Refocus (Refugee background women for cultural safety): A photovoice study exploring culturally safe pregnancy care in Victoria, Australia
When Karen women can embrace their cultural and spiritual identity without fear of racism and discrimination, culturally safe pregnancy care is possible.
There are more displaced people worldwide than ever before. Addressing perinatal health disparities for refugee background women, babies, and families in Australia relies on accessible, culturally safe pregnancy care.
The Refocus photovoice study aimed to understand what culturally safe pregnancy care is to Karen (Kah-REN) women of refugee background in Victoria, Australia.
Karen people are Indigenous to the Karen State, located in the country formerly known as Burma. Being the oldest and one of multiple ethnic groups in the Burma region, Karen people speak many languages and dialects. One of the main languages spoken is S’gaw Karen.
Due to sustained oppression by the Burmese Military since the 1940s, thousands of Karen families have faced genocide and persecution and been forced to flee their homes to seek safety in neighbouring countries such as India, Bangladesh, and Thailand. Additionally, over 700,000 people have been internally displaced since the latest 2021 military coup in Burma.
Fifty-three per cent (7,165 people) of the Karen community in Australia have resettled in the state of Victoria. With unresolved conflict in Burma, Karen people will continue to be forcibly displaced and therefore continue to seek asylum in Australia.
What is already known?
Refugee background women experience poorer pregnancy care when compared to their non-refugee counterparts. The reasons why are complex but include racism, other forms of discrimination, and problems when navigating the Australian healthcare system.
A critical framework to addressing racism and other forms of discrimination in pregnancy care is cultural safety. Cultural safety challenges health professionals to critically reflect on themselves and the systems in which they work. By doing so, sharing power within pregnancy care relationships and health equity is possible.
Following a review of the literature, a significant gap was identified: no studies had asked women of refugee background what culturally safe pregnancy care is to them in Australia. Therefore, this study addresses elements of this gap by exploring what makes pregnancy care culturally safe for Karen women living in Victoria, Australia.
What this study adds
Using photovoice as a research method, we invited Karen women who had a baby in Victoria to explore their understandings of cultural safety within pregnancy care through group discussions and photos they had taken in their own communities.
We heard that when Karen women can embrace their cultural and spiritual identity without fear of racism and discrimination, culturally safe pregnancy care is possible. Karen women are conscious of the unequal power relationships within pregnancy care. Cultural safety is however attainable when power is shared between health professionals, interpreters, and Karen women. Steeped in a history of oral tradition, Karen people can be natural orators. There is an opportunity for health professionals and interpreters to share power by creating space within pregnancy care for women to share and celebrate stories.
To help share study findings, a letter to health professionals was co-written with participants, which can be found below.
When Karen women can be their true, authentic selves; Karen women can feel safe, and feel that they belong.
Who was involved in this study?
This community-based participatory research project was conducted in partnership with the Stronger Futures CRE, the Murdoch Children’s Research Institute, and The Victorian Foundation for Survivors of Torture (Foundation House). Engaging in cross-cultural research practices, Refocus included a Karen community researcher, Shadow Toke, and established a Karen Community Advisory Group to guide study design, conduct, and dissemination.
Shadow Toke
Community researcher and PhD candidate
