, , , , , , , , ,

NEW MOTHERS AND APPS DURING COVID-19


Sukhmani Khorana, Bhavya Chitranshi and I recently completed research about the experiences of six cisgender South Asian-Australian women who gave birth during the COVID-19 pandemic.

Design by Georgia Hodgkinson.

A note about language in this report: The South Asian “women” in our study identified as cisgender. However, we have used a gender-additive approach to language to be respectful and inclusive of trans, genderqueer and intersex people by using gender-neutral language alongside the language of womanhood. For example, both ‘maternal’ and ‘parental’, ‘breast- feeding’ and ‘chest-feeding’, and so on (Green & Riddington, 2020).

Prior to the pandemic negatively racialised women experienced barriers to healthcare and a lack of social support, which were further exacerbated during the COVID-19 pandemic. International border closures in Australia combined with local mitigation strategies inhibited social and cultural support from families, impacting many migrant mothers who gave birth for the first time in Australia. Many hospitals in New South Wales and Victoria instituted restrictions to birthing services as a way of reducing exposure to the coronavirus during the pandemic. These restrictions varied, but included not allowing partner attendance for antenatal appointments, reducing support people to one person that could be present during the labor and birth, and sometimes not permitting partners on postnatal wards.

South Asian women were recruited via social media, and qualitative semi-structured interviews were conducted between May and October 2021 via video, following ethical approval from the RMIT University Ethics Committee. Findings from our in-depth interviews indicate that perinatal experiences were adversely impacted by:

a) limited face-to-face support from healthcare providers;
b) limited access to partner support during appointments and in childbirth;
c) isolation and mental health impacts of not having access to family networks, particularly to those who could provide culturally specific perinatal knowledge and postpartum support;
d) increased reliance on an ecosystem of online support including apps, social media groups and credible websites, which had mixed results in terms of being culturally appropriate.

Our research suggests that pre-existing limitations of healthcare providers, services and apps with regard to culturally and linguistically diverse (CALD) women in Australia have been amplified during the pandemic. Disruptions in the physical and social presence of family, friends and healthcare workers, caused by international travel restrictions and changing healthcare practices during the pandemic, add significantly to the everyday stress, anxiety and challenges faced by new parents. That responsibilization – the shifting back of responsibility from health services to mothers and their families – has led to mothers shouldering many of the burdens of a new transition by themselves, rather than in a system of collective care by wider family or partners as they might have expected.

These health system reconfigurations combined with the absence of support from family could have longitudinal adverse consequences for new parents and their children. Online Facebook groups from the mothers’ countries of origin or cultural backgrounds, or for mothers who had babies due in the same month, represented a significant source of information and support for the participants. This was particularly important at a time when women’s capacities to engage in traditional cultural practices, which provide practical, emotional and informational support, were compromised by the inability to garner familial support. In the context of a long-term pandemic, we suggest that health services: use flexible harm reduction approaches to facilitate parental support (rather than institute blanket bans), engage in active outreach, and that services are better integrated and smartphone enabled.

New-Mothers-and-Apps-during-COVID-19-1Download

/by
, , , , ,

I have long been interested in the significance of food for migrants. As a child whose family moved to Aotearoa, New Zealand in the 70s, I remember the singular pursuit of ingredients. The long-grain rice we tried to buy from an importer, the coriander we grew in the garden, my mother purchasing olive oil from the pharmacy (that’s another story), and the trips to Goa which had us return with dried kokum, dried shrimps, Goa sausages (confiscated) chilies and other spices, much to the bemusement of customs. I also remember the longing: for pickles, chevda, samosas and much more.

On a scholarly note, I am also interested in what happens when food (and the people attached to said food) encounter institutions. Whether it’s the sign on the wall in the motel that says ‘no smells thanks’ or public institutions that we expect in an age of consumptive diversity to also accommodate people’s preferences and lifeways. In 1994 I worked on a postnatal ward and became interested in how the public health system accommodated the dietary preferences of diverse populations. Food choices were primarily oriented to the dominant culture, so people often brought in food for their family members. Yet there was only one place where food could be warmed and it was the staff meal room. The different smells led to complaints from staff.

