Hazlitt:

The ethnic—the collective traditions and practices of the world’s majority—thus works as an undiscovered country, full of resources to be mined. Rather than sugar or coffee or oil, however, the ore of the ethnic is raw material for performance and self-definition: refine this rough, crude tradition, bottle it in pretty jars, and display both it and yourself as ideals of contemporary cosmopolitanism. But each act of cultural appropriation, in which some facet of a non-Western culture is columbused, accepted into the mainstream, and commodified, reasserts the white and Western as norm—the end of a timeline toward which the whole world is moving.

If this is the first time someone has heard these concepts, and they’re feeling confused, or a bit defensive, what can they do to understand more about it?

Here are some resources that might help, videos, illustrations, reading and more.

White privilege

Cultural appropriation

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All I want for Christmas is… On International Day of Solidarity with Migrants 2015

December 18th marks the anniversary of the signing of the International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families by the United Nations in 1990. Lobbying from Filipino and other Asian migrant organisations in 1997, led to December18th being promoted as an International Day of Solidarity with Migrants. The day recognises the contributions of migrants to both the economies of their receiving and home countries, and promotes respect for their human rights. However, as of 2015, the Convention has only been signed by a quarter of UN member states.

2015 has seen the unprecedented displacement of people globally with tragic consequences. UNHCR’s annual Global Trends report shows a massive increase in the number of people forced to flee their homes. 59.5 million people were forcibly displaced at the end of 2014 compared to 51.2 million a year earlier and 37.5 million a decade ago.

Politicians and media have a pivotal role in agenda setting and shaping public opinion around migrants, refugees and asylum seekers. A 100-page report, Moving Stories, released for International Migrants Day reviews media coverage of migration across the European Union and 14 countries across the world. The report acknowledges the vulnerability of refugees and migrants and the propensity for them to be politically scapegoated for society’s ills and has five key recommendations, briefly (p.8):

  1. Ethical context: that the following five core principles of journalism are adhered to:
    accuracy, independence, impartiality, humanity and accountability;
  2. Newsroom practice: have diversity in the newsroom, journalists with specialist knowledge, provide detailed information on the background of migrants and refugees and the consequences of migration;
  3. Engage with communities: Refugee groups, activists and NGOs can be briefed
    on how best to communicate with journalists;
  4. Challenge hate speech.
  5. Demand access to information: When access to information is restricted, media and civil society groups should press the national and international governments to be more transparent.

Much remains to be done, but it is heartening to see Canadian Prime Minister Justin Trudeau’s response to the arrival of thousands of Syrian refugees: 

You are home…Welcome home…

Tonight they step off the plane as refugees, but they walk out of this terminal as permanent residents of Canada. With social insurance numbers. With health cards and with an opportunity to become full Canadians

Trudeau’s response sharply contrasts with that of the United States, where many politicians have responded to Islamophobic constituencies with restrictions or bans on receiving refugees. The welcome from Indigenous Canadians to newly arrived refugees has also been generous and inclusive, considering that refugees and migrants are implicated in the ongoing colonial practices of the state. These practices can maintain Indigenous disadvantage while economic, social and political advantage accrue to settlers. It is encouraging that Trudeau’s welcome coincided with an acknowledgement of the multiple harms Canada has imposed on Indigenous people since colonisation. 

Alarmingly, the center-right Danish government’s bill currently before the Danish Parliament on asylum policy, allows for immigration authorities to seize jewellery and other valuables from refugees in order to recoup costs. The capacity to remove personal valuables from people seeking sanctuary is expected to be effective from February 2016 and has a chilling precedent in Europe, as Dylan Matthews notes in Vox:

Denmark was occupied by Nazi Germany for five years, from 1940 to 1945, during which time Germany confiscated assets from Jewish Danes, just as it did to Jews across Europe. Danish Jews saw less seized than most nations under Nazi occupation; the Danish government successfully prevented most confiscations until 1943, and Danes who survived the concentration camps generally returned to find their homes as they had left them, as their neighbors prevented Nazis from looting them too thoroughly. But Nazi confiscations still loom large in European historical memory more generally.

