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A fair go? Using liberal principles to support Islamophobia and racism.

I am interested in the issue of fairness. Anyone with siblings might be I would think. Whether it’s about making sure everyone gets an equally sized piece of cake or equal chances to speak, fairness has been a driving force in my life that I might have inherited.  As one of three daughters it was very important to our parents that we were treated fairly. So every birthday and Christmas we got the same kinds of presents, matching housecoats, matching crockery and so on. I kinda like the way I can go to both my sisters’ houses and enjoy drinking from the same cups. But over the years I’ve realised that treating people the same (is universalism) isn’t always all it’s cracked up to be and sometimes we need to treat people differently (particularism) to support them to get their needs met. For example, my parents have a prolific avocado tree and out of all my sisters I like avocados the most (hint hint), therefore is it fair that we all get the same number of them? This issue has resonance in health too, treating everyone the same can result in differential outcomes and sometimes you need to treat people differently to get the same outcome-for example for different population groups to have a long life different strategies might be needed. Which brings me to the issue that’s driving this blog post. How can we ensure that what we do is fair? and how do we define what fairness is? How might discourses invoking equality reinforce inequity and oppression?

The backlash against KONY 2012 did something useful. It made people think twice before re-posting items on their newsfeed and drew attention to the ways in which activism through social media can go horribly wrong. Joshua Foust says KONY 2012 accentuated the challenges “of enthusiastic support for someone who seems to be doing the right thing without really investigating whether their methods are the best, and privileging the easy and fun over the constructive”. In the case of the social media whirl around Russian punk band Pussy Riot, Foust’s criticism is that a serious concern about the erosion of political freedoms and civil liberties has been converted into a celebration of feminist punk music and art, detracting from the brutality and mistreatment being meted by Putin’s government to Russian activists or political prisoners.

It’s been a lousy few weeks for women in the west. The Julian Assange saga, Republican Todd Akin’s stupidity and comments that women can’t get pregnant from rape and more. But even more grump inducing has been the appearance on my Facebook feed of more white saviour complex campaigns, this time run by white feminists. Feminism is supposedly about building a fairer and more just society for women, but these campaigns only reinforce the limitations of western feminisms for engaging with axes of oppression such as ethnicity, racialisation and social class. This isn’t my only beef with western feminisms, the others are that they have a decidedly liberal tone with a focus on individual rights and also the frequency with which feminist discourses are co-opted for neoliberal ends. For example, the way in which western feminisms have legitimated expansionist neoliberalism, think Muslim women needing to be rescued from the Taleban by the Enlightened West in Afghanistan.

This hero/martyr narrative in this annoying image from Feminists United is illustrative of a hierarchy that pits western women against non-Western women.

The advert represents a white woman as a hero, both educated and modern and able to freely exercise choice and control over her own body. In contrast, the ‘non Western woman’ is represented as oppressed by her culture, other women and tradition, all of which impinge on her sexuality. The comments on this image included:”Indeed, a horrific practice that comes from satan’s kingdom of darkness and needs to end; ” and “In Africa 3000 girls every day!!!”. Thankfully commentators also pointed out the racist and imperial assumptions of this advert. The comments recentre Western feminisms rather than expose the limitations of Western epistemological frameworks for making sense of women’s experiences outside the West. Given my own health background, I’m conscious of the ways in which FGM/C is constructed as a health issue. The image implicitly reifies the superiority of Western medicine for having the values most emblematic of Western civilisation such as enlightenment, benevolence and humanitarianism. We’ll just ignore the collusion of Christian missionary medicine and biomedicine in the advancement of colonialism and imperialism.

One of my intellectual and political concerns is with the ways in which certain practices and subjectivities are privileged through liberal feminist discourses that actually replicate the colonising impacts of heteropatriarchy (even though feminism was developed to critique it). These liberal feminist discourses construct femininity within particular norms such as being liberated that are within normative modes of middle class white behaviour. Racialised “oppressed” women are constituted as a threat to the liberal and neoliberal projects of self regulation and improvement which in turn reinforce the centrality of a white world view

The comments on the second set of images that popped up on my feed were also disturbing, viewing Muslim women as victims of their male partners. The comments framed the woman as unagentic and Muslim males as dominating and unable to control their sexual drives. The inability to recognise sexism and misogyny closer to home in the context of Todd Akin talking about “legitimate rape” were interestingly absent. This ‘fighting sexism with racism’as Sherene Razack (1995) calls it fills me with dismay, especially when differences are framed as a civilisational clash between western liberal values of equality and individualism versus the patriarchal, hierarchical and communal values of the ‘other’.

As Arundhati Roy articulates in a pointed essay:

Western-liberal feminism (by virtue of its being the most funded brand) [has become], the standard-bearer of what constitutes feminism. The battles as usual, have been played out on women’s bodies, extruding Botox at one end and Burkhas at the other. (And then there are those who suffer the double-whammy, Botox and the Burkha.) When, as happened recently in France, an attempt is made to coerce women out of the burkha rather than creating a situation in which a woman can choose what she wishes to do, it’s not about liberating her, but about unclothing her. It becomes an act of humiliation and cultural imperialism. Coercing a woman out of her burkha is as bad as coercing her into one. It’s not about the burkha. It’s about the coercion. Viewing gender in this way, shorn of social, political and economic context, makes it an issue of identity, a battle of props and costumes. It’s what allowed the US Government to use western feminist liberal groups as moral cover when it invaded Afghanistan in 2001. Afghan women were (and are) in terrible trouble under the Taliban. But dropping daisy-cutters on them was not going to solve the problem.

