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“Kiwi food is okay for Kiwis, but it isn’t okay for us”: Special food in the perinatal period for migrant mothers

I attended the 5th International Conference on Nutrition and Nurture in Infancy and Childhood: Relational, Bio-cultural and Spatial Perspectives from Wednesday, 5 November 2014 – Friday, 7 November 2014.

Those who know me or follow my work will know that I am deeply interested in eating and thinking about food. I’m interested in how food structures our days and our lives,it nourishes and sustains us, reminds us of people, events, history, all in a mouthful.

Birthday cake

A special birthday cake, made for a surfer on his special birthday.

I’ve written elsewhere about how migrants perform identity through food preparation and consumption. I’ve also written about consumptive multiculturalism. I’m also interested in the provision of food in (monocultural) institutional contexts such as health where people are racialised by the foods that they eat and how the processes of hospitalisation strip people of their cultural and social identities and often lead people into being unable to access culturally appropriate food. This presentation brings those ideas together.

Abstract

Food, its preparation and ingestion, constitutes a source of physical, emotional, spiritual and cultural nourishment. Food structures both daily life and major life transitions, including the transition to parenthood, where food is prepared and consumed that recognises the unique status of the mother. However, the reductive focus of hospitals where efficiency, economy and a focus on nutrients dominate and where birth is viewed as a normal event can mean that there is a mismatch between the cultural and religious dietary needs of migrant mothers with the food that is available from Western instititutional environments. In this paper I outline a research study, which examined the transition to parenthood among new migrant groups in New Zealand. Based on a number of focus groups with mothers and fathers, the data were analysed using a postcolonial feminist lens and drew upon Foucauldian concepts to examine the transition to parenthood. The findings show that Asian new migrant parents construct the postnatal body as vulnerable, requiring specific kinds of foods to facilitate recovery from the trials of pregnancy and delivery and optimize long term recovery from pregnancy. This discourse of risk contrasts with the dominant discourse of birth as normal, and signals the limitations of a universal diet for all postnatal mothers, where consuming the wrong food can pose a threat to good maternal health. Paying attention to what nutrition and nurturing might mean for different cultural groups during the perinatal period can contribute to long term maternal well-being and cultural safety. Health practitioners need to understand the meanings and significance attached to specific foods and eating practices in the perinatal period. I propose that institutional arrangements become responsive to dietary needs and practices by providing facilities and resources to facilitate food preparation.

I’m hoping that the written form of the paper becomes part of an edited book about mothers and food. Fingers crossed, it’s under review at the moment.

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Nursing in media-saturated societies: implications for cultural safety in nursing practice

Nairn, DeSouza, Moewaka Barnes, Rankine,  Borell, and McCreanor (2014). Nursing in media-saturated societies: implications for cultural safety in nursing practice in Aotearoa New Zealand. Journal of Research in Nursing September  19: 477-487,doi:10.1177/1744987114546724

Great to be published in the Journal of Research in Nursing September 2014 issue on ‘Race’, Ethnicity and Nursing, Edited by: Lorraine Culley. I had the pleasure of being included in a previous issue in 2007, so it’s great to be in this one.

Abstract

This educational piece seeks to apprise nurses and other health professionals of mass media news practices that distort social and health policy development. It focuses on two media discourses evident in White settler societies, primarily Australia, Canada, New Zealand and the United States, drawing out implications of these media practices for those committed to social justice and health equity. The first discourse masks the dominant culture, ensuring it is not readily recognised as a culture, naturalising the dominant values, practices and institutions, and rendering their cultural foundations invisible. The second discourse represents indigenous peoples and minority ethnic groups as ‘raced’ – portrayed in ways that marginalise their culture and disparage them as peoples. Grounded in media research from different societies, the paper focuses on the implications for New Zealand nurses and their ability to practise in a culturally safe manner as an exemplary case. It is imperative that these findings are elaborated for New Zealand and that nurses and other health professionals extend the work in relation to practice in their own society.

One of my favourite pieces of the article proposes some ways in which nurses can engage in critical assessment of mass media, by asking questions like:

  • From whose point of view is this story told?
  • Who is present?
  • How are they named and/or described?
  • Who, of those present, is allowed to give their interpretation of the matter?
  • Who is absent?
  • Whose interests are served by telling the story this way?

One of the things that I love about this journal is that they ask for commentaries from a reviewer. My former colleague Denise Wilson (Professor, Māori Health Taupua Waiora Centre for Māori Health Research/School of Public Health & Psychosocial Studies, National Institute of Public Health and Mental Health Research, Auckland University of Technology, New Zealand), has reviewed our paper and says:

I would urge nurses to read this paper and reflect on how the media influences their own practice and engagement with minority and marginalised groups. Media portrayals of minority groups often reflect negatively geared dominant cultural sentiments, becoming ‘accepted’ fact within our communities. Nurses need to be aware that their efforts to be culturally safe in their practice can be undermined by the normalisation and acceptance of what is portrayed in the media. Therefore, nurses are encouraged by the authors to come together and question the ‘taken-for-granted’ dominant cultural media portrayals to create a stronger platform for culturally safe practice.

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Mind the gap: Cultural safety in Australia

In August 2014 there was a wonderful story of how “people power” had freed a man in Perth, whose leg had become caught in the gap between a platform and train on his morning commute. You can watch the video here. What struck me about this story was that people taking part in their “regular” commute noticed something out of the ordinary and used their combined energy to free the man. Someone alerted the driver to make sure that the train didn’t move, staff then asked passengers to help and in tandem they rocked the train backwards from the platform so it tilted and his leg could be freed. It made me think about the gaps people are stuck in, that exist all around us, that have become so routine, that we are habituated to, and fail to notice.

One of the biggest gaps is in the health outcomes between Indigenous and non-indigenous people in settler nations. Oxfam notes that Australia equals Nepal for the world’s greatest life expectancy gap between Indigenous and non-Indigenous people. This is despite Australians enjoying one of the highest life expectancies of any country in the world. Indigenous Australians (who numbered 669,900 people in 2011, ie 3% of the total population) live 10-17 years less than other Australians. In the 35–44 age group, Indigenous people die at about 5 times the rate of non-Indigenous people. Babies born to Aboriginal mothers die at more than twice the rate of other Australian babies, and Aboriginal and Torres Strait Islander people experience higher rates of preventable illness such as heart disease, kidney disease and diabetes.

One of the most galvanising visions for addressing the health and social disparities between Indigenous and non-indigenous people is  The Close the Gap campaign aiming to close the health and life expectancy gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians within a generation. By 2030 any Aboriginal or Torres Strait Islander child born in Australia will have the same opportunity as other Australian children to live a long, healthy and happy life.

Mind the gap

 

Nurses play an important role in creating a more equitable society and have  been forerunners in the field of cultural safety and competence. For the gap to close, nurses need an understanding of health that includes social, economic, environmental and historical relations. Cultural safety from Aotearoa New Zealand has been an invaluable tool for me as nurse for analysing this set of relations. However, as a newcomer to Australia, I have a lot to learn about what cultural competency means here and how I fulfil my responsibilities as a nurse educator to Aboriginal and Torres Strait Islander peoples. To that end, this blog piece focuses on some of the frameworks in nursing that might enable nurses to close the gap. I am particularly interested in frameworks that enable nurses to widen the lens of care beyond the individual and consider service users in the context of their families and communities and broader social and structural inequities. I’m also interested in policy frameworks that can support practice.

