Content warning: references pregnancy loss
When Reena Rana miscarried her first pregnancy in 2013, she waited at the hospital’s A&E department for hours.
“I was two and a half months pregnant and I started spotting. I rushed to the hospital, and they said, ‘Why don’t you take a seat, we are very busy.' They made me sit for four and half hours,” the 36-year-old said.
It wasn’t until Reena lost more blood that she said she was given more attention, and then sent home with the message that she had lost her baby.
“It’s a very emotional time, and there was no empathy. If they could just explain the procedure to me, [instead] they said, ‘When you have big clots, you come and see us’. That’s not very nice.”
Reena is originally from India and now calls Australia home.
A report released on Wednesday by the Multicultural Centre for Women’s Health (MCWH) in Melbourne found Australia’s health system “doesn’t cater adequately for migrant and refugee women” when it comes to sexual and reproductive health.
“Migrant women have much lower levels of access to sexual and reproductive health services, particularly preventative and early intervention services,” MCWH executive director Dr Adele Murdolo said.
“We see high rates of stillbirth, we see high interventions during birth, so [they are] much [more] likely to have a caesarean.
“Our report shows that migrant and refugee women tend to have lower levels of satisfaction with the health care that they receive.”
Reena Rana and her daughter. Source: Supplied
According to the report - titled Sexual and Reproductive Health Data Report 2021, and its sister document, Act Now - migrant and refugee women also have an increased risk of contracting a sexually transmitted condition, experiencing family violence, and suffering poorer maternal and child health outcomes than non-First Nations Australian-born women.
“Prior to COVID, [some] women weren’t accessing their contraception in Australia. They’d go back home and get a year or two worth of contraception,” Dr Murdolo said.
“That’s obviously a big fail in the Australian health system, where you’ve got people who live here permanently who don’t use it.”
After her miscarriage, Reena decided to get private medical insurance. She fell pregnant again in 2016 and at her 20-week scan, a radiologist saw abnormalities in the baby.
“I was there alone, and the doctor said, ‘there's a problem’. He started explaining the laws of abortion in Victoria.”
Reena waited for her husband to arrive from work and together they returned to the doctor and asked for a second opinion.
There had been a mistake, Reena was told, and she is now the mother of a healthy four-year-old girl.
“The system is designed for a very narrow group of society, which is health-literate, speaks English, can advocate for itself [and] can understand what you say the first time around,” obstetrician Dr Nisha Khot said.
Language and location
There are some success stories though.
For Vandna Chawla, who lives in Ballarat, Victoria, a Hindi-speaking gynaecologist made the world of difference in her second pregnancy in 2020.
“It was more comfortable and reassuring to talk with her in my first language,” the 36-year-old said.
“She explained my pregnancy with medical terms that I understand better in Hindi. Whenever I saw her, I was happy.”
Vandna Chawla was grateful to find a Hindi-speaking gynaecologist. Source: Supplied
But language and location barriers can play a role in health outcomes, Dr Murdolo said.
“You can go to a health service in one part of the country where the resources are just very limited. It’s all about socio-economic disadvantage. Migrants tend to live in areas where housing is cheaper, for instance.”
“We’ve heard of women, particularly in rural areas, go back for appointments two or three times and there isn’t an interpreter available.”
“There’s [existing] inequity in the system, racism, and sexism. When a woman is faced with all these barriers, it can be very difficult for them to access the healthcare that they need,” she said.
And it isn’t just an issue for first-generation migrants, Dr Khot says.
“The outcomes and treatment that migrant and refugee women get are very different, even for people who are second or third-generation migrants in Australia. We can’t ignore it.”
Elvira, 34, from Sydenham in Victoria, has a degenerative condition called spinal muscular atrophy (type 2). Her parents migrated to Australia from Montenegro when they were just 18 and 23 years old.
Elvira and her family. Source: Supplied
“It’s hard growing up and seeing your parents belittled because of their English,” she said.
“They came from relying solely on themselves, so it was very much ingrained in them to just take on my disability.”
Elvira grew up in a loving family that couldn’t access government help. So she did that herself.
When Elvira had her second child, a nurse told her mother that she’d have to stop working to look after her daughter and granddaughter.
“I think you can leave,” Elvira told the nurse.
Since then, Elvira has encouraged her mother to be more confident in her health rights.
The MCWH is calling for migrant and refugee women in Australia to be part of the policymaking process that affects their health, instead of working around it.
Minister for Health Greg Hunt, who will launch the report on Wednesday, said: “Within our migrant community, this can lead to mental health outcomes, to delayed treatment, so these are really important findings. We have a task before us".
Fernanda Fain-Binda is a freelance writer.