These coercive aspects reeking of cultural imperialism and humiliation have been close to home this week in Aotearoa with the furore over the decision by Lower Hutt’s Dowse Art Museum to ban men from seeing a video work by Qatari-American Sophia Al-Maria. The video Cinderazahd: For your eyes only was filmed in a woman only section of her grandmother’s home in Doha and shows Muslim women preparing for a relative’s wedding without their veils. Al-Maria requested that it only be shown to women and children in keeping with the belief that male strangers should not see their faces. However, this ban on mail viewers has resulted in complaints of gender discrimination to the Human Rights Commission.

The Dominion Post argues:

The real issue is that the Dowse is a ratepayer-funded organisation. As such, it should not be using the public purse to stage exhibits from which some ratepayers are excluded. The sum involved in this case – $6000 for the complete exhibition of 17 artists – is small, but the principle is important.

Clearly, the conflict between Al-Maria offering a work that can be seen only by women and the gallery’s duty to ensure equal access to all those who contribute towards funding it cannot be reconciled. That being the case, the Dowse should withdraw the video from the exhibition and Al-Maria should find a private gallery in which to show it.

Luckily there’s been some great responses from the blogosphere. Especially from QOT who says:

There’s a lot of argument going down around the fact that the Dowse is publicly-funded, is this discrimination, do we owe it to the poor oppressed brown women to tear away their autonomy because they’re too stupid to know they’re oppressed … yeah, guess where I fall on that one.

QOT checks our Human Rights legislation and notes that it is not unlawful to discriminate on the ground of religious belief (within particular circumstances). QOT acidly remarks that this legislation is what enables Catholics to ban women from the priesthood, but who’s complaining? If the primary complainant was a male student taking a third-year compulsory Art History paper where half the final exam marks were based on the film this would then disadvantage the males in the class. But is not being able to see that exhibit going to disadvantage the complainant really? Wise words also from Gaayathri, pointing out how important it is for those who are marginalised to be able to create and have access to safe spaces. Gaayathri cynically notes how the incident smacks of using Islamic women’s rights as a political football and if we indeed gave a damn then listening to their wishes would be a great start, and even better respecting the boundaries that have been set for the viewing of the work.

Contemporary racism is covert and subtle, a response to the social taboo against the open expression of racist sentiments. It is also more likely to be denied by majority group members.What I find most interesting about the Dowse drama is how the parameters of cultural consumption can only be set by the dominant culture. Whether it’s invoking the white saviour discourse or railing against so-called Islamic oppression, it’s the dominant white settler culture who decides how much culture is palatable and in what form. Setting boundaries results in the range of devastating comments that you can see on the interweb and it shows me that the veneer of civility is wafer thin. Kiwis can indeed hold negative views of particular groups in tandem with liberal principles of equality, tolerance, fairness and justice and just as quickly invoke these liberal values of fairness and equity in the service of  Islamophobia and racism. Our attitudes and beliefs in New Zealand haven’t been tested in the same way Australians have. They are forever in the spotlight about asylum seekers, but what it does make me think is that we should not be too complacent in New Zealand about the moral high ground. In all of this, what I am most grateful for is that like KONY 2012, these frustrating and painful incidents provide an opportunity to consider more deeply questions of freedom and liberation and more importantly to find out who our allies are.

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Refugee women on their own in New Zealand: Uncommon courage

Recently the report  “Doing it for ourselves and our children: Refugee women on their own in New Zealand” was launched in Auckland, New Zealand. The project was jointly undertaken by AUT University and Refugee Services New Zealand with the support, guidance and practical assistance of the three Strengthening Refugee Voices groups in Auckland, Wellington and Christchurch. It was an honour for me to write the report.

The purpose of this project was to examine the resettlement experiences of women who entered New Zealand through the category of Women at Risk (identified by the Office of the United Nations High Commissioner for Refugees (UNHCR). This category constitutes up to 75 places (10%) of New Zealand’s annual refugee quota of 750 applicants) or who became sole heads of households as a consequence of their resettlement experiences. The terms ‘refugee women’ and ‘communities’ refer to highly diverse groups of people  and in this report we don’t assume a “single, essential, transhistorical refugee condition” (Malkki, 1995, p.511).

A focus on strengths and principles of social justice, community development and capacity building were central to this investigation. Specifically, we had a transformative agenda, which was to enhance the wellbeing of refugee women by focussing on the roots of inequality in the structures and processes of society rather than in personal or community pathology. Within this frame, we were committed to constructing refugee women as assets rather than deploying as replicating deficit models where refugee women are represented as burdens for the receiving society.

You can read the whole report on the Refugee Services website 

 

 

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Sisters, friends or whānau?

This is a lengthier version of an editorial published in this month’s Kai Tiaki New Zealand Nursing Journal. It is based on an invited address I gave at the 10th Annual Conference of the Women’s Health Section:’Divine Secrets of the Sisterhood’ on April 26th  2012.

I recently spoke at the NZNO Women’s health conference about sisterhood. Not that I don’t care about men (I do deeply), but as one of three sisters and as a woman who has spent most of my adult life working in the female dominated profession of nursing, relationships between women are of great personal and professional interest. The call to action in the women’s movement almost thirty years ago emphasised sisterhood and demanded the end of oppression and the commitment to women as a social group (Klein & Hawthorne, 1994). However, the movement also raised questions of difference. Many suggested that in order to understand what women had in common they also needed to pay attention to what they didn’t have in common such as race, gender and sexuality. Focusing on similarity erased and overlooked important differences, but only focusing on difference led to the “othering” of others, stereotyping and pushing people away.

