When you arrive in a new country as a migrant, your health is often the last thing on your mind as you focus on more immediate demands like securing housing, enrolling children into school and finding a job.
Health, especially for women, “slips down the list of priorities,” says Regina Quiazon, Senior Policy and Research Advocate at Melbourne’s Multicultural Centre for Women's Health (MCWH), a national community-based women's health organisation that focuses on improving the health and wellbeing of migrant and refugee women across Australia.
Migrant and refugee women experience the same health issues as the rest of the Australian population, but accessing a healthcare system that’s unfamiliar to them can make seeking medical help a daunting experience.
In Safe Harbour, the new SBS series examining attitudes towards asylum seekers arriving by boat, character Zahra is seeking more information about women's health services and is unsure of the process, an experience common to refugee women.
“Their issues are exacerbated by lack of access to services,” says Quiazon. “They're not really given the support to navigate a system that's quite complex.”
Language can also act as a barrier, especially when interpreter services are under-utilised or mismanaged, says Quiazon. There may be a mismatch in language or gender, where a “woman gets a male interpreter when they're interpreting about very confidential or sensitive issues around their health.”
Overall, she says, there is a lack of culturally responsive care in the health system. “[We need to] value bilingual workers and properly train them to deliver services to women specifically.”
Another issue is cost – especially when a woman is not covered by Medicare.
Who is covered by Medicare?
According to the Department of Human Services’ website, if you live in Australia and have applied for permanent residency, you may get a Medicare card. This covers the 190,000 people who arrive in Australia each year through the country’s migration programme.
But “overwhelmingly, those on temporary visas don't have Medicare,” says Quiazon, which could apply to more than one million migrants and visitors at a time.
“If you're not covered by Medicare, you will have to pay out of pocket. Usually, those out-of-pocket costs are quite hefty,” she says.
Services like the ASRC Health Centre in Melbourne provide healthcare to people in the community seeking asylum – particularly those with no access to Medicare. Its services include general practice, immunisation and psychiatry clinics, as well as diabetes screening and first-aid training.
Case study: unplanned pregnancy
In many cases, the combination of increased sexual activity, limited sexual education and poor access to health services put international students in Australia at an increased risk of unplanned pregnancy.
The numbers tell the story: according to an SBS News report in March, 4000 international students access abortion services each year. A 2009 study revealed that one in three abortions performed at the Women's and Children's Hospital in Adelaide involved overseas students.
An unplanned pregnancy can cause havoc in an international student’s life. “It impacts on their choices around whether to continue their education or…go back to their home country to deliver the baby,” says Quiazon.
International students are required to have health insurance, known as Overseas Student Health Cover (OSHC), which covers in-hospital medical services, out-of-hospital medical services, surgical implanted prostheses, some prescription medicines and emergency ambulance transportation.
Surgical and medical terminations cost around $1000 without private health insurance or Medicare cover.
Changes made to the OHSC rules in 2011 mean that providers do not have to pay benefits for pregnancy-related conditions for the first 12 months following an international student’s arrival in Australia.
According to the East Melbourne clinic that I spoke to, surgical and medical terminations cost around $1000 without private health insurance or Medicare cover – a significant amount of money for someone with limited funds, whether she is an international student or an asylum seeker.
Quiazon estimates that the cost of delivering a baby without no health cover in Victoria is somewhere between $5000 and $12,000, depending on whether there are any complications during childbirth.
Both options are potentially prohibitively expensive for an international student, and a number of scenarios, outlined in a 2011 MCWH report, could follow. She could drop out of her course and return home to have the baby, or she could continue studying and have the baby in Australia, often without appropriate antenatal care.
“Many female international students who have a baby in Australia experience great difficulties in combining studies with motherhood, so they return to their country of origin with their newborn infant and leave their baby with family members before returning to Australia to resume their studies. Subsequently, these students experience separation anxiety and depression, which in turn affects their ability to study,” states the report.
“For some female students, pregnancy is not an option, so women may take drastic measures to end an unplanned pregnancy if they are not able to fund an abortion.”
For assistance across refugee health issues, visit refugeehealthaustralia.org.
Thriller Safe Harbour airs over four weeks, exploring issues facing asylum seekers once they settle in Australia. All episodes will be available after broadcast anytime, anywhere, for free via SBS On Demand. Join the conversation with #SafeHarbour. Watch episode one now: