4/28/2021 0 Comments Racism toward Aboriginal and Torres Strait Islander people within my future midwifery workplaceIn this essay I will discuss the impact on individuals of implied racism, overt racism and racial commentary toward Aboriginal and Torres Strait Islander people within my future midwifery workplace. I will discuss the differences and offer specific examples and evidence to support the discussion. In the given example, Adam Goodes, an Australian Rules footballer, in 2013 was publicly discriminated against for his features which brought about much commentary and discussion about the normalisation of overt and implied racism and how this gets responded to. Racism is an assumption of natural hierarchy of culturally and characteristically identifiable groups bringing with it bias and prejudice 1. The ‘lesser’ groups are avoidably and unfairly treated differently 2. Within Australia, these groups are protected by the Racial Discrimination Act of 1975 3 and when the football fan publicly labelled Adam an ‘ape’, this violated this act. This public name calling can be categorised as overt or explicit racism where the discriminatory behaviour is clear, conscious, direct, obvious, undisguised and blatant and can manifest in physical violence, unfair treatment and insults 4. Overt racism can intentionally be self-monitored to consciously avoid appearing racist 5. This form of racism has also been called ‘old fashioned’ 6 but over time, legal sanctions have inadvertently created a more subtle form of ‘modern’, implied, implicit, racism that is much harder to detect, label and therefore call out 2. This more covert racism can be found where individuals or organisations behave on the basis of prejudice and stereotypes automatically, unintentionally and unconsciously 7,8. This implied racism can be seen in the relentless ‘booing’ of Mr Goodes, from many different football clubs until his retirement. This reaction appearing outside of normal fan barracking and jeering behaviour. There is an underlying acceptance of discrimination against this man’s heritage and a lack of acknowledgement of the historical cultural oppression. This ‘booing;’ and the responses in the media and social media in responses to the acts of racism are called racial commentary and have the ability to exacerbate any discrimination but also magnify the need for reform. Racism also remains very active across the health sector and midwifery workplace 9 with over 70% of surveyed midwives admitting that some staff were disrespectful and racist to indigenous colleagues in their workplace including stereotyping, discrimination and prejudice 10. Ninety nine percent also agreed that racism negatively impacted student outcomes for First Peoples 10. Indigenous midwifes are feeling unsafe and burnt out and not remaining in the workforce 11. There is also evidence of implicit racism that has influenced hiring decisions in the sector 12. As consumers of health services, First Peoples carry the weight of health inequality 13 and often report experiencing racism 10. Racism causes health inequities and contributes to poor health outcomes experienced by these people 2. Within maternity care, over half of women who identified as Aboriginal, professed experiencing discrimination within their care setting and did not receive care to match their needs 14. These women were more likely to have poor infant health outcomes, including low birthweight and small for gestational age 14. Examples of this implied racism can be brought about by carer anxiety about working with clients who appear different and include not looking at the women, shortening the consultation or withholding information they would otherwise provide 2. When questioned if they ask all clients if they are an Aboriginal or Torres Strait Islander, midwives replied with “Not if they don’t look it.”, “don’t want to offend someone.” 9. This implies that it is shameful to be Aboriginal. Not only is this racism seen on an individual level, but there is also outcome disparity within Australian hospitals affected by institutional racism with an organisational change failure rate of 70% 15. On this level we also see a lack of access to care 9 including Aboriginal women not having the ability to honour customs like birthing on country due to lack of an appropriate insurance product to allow midwives to provide evidence based midwifery continuity of care in this setting 16. Practicing culturally unsafe is racist 2. This includes not listening to or treating a person with dignity and disrespecting their cultural identity 17. Culturally