I believe these questions remain important for nursing, because I think our differences can make nursing stronger. An understanding of our differences can help us to better understand our similarities. As Audre Lorde points out “it is within our differences that we are both most powerful and most vulnerable, and some of the most difficult tasks of our lives are the claiming of differences and learning to use those differences for bridges rather than as barriers between us”. So I believe an important question for nurses is how can we capitalise on the energy and movement in difference and resist the coercive force of sameness?

One of the challenges is that differences raise critical issues of power, because differences are often institutionalised (Crenshaw,1994, p.411). Take the idea of the implicit ideal nurse-typically the ideal nurse is female, white, middle class, heterosexual, able bodied, nice, obedient and nurturing (Giddings, 2005; Reverby, 2001). Those nurses that fit the norm experience privilege and those that don’t are marginalised. Internationally, women of colour are present in practice settings with less prestige, lower wages, less security, and less professional autonomy (Gustafson, 2007). While, a disproportionate number of white men and women are ensconced in nursing management, academia and research, whose world view is supported by the dominance of white, Western, biomedical interpretations of health and illness. Grada Kilomba defines whiteness as “a political definition, which represents historical, political and social privileges of a certain group that has access to dominant structures and institutions of society”.  As Ang-Lygate (1997, p,2) points out “political sisterhood is suspect unless those sisters who enjoy privileges denied to other sisters are seen to share the responsibility of dismantling the differences”.

This dominance of whiteness in our workforce and our ideas about health and illness are present in nursing in New Zealand too. We are undergoing a period of unprecedented diversity. Transitioning from largely New Zealand-born European to being increasingly ethnically diverse, our dependence on overseas-born migrant nurses is evident in their composition of 29% of the workforce- one of the highest proportions in the OECD. At the same time Māori and Pacific Islands nurses are under-represented in our workforce while these communities experience the greatest health need. This inequity is challenging and as Margaret Southwick notes provides “justification (if one be needed) for the claim that nursing needs to take seriously the challenge of working with diverse and marginalised groups within society is to be found in the health status of these very same groups of people.” (Southwick, 2001).

So given the diversities in nursing and the health inequities that confront our communities, new strategies are necessary. I’m proposing moving away from sisterhood which implies the shared experience of being a woman and experiencing gender oppression to consider a new metaphor that allows greater consideration of our differences so that we can better articulate our similarities (Simmonds, 1997). There’s friendship for a start, a relationship based on equals who have affection, and interest in each other (Friedman, 1993, p.189). Its etymology is in the word free. It means to love, to love our own freedom, and to love and encourage the freedom of the other (Mary Daly, 1987). Friendship allows us to work in each other’s interests because part of what is compelling is our differences.

The notion of friendship as an alliance within the context of difference can be seen in this brilliant blog post entitled Queer Sisters Keep Saving Me: The Brilliantly Selfish Act of Being an Ally by Black Artemis

Heterosexual people especially women owe a tremendous debt to the LGBTQ struggle for some of the sexual freedoms we enjoy…the boundaries queer people bend and bust at the risk of their own lives in many ways expand our heteronormative privilege. Their radical decision to be simply who they are makes it much safer for the rest of us to redefine who we may want to be. We have a broader range of acceptable sexual expression because of the queer liberation movement for every time they push the envelope, they set a new “normal,” and it’s not even they who benefit the most for their courage. Rather it is those of us whose sexual identity is already validated.

If we are going to use the metaphor of sisterhood we consider the idea of a “chosen family” used by LGBTQ communities or the Māori concept of whānau. It too is based on love rather than biology and includes people as who are a source of love and support outside the heteronormative idea of family.

I’d like us to strengthen nursing by strengthening ourselves, for creating space for all nurses to be able to come together with our diverse traditions and values, to be united based on solidarity not sameness. I’d like us to be able to articulate our shared beliefs and practices while acknowledging how we differ.

I’m proud to be a nurse in New Zealand, I value the shared commitment to caring and to social justice in the shape of cultural safety. I’d like to build on our legacy and see nurses critically examine the values, goals, and intents shaping our profession. I’d like us to have some challenging conversations about power and privilege, to deconstruct our own classism, racism, and homophobia and to think about recognition and reparation. I leave my final words to Audre Lorde:

So this is a call for each of you to remember herself and himself, to reach for new definitions of that self, and to live intensely. To not settle for the safety of pretended sameness and the false security that sameness seems to offer. To feel the consequences of who you wish to be, lest you bring nothing of lasting worth because you have withheld some piece of the essential, which is you.

References

ANG-LYGATE, M., CORRIN, C. & HENRY, M. S. 1997. Desperately seeking sisterhood: Still challenging and building, London, Taylor and Francis.

CRENSHAW, K. 1994. Mapping the margins: Intersectionality, identity politics, and violence against women of color. In: FINEMAN, M. A. & MYKITIUK, R. (eds.) The public nature of private violence. New York: Routledge.

DALY, M. (1978) Gyn/Ecology: The Metaethics of Radical Feminism, Boston: Beacon.

FRIEDMAN, M. 1993. What are friends for?: feminist perspectives on personal relationships and moral theory, New York: Cornell University Press.