Later, in 2001 when I was researching the experiences of Goan women in New Zealand around birth, it became apparent that food played a crucial role both in settlement and at special occasions. Lorna for example said: “Goan things like moong, godshem and other lentils, millet, tizan, and things like that, you know”. For Rowena, the absence of family meant that she had to prepare her own meals and did not eat anything special. While Greta, had maternal figures taking care of her: “Fenugreek seeds and jaggery and coconut milk [Methi Paez] and she kept giving me that and I found that quite nourishing”. The importance of food extended also beyond postpartum health to inducting the new member of the family into the community at the christening. Flora spoke about how according to Goan tradition, coconut and boiled grams (chickpeas) had to be served. “My aunt was going around to all the Kiwi guests saying …chickpeas are the food of the soil, and coconut is also a food of the soil.”

This brings me to the purpose of this blog post. In my PhD, I spoke with birthing people about their experiences of cultural safety and services. It has taken a while, but from this work, I’ve written a book chapter that is about to be published by Demeter Press.

Abstract

Hospital admission signifies the induction into a distinct patient subculture in Western medical healthcare systems (Yarbrough and Klotz). Clothes, belongings, and identity are relinquished, and autonomy over everyday activities and routines is ceded to health professionals and institutional processes. The dominant mode of biomedicine emphasizes the individual and the physical body, shifting a person from a socially integrated member of a community into an object who receives care. Food structures both our daily lives and life transitions, such as maternity, and is an arena where powerful values and beliefs about being a human are evident. More than sustenance and nutrition, food has social, cultural, and symbolic meanings. Practices relating to food demarcate cultural boundaries of belonging and not belonging on the basis of religion, nation, class, race, ethnicity, and gender (Wright and Annes; Bell and Valentine). Being unable to access one’s own food can result in cultural disadvantages, in which a person is separated from their own cultural context and cannot provide for themselves within an institutional environment (Woods).
Examining the significance of food in the institutional context of health highlights how people are racialized by the foods that they eat and how institutions and staff working within them regulate migrant bodies. This chapter analyses literature related to food and provides an excerpt from a study of migrant maternity in New Zealand. It shows how food habits are shaped by everyday institutional practices, which maintain order and simultaneously impose disciplinary processes on migrant bodies. The preparation of food represents the continuity and affirmation of tradition and culture, a mechanism for promoting wellness within the physical, emotional, and social transitions of birth. Food as an analytic shows how ethnic identity is performative and processual—that is, it reacts and is reacted to by the host culture. I propose that health services can provide care that is more culturally safe by developing a better understanding of the importance of culture and food in constructing, maintaining, and transforming identities and by providing facilities and resources to facilitate food preparation during the perinatal period.

Moving Meals and Migrating Mothers: Culinary cultures, diasporic dishes and familial foodways explores the complex interplay between the important global issues of food, families and migration.
Moving Meals and Migrating Mothers: Culinary cultures, diasporic dishes and familial foodways explores the complex interplay between the important global issues of food, families and migration.
/by
, , , , , ,

Review: Nurses’ views on the impact of mass media on the public perception of nursing and nurse–service user interactions

This is a review of paper published in the Journal of Research in Nursing about Nurses’ views on the impact of mass media on the public perception of nursing and nurse–service user interactions by Louise P Hoyle, Richard G Kyle and Catherine Mahoney. Cite as: De Souza, R. (2017). Review: Nurses’ views on the impact of mass media on the public perception of nursing and nurse–service user interactions . Journal of Research in Nursing, 0(0) 1–2. https://dx.doi.org/10.1177/1744987117736600