Gosford Anglican church

A social determinants of health approach takes into account “the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics” (WHO, 2010). A health equity lens has also been invaluable to my own practice, it refers to the absence of systematic disparities in health (or in the major social determinants of health) between groups with different social advantage/disadvantage. Social inequalities refer to “relatively long-lasting differences among individuals or groups of people that have implications for individual lives” (McMullin, 2010, p.7). While an inequity, refers to an unjust distribution of resources and services. “equity means social justice” (see, Braverman 2003). The term “social and structural inequities,” refers to unfair and avoidable ways in which members of different groups in society are treated and/or their ability to access services.

Equality justice

Principle Four of the New Zealand Nursing Council: Guidelines for Cultural safety in Nursing and Midwifery Education (2011) pay great attention to the issue of power:

PRINCIPLE FOUR Cultural safety has a close focus on:

 

4.1 understanding the impact of the nurse as a bearer of his/her own culture, history, attitudes and life experiences and the response other people make to these factors

4.2 challenging nurses to examine their practice carefully, recognising the power relationship in nursing is biased toward the provider of the health and disability service

4.3 balancing the power relationships in the practice of nursing so that every consumer receives an effective service

4.4 preparing nurses to resolve any tension between the cultures of nursing and the people using the services

4.5 understanding that such power imbalances can be examined, negotiated and changed to provide equitable, effective, efficient and acceptable service delivery, which minimises risk to people who might otherwise be alienated from the service.

The Australian Code of Ethics for nurses and midwives in Australia also pays attention to the role of nurses in having a moral responsibility to protect and safe guard human rights as means to improving health outcomes and having concern for the structural and historical:

The nursing profession recognises the universal human rights of people and the moral responsibility to safeguard the inherent dignity and equal worth of everyone. This includes recognising, respecting and, where possible, protecting the wide range of civil, cultural, economic, political and social rights that apply to all human beings.

 

The nursing profession acknowledges and accepts the critical relationship between health and human rights and ‘the powerful contribution that human rights can make in improving health outcomes’. Accordingly, the profession recognises that accepting the principles and standards of human rights in health care domains involves recognising, respecting, actively promoting and safeguarding the right of all people to the highest attainable standard of health as a fundamental human right, and that ‘violations or lack of attention to human rights can have serious health consequences’.

 

In recognising the linkages and operational relationships that exist between health and human rights, the nursing profession respects the human rights of Australia’s Aboriginal and Torres Strait Islander peoples as the traditional owners of this land, who have ownership of and live a distinct and viable culture that shapes their world view and influences their daily decision making. Nurses recognise that the process of reconciliation between Aboriginal and Torres Strait Islander and non-indigenous Australians is rightly shared and owned across the Australian community. For Aboriginal and Torres Strait Islander people, while physical, emotional, spiritual and cultural wellbeing are distinct, they also form the expected whole of the Aboriginal and Torres Strait Islander model of care.

The Code stops short of using words like colonisation and racism, but the National Aboriginal Community Controlled Health Organisation background paper “Creating the Cultural Safety Training Standards and Assessment Paper” (2011, p. 9) points out that awareness and sensitivity training, result in individuals becoming more aware of cultural, social and historical factors and engaging in self-reflection however if there isn’t an institutional response and the responsibilities for institutional racism remain individualised:

Even if racism is named, the focus is on individual acts of racial prejudice and racial discrimination. While historic overviews may be provided, the focus is again on the individual impact of colonization in this country, rather than the inherent embedding of colonizing practices in contemporary health and human service institutions

The focus is on the individual and personal, rather than the historical and institutional nature of such individual and personal contexts.

Cultural Respect
The concept of cultural respect (Aboriginal Cultural Security: Background Paper, Health Department of Western Australia) comes the closest to embedding the health care system with policies and practices to help improve the health care outcomes of Aboriginal and Torres Strait Islander peoples. Having a cultural respect framework means that there is an acknowledgement that:

the health and cultural wellbeing of Aboriginal and Torres Strait Islander peoples within mainstream health care settings warrant special attention.   Cultural Respect is the:  recognition, protection and continual advancement of the inherent rights, cultures and tradition of Aboriginal and Torres Strait Islander Peoples. ….   [it] is about shared respect ….[and] is achieved when the health system is a safe environment for Aboriginal and Torres Strait Islander peoples and where cultural differences are respected. It is commitment to the principle that the construct and provision of services offered by the Australian health care system will not compromise the legitimate cultural rights, values and expectations of Aboriginal and Torres Strait Islander peoples. The goal is to uphold the rights of Aboriginal and Torres Strait Islander peoples to maintain, protect and develop their culture and achieve equitable health outcomes.

The framework includes the following dimensions:
Knowledge and awareness, where the focus is on understandings and awareness of  history, experience, cultures and rights of Aboriginal and Torres Strait Islander peoples.
A focus on changed behaviour and practice to that which is culturally appropriate. Education and training and robust performance management processes are strategies to encourage good practice and culturally appropriate behavior.
Strong relationships between Aboriginal and Torres Strait Islander peoples and communities, and the health agencies providing services to them. Here the focus is on the business practices of the organization to ensure they uphold and secure the cultural rights of Aboriginal and Torres Strait Islander peoples.
Equity of outcomes for individuals and communities. Strategies include ensuring feedback on relevant key performance indicators and targets at all levels.
What I like about this framework is that it goes beyond attitudes and knowledge-based to also demand changed behaviour and action that leads to culturally safe healthcare for Aboriginal and Torres Strait Islander peoples. Central to cultural respect is the need for organisations to engage with and seek advice from local Aboriginal or Torres Strait Islander communities.
Cultural Security
Another new term is the notion of cultural security (developed by the Department of Health, Western Australian Health, 2003, Aboriginal Cultural Security: A background paper, page 10) which focuses on behavior: the practice, skills and behaviour of both professionals as individuals and the health system:

commitment to the principle that the construct and provision of services offered by the health system will not compromise the legitimate cultural rights, values and expectations of Aboriginal people. It is a recognition, appreciation and response to the impact of cultural diversity on the utilisation and provision of effective clinical care, public health and health system administration

Cultural Responsiveness
Defined by the Victorian Health Department as: The capacity to respond to the healthcare issues of diverse communities. This term broadly considers diversity rather than the unique needs of Aboriginal and Torres Strait Islander peoples which are a consequence of colonialism and racism.
Cultural Competence

The term ‘Cultural competence’ originates from Transcultural Nursing developed by Madeleine Leininger. Borrowing from anthropology, the aim was to develop a model that encouraged nurses to study and understand cultures other than their own. You can read my paper on the complementariness of cultural safety and competence here. Wellness for all: the possibilities of cultural safety and cultural competence in New Zealand. Betancourt, et al., 2002, p. v define it as:

the ability of systems to provide care to patients with diverse values, beliefs and behaviours, including tailoring delivery to meet patients’ social, cultural and linguistic needs