The UN, the Parliamentary Assembly of the Council of Europe (PACE) and the International Organization for Migration (IOM) have advocated for the development of regional and longer term responses. Statements echoed by Ban Ki-moon which proposed better cooperation and responsibility sharing between countries and the upholding of the human rights of migrants regardless of their status (Australia take note). He proposes that we:

must expand safe channels for regular migration, including for family reunification, labour mobility at all skill levels, greater resettlement opportunities, and education opportunities for children and adults.

On International Migrants Day, let us commit to coherent, comprehensive and human-rights-based responses guided by international law and standards and a shared resolve to leave no one behind.

What does this all mean for Australia and New Zealand? I’ve written elsewhere about the contradiction between the consumptive celebrations of multiculturalism and the increasing brutality and punitiveness of policies in both countries; the concerns of Australia’s key professional nursing and midwifery bodies about the secrecy provisions in the Australian Border Force Act 2015 and the ways in which New Zealand is emulating a punitive and dehumanising Australian asylum seeker policy.

It is appropriate then in this season of goodwill and peace to write an updated Christmas wish list, but with a migration focus. As a child growing up in Nairobi, one of my pleasures around Christmas time was drawing up such a list. I was so captivated with this activity that I used to drag our Hindu landlord’s children into it. This was kind of unfair as I don’t think they received any of the gifts on their list. For those who aren’t in the know, a wish list is a list of goods or services that are wanted and then distributed to family and friends, so that they know what to purchase for the would-be recipient. The idea of a list is somewhat manipulative as it is designed around the desires of the recipient rather than the financial and emotional capacity of the giver. Now that I’ve grown up a little, I’ve eschewed the consumptive, labour exploitative, commercial and land-filling aspects of Christmas in favour of spending time with family, as George Monbiot notes in his essay The Gift of Death:

They seem amusing on the first day of Christmas, daft on the second, embarrassing on the third. By the twelfth they’re in landfill. For thirty seconds of dubious entertainment, or a hedonic stimulus that lasts no longer than a nicotine hit, we commission the use of materials whose impacts will ramify for generations.

So, this list focuses on International Day of Solidarity with Migrants. All I want for Christmas is that ‘we’:

  1. End the Australian Government policy of turning back people seeking asylum by boat ie “unauthorised maritime arrivals”. 
  2. Stop punishing the courageous and legitimate right to seek asylum with the uniquely cruel policy of mandatory indefinite detention and offshore processing. Mandatory detention must end. It is highly distressing and has long-term consequences.
  3. Remove children and adolescents from mandatory detention. Children, make up half of all asylum seekers in the industrialized world. Australia, The United States, the United Kingdom, Germany and Italy directly contradict The Convention on the Rights of the Child (UNCRC).
  4. Engage in regional co-operation to effectively and efficiently process refugee claims and provide safe interim places. Ensure solutions that uphold people’s human rights and dignity, see this piece about the Calais “Jungle”.
  5. End the use of asylum-seeker, refugee and migrant bodies for political gain.
  6. Demand more ethical reporting by having news media: appoint specialist migration reporters; improve training of journalists on migration issues and problems of hate-speech; create better links with migrant and refugee groups; and employ journalists from ethnic minority communities, see Moving Stories.
  7. Follow the money. Is our money enabling corporate complicity in detention? Support divestment campaigns, see X Border Operational matters. Support pledges that challenge the outsourcing of misery for example No Business in Abuse (NBIA) who have partnered with GetUp.
  8. Support the many actions by Indigenous peoples to welcome refugees. Indigenous demands for sovereignty and migrant inclusion are both characterised as threats to social cohesion in settler-colonial societies.
  9. Challenge further racial injustice through social and economic exclusion and violence that often face people from migrantnd refugee backgrounds.
  10. Ask ourselves these questions:‘What are my borders?’ ‘Who do I/my community exile?’ ’How and where does my body act as a border?’ and ‘What kind of borders exist in my spaces?’ The questions are from a wonderful piece by Farzana Khan.

Seppo Leinonen, a cartoonist and illustrator from Finland

Seppo Leinonen, a cartoonist and illustrator from Finland

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Making visible: The role of the arts in supporting participation and inclusion for people with experience of mental ill health

600-Mangere Arts Centre Ext 1 sm (1)

I was honored to be invited to write a catalogue piece for an exhibition which opened during Mental Health Awareness Week 2015 at Mangere Arts Centre – Nga tohu o Uenuku and which closes on 22nd November. Lotus in Bloom is an exhibition of works by artist members of the Tufunga Arts Trust, whose visual arts programme enables artists living with mental illness to develop their art practice and the Trust supports artists by providing opportunities to exhibit their work.

