Incarcerated Aboriginal women’s experiences of accessing healthcare and the limitations of the ‘equal treatment’ principle

Abstract

Background: Colonization continues in Australia, sustained through institutional and systemic racism. Targeted discrimination and intergenerational trauma have undermined the health and wellbeing of Australia's Aboriginal and Torres Strait Islander population, leading to significantly poorer health status, social impoverishment and inequity resulting in the over-representation of Aboriginal people in Australian prisons. Despite adoption of the 'equal treatment' principle, on entering prison in Australia entitlements to the national universal healthcare system are revoked and Aboriginal people lose access to health services modelled on Aboriginal concepts of culturally safe healthcare available in the community. Incarcerated Aboriginal women experience poorer health outcomes than incarcerated non-Indigenous women and Aboriginal men, yet little is known about their experiences of accessing healthcare. We report the findings of the largest qualitative study with incarcerated Aboriginal women in New South Wales (NSW) Australia in over 15 years. Methods: We employed a decolonizing research methodology, 'community collaborative participatory action research', involving consultation with Aboriginal communities prior to the study and establishment of a Project Advisory Group (PAG) of community expert Aboriginal women to guide the project. Forty-three semi-structured interviews were conducted in 2013 with Aboriginal women in urban and regional prisons in NSW. We applied a grounded theory approach for the data analysis with guidance from the PAG. Results: Whilst Aboriginal women reported positive and negative experiences of prison healthcare, the custodial system created numerous barriers to accessing healthcare. Aboriginal women experienced institutional racism and discrimination in the form of not being listened to, stereotyping, and inequitable healthcare compared with non-Indigenous women in prison and the community.

Healthcare challenges of incarcerated women in Australia: An integrative review

“…[36] Furthermore, infectious disease prevalence is high in this population including Hepatitis B and Hepatitis C rates. [36] Aboriginal women are also at higher risk of mental health issues and more likely to have been victims of violence. [37] The relationship between prior history of childhood physical and sexual abuse and mental health illness equally applies here as identified earlier.…”

“…[21] More than 80% of incarcerated Aboriginal women are also mothers, and many also have primary care responsibilities for children and their extended families. [36] Of these Aboriginal women in prison, 59% reported significant morbidity attributed to three or more of the following conditions: kidney disease, asthma, bronchitis, migraines, diabetes mellitus, hypercholesterolemia and cancer. [36] In addition, it is reported that 91% of Aboriginal women required prescription medication.…”

“…[36] Of these Aboriginal women in prison, 59% reported significant morbidity attributed to three or more of the following conditions: kidney disease, asthma, bronchitis, migraines, diabetes mellitus, hypercholesterolemia and cancer. [36] In addition, it is reported that 91% of Aboriginal women required prescription medication. [36] Furthermore, infectious disease prevalence is high in this population including Hepatitis B and Hepatitis C rates.…”

“…[36] In addition, it is reported that 91% of Aboriginal women required prescription medication. [36] Furthermore, infectious disease prevalence is high in this population including Hepatitis B and Hepatitis C rates. [36] Aboriginal women are also at higher risk of mental health issues and more likely to have been victims of violence.…”

“…It has been suggested that a major factor impacting on Aboriginal women's mental health is stress and anxiety attributed to family and children whilst incarcerated. [36] The mental health of incarcerated Indigenous Australians is also impacted by historical outcomes, intergenerational trauma, racism, discrimination, political inequities and trauma which compounds the childhood abuse these women may have experienced and the resultant mental health issues. [36,38] Incarcerated Aboriginal women's health needs are, therefore, complex.…”