The Australian National Health and Medical Research Council (NHMRC)’s  Cultural Competency in Health: A guide for policy, partnerships and participation supports the notion of the capacity of the health system to improve health and wellbeing by integrating culture into the delivery of health services, but the scope of the document does not extend to cultural competency as applied to Aboriginal and Torres Strait Islander health care.
Government interventions to address health inequities are being deployed in tandem with neoliberalism and economic globalisation, which push back responsibility to individuals. Now, more than ever, attention needs to be paid to power relations and structures that contribute to inequality in society and injustice within nursing, using approaches that consider equity and the social determinants of health. I personally am looking forward to the day when we don’t need this sign, because there isn’t a gap.
Mind-the-Gap
What you can do:
Support the Close the Gap campaign
Dr Tom Calma’s (Aboriginal and Torres Strait Islander Commissioner )  Social Justice Report 2005 instigated a human rights-based approach Campaign to close the gap in life expectancy between Indigenous and non-Indigenous Australians (up to 17 years less than other Australians at the time). This report called on all Australian governments to commit to achieving equality of health status and life expectancy within a generation (by 2030).
A coalition drawn from Indigenous and non-Indigenous health and human rights organisations formed the Close the Gap Campaign, which was launched in April 2007 by Catherine Freeman and Ian Thorpe, the Campaign’s Patrons.  The CTG Campaign is currently Co-Chaired by the Aboriginal and Torres Strait Islander Social Justice Commissioner Mick Gooda and Co- Chair of the National Congress of Australia’s First Peoples, Kirstie Parker. The Campaign Steering Committee is comprised of 32 health and human rights organisations. The members of the Campaign Steering Committee have worked collaboratively for approximately nine years to address Aboriginal and Torres Strait Islander health inequality through two primary mechanisms: attempting to gain public support of the issue and demanding government action to address it.
Some useful videos
Aboriginal and Torres Strait Islander health videos:
http://blogs.crikey.com.au/croakey/2013/08/04/youtube-an-excellent-resource-for-aboriginal-and-torres-strait-islander-health/Cultural competence video:
https://www.youtube.com/watch?v=JpzLzgeL2sADr Tom Calma – Cultural Competency
https://www.youtube.com/watch?v=tnYuTY0fn3s
White privilege: Unpacking the invisible knapsack
http://amptoons.com/blog/files/mcintosh.htmlWhat kind of Asian are you?
https://www.youtube.com/watch?v=DWynJkN5HbQReverse racism, Aamer Rahman:
https://www.youtube.com/watch?v=dw_mRaIHb-M
Terminology
Aboriginal and Torres Strait Islander peoples are the first inhabitants of Australia.  Aboriginal people are extremely heterogenous groups differing in language and tradition. Torres Strait Islander peoples come from the islands of the Torres Strait, between the tip of Cape York in Queensland and Papua New Guinea but who may live on mainland Australia. The term ‘Indigenous’ is often used to refer to both Aboriginal and Torres Strait Islander peoples. In the spirit of being both relational and political then I’d like to share with you my learning about cultural competency and Aboriginal and Torres Strait Islander health care.
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‘This child is a planned baby’: skilled migrant fathers and reproductive decision-making

Article first published online: 13 MAY 2014  De Souza, Ruth Noreen Argie. (2014). ‘This child is a planned baby’: skilled migrant fathers and reproductive decision-making. Journal of Advanced Nursing. doi: 10.1111/jan.12448

Risk management and life planning are a feature of contemporary parenting, which enable children to be shaped into responsible citizens, who are successful and do not unduly burden the state (Shirani et al. 2012). This neoliberal project of intensive parenting and parental responsibility (typically gendered as maternal) involves child centredness and detailed knowledge of child development (Hays 1998). Simultaneously, contemporary masculinities are increasingly being situated beyond the traditional Western binary of the active home-caring mother and passive breadwinning father. Following Connell (1995), the plural word masculinities refers to the many definitions and practices of masculinity (See e.g. Archer 2001, Cleaver 2002, Finn & Henwood 2009, Haggis & Schech 2009, Walsh 2011). Broader and more inclusive repertoires of fathering emerge from diverse family practices and formations including queer/homoparental families; cohabitation; new technologies; changing domestic labour arrangements; the changing organization of childcare and growing involvement of fathers; and social policy initiatives including parental leave and family-friendly employment practices (Draper 2003).

These rapid societal changes have ushered in new forms of participatory fathering and family involvement for men in the Western world. However, the pressure to integrate traditional breadwinner and authority figure roles with contemporary demands for involvement in all aspects of the perinatal period has not been matched by reduced work pressures or the provision of active societal support and preparation (Barclay & Lupton 1999). As a result, men often feel isolated, excluded, uninformed and unable to obtain resources and support in the perinatal period placing pressure on relationships, challenging feelings of competence and requiring negotiation of competing demands (Deave & Johnson 2008). Furthermore, men have gender- specific risk factors for perinatal distress including their more limited support networks; dependence on partners for support; additional exposure to financial and work stresses; a more idealized view of pregnancy, childbirth and parent- hood stemming from a lack of exposure to contemporary models of parenting; and lastly being less keen to seek help with emotional problems (Condon et al. 2004). All of these factors are compounded by practitioners and services oriented towards mothers and babies marginalizing fathers (Deave & Johnson 2008, Lohan et al. 2013).

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Happy Mothers’ Day

I’ve written a lot about maternity, an interest  derived from my clinical nursing practice and an interest in the intellectual and political ways in which women’s bodies have been mobilised in nationalist state interests. My interest in ‘maternity’ (the initial life-changing journey of being pregnant, giving birth and nurturing and the corporeal processes of the transition to motherhood) is supplemented with an interest in ‘mothering’ (the work of meeting the needs of and being responsible for dependent children) and ‘motherhood’ (the context where mothering occurs). All of which are shaped by the historical, the cultural, the political, the social and the moral.

Mother’s day is one of mixed emotions for many. It brings sadness for those who have lost their mothers, mothers who were never there and for mothers who were present yet absent, who didn’t fulfil the sentimental fantasy. It’s also a day when particular idealised mothers are invoked while others are made invisible as Ali Smith points out in her collection of 40 portraits of mothers in the act of mothering, Momma Love:

I am sick to death of the blandness of the “family mystique.” We all know that every family has cracks in it, and that some of those are profound. Silence, secrecy, disillusionment, lies, in my experience, are the most poisonous ingredients in any family and can exist in traditionally picture perfect households too.

I can’t stomach the lack of diversity in pop culture. I can’t stomach one more TV show that has a single character “of color” on it being considered ethnically diverse. I can’t stomach another public discourse about whether or not members of the LGBT community are complete human beings who deserve the same human rights as straight white men. I can’t stomach these things and so, I chose not to participate in them. I went the other way. I portrayed the world I see, which includes challenges and love in a variety of situations.

The ironies of celebrating this day are also pointed out in Ann Lamott‘s powerful essay about how mothers are simultaneously exalted and vilified. Her critique of mother’s day extends to the ways in which women who mother are viewed as superior and more evolved for having ‘chosen’ a  more challenging path. More importantly she points out how the focus on individual mothers means that the sociality of mothering is forgotten:

But my main gripe about Mother’s Day is that it feels incomplete and imprecise. The main thing that ever helped mothers was other people mothering them; a chain of mothering that keeps the whole shebang afloat. I am the woman I grew to be partly in spite of my mother, and partly because of the extraordinary love of her best friends, and my own best friends’ mothers, and from surrogates, many of whom were not women at all but gay men. I have loved them my entire life, even after their passing.

So with these two beautiful pieces in mind, I thought I would acknowledge the gaps and silences in the pop culture version of mothering and acknowledge those who mother on the margins, without acknowledgement, without the support of the State or who mother while vilified by the State.