GIDDINGS, L. S. 2005. Health disparities, social injustice, and the culture of nursing. Nursing Research, 54, 304.

GUSTAFSON, D. L. 2007. White on whiteness: Becoming radicalized about race. Nursing Inquiry, 14, 153-161.

HAWTHORNE, S. & KLEIN, R. 1994. Australia for Women: travel and culture, New York, Spinifex Press.

LORDE, A. 2009. Difference and Survival: An Address to Hunter College” Rudolph, New York:, Oxford University Press.

REVERBY, S. 2001. A caring dilemma: Womanhood and nursing in historical perspective. In: HEIN, E. C. (ed.) Nursing issues in the twenty-first century: Perspectives from the literature. Philadelphia: Lippincott, Williams and Wilkins.

SIMMONDS, F. N. 1997. Who Are the Sisters? Difference, Feminism, and Friendship. 19-30. In ANG-LYGATE, M., CORRIN, C. & HENRY, M. S. 1997. Desperately seeking sisterhood: Still challenging and building, London, Taylor and Francis.

SIMMONDS, F. N. 1997. Who Are the Sisters? Difference, Feminism, and Friendship. Desperately Seeking Sisterhood: Still challenging and building, 19-30.

SOUTHWICK, M. R. 2001. Pacific women’s stories of becoming a nurse in New Zealand: A radical hermeneutic reconstruction of marginality. Unpublished Doctoral thesis, Wellington: Victoria University of Wellington.

 

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Questions haunt nursing student

In 2007 a student nurse called Lisa Kenyon wrote to the Kai Tiaki asking questions about nursing. I’ve reprinted her letter here and then my response. It seems relevant at the moment

I am a year-one nursing student from Waiariki Institute of Technology, doing my bachelor of nursing at Windermere in Tauranga. I have recently been out on my first practicum for three weeks and have come away with a multitude of questions. I am a 34-year-old married woman with a child, and consider myself experienced in the traumas and joys that life can bring. After finishing my practicum, which I thoroughly enjoyed, I was left reflecting on my personal experience with the elderly.

I cared for a dear man who unfortunately died in my second week of being his student nurse; I was so privileged to have spent that time with him and his family. But I was left with a list of questions and thoughts to which I have no answers. Maybe there are no answers and maybe, with more nursing experience, these questions will make sense, but for now I want to share my thoughts and wonder how other experienced nurses or student nurses have overcome these difficulties.

The questions that bother me are: Can a nurse “care” too much? Don’t patients deserve everything I can give them? How do I protect myself and still engage on a deeper level with the patient? How do I avoid burnout? Why can’t I push practice boundaries, when I see there could be room for adjustment or improvement? Isn’t it okay to feet emotionally connected to the patient? Don’t I need to continually ask questions, if nursing is to change, or will that just get me fired?! Finally, am I just being a laughable year-one student, with hopes and dreams and in need of a reality check?

I would really appreciate feedback from other student nurses who have felt the same or from experienced nurses with some insight into these questions, as I am left doubting what kind of nurse I am going to be.

Lisa Kenyon, nursing student, Waiariki Institute of Technology, Tauranga.

My response below:

I was pleased to see Lisa Kenyon’s letter, Questions haunt nursing student, in the December/ January 2006/2007 issue of Kai Tioki Nursing New Zealand (p4). The questions she has reflected on indicate she is going to be an amazing nurse.

I believe nursing is both an art and a science, and our biggest tools are our heart and who we are as human beings. I was moved by her letter and thought I’d share my thoughts. The questions she posed were important because the minute we stop asking them, we risk losing what makes us compassionate and caring human beings.

Let me try to give my responses to some of the questions Lisa raised–I’ve been reflecting on them my whole career and continue to do so.

1) Can a nurse “care” too much?

Yes, when we use caring for others as a way of ignoring our own “issues”. No, when we are fully present in the moment when we are with a client.

2) Don’t patients deserve everything I can give them?

They deserve the best of your skills, compassion and knowledge. Sometimes we can’t give everything because of what is happening in our own lives, but we can do our best and remember we are part of a team, and collaborate and develop synergy with others, so we are resourced and can give our best.

3) How do I protect myself and still engage on a deeper level with the patient?

I think we have to look after our energy and maintain a balance in our personal lives, so we can do our work weft. We also need healthy boundaries so we can have therapeutic communication.

4) How do I avoid burnout?

Pace yourself, get your needs met outside work, have good colleagues and friends, find mentors who have walked the same road to support you. I’ve had breaks from nursing so I could replenish myself.

5) Why can’t I push practice boundaries, when I see there could be room for adjustment or improvement?

I think you can and should, but always find allies and justification for doing something. Sometimes you have to be a squeaky wheel

6) Isn’t it okay to feet emotionally connected to the patient?

Yes, it is okay to feel emotionally connected to the patient, but we also have to remember that this is a job and our feelings need transmutation into the ones we live with daily.

7) Don’t I need to continually ask questions, if nursing is to change, or will that just get me fired?

Yes, you do have to ask questions but it is a risky business. Things don’t change if we don’t have pioneers and change makers.

8) Finally, am I just being a laughable year-one student with hopes and dreams, and in need of a reality check?

No, your wisdom and promise are shining through already and we want more people like you. Kia Kaha!