Mass media comprises the storytellers and portrayers of our social worlds (Nairn et al., 2014), and has a central role in reproducing the contradictory views held about nurses by the public. As the reviewed paper shows, media representations are far from harmless: they influence public understanding and confidence in the profession and impact on recruitment, policy and nurses’ self-image (Kalisch et al., 2007). Nurses are considered
highly trustworthy by the public due to their virtues of care and compassion. However, the dominant representations of nurses in the media are often inaccurate, erasing male nurses from the profession and downplaying the autonomous judgement of the nursing
professional. Nurses as feminised handmaidens play a subordinate support role to medical decision makers. The media nurse engages in bedside routines and repetitive tasks, and is sometimes a sex object, an angel of mercy or a battleaxe, sometimes all three. These stereotypical representations have changed over time, and sometimes nurses are depicted as strong and confident professionals (Kalisch et al., 1981; Stanley, 2008). Yet the significant professional, theoretical and scholarly innovations that have reshaped the role of nurses are largely invisible to the public (Ten Hoeve et al., 2014). In tandem with nursing’s processes of
professionalisation, austerity measures in the neoliberal health system have demanded efficiency and cost containment, while also reorienting services so they can be more clientcentred. This twin move to the proletarianisation of nursing care (through the growth of
various classes of healthcare assistants doing tasks previously performed by nurses) and democratisation of health within a technocratic, market-led and more participatory health system has profound implications for the future of nursing.

The reviewed paper is timely, given the growing focus on shared decision making and participation as an outcome of client-centredness in Western health systems. It raises questions about the customary role of nurses as gap fillers and problem solvers, who maintain the status quo on doctors’ orders. New media channels such as the Internet allow access to on-demand health information outside of authoritative channels, and new
technologies such as fitness trackers and wearables produce a wide range of personal health information. These technologies do some of the work of nursing in the sense that they put recipients at the centre of the health experience and allow health information to enhance the consumer’s knowledge of, control of and impact on their own healthcare. The role of the
nurse as a facilitator in these new flows of health information is yet to be effectively represented within the profession’s view of itself, let alone in the mass media, as this paper suggests.

The reviewed study’s findings on the aversion felt by nurse participants to informed consumers is an issue with significant ramifications. The question that remains is whether there is an opportunity for nurses to enter the public sphere in a meaningful alignment with consumer aspirations for healthcare? If healthcare is to become more participatory, equitable and consumer-driven, what transformative changes will we as nurses need to
make in our own self-identity and practice?

References
Kalisch BJ, Begeny S and Neumann S (2007) The image of the nurse on the internet. Nursing Outlook 55(4): 182–188.
Kalisch BJ, Kalisch PA and Scobey M (1981) Reflections on a television image: The nurses 1962–1965. Nursing & Health Care: Official Publication of the National League for Nursing 2(5): 248–255.
Nairn R, De Souza R, Barnes AM, et al. (2014) Nursing in media-saturated societies: Implications for cultural safety in nursing practice in Aotearoa New Zealand. Journal of Research in Nursing 19(6): 477–487.
Stanley DJ (2008) Celluloid angels: A research study of nurses in feature films 1900–2007. Journal of Advanced Nursing Available at: http://onlinelibrary.wiley.com/doi/10.1111/j. 1365-2648.2008.04793.x/full (accessed 30 September 2017).
Ten Hoeve Y, Jansen G and Roodbol P (2014) The nursing profession: Public image, self-concept and professional identity. A discussion paper. Journal of Advanced Nursing 70(2): 295–309.

/by
, ,

The Australian Women’s and Gender Studies Association (AWGSA) member profile

If you could have a superpower, what would it be?

Fearless speech or parrhesia.

Favourite food?

I have to say Goan food. It represents connection to my ancestral homeland, as well as to my family. It has sustained me through multiple migrations and immediately evokes comfort and nurturance.

What do you think is an important feminist issue in Australia at the moment?