Happy Mother's day chilout

I dedicate this day to those who have birthed and brought into being projects and works that were a labour of love into the world in forms other than flesh. I acknowledge those who grieve for their mothers, for those whose mothering is painful, for those who can’t be mothers but contribute to their communities and families. I acknowledge fathers, extended family, grandparents and “other” mothers that mother. I pay tribute to those mothers who mother against the odds, who mother while in detention, under occupation, in war, in poverty, in prison, in marginalised spaces and places. I salute the mothers whose mothering knowledges have been marginalised by colonisation, by assimilation, by racism, by the medicalisation of the body. I bless the animal mothers we share this earth with, I give thanks to our Earth mother who nourishes and sustains us all. Let us all acknowledge those who create and bring to life, those who nurture and sustain life and those who plant seeds, care for and protect.

Mother's day

Dedication: This blog is dedicated to both my grandmothers who died in May 1965 and who I never met, but whose presences have been with me. For Joyce and Kadogo Ayagwe, always in my heart.

Acknowledgements: Thanks to Rosemarie North for reminding me of the plural, to Alison Barrett for reminding me of Anne Lamott’s great piece and to Danny Butt for sharing the Momma Love link.

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Babies on board: Families in detention

The rather time-worn yellow sign “Baby on Board” seen in the back window of vehicles is meant to encourage safe driving, but also is a public announcement of one’s new status as a parent (It’s also a pun referring to pregnant women commuters in London, as an incitement for commuters to offer their seats to pregnant women). In Australia, when I think of “Babies on Board” there is a poignancy and a deep and overwhelming sadness, because it evokes images of people seeking asylum via boat. The official term is “unauthorised maritime arrivals”, a dehumanising and bureaucratic term rather like the hardline policies of deterrence and detention. Abbott’s cruel “stop-the-boats” strategy ensures that maternity and infancy cannot be the celebrations they are in every culture. Mothers, babies, children and families will encounter the opposite of tender loving care at the hands of the Australian Government who will send them to detention centres in remote locations run by global companies including G4S, Serco and Transfield (See Cathy Alexanders Crikey post for more details). This outsourcing of misery costs the Australian taxpayer a load of money ($2.97 billion has been budgeted by the Federal Government (2013-2014) for detention-related services and offshore asylum seeker management while $19.3 million is  allocated ($65.8 million over four years) for regional solutions).

baby-on-board-2

Consistent with other responses to asylum seekers in western countries, Australia has developed policies of deterrence and detention for boat arrivals without a valid visa. Australia’s Migration Act 1958 requires all “unlawful non-citizens” (people who are not Australian citizens and do not have permission to be in the country) to be detained, until they are granted a visa or leave the country. This detention policy was introduced in 1992 and continues until today. What makes Australia’s response to a legitimate right to seek asylum is the uniquely cruel policy of mandatory, indefinite detention and offshore processing. Without an age exemption it means that detainees can include families and unaccompanied children with processing taking months or years. A range of international literature shows that detention is highly distressing for both adults and children with long-term consequences. The majority of asylum seekers are found to be refugees under the 1951 Convention.

Everyone has the right to seek and enjoy in other countries asylum from persecution. Article 14, Universal Declaration of Human Rights (signed by member countries in 1948, including Australia).

The child shall have the right to adequate nutrition, housing, recreation and medical services. Principle 4. United Nations Declaration of the Rights of the Child. Proclaimed by General Assembly resolution 1386(XIV) of 20 November 1959.

I am horrified that many new babies and new parents will be starting their lives in detention, the latter having already navigated treacherous borders, war strife and dangerous seas but now officialdom to meet the needs of their babies. Most of my professional career has involved supporting new parents. Aside from working on a postnatal ward, I helped to set up a service for women with postnatal depression in Auckland in the mid-nineties, my colleagues and I offered assessment, consultation and therapy to women. Aside from the hundreds of women I met I also heard many stories in the weekly support group I facilitated for depressed women for three years. My Master’s research considered the experiences of new migrant mothers and the challenges of establishing a new life without support and access to cultural rituals. In my PhD research I looked at the “the politics of the womb” and the role of maternity in projects of capitalism, nation building, imperialism and globalisation. See my other blog posts on supporting migrant fathering, ‘good’ mothering, pronatalist and antinatalist policies (including Australia’s forcible removal of Aboriginal – and some Torres Strait Islander – children). I’ve also researched and written about the experiences of Refugee women in New Zealand, Korean migrant mothers and the discursive repertoires of Plunket Nurses. I have spent decades educating organisations and professionals about the needs of new mothers and I developed a brochure about Postnatal depression for the New Zealand Mental Health Foundation with the help of consumer organisations and many new parents and professionals. So you could say I know a little about what new mothers and babies might need to help them thrive.

Parenting and mothering are not easy. The transition is challenging emotionally, physically and socially. That’s why so many cultures have rituals for protecting and nurturing new mothers, whether it’s special foods, attention or ceremonies. The mother has experienced a massive transition requiring time to recoup, hence postpartum rest and loving attentive care are provided to women. Maternity professionals have a unique role in supporting the health and wellbeing of new migrant and refugee families, as they have privileged access to women at a time that is culturally and spiritually important to a woman and her family. However, women’s experiences of maternity services that are designed to meet their needs, can lead them to feel isolated, disrespected and invisible (and that’s when they aren’t in detention). 

Detention centres have been called factories for mental illness. The conditions in immigration detention are not conducive to establishing or maintaining family life, let alone helping families thrive. For asylum seekers who may have experienced torture or trauma, there is a vulnerable to experiencing mental health problems even before they reach countries of resettlement. The conditions of detention are demanding and difficult without the resources and support of family and friends, community and culture, no direct access to services and support. This situation is exacerbated by the unknown length for which people will be detained and to where they might be sent. It is further compounded by the punitive and coercive ways in which people are treated in detention. Existing trauma is only exacerbated while in prolonged detention which has an impact not only on the individuals in a family, but families themselves with the role of parent being undermined. Imagine powerless parents in unpredictable, hostile and degrading surroundings who cannot ensure their children’s safety or comfort. Yes, Australian policies of detention and deterrence are contributing to long term mental ill health for children and their families. Detention facilities have been criticised for the “culture of punishment, humiliating treatment of detainees, including children, and a failure to provide appropriate psychological support for high-risk populations”.

Children in detention

 In all actions concerning children … the best interests of the child shall be a primary consideration. UN Convention on the Rights of the Child (1989)  – Article 3.

.. a child who is seeking refugee status … whether unaccompanied or accompanied … [shall] receive appropriate protection and humanitarian assistance.

UN Convention on the Rights of the Child  (1989) – Article 22 .

 

No child shall be deprived of his or her liberty unlawfully or arbitrarily. The arrest, detention or imprisonment of a child shall be in conformity with the law and shall be used only as a measure of last resort and for the shortest appropriate period of time.

UN Convention on the Rights of the Child  (1989) – Article 37 (b).

 

Children subjected to abuse, torture or armed conflicts should recover in an environment which fosters the health, self-respect and dignity of the child.

UN Convention on the Rights of the Child (1989) Article 39.