Ruth DeSouza RN, GradDipAdv, MA, Centre co-ordinator/Senior Research Fellow, Centre for Asian and Migrant Health Research, National Institute for Public Health and Mental Health Research Auckland University of Technology

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Celebrating African women in Aotearoa New Zealand

I was honoured to be invited by the African Community Forum Incorporated to attend and speak at an event on March 10th 2012 to celebrate International Women’s Day. I have written elsewhere about my links with East Africa. Briefly, I was born in Tabora Tanzania and lived in Nairobi, Kenya until the age of ten, when my family migrated to New Zealand. Originating from Goa, India, both sets of grandparents moved to Tanzania in the late 19th Century and both my parents were born there. Until moving to New Zealand I was fluent in both Swahili and Maragoli.  The African part of my identity rarely gets the opportunity to play, so I was thrilled to attend the event.

 

Indians in Africa

Many people might be surprised to know that the Indian connection to Africa goes back three thousand years. Indians were traders and later sojourners. The British indentured labour scheme which replaced slave labour, ushered a new era of cheap and reliable labour for plantations and the building of railways. The construction of the great railway from Mombasa to Lake Victoria in Uganda in the late nineteenth century brought fifteen thousand (of the sixteen thousand) workers or ‘coolies’ from India. Tragically one quarter of them died or returned disabled (Sowell, 1996). Indians (especially Goans) were also recruited to run the railways after they were built (as my grandparents were) and Goans came to dominate the colonial civil services.

Africans in New Zealand

The history of African migration to New Zealand is much more recent. Te Ara online encyclopedia notes that the first black African in New Zealand was travelling on James Cook’s second voyage as a servant (no name is provided) and later killed by Maori in 1773. The 1871 New Zealand census recorded 34 people who were born in ‘British African Possessions’ and another 31 from other African countries. The 1911 census recorded 92 African-born people. However, these African born people were likely to have been white given the mobility of white settlers through the then British Empire. The 1916 census recorded 95 “Negroes” referring to African Americans and six African born people, four Abyssinians (Ethiopians) and two Egyptians. The Colombo Plan saw the arrival of Black Africans as students in the 1960s, some of whom remained in New Zealand and had families. During the 1970s two groups of Africans arrived in New Zealand. White Rhodesians who were escaping from the war and two hundred Ugandans (not sure if they were all Asian Ugandans) who were ejected by Idi Amin. The number of African born residents (mainly from Commonwealth countries) increased to 3,939 Africans by 1986, but again were mainly white. It was not until the changes in migration policy of 1987 that there were significant demographic changes as a result of the development of a formal refugee quota  which saw arrivals especially from Ethiopia (1991-3), Somalia (1992-4), Rwanda (1994) and the shift to a migration points policy which saw a greater number of African people coming New Zealand as migrants. The 2006 Census 10,647 or 0.3% of the population identified as African. 4,806  Africans reside in Auckland and 5,841 outside of Auckland. In the 10 years between 1991 and 2001 the number of women from African countries increased considerably with numbers of women from South Africa, Zimbabwe and Somalia more than quadrupling in that time (Statistics New Zealand, 2005).

The growth of the African community is an exciting development and the event organised by ACOFI was a fantastic celebration of Pan-African culture and the vitality and energy of the community. I look forward to taking part in more events and improving my now very rusty Swahili! By the way, the art work is from a drawing competition run on the night. My big thanks to all the organisers especially Carlos Carl, Boubacar Coulibaly and Sharon Sandra Paulus and all the people that worked hard to make the event happen.

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Postnatal depression in the Year of the Dragon

Women are more likely to develop emotional problems after childbirth than at any other time in their lives and the life time prevalence of major depression in women is almost twice that of men (Kohen, 2001). According to Lumley et al. (2004), one out of every six women experiences a depressive illness in the first year after giving birth. Thirty per cent of those women will still be depressed when their child is two years old. Of those women, 94% report experiencing a related health problem. Women who experience problems in the early stages of motherhood also report problems with their relationships, their own physical health and well-being. Women report that a lack of support, isolation, and exhaustion are common experiences.

Several years ago I was approached to develop a new brochure about Women’s perinatal mental health (given my expertise as as a clinician and educator in maternal mental health) for the New Zealand Mental Health Foundation who were partnering with EGG maternity a New Zealand company specialising in maternity wear. In developing the brochure, my partner and I consulted widely with consumer groups, mothers, fathers, health professionals in order to ascertain what would be the most important and clear information we could put inside the brochure. This was the end result:

The PND brochure has become widely available, it is included in information packs given to new mothers by Plunket, available from the resource centre at the Mental Health Foundation, the Foundation website and EGG maternity boutiques in New Zealand.  It has been one of the most requested brochures ever with 33,800 sent out in 2011 alone.

Women who have a baby in a new country and are separated from their support networks and special perinatal customs (including special foods, nurturing, rest and household help) through migration can experience isolation and postnatal depression.

For the Year of the Dragon this brochure has been translated into Chinese by Kai Xin Xing Dong -a public education programme aimed at reducing the stigma and discrimination faced by Chinese people who experience mental illness. Funded by the Ministry of Health, the project aims to raise mental health awareness in the Chinese community and to counter stigma and discrimination.

See here for other PND resources

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When activists become oppressors: Nurses and migrant mothers.

This Sunday I’ll be doing a Picnic lecture where I’ll be sharing stories from nurses and migrant mothers from my PhD to discuss how well intentioned activism can become a form of oppression. The lecture will be held in the Albert Park rotunda in Auckland on Sunday 1st April at 3pm and is linked with Te Tuhi’s What do you mean, we? exhibition which brings together an international selection of artists to examine prejudice.