The policies of detention and deterrence that are being invoked in the state management of asylum seekers

Why are you a member of AWGSA?

As a relative newcomer to Australia, I want to be involved in the inter-disciplinary conversations happening in feminist spaces. I attended the conference in Melbourne two years ago and made some great new friends. As a nurse socialised into a very gendered hierarchy, I have a unique contribution to makes as a feminist woman of colour, but I don’t want to be limited to conversations only within my discipline.

If you could have been at one historical event, which one would it have been?

Being a diasporic Goan I would have been interested in being at the liberation/Invasion of Goa by the Indian government.

Who are your academic/feminist heroes?

Octavia Butler (overcoming shyness, having self-belief and being committed to her writing), Audre Lorde (for living with illness, for her writing), Angela Davis (for her activism).

Where would you like to live?
Exactly where I live now, South Gippsland.

What do you appreciate most about your friends?

I’d have to say conversations that are energising, learning, rich and which mean that the friendship continues to deepen and has potential for depth and transformation.

Favourite book?

Too many to count but I’ve just been reading Jhumpa Lahiri’s short stories and am awed by her ability to draw you into her character’s worlds. Another favourite was Americanah by the Nigerian author Chimamanda Ngozi Adichie.

A goal?

To learn more about the Aboriginal history of Australia and Aboriginal feminists. Not in an appropriative way but to be a better ally.

/by
, , , , , ,

Review: Australian mental health nurses and transgender clients: Attitudes and knowledge

This is a longer version of a review of Damien Riggs & Clare Bartholomaeus’ paper published in the Journal of Research in Nursing: Australian mental health nurses and transgender clients: Attitudes and knowledge. Cite as: De Souza, R. (2016). Review: Australian mental health nurses and transgender clients: Attitudes and knowledge. Journal of Research in Nursing, 0(0) 1–2. DOI: 10.1177/1744987115625008

I have never forgotten her face, her body, even though more than twenty years have passed. She was not much older than me and she desperately wanted to be a he. I had no idea how to respond to her depression and her recent self-harm attempt in the context of her desire to change gender. There was nothing in my nursing education that had prepared me for how I might be therapeutic and there was no one and nothing in the acute psychiatric inpatient unit that could resource me. I feel embarrassed now that I had no professional understanding and experience to guide me to help me provide effective mental health care to my client. I was an empathic kind listener, but I had been immersed in a biologically deterministic (one’s sex at birth determines ones’ gender) and binary view of gender despite my own diverse cultural background which I had been socialized to see as separate from my mainly white nursing education. I had not been educated to critically consider discourses of sex and gender, to provide competent safe care to someone who wanted to change her gender and express her gender differently from normative gender categories (Merryfeather & Bruce, 2014). My work has since led me to consider the ways in which “differences” are produced culturally, politically, and epistemologically specifically in terms of categories including “race”, ethnicity, nationality, class, and more recently sexuality and gender.

Four critiques of biomedicine as a dominant framework for understanding ‘problems with living’ have inspired transformation of the mental health system. Firstly, the emphasis on participation and inclusion through consumer-led and recovery-oriented practice has profoundly changed the role of consumers from passive recipients of care to being more informed and empowered decision-makers whose lay knowledge and personal experience of mental illness are a resource (McCann and Sharek, 2014). This reconceptualisation has been formalised in the ‘recovery’ model, which has critiqued the stigmatising judgements of medico-psychiatric discourse about deviance and their accompanying social exclusion and disadvantage (Masterson and Owen, 2006). The third has been the recognition of cultural diversity and a critique of the limits of universalism. Finally, gender activism has exposed fractures in the sex/gender system and has led to a greater awareness of diversity, with regard to gender and sexual orientation.