Children, accompanied or on their own, account for as up to half of all asylum seekers in the industrialized world. Australia is not the only country to detain children, The United States, the United Kingdom, Germany and Italy also directly contradict The Convention on the Rights of the Child (UNCRC), which stresses that detention of children should only be a last resort and for the shortest appropriate period of time. In Australia up till 1994 there was a 273-day time limit on detention, however, after this time indefinite detention became the norm with no exemptions made for children or unaccompanied minors. A Human Rights Commission National Inquiry into Children in Immigration Detention in 2001 noted that (CRC)  requires the detention of children to be ‘a measure of last resort’, but Australia’s detention laws make detention of unauthorised arrival children ‘the first, and only, resort’. Mandatory detention overrides the rights and protections of child asylum seekers as enshrined in other international and regional conventions and declarations the European Convention on Human Rights, the Geneva Convention, the International Covenant on Civil and Political Rights, and the International Covenant on Economic, Social and Cultural Rights. 

Source: Department of Immigration and Citizenship, 13 September 2013. Adapted by the Australian Human Rights Commission.

Source: Department of Immigration and Citizenship, 13 September 2013. Adapted by the Australian Human Rights Commission.

The Australian Department of Immigration and Border Protection (DIBP) statistics (2014) show that:

  • 1106 children are held in Australia’s secure immigration detention facilities,
  • 356 on Christmas Island and 177 of the children in Nauru
  • 1579 are detained in the community under residence determinations.
  • 1816 children live in the community on Bridging Visas (their parents have no work rights and limited access to Government support).

Research shows that even “brief” detention is detrimental to children. Prior to 2008, all children seeking asylum In Australia were faced with mandatory detention for an average of two years. In a summary of the impacts on children’s physical and mental health, Kronick, Rousseau, & Cleveland (2011) noted all manner of behvioural problems including disruptive conduct, nighttime bedwetting, separation anxiety, sleep disturbance, nightmares and impaired cognitive development. More severe symptoms includied mutism, stereotypic behaviours, and refusal to eat and drink. Mental health problems such as post-traumatic stress disorder, major depression, self harm and suicidal ideation were common. Younger children experienced developmental delays, attachment and behavioural problems Parents self-reported a decrease in the capacity to parent while in detention, and detention can trigger memories of previous trauma, humiliation and hopelessness. United Kingdom research has also found behavioural difficulties, developmental delay, weight loss, difficulty breast-feeding in infants, food refusal and loss of previously obtained developmental milestones. The neurodevelopmental vulnerability of infants means that they are highly sensitive to their socio-cultural environments. The Australian Human Rights Commission is conducting an inquiry into children in immigration detention. You can read powerful testimonials from children themselves, educators and health professionals including this account from Paediatrician Karen Zwi who visited Christmas Island:

Babies are unable to crawl because the ground is so rough and the only playground is unusable during the day due to the extreme heat.New mothers are forced to queue up for strictly rationed nappies, baby wipes and powdered milk, with staff telling them constantly they will never be resettled in Australia.

Parenting in detention

Changes to the Migration Act since July 19, 2013 mean that pregnant asylum seekers in offshore detention (classed as “unauthorised maritime arrivals”) can be removed offshore. Recently babies have been sent from Darwin to Nauru and Greens Senator Sarah Hanson-Young plans to introduce a bill banning the removal of Australian-born babies to offshore detention centres to Parliament in May. She says:

‘‘We are, by incarcerating these newborn babies, creating the next damaged generation . . . we know the damage the detention of children has (on them),’’ she said. ‘‘If we allow this to continue, we are knowingly destroying them,’’ she said. ‘‘I don’t think that’s a political issue, it’s a moral issue.’’

(Note that Section 21(8) of the Australian Citizenship Act makes clear that a baby, born in Australia, who is stateless, is eligible to apply for Australian citizenship).

Louise Newman (see reference below) has worked extensively with women asylum seekers and notes that they have unique health and mental health needs related to pregnancy and delivery which can be exacerbated by limited antenatal care or screening. Their histories can include sexual trauma and abuse and perinatal loss. Receiving perinatal “care” in a detention facility means that professionals are balancing competing priorities and subject to varying forms of regulation and administration which put complex demands on their time. There may be ambiguity about how to respond to the needs of pregnant or postpartum women who they might be ill-equipped or resourced to support as reports have indicated.

In a detention context, women are isolated from their cultural traditions and supports and sometimes physical isolation begins weeks prior to delivery. This cultural isolation compounded with a lack of access to interpreters during delivery can increased fear and distress and is implicated in the high rates of postnatal depression and anxiety and attachment difficulties with infants seen in women in detention. Newman notes that research in the United Kingdom would resonate with women’s experiences and clinician observations in Australia. Where women expressed high levels of of distress and reported poor care. The context also impacted on their capacity to parent with women feeling isolated, incompetent, ashamed and guilty for delivering a baby in detention. Consequently, a highly anticipated, magnificent, sacred and profound time in a woman and her family’s life becomes one that is painful. In a powerful article describing his visit to Christmas Island, acting for some 26 babies born in detention Jacob Varghese notes how cruel asylum seeker policy is for new parents:

…what it is like being a new parent in a remote prison, with no control over your circumstances, every daily routine determined for you by guards and bureaucrats.

 

How the Australian government reports on conditions in detention differs from the reality. In an article for Crikey, Caroline de Costa, Professor of Obstetrics and Gynaecology and Director of the Clinical School at James Cook University School of Medicine, Cairns Campus in North Queensland notes:

We were told that there is 24/7 access to a nursing triage service, with a doctor on call, for asylum seekers (male and female, adults and children) in all three camps.  We were also told that there are regular playgroups and ‘Mums and Bubs’ sessions held in all three camps for pregnant women and new mothers. Meeting individual asylum seekers, in the visitors’ rooms of all three facilities, in the two days following our formal visit, we heard stories quite different from the official accounts. We observed in many parts of the camps that asylum seekers including children and women are routinely listed, dealt with and addressed by the numbers given to them on arrival by boat in Australia, rather than by their names.

Caroline de Costa also “unequivocally” states that neither Manus nor Nauru are suitable places for the detention of very young babies and their families. She suggests that:

the greatest and most pervasive risk is to the mental health of children and their families. The fact of ongoing uncertain detention is bad enough; adding to it with an extremely isolated hot and crowded environment with few diversions within the detention facility and none outside is demonstrably contributing to very high levels of psychiatric presentations among asylum seekers, well documented by many of my colleagues in recent weeks. My own observations of recent mothers I met in Darwin is of a high level of postnatal depression that is continuing on well past the postnatal period…

The Australian Immigration Minister’s (Scott Morrison) office says:

the Government’s policy is to transfer illegal boat arrivals to offshore processing centres and families are transferred to Nauru. The statement says creating exemptions for offshore processing will only create dangerous incentives for people smugglers to fill boats with women and children.

Cartoon by Oslo Davis Source: Museum Victoria

Cartoon by Oslo Davis
Source: Museum Victoria

So what can we do?

The good news is that there is plenty of resistance both professionally, in the community and among refugee advocacy organisations. DASSAN (Darwin Asylum Seekers Support and Advocacy Network) believe that families should not be detained and babies should not be born into detention. They advocate for policy change but have also been providing practical help and support including: making welcome packs for new babies; sewing gifts: and collecting clothes for babies and women in detention on Christmas Island. They observe:

At a time when families should be focused on preparing for the joy of welcoming new life, they are instead dealing with the trauma of having fled from their home, the great anxiety of being told they will be sent to Nauru or Manus Island, and the daily despair of being kept locked up.

(Note, if you’d like to support their work there are details on the DASSAN site). Chilout (Children out of immigration detention) have worked tirelessly to lobby for children aged from zero to eighteen. I recommend reading their Factsheet and accessing the extensive range of resources and reports on their website.