Tufuga Arts Trust exhibition

Art makes visible experiences, hopes, ideas; it is a reflective space and socially it brings something new into the world—it contributes to knowledge and understanding. In so doing it is intrinsically political (O’Neill, 2008)

“Lotus in Bloom” an exhibition at Mangere Arts Centre of 80 works by thirty artists with experience of mental ill health makes visible their experiences and hopes, while simultaneously bringing new knowledge and understanding to the broader community. Tufuga – Creative hands, mind and spirit is a charitable trust that supports people with experience of mental ill health to lead their own recovery. Set up in May 2004 in Counties Manukau, South Auckland it aims to “enable access to art and creative experiences in an environment that nurtures cultural well-being”. In using arts as a medium, people with experience of mental ill health are supported to engage in creative expression and meaningful activity, countering experiences of social exclusion. Lasting impact was the second exhibition of their artwork.

The notion of recovery permeates contemporary mental health services inspiring a transition from symptom amelioration to supporting people experiencing mental ill health to ‘live well’ on their own terms. Recovery approaches and mental health promotion challenge the confining language of psychiatric symptomatology and endemic “therapeutic pessimism” in biomedical models, which contribute to stigma and discrimination and compound social exclusion. Mental health promotion refers to:

the process of enhancing the capacity of individuals and communities to take control over their lives and improve their mental health. Mental health promotion uses strategies that foster supportive environments while showing respect for culture, equity, social justice and personal dignity. (Joubert and Raeburn, p.19).

Most powerfully, recovery approaches promote a philosophical shift from a medical model of mental illness to a social model. The possibility of recovery despite illness is invoked through offering hope and enabling self-determination, by resourcing people with experience of mental ill health to pursue their own goals. These philosophical changes in mental health care provision have instigated a shift in power relations, challenging mental health professionals, policy makers and service providers to consider the adequacy of expert knowledge and in doing so dismantling a hierarchy where expert driven practices are valued above client and family knowledge. The client’s lived experience of illness and their needs have become more central to the mental health support offered. However, these changes go beyond inclusion in the therapeutic encounter, requiring that communities support participation and inclusion. The Like Minds Like Mine social marketing programme in New Zealand is one example of a stigma countering initiative that has helped to both educate and build public support.

Photo by James Pinker

The arts hold promise for meeting inclusion and recovery agendas. Participation in community arts can further public health imperatives for reducing social and health inequalities and facilitating social inclusion by enhancing social capital. Having one’s experiences refracted through an asset and strengths based lens rather than as a dependent consumer of services, can help an artist with an experience of mental ill health to develop a more positive self-image. Being recognised as having an ability, whether as an artist or teacher can counter pathology and illness laden representations. The safety and mutual support in arts environments for the recovery journeys of participants can extend beyond feeling good to opening up opportunities for artists to generate income and work.

My sincere hope is that this exciting exhibition incites the broader community to support the aspirations of artists who experience mental ill health; to examine the ways in which “we” can make our world less disabling and in the process create worlds where we can all have lives that are worth living.

An edited quote from this essay printed on vinyl and exhibited on the wall of Mangere Arts Centre

An edited quote from this essay printed on vinyl and exhibited on the wall of Mangere Arts Centre. Photo by James Pinker.

References
Joubert, N. & Raeburn, J. (1998). Mental health promotion: People, power and passion. International Journal of Mental Health Promotion, 1 (1), 15–22.
O’Neill, Maggie (2008). Transnational Refugees: The Transformative Role of
Art? [53 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative
Social Research, 9(2), Art. 59, http://nbn- resolving.de/urn:nbn:de:0114-fqs0802590.
Stickley, T. (2008). Promoting mental health through an inner city community arts programme: A narrative inquiry. PhD diss, University of Nottingham, United Kingdom.

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Cultural safety in Aotearoa New Zealand 2nd Edition

Very excited about the 2nd Edition of Cultural safety in Aotearoa New Zealand being published by Cambridge Press in December 2015.

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.

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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.

 

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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.

Book cover

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