Of these critiques, gender activism has received the least attention in mental health nursing; which is a concern, given the negative effects of heteronormativity and cisgenderism. Mental health nurses must continue to challenge or trouble the dominant binary views of gender and the discourse of biological determinism, the notion that the sex that one is assigned at birth determines ones’ gender (Merryfeather and Bruce, 2014). There is growing evidence of negative attitudes, a lack of knowledge, and a lack of sensitivity toward people whom are expressing diverse genders and sexualities. This discrimination creates barriers to the patients’ health gain and creates disparity (Chapman et al., 2012; McCann and Sharek, 2014).

The reviewed article on the attitudes of mental health nurses towards transgender people is therefore timely, given the relative invisibility of issues of gender identity within nursing theory, practice and research. As Fish (2010) wrote previously in this journal, the culture, norms and values of social institutions can inhibit access to healthcare and reinforce disparities in health outcomes. Cisgenderism (the alignment of one’s assigned sex at birth and one’s gender identity and gender expression with societal expectations) suffuses every aspect of clinical access to and through services, from written materials including mission statements, forms, posters and pamphlets; the built environment such as gender-specific washrooms; and interactions with both health professionals and allied staff, all of which reinforce a message of exclusion of transgender people (Baker and Beagan, 2014; Rager Zuzelo, 2014). In turn, these exclusionary practices are shaped through a dearth of policies and procedures, and scant educational preparation at the undergraduate and graduate levels (Eliason et al., 2010; Fish, 2010).

Nurses have a professional responsibility to challenge structural constraints and social policies, rather than passively accepting them. This paper provided compelling evidence for how nursing as a discipline and mental health nursing as a unique speciality can critically reflect on discourses regarding sex and gender; and on how these influence practice and consequently, can develop safer, ethical, effective and high-quality care for people whom either change their sex or express their gender differently from the standard culturally determined gender categories (Merryfeather and Bruce, 2014). Furthermore, this paper challenges mental health nurses to challenge heterosexism and cisgenderism; to speak out about social determinants of health that contribute to health inequities and health disparities, such as transphobia; and to address discrimination against transgender people. These challenges must be embedded into processes at the organizational, regulatory and political level (DeSouza, 2015).

References
Baker K and Beagan B (2014) Making assumptions, making space: An anthropological critique of cultural competency and its relevance to queer patients. Medical Anthropology Quarterly 28(4): 578–598. doi:10.1111/maq.1212.
Chapman R, Watkins R, Zappia T, et al. (2012) Nursing and medical students’ attitude, knowledge and beliefs regarding lesbian, gay, bisexual and transgender parents seeking health care for their children. Journal of Clinical Nursing 21(7,8): 938–945. doi:10.1111/j.1365-2702.2011.03892.
De Souza R (2015) Navigating the ethics in cultural safety. In: Wepa D (ed.) Cultural safety. Port Melbourne, Australia: Cambridge University Press, pp. 111–124.
Eliason MJ, Dibble S and Dejoseph J (2010) Nursing’s silence on lesbian, gay, bisexual and transgender issues: The need for emancipatory efforts. Advances in Nursing Science 33(3): 206–218. doi:10.1097/ANS.0b013e3181e63e4.
McCann E and Sharek D (2014) Challenges to and opportunities for improving mental health services for lesbian, gay, bisexual and transgender people in Ireland: A narrative account. International Journal of Mental Health Nursing 23(6): 525–533. doi:10.1111/inm.12081.
Masterson S and Owen S (2006) Mental health service user’s social and individual empowerment: Using theories of power to elucidate far-reaching strategies. Journal of Mental Health 15(1): 19–34. doi:10.1080/0963823050051271.
Merryfeather L and Bruce A (2014) The invisibility of gender diversity: Understanding transgender and transsexuality in nursing literature. Nursing forum 49(2): 110–123.
Rager Zuzelo P (2014) Improving nursing care for lesbian, bisexual and transgender women. Journal of Obstetric, Gynecologic and Neonatal Nursing 43(4): 520–530. doi:10.1111/1552-6909.1247.

/by