The use of prolonged detention for pregnant women and mothers with young children inflicts physical and psychological harm disproportionate to the policy aim of immigration control and should be stopped immediately .

 

The Royal Australasian College of Physicians (RACP) made a passionate plea on World  Refugee Day for the Australian Government to end the mandatory detention of children and adolescents seeking asylum in Australia and in offshore centres. Their Position Statement Towards better health for refugee children and young people in Australia and New Zealand advocates for the abolition of  Australian legislation that allows children to be housed in detention centres and they propose that the Australian Government  immediately place detained children in the community with their families where they can be provided with appropriate health and social support. There is a Paediatrics & Child Health advocacy campaign for health and well-being of children in detention/refugees which was launched on 7 June 2013. Information and template letters addressed to Government Ministers can be used to advocate for health of children in detention. These are just a few of the national and local responses to mothers, children and families in detention.
There is also a National Inquiry into Children in Immigration Detention 2014: Discussion Paper. The the Australian Human Rights Commission (HRC) is investigating the ways in which life in immigration detention affects the health, well-being and development of children and inviting people previously detained as children in closed immigration detention and assessing the current circumstances and responses of children to immigration detention. A follow up to their report ten years ago A last resort? the report of the National Inquiry into Children in Immigration Detention (National Inquiry). After the National Inquiry positive developments including the removal of children from high security Immigration Detention Centres, the creation of the Community Detention system and the use of bridging visas for asylum seekers who arrive by boat. However, there are still around 1,000 children in closed immigration detention, a higher number than the last inquiry, and the Commission’s monitoring work reveals that key concerns remain. Their aim is to discover if there have been any changes in the ten years since the last investigation, and whether Australia is meeting its obligations under the Convention on the Rights of the Child (CRC). You can read the inquiry discussion paper and make a submission that addresses the inquiry terms of reference. This inquiry is focused on closed detention facilities (not community) and the impact of detention on children under 18 years. You can also read about their work on alternatives to closed detention The last words really belong to Murray Watt who in an article Why is an Australian baby locked up in detention? says:

 

It’s not fair that children – or anyone for that matter – should be locked up for years on end, without any consideration of their claims to protection.   It’s not fair that the conditions in offshore detention camps, overseen by our own government, are dangerous, inhumane and deliberately designed to break people’s spirit.   And it’s not fair that Australia – ranked by the IMF as the 10th richest country in the world – should pass our refugee “problem” on to countries that are far poorer and less safe than many of the countries from which refugees come in the first place.   Australia can do better than this. Over our history, we have led the world in protecting others in distress, and in improving the rights and living conditions of our citizens and those across the world. We should live up to our history.

References

  • Kronick, Rachel, Rousseau, Cécile, & Cleveland, Janet. (2011). Mandatory detention of refugee children: A public health issue? Paediatrics & child health, 16(8), e65.
  • Mares, Newman, Dudley, & Gale, (2002). Seeking Refuge, Losing Hope: Parents and Children in Immigration Detention. Australasian Psychiatry, 10(2), 91-96. doi: 10.1046/j.1440-1665.2002.00414.x)
  • Newman, Louise K, & Steel, Zachary. (2008). The child asylum seeker: psychological and developmental impact of immigration detention. Child and adolescent psychiatric clinics of North America, 17(3), 665-683.
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Korean migrant mothers on giving birth in Aotearoa New Zealand

Cite as: DeSouza, Ruth. (2014). One woman’s empowerment is another’s oppression: Korean migrant mothers on giving birth in Aotearoa New Zealand. Journal of Transcultural Nursing. doi: 10.1177/1043659614523472.  Download pdf (262KB) DeSouza J Transcult Nurs-2014.

Published online before print on February 28, 2014.

Abstract

Purpose: To critically analyze the power relations underpinning New Zealand maternity, through analysis of discourses used by Korean migrant mothers. Design: Data from a focus group with Korean new mothers was subjected to a secondary analysis using a discourse analysis drawing on postcolonial feminist and Foucauldian theoretical ideas. Results: Korean mothers in the study framed the maternal body as an at-risk body, which meant that they struggled to fit into the local discursive landscape of maternity as empowering. They described feeling silenced, unrecognized, and uncared for. Discussion and Conclusions: The Korean mothers’ culturally different beliefs and practices were not incorporated into their care. They were interpellated into understanding themselves as problematic and othered, evidenced in their take up of marginalized discourses. Implications for practice: Providing culturally safe services in maternity requires considering their affects on culturally different women and expanding the discourses that are available.

Keywords: focus group interview, cultural safety, Korean women, maternal, postcolonial, Foucault.

Introduction

A feature of contemporary maternity is the notion that birth can be empowering for women if they take charge of the experience by being informed consumers. However, maternity is not necessarily empowering for all mothers. In this article, I suggest that the discourses of the Pākehā maternity system discipline and normalize culturally different women by rendering their mothering practices as deviant and patho- logical. Using the example of Korean migrant mothers, I begin the article by contextualizing maternity care in New Zealand and outlining Korean migration to New Zealand. The research project is then detailed, followed by the findings, which show the ways in which Korean mothers are interpellated as others in maternity services in New Zealand. I conclude the article with a brief discussion on the implications for nursing and midwifery with a particular focus on cultural safety.

You can read the rest at: Journal of Transcultural Nursing or download DeSouza TCN proof.

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I wish we cared about every new baby, the way we care about the Royal baby.

Sleeping beauty fairies

As a child I was enchanted by the idea of princesses and fairy godmothers and obsessed with the story of Sleeping Beauty. I even directed classmates in a play version of it in the playground of my Nairobi primary school. In case you aren’t familiar with the story, three good fairies arrive to bless the infant princess. Using their magic wands, one gives her the gift of beauty and the second the gift of song, but before the third can give her blessing, an evil fairy appears and curses the princess because she wasn’t invited to the christening ceremony. The curse is that the princess will die when she touches a spinning wheel’s spindle before sunset on her sixteenth birthday. Luckily the third fairy who was interrupted from her wish making uses her blessing to weaken the curse so that instead of death, the princess will fall into a deep sleep until she is awakened by a kiss.

Since the Royal baby was born, there has been a lot of fanfare with landmarks in London and all over the world lit up to celebrate the birth of the Royal baby. Many in both red and blue leading up to the birth and then blue upon confirmation of the baby’s gender. Former colonies have also got in on the act with almost 40 buildings in New Zealand partaking in the lighting frenzy. This baby has certainly had the Royal treatment in the media:

Daily mail Royal delivery

Daily mail Royal delivery

Led to creative gestures like this one from the crew of the HMS Lancaster based in the Caribbean:

Crew of HMS Lancaster

Crew of HMS Lancaster

I’ve loved the idea of being able to bestow wishes, fancying myself as a fairy godmother even if I haven’t had a magic wand. Working on a postnatal ward in the 90s, I would wish every infant and their family a wonderful new life. The birth of the Royal baby has rekindled my desire for godmothership, so this is what I wish for every infant, mother,  and family:

  • I wish the arrival of every infant in the world was greeted with the same sense of anticipation and enthusiasm as the Royal arrival.
  • I wish every mother, infant and family could receive the same “care” as the Royals will.
  • I wish “we” cared as much about maternal and infant mortality around the world.
  • I wish “we” cared as much about “other” mothers who aren’t supported in their mothering and against whom active measures are taken to regulate and surveil their bodies merely because of the accident of their own circumstances.
  • I wish we could remember the resources that have been extracted globally to maintain the Royal Family in the lifestyle they are accustomed to and that these could be redistributed.