The kinds of questions that my work has been concerned with are:

  • What subjectivities and beliefs and values are being reproduced when a woman has a baby in neoliberal Aotearoa New Zealand?
  • How does a maternal health care system provide services for birthing women whose subjectivities have been partially or significantly formed outside a white settler nation context and specifically outside the colonial dyad of settler and indigenous?
  • Do the policy rhetoric of biculturalism in response to Treaty of Waitangi obligations and the requirement for culturally competent practice actually improve the care migrant mothers receive?
  • Do the liberal feminist aspirations for birth as an empowering experience extend to women outside the world of white middle-class feminism?
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People of colour decolonisation hui

The Decolonise Your Minds! Hui on February 5th in Tamaki Makaurau, Aotearoa provided a great opportunity to present my PhD work to awesome folks with similar theoretical and political commitments. Outside a professional or academic context and supported by fabulous vegan food and great korero and creativity, the radical space provided a great opportunity to not have to explain everything!

In my presentation, I talked about the ways in which the people who are supposed to care in institutions can engage in subtle coercions and “do” violence. This violence works through the reproduction of taken for granted norms and values, such that pressure is exerted on those whose personhood sits outside the accepted norms and values and reshapes their personhood. Reflecting an assimilatory process similar to the colonial process of moral improvement. Hardly a surprise considering that institutions like health and education are colonial, having been transplanted from the metropole to the colony and super-imposed over indigenous ways of learning and maintaining health.

Using the example of maternity I talked about the ways in which heath professionals draw on culturally and socially available repertoires of care that can be less than helpful when imposed on women of colour. This is because so often these repertoires are drawn on the basis of an implicit ideal user who tends to be cis-woman, heterosexual, white, middle class and one who takes up the ‘imperative of health’. That is the ideal neoliberal consumer who makes herself an expert through her consumption of self-help books and its acceptable accoutrements, who takes responsibility by attending ante-natal classes and who labours naturally with her loving and supportive partner present. She obeys the edicts of the health professional and makes reasonable requests that align with the dominant discourse of maternity as an empowering experience (if you are “informed” and “take responsibility”).

You can listen to the audio which is hosted by the Pride New Zealand website. I take the audience through the idea of discourses and how they shape subjectivity and practice.

Please note I have a tendency to swear when I am speaking passionately about something!

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Submission to the New Zealand Suicide Prevention Strategy 2008

Congratulations on a wonderful job in developing the New Zealand Suicide Prevention Strategy. I am pleased to see an inter-sectoral approach that is both evidence and strengths based. It is also encouraging to see mention of diverse communities and an approach that integrates protection, promotion, early identification, crisis support, attention to families and support in the aftermath of suicide. Thanks for the opportunity to add my rather swiftly developed submission to the New Zealand suicide prevention strategy. I am focussing this submission on Asians and South Asians in particular, but am aware (as per our teleconference on Friday) that these issues pertain to other migrant and refugee groups as well.

My key points are:

  1. Asians are a high risk group for suicide and attempted suicide according to overseas research (especially South Asian young women).
  2. We need better ethnicity data collection practices as data is limited.
  3. There are issues with the umbrella term Asian which disguise differenceswithin groups.
  4. There are significant barriers in accessing services, particularly mental health services.
  5. Further research is needed that is clinical and epidemiological in order to identify prevention and intervention strategies that may vary from other groups.

Asians and statistics

Asians are a growing population in New Zealand. By 2016 they are expected to make up 9% of New Zealand’s and 20% of the Auckland Region’s total population. As such the health and social service needs of Asians must be considered by service providers. As you are aware there is limited research data available in New Zealand, 12 Asian people died by suicide (10 males and two females) in 2002, compared to 20 deaths

in 2001 and 21 deaths in 2000 (Ministry of Health, 2005). In our teleconference we also expressed concern the underreporting of suicide and coronial issues. I am concerned about the category as there is diversity within the people subsumed into the category Asian, with some groups especially at risk and others well protected) and the concept has limited use (Aspinall, 2003; Henare & Ehrhardt, 2004).

High rates of suicide and attempted suicide

Disproportionally high rates of suicide and attempted suicide have been found among South Asians in the diaspora (Batsleer, Chantler, & Burman, 2003; Bhugra & Desai, 2002; Bhugra & Hicks, 2004; Burr, 2002; Hicks & Bhugra, 2003). The highest were in young women of South Asian origin who have rates that are double that of the White population in the United Kingdom of completed suicide and 1.6 times more likely to attempt suicide(Hicks & Bhugra, 2003). Hicks and Bhugra examined perceived causes of suicide attempts in 180 ethnic South Asian women living in the London area. The three factors endorsed most frequently and strongly as causes of suicide attempts in South Asian women were violence by the husband, being trapped in an unhappy family situation, and depression. South Asian women are also two and a half times more likely to attempt suicide that South Asian men.

Barriers to accessing services

Recent New Zealand research has found that barriers for Chinese people accessing services include a lack of English language proficiency leading to communication difficulties and knowledge gaps, for example, being unaware of what services are available; the important role of primary healthy care and General Practitioners in particular as a first point of contact and a lack of awareness of the health and civil rights of citizens in New Zealand (Ruth DeSouza & Garrett, 2005). The research identified regional differences in terms of the place of birth of respondents and, in particularly, it was noted that Chinese-born respondents experienced more communication difficulties than those born in Hong Kong or Taiwan. Some of the strategies recommended in the report which are pertinent here include: encouraging cultural competence in health services (clinical, systemic and organisational), staff training and workforce development, developing partnerships with ethnic communities and community organisations, involving ethnic communities in strategic planning and linguistic competence. The latter involves not only ensuring that resources are available in several languages but also that interpreting and translation services are available.