safe maternity care includes an holistic view of a woman’s needs including culture and seeks to reduce any power that may be felt by the women in their care 16. It is important that “only the woman and/or her family can determine whether or not care is culturally safe and respectful” 18 I have defined and discussed the impact on First Nations of implied and overt racism and how racial commentary can affect its effects. I have examined these concepts more comprehensively within my future midwifery workplace, offering specific examples and evidence to support the discussion. As a student and future midwife, I can make a positive contribution to health equity particularly for indigenous Australians by providing care that is culturally safe and respectful. References
(1) Hampton, R.; Toombs, M. Racism, Colonisation/Colonialism and Impacts on Indigenous People. In Indigenous Australians and Health : The Wombat in the Room; Oxford University Press, 2013; p 21. (2) Taylor, K.; Thompson Guerin, P. Determinants of Health. In Health Care and Indigenous Australians : Cultural Safety in Practice : Cultural Safety in Practice; Macmillan Education UK, 2019. (3) Australian Government. Racial Discrimination Act 1975. (4) Lui, P. P. Racial Microaggression, Overt Discrimination, and Distress: (In)Direct Associations With Psychological Adjustment. Couns. Psychol. 2020, 48 (4), 551–582. https://doi.org/10.1177/0011000020901714. (5) Banks, A. J.; Hicks, H. M. Fear and Implicit Racism: Whites’ Support for Voter ID Laws: Fear and Implicit Racism. Polit. Psychol. 2016, 37 (5), 641–658. https://doi.org/10.1111/pops.12292. (6) Pedersen, A.; Beven, J.; Walker, I.; Griffiths, B. Attitudes toward Indigenous Australians: The Role of Empathy and Guilt. J. Community Appl. Soc. Psychol. 2004, 14 (4), 233–249. https://doi.org/10.1002/casp.771. (7) Brownstein, M. Implicit Bias https://plato.stanford.edu/archives/fall2019/entries/implicit-bias/. (8) Quigley, A.; Hutton, J.; Phillips, G.; Dreise, D.; Mason, T.; Garvey, G.; Paradies, Y. Review Article: Implicit Bias towards Aboriginal and Torres Strait Islander Patients within Australian Emergency Departments. Emerg. Med. Australas.2021, 33 (1), 9–18. https://doi.org/10.1111/1742-6723.13691. (9) Sherwood, J.; Mohamed, J. Racism a Social Determinant of Indigenous Health: Yarning About Cultural Safety and Cultural Competence Strategies to Improve Indigenous Health. In Cultural Competence and the Higher Education Sector; Frawley, J., Russell, G., Sherwood, J., Eds.; Springer Singapore: Singapore, 2020; pp 159–174. https://doi.org/10.1007/978-981-15-5362-2_9. (10) Fleming, T.; Creedy, D. K.; West, R. Evaluating Awareness of Cultural Safety in the Australian Midwifery Workforce: A Snapshot. Women Birth 2019, 32 (6), 549–557. https://doi.org/10.1016/j.wombi.2018.11.001. (11) Lai, G.; Taylor, E.; Haigh, M.; Thompson, S. Factors Affecting the Retention of Indigenous Australians in the Health Workforce: A Systematic Review. Int. J. Environ. Res. Public. Health 2018, 15 (5), 914. https://doi.org/10.3390/ijerph15050914. (12) Ditonto, T. M.; Lau, R. R.; Sears, D. O. AMPing Racial Attitudes: Comparing the Power of Explicit and Implicit Racism Measures in 2008: Comparing 2008 Racism Measures. Polit. Psychol. 2013, 34 (4), 487–510. https://doi.org/10.1111/pops.12013. (13) CATSINaM; NMBA. NMBA and CATSINaM Joint Statement on Culturally Safe Care. 2018. (14) Brown, S. J.; Gartland, D.; Weetra, D.; Leane, C.; Francis, T.; Mitchell, A.; Glover, K. Health Care Experiences and Birth Outcomes: Results of an Aboriginal Birth Cohort. Women Birth 2019, 32 (5), 404–411. https://doi.org/10.1016/j.wombi.2019.05.015. (15) Bourke, C. J.; Marrie, H.; Marrie, A. Transforming Institutional Racism at an Australian Hospital. Aust. Health Rev. 2019, 43 (6), 611. https://doi.org/10.1071/AH18062. (16) Kildea, S.; Gao, Y.; Hickey, S.; Nelson, C.; Kruske, S.; Carson, A.; Currie, J.; Reynolds, M.; Wilson, K.; Watego, K.; Costello, J.; Roe, Y. Effect of a Birthing on Country Service Redesign on Maternal and Neonatal Health Outcomes for First Nations Australians: A Prospective, Non-Randomised, Interventional Trial. Lancet Glob. Health 2021, S2214109X21000619. https://doi.org/10.1016/S2214-109X(21)00061-9. (17) Williams, R. Cultural Safety - What Does It Mean for Our Work Practice? Aust. N. Z. J. Public Health 1999, 23(2), 213–214. https://doi.org/10.1111/j.1467-842X.1999.tb01240.x. (18) Nursing and Midwifery Board of Australia. Code of Conduct for Midwives. Nursing and Midwifery Board of Australia. 2018.
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