Oxfam babyHowever, all babies are not created equal and neither are all mothers. Regulating the reproduction of those considered to be a burden on society has been a way to secure and control the well-being of the population, leading to the surveillance and management of women’s bodies. The quality and quantity of the populations been an enduring concern of governments, a concern which has seen two kinds of policies, the ones that encourage some mothers to procreate (pronatalist) and others that discourage or even coerce other mothers from reproducing (antinatalist).

Our recent colonial history is emblematic of these concerns, reflecting a shift from Malthusian anxiety about over-population and the inability of the environment to support growth to a concern with the quality of the population. In white settler nations pronatalist movements often had nationalist overtones, equating international prominence with demographic strength, requiring both productive and reproductive capacity. For example in the United States, Republican motherhood was a site of civic virtue, demonstrated through bearing arms if you were a man and producing and rearing sons if you were a woman. These sons would embody republican virtues, even if as a woman you were excluded from citizenship.

1789 Charles Willson Peale 1741-1827 Mary Gibson (Mrs. Richard Tilghman) & sons. Maryland Historical Society.

18th-Century American Mothers & Their Children By Charles Willson Peale

Fears of ‘race suicide’ arose in early 20th Century Australia, New Zealand and the United States and made motherhood a political duty for white women in the interests of the nation and the health of the race. Reproducing white citizens in the colonies was a patriotic duty for women superseding involvement in public affairs. The concern about ‘race suicide’ was attributed to middle class women neglecting their duties by not having children while ‘other’ women (migrant, indigenous or working class) had too many in white settler societies. Anglo-Saxon middle class’ individualised mothering contrasted with shared child rearing that was more common in other societies. This resulted in women from those communities, for example immigrant and indigenous women, being labelled as bad mothers. Evolutionary theory played a role in demarcating good and bad mothering: Anglo-Saxon and Northern European women were positioned on the top of the hierarchy of the ‘races’ and were the only women capable of being good mothers irrespective of what other mothers did. Such women bore the responsibility for ensuring the well-being of their families, the future of the nation and the progress of the race. Anglo-Saxon mothers were thus both exalted and pressured.

Market Court, Kensington High Street, London

Market Court, Kensington High Street, London

It has always been easier to focus on the management of mothers rather than politically challenging public health issues. Schemes to address maternal malpractice such as health visitors (whose job it was to keep surveillance and intervene to educate women) were initiated to ensure that the British working class mother was subjected to the imperatives of the infant welfare movement and became a ‘responsible’ mother. A proliferation of organisations to promote public health and domestic hygiene among the working class thrived, assisted by upper or middle class women. This class-based maternalism in Europe and North America reflected a race-based maternalism in the colonies, where Europeans challenged and transformed indigenous mothering in the name of “civilisation, modernity and scientific medicine” (Jolly, 1998, p.1). Similarly, in colonised countries the ‘cleaning up’ of birth was achieved through both surveillance and improved hygiene and sanitation. Sadly, interventions have involved the removal of children, most notably in the Stolen Generation in Australia, where Aboriginal – and some Torres Strait Islander – children were forcibly removed from their families by Australian Federal, State and Territory government agencies, and church missions, from the late 1800s to the 1970s and children sent either to institutions or adopted by non-Indigenous families.

Slightly late..

Slightly late..

A grassroots campaign calling for a national apology led to the first national Sorry Day on 26 May 1998 marked by ceremonies, rallies and meetings. Sadly, Australian Greens leader Bob Brown’s move to amend the sorry motion by offering “just compensation to all those who suffered loss” – was voted out by all the non-Green Australian Senators.

Australia Day 2008. The ‘Sorry’ writing was commissioned by a private person. Photo: Michael Davies, Flickr

Australia Day 2008. The ‘Sorry’ writing was commissioned by a private person. Photo: Michael Davies, Flickr

Forced sterilisations without consent occurred as recently as between 2006 and 2010 where prison doctors sterilized 150 California women. The targets of Golden State prisons were people with a mental illness or who were poor. The practice was eventually banned in 1979, but even by 1933, California had subjected more people to  forceful sterilization than all other U.S. states combined. This eugenic programme spread to Nazi Germany where extreme anti-natal racial hygiene doctrines were implemented against ‘unfit mothers’. Anti-natalist ideologies have often occurred concurrently with pronatalist ones. Women with mental or physical impairments or ethnically ‘other’ women such as Jews, Gypsies and Slavs were forcibly sterilised and abortions conducted, while Hitler simultaneously supported initiatives for the growth of a strong German Nazi Volk through a virtuous German motherhood. Breastfeeding in Nazi Germany was obligatory and women were awarded the Mutterkreuz medal (Honour of the German Mother (Ehrenkreuz der deutschen Mutter) for rearing four or more children.

MothersCross

So how will the other children born in the UK on 22 July 2013 fare? Emily Harle in The new Prince and his 2,000 birthday buddies paints a bleak picture. To summarise, 226 children of the 2,000 will live in overcrowded, temporary or run down housing, 11 will be homeless. 540 children will live in poverty. 8 children will die before their first birthdays and poor housing and low quality healthcare will be contributing factors.13  children will be taken into care during their childhood and have around five different sets of carers and nine of them will leave school with no qualifications. 120 will have a disability and 40 will have difficulty accessing services, support and activities that their able-bodied friends can. 25 of the 2,000 will be young carers who look after ill or disabled family members. Eleven of the children born on the same day will suffer from severe depression during their childhood, and 500 will experience mental illness during their lives, half of whom will have reported that the problem began before they were 18.

State handouts

Seumas Milne contends that the monarchy embodies inequality and fosters a “phonily apolitical conservatism”. The hypocrisy at the heart of the celebration of the monarchy is seen in the British government’s preaching of democracy globally, whilst supporting an undemocratic system at home through an unelected head of state and an appointed second chamber giving the monarchy significant unaccountable powers and influence aside from the more visible deferential culture and invented traditions.

The festivities to mark the Royal baby’s arrival are likely to continue for some time but let’s not forget the ‘other’ mothers, infants and families for whom there are no celebrations and for whom there will never be. Let us not forget that not all lives are equal, there are those whose lives are valued and those who aren’t. Most of all, let’s do something about it.

Niagara lit blue

Niagara Falls turns blue to celebrate the arrival of the royal baby.

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Cartoons displace the blame for social consequences of neoliberal policy away from real culprits

Over the last few years I’ve been involved in various public health and health promotion programmes related to healthy eating and weight management (Clinical Guidelines for Weight Management in New Zealand Adults and the Clinical Guidelines for Weight Management in New Zealand Children and Young People) as well as a social marketing strategy called Feeding our Futures. I’ve also facilitated four Asian Nutrition and Physical Activity Fora for the Agencies for Nutrition Action (ANA) since they began in 2008. I’ve also been involved in research with colleagues at AUT University about problem gambling.

It was my involvement in community organisations and governance rather than my own background as a health practitioner with its attendant reductionist biomedical socialisation that prepared me for the sheer complexities of the determinants of health. I understand now more than ever that macro-level health determinants (that is factors that affect health) including socio-economic status, education, employment, physical and social environment affect health and reinforce the unequal distribution of health-related resources. In contrast, micro-level determinants (lifestyle, genes) have modest impacts on population health. However, more individualistic views dominate our understanding of obesity, smoking and problem gambling. Within that frame, food “choices” are linked with moral acceptability and people who eat “unhealthy” food (with “bad” nutritional elements are deemed as less moral. Equally people that smoke and people that gamble are less “good” than people who “take care” of themselves. Such views ignore the systemic, structural and historical origins of inequality.