Accessing mental health services

There are issues in attempting to access mental health services as well which are compounded by stigma within ethnic communities and anxiety from the mental health workforce. Increasingly mental health services are being called on to provide culturally appropriate care, but little is known about what that constitutes. Such a call cannot be answered if mental health professionals are not prepared for working in ways that are culturally competent. Despite the emphasis on cultural safety as part of the curricula of undergraduate health professional preparation, it has largely been concerned with Treaty obligations to Tangata whenua rather than evolving to meet the needs of ethnic communities (R. DeSouza, 2004). Burman, 2003, p.106) found in a research project investigating suicide and self-harm in the United Kingdom among South Asians that staff working with the women were caught in ‘race anxiety’ whereby white staff were hesitant and silent around issues to do with race, gender and mental health and were concerned that their actions were not misinterpreted. Their responses were to pass on issues to their South Asian counterparts or to avoid them. For the South Asian workers there was concern that discussing issues like this would reinforce or add to the existing stereotypes. This culture of silence within mainstream services was viewed as frustrating and annoying.

Ruth DeSouza Centre Co-ordinator/Senior Research Fellow Centre for Asian and Migrant Health Research Faculty of Health & Environmental Science Auckland University of Technology Address: Private Bag 92006, Auckland 1020

Ethnicity data collection

There is a need for improvements in quality ethnicity data collection so as to more clearly ascertain health needs and dispraities (Aspinall, 2003; British Medical Journal, 1996; Klajakovic, 1993; Latimer, 2003; McLeod et al., 2000; Ministry of Health, 2001, 2003, nd-a, nd-b; New Zealand Health Information System, 1996; Pringle & Rothera, 1996; Senior & Bhopal, 1994; Statistics New Zealand, 1996; Thiru, Hassey, & Sullivan, 2003; D. R. Thomas, 2000; S. B. Thomas, 2001). Several reports and research findings confirm that ethnicity data collection is poorly conducted by staff. A Waitemata District Health Board review found that staff were unaware of national guidelines for collecting data, had not received training on why and how ethnicity data was collected and consequently collected it inconsistently (Latimer, 2003). An internal paper for the Ministry of Health based on interviews with key stakeholders and a literature review found that there was inconsistency in the way in which data was collected and that what was collected was inaccurate and incomplete and that the concept of ethnicity was misunderstood (Ministry of Health, nd-a). These factors point to the need for support and training to facilitate accurate data collection. In order that ethnicity data is collected consistently and accurately ethnicity questions need to be aligned with Statistics New Zealand Census question for 2001 so that they are standardised. Variation exists across health providers around the method of ethnicity data collection, ranging from not asking and using previous admission information, to asking verbally to postal or using a show card. Furthermore, in secondary care, staff rely on information from GP’s which has been found to be problematic. A national survey of 1,062 members of the Royal New Zealand College of General Practitioners (RNZCGP) found that only 20% of practices collected ethnicity data. A recent study of 12 South Island practices found ethnicity was recorded for only 5% of patients (McLeod et al., 2000). Other problematic areas include the assumption of ethnicity by a provider.

Recommendations

• Further research and exploration of factors is needed in clinical and epidemiological studies of suicidality in South Asian women which might then contribute to prevention and intervention strategies.

• Better collection of ethnicity data (McKenzie, Serfaty, & Crawford, 2003). • Access to information in commonly used languages. • Encouraging cultural competence in health services (clinical, systemic and

organisational). • Staff training and workforce development. • Developing partnerships with ethnic communities and community

organisations. • Involving ethnic communities in the design of services.

Ruth DeSouza Centre Co-ordinator/Senior Research Fellow Centre for Asian and Migrant Health Research Faculty of Health & Environmental Science Auckland University of Technology Address: Private Bag 92006, Auckland 1020

References

Aspinall, P. J. (2003). Who is Asian? A Category that Remains Contrived in Population and Health Research. Journal of Public Health Medicine, 25(2), 91-97.

Batsleer, J., Chantler, K., & Burman, E. (2003). Responses of health and social care staff top South Asian women who attempt suicide and/or self-harm. Journal of Social Work Practice, 17(1), 103-114.

Bhugra, D., & Desai, M. (2002). Attempted suicide in South Asian women. Adv Psychiatr Treat, 8(6), 418-423.

Bhugra, D., & Hicks, M. H.-R. (2004). Effect of an Educational Pamphlet on Help- Seeking Attitudes for Depression Among British South Asian Women. Psychiatric Services, 55(7), 827-829.

British Medical Journal. (1996). Style Matters: Ethnicity, race, and culture: guidelines for research, audit, and publication. British Medical Journal, 312, 1094. Burr, J. (2002). Cultural stereotypes of women from South Asian communities: mental health care professionals’ explanations for patterns of suicide anddepression. Social Science & Medicine, 55(5), 835-845.

DeSouza, R. (2004). Working with refugees and migrants. In D. Wepa (Ed.), Culturalsafety (pp. 122-133). Auckland: Pearson Education New Zealand.

DeSouza, R., & Garrett, N. (2005). Access Issues for Chinese People in New Zealand(draft). Auckland: Accident Compensation Corporation.