Which brings me to two cartoons by Al Nisbet, which were printed in New Zealand media. In the first one published in the Marlborough Express yesterday an inter-generational group of people of “Polynesian appearance” wearing children’s school uniforms and joining a queue for a free school meal. The male adult wearing tattoos and a back-to-front baseball cap, says: “Psst! … If we can get away with this, the more cash left for booze, smokes and pokies!”

Marlborough

In the second cartoon published in the Press today, what appears to be a family group of seven large people are shown with Lotto tickets, beer cans, cigarette packets and flash electronics. The man with a back to front cap on his head says: “Free school food is great. Eases our poverty and puts something in you kids’ bellies.”

From the Press

From the Press

These despicable cartoons highlight the media’s role in perpetuating the myth that  responsibility for poor health (whether it’s about people who are obese, smokers or problem gamblers) is an individual and group one rather than linked with broader issues for example colonisation, economic restructuring or the devastating social consequences of state neoliberal policies. The editor of the Marlborough Express Steve Mason has “apologised for any offence”, a phrase that has always struck me as being bereft of any remorse at harm caused, let alone an understanding of the ramifications of the incident. More callously he commented that “he was delighted that it had sparked discussion on an important issue”. But at whose expense? I am so over the casual racism by white male media influencers that shape public opinion so profoundly, the abuse of their authoritative positions to portray and represent vulnerable groups in ways that further marginalise those groups.

Luckily the Mana party have also noticed how the cartoon takes aim at New Zealand’s most vulnerable children in particular Māori and Pacific children. John Minto, MANA party co-vice president contends in an interview with TVNZ, that the cartoon is insensitive to over 270,000 New Zealand children growing up in poverty who will benefit from the Breakfast at School programme and invites the public to further “scorn them as devious parasites.” Equally this cartoon hits out at Māori and Pacific Island people who are hardest hit by gambling related harms. About 50,000 New Zealanders or 1.2% of the population have a gambling problem (defined as patterns of gambling that disrupt personal, family, or vocational pursuits) and research shows that gambling and social inequality are linked. Māori experience high rates of problem gambling and are more likely than NZ Europeans to be worried about their gambling behaviour and more likely to want immediate help. Pacific peoples living in New Zealand experience socio-demographic risk factors that are associated with developing problem gambling, such as low socio-economic status, being young, living in urban areas and having low educational and low occupational status. In addition, Maori and Pacific women have been identified as an at risk group since “pokies”  (Electronic Gaming Machines) were introduced into Aotearoa New Zealand. Tobacco smoking is a leading cause of preventable death for Māori in New Zealand and responsible for 10 percent of the gap in health disparities between Māori and non-Māori. 45.4 percent of Māori adults identify themselves as smokers, –double that of non-Māori.  Māori contribute over $260 million in tobacco taxes each year. Cumulatively as Minto points out, the cartoon “plays to the lazy racism and deep bigotry of many well-off Pakeha”. It also neglects to consider the historical impacts of colonisation on the health status of Māori and punitive neoliberal social policy on both Māori and Pacific people.

Given that the wider community depend and receive their knowledge of raced and classed ‘others’ through the media, often in the absence of direct experience with those ‘others’, I am grateful for Media commentator Martyn Bradbury and the Daily Blog for alerting me to the cartoon and broadcasters like Marcus Lush, a thriving blogosphere and social media which enable the wide dissemination of alternative discourses. As I’ve said in other blogposts, the racist soup of Pakeha media culture not only excludes particular groups but it also reproduces pathological, deficient and destructive representations of groups that are already discriminated against and marginalised. Take the “common sense” racism of Paul Henry, Michael Laws and Paul Holmes who all compete for New Zealand’s top racist. And now Steve Mason who claims in the New Zealand Herald that “Cartoons are designed to stimulate discussion and obviously that has worked in this case. So that’s what it’s all about.” He obviously missed the hard work that former Race Relations Commissioner Joris de Bres and others did after the publication by the media of cartoons depicting the prophet Mohammed in 2006 (the New Zealand Herald took a leadership role and declined to publish them). At the time de Bres asked what media purpose was served by their publication and pointed out the tensions between “the principle of the freedom of the press and the responsibility of the press in exercising that freedom”. His leadership led to improvements in the relationships between media and communities, in Auckland I took part in a forum and in Wellington religious leaders from Muslim, Catholic and Jewish faiths met with the editors of The Dominion Post and The Press.

Let’s hope our new Race Relations Commissioner Dame Susan Devoy can similarly  take a leadership role in clearly articulating why publication of the cartoons is morally wrong and propose a way forward. But, she is only one person. We also need to address the other forces that reinforce casual racism and classism in our society. The media, the smug comfortable people reading the newspaper and feeling affirmed in their righteous anger by the cartoon, all of us I’d like to leave you with last words from another cartoonist and a cartoon representing another marginalised group. In an in interview in December 2012 in the Age about the role of the cartoonist as being “not to be balanced but to give balance”. Leunig said:

As a cartoonist I am not interested in defending the dominant, the powerful, the well-resourced and the well-armed because such groups are usually not in need of advocacy, moral support or sympathetic understanding; they have already organised sufficient publicity for themselves and prosecute their points of view with great efficiency.
The work of the artist is to express what is repressed or even to speak the unspoken grief of society. And the cartoonist’s task is not so much to be balanced as to give balance, particularly in situations of disproportionate power relationships such as we see in the Israeli-Palestinian conflict. It is a healthy tradition dating back to the court jester and beyond: to be the dissenting protesting voice that speaks when others cannot or will not.

 

Leunig in the Age Wednesday 15 August 2012

Leunig in the Age Wednesday 15 August 2012

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Regulating migrant maternity: Nursing and midwifery’s emancipatory aims and assimilatory practices

I’ve just had the first paper from my PhD published: DeSouza, R. (2013), Regulating migrant maternity: Nursing and midwifery’s emancipatory aims and assimilatory practices. Nursing Inquiry. doi: 10.1111/nin.12020

In contemporary Western societies, birthing is framed as transformative for mothers; however, it is also a site for the regulation of women and the exercise of power relations by health professionals. Nursing scholarship often frames migrant mothers as a problem, yet nurses are imbricated within systems of scrutiny and regulation that are unevenly imposed on ‘other’ mothers. Discourses deployed by New Zealand Plunket nurses (who provide a universal ‘well child’ health service) to frame their understandings of migrant mothers were analysed using discourse analysis and concepts of power drawn from the work of French philosopher Michel Foucault, read through a postcolonial feminist perspective. This research shows how Plunket nurses draw on liberal feminist discourses, which have emancipatory aims but reflect assimilatory practices, paradoxically disempowering women who do not subscribe to ideals of individual autonomy. Consequently, the migrant mother, her family and new baby are brought into a neoliberal project of maternal improvement through surveillance. This project – enacted differentially but consistently among nurses – attempts to alter maternal and familial relationships by ‘improving’ mothering. Feminist critiques of patriarchy in maternity must be supplemented by a critique of the implicitly western subject of maternity to make empowerment a possibility for all mothers.

 

 

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