Henare, K., & Ehrhardt, P. (2004). Support for Maori, Pacific and Asian Family,Whanau, and Significant Others who have been bereaved by suicide: Findings of a literature search. Wellington: Ministry of Youth Development.

Hicks, M. H. R., & Bhugra, D. ( 2003). Perceived Causes of Suicide Attempts by U.K. South Asian Women. American Journal of Orthopsychiatry, 73(4), 455-462.

Klajakovic, M. (1993). Is it easy collecting ethnicity data in general practice? NewZealand Medical Journal, 106, 103-104.

Latimer, S. (2003). Waitemata District Health Board: Ethnicity Data Collection Baseline Review. Auckland: Waitemata District Health Board.

McKenzie, K., Serfaty, M., & Crawford, M. (2003). Suicide in ethnic minoritygroups. British Journal of Psychiatry, 183(2), 100-101.

McLeod, D., Harris, R., Bailey, T., Dowell, A., Robson, B., & Reid, P. (2000). The collection of patient ethnicity data: a challenge for general practice. New Zealand Family Physician, 27(3), 51-57.

Ministry of Health. (2001). Monitoring Ethnic Inequalities in Health. Wellington:

Ministry of Health. Ministry of Health. (2003). Health and disability sector ethnicity data protocols. Wellington:

Ministry of Health. Ministry of Health. (2005). Suicide Facts: Provisional 2002 All-Ages Statistics. Wellington: Ministry of Health. Ministry of Health. (nd-a). Environmental scan: Ethnicity data collection issues.Wellington: Ministry of Health.

Ministry of Health. (nd-b). Submission on the review of the measurement of ethnicity. New Zealand Health Information System. (1996). Recording patient information:Ethnicity. Wellington: New Zealand Health Information System.

Pringle, M., & Rothera, I. (1996). Practicality of recording patient ethnicity in general practice: descriptive intervention study and attitude survey. Retrieved 8th February, 2004, from http://bmj.bmjjournals.com/cgi/content/full/312/7038/1080

Senior, P., & Bhopal, R. (1994). Ethnicity as a variable in epidemiological research. British Medical Journal, 309, 327-330.

Statistics New Zealand. (1996). Ethnicity – Standard Classification 1996. Retrieved 8th February, 2003, from http://www.stats.govt.nz/domino/external/web/carsweb.nsf/Classifications/Ethnicity+-+Standard+Classification+1996

Thiru, K., Hassey, A., & Sullivan, F. (2003). Systematic review of scope and quality of electronic patient record data in primary care. BMJ, 326(7398), 1070-1070.

Thomas, D. R. (2000). Assessing Ethnicity in New Zealand Health Research. New Zealand Medical Journal, 114, 12-14.

Thomas, S. B. (2001). The color line: Race matters in the elimination of health disparities. American Journal of Public Health, 91(7), 1046-1049.

 

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Shifting Out the Sweetness: Migrant Motherhood in New Zealand

DeSouza, R. (2007). Sifting out the sweetness: Migrant motherhood in New Zealand. In P. Liamputtong (Ed.), Reproduction, Childbearing and Motherhood: A Cross-Cultural Perspective (pp. 239-251). New York: Nova Science Publishers.

Abstract

Migration leads to transformation, willingly or unwillingly, for both the migrant and the receiving society. The changes that result can be superficial or visible; for example, cuisine or more subtle and private, such as identities. In considering motherhood in a new country, women are challenged with an opportunity to reshape their identity, from viewing their culture as static with fixed boundaries and members to fluid, pliable, negotiated and renegotiated through interactions with others. The pluralising of identities that accompanies migrant motherhood is brought to the fore with migrant women having to sift and reclaim aspects of culture that may have been lost, preserve memories of cultural practices, transmit, maintain or discard traditional perinatal practices and  choose new practices. In addition, there may be old and new authority figures in the shape of midwives or mothers to appease. This chapter provides an overview of how women originating from Goa, India who had babies in New Zealand actively considered their past, present and future in terms of cultural maintenance and reclamation during the perinatal period. The history of Goan colonisation as a catalyst for dispersal had already led to the modification of cultural practices. The development of plural identities and the strategic utilization of cultural resources new and old are examined, as is the potential to apply notions of cultural safety to migrant health. The chapter concludes with a discussion of the implications of plural identities for health services and workforce development in New Zealand.

Introduction

At no other time in their lives do women get bombarded and overwhelmed with more information and advice, which is frequently unsolicited, as when they are pregnant and have babies. As a nurse working on a post-natal ward many years ago, I remember meeting a vibrant and loving couple, who said their strategy for managing the mountain of advice, was to “sift out the sweetness.” This sifting process is doubly significant for migrant women who have a baby in a new country. They must sift between their own cultural practices and those of the receiving communities. For many, it involves reclaiming long forgotten practices especially if they are separated from their traditional knowledge sources. In turn, there is an opportunity for receiving societies and their systems to sift through their practices and consider ones brought by immigrants to see if there are opportunities for improvement and innovation.

This chapter focuses on a study of women from the Goan/Indian community in Auckland, New Zealand and discusses how women manage the dual transition of motherhood and migration while separated from networks and supports. A brief history of New Zealand demographics, migration and policy is given, followed by an overview of Goan migration. A description of the study that took place follows including the theoretical standpoint and social and cultural context. The findings of the study are then discussed, focusing on how women negotiated their cultural identities. The chapter concludes with an overview of implications for social care and health professionals.

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