Response 702382655

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Introduction

1. What is your name?

Name
Sana Ashraf

3. Please tell us whether you are providing a submission as an individual, health professional or on behalf of an organisation

Please select one item
Individual
Health Professional
Organisation

5. If you are an organisation, what category best describes the role of your organisation?

Please select all that apply
Advocacy group
Community based clinical services
Government
Hospital based clinical services
Maternity services
Peak body
Professional college
Research
Other (please specify)

6. In which State or Territory do you live or does your organisation operate?

Please select one item
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australian
Tasmania
Victoria
Western Australian
National

7. The Department of Health would like your permission to publish your consultation response. Please indicate your publishing response.

Please select one item
(Required)
Publish response (your email address will not be published but all other answers, including your name, will be published)
Publish response anonymously (your name and email address will not be published but all other answers, including organisation names, will be published)
Do not publish response

About the document

8. Is the language used in the Plan appropriate and easily understood?

Please select one item
Yes
No

9. Is the vision appropriate for the Plan?

Please select one item
Yes
No

10. Is the overarching goal appropriate for the Plan?

Please select one item
Yes
No

11. Please provide further comment/feedback on the Plan's language, vision, overarching goal; and priority areas? Include identified gaps and any significant strengths and weakness?

(answer in dot point format, maximum 200 words)
• Harmony Alliance is one of six National Women’s Alliances funded by the Australian Government to promote the views of all Australian women, to ensure their voices are heard in decision-making processes. We are a membership-driven body representing over 130 organisations and individuals working for the advancement and inclusion of migrant and refugee women. Our purpose is to provide a national inclusive and informed voice on the multiplicity of issues impacting migrant and refugee women in Australia. We adopt a feminist and human rights-based approach to the full and effective participation of women from migrant and refugee backgrounds in Australian society. We believe that all women have a right to free, safe, accessible, and culturally responsive healthcare.

• We welcome the recognition of migrant and refugee women’s health concerns and needs—including higher risk factors and additional barriers to accessing healthcare—in the National Stillbirth Action and Implementation Plan. We commend the commitment to providing high quality, safe, accessible, equitable, and culturally responsive care and support to women from migrant and refugee backgrounds who are bereaved or at high risk of experiencing stillbirth. While all priority areas identified by the Plan reflect this commitment, this submission offers recommendations to strengthen the approach and specific actions related to each priority area.

12. Please identify any published and peer-reviewed evidence that would further inform the draft Plan, specifying the relevant priority and action areas?

Davies-Tuck ML, Davey M-A, Wallace EM (2017) Maternal region of birth and stillbirth in Victoria, Australia 2000–2011: A retrospective cohort study of Victorian perinatal data. PLoS ONE 12(6): e0178727. https://doi.org/10.1371/journal.pone.0178727

Pollock D, Ziaian T, Pearson E, Cooper M, Warland J (2020) Understanding stillbirth stigma: A scoping literature review. Women and Birth 33(3):207-218. https://doi.org/10.1016/j.wombi.2019.05.004

Priority Area 1 - Ensuring high quality stillbirth prevention and care

13. Are the action areas appropriate for Priority Area 1: Ensuring high quality stillbirth prevention and care?

Please select one item
Yes
No

14. Are the goals appropriate for Priority Area 1: Ensuring high quality stillbirth prevention and care?

Please select one item
Yes
No

15. Are the implementation tasks appropriate for Priority Area 1: Ensuring high quality stillbirth prevention and care?

Please select one item
Yes
No

16. Please outline any changes you consider should be made to the existing action areas, goals or implementation tasks that would be relevant to and Priority Area 1: Ensuring high quality stillbirth prevention and care.

(answer in dot point format, maximum 200 word)
• Ensure that high-risk groups of women, including migrant and refugee women from certain ethnic backgrounds, are provided adequate stillbirth prevention and care throughout their pregnancies
• As part of migrant and refugee women’s health literacy strategy and when co-designing models of culturally responsive care, provide women with information and authoritative guidance on safe and evidence-based clinical practices as well as the risk of harm to women’s health and wellbeing that may be posed by some cultural and traditional beliefs and practices related to pregnancy, birth and stillbirth.
• As part of training and education, enhance the capacity of health professionals to prioritise women’s health and safety while delivering culturally responsive care
• Culturally responsive clinical practice should be informed by the Competency Standards Framework (https://culturaldiversityhealth.org.au/competency-standards-framework/) which has been widely endorsed by peak professional bodies for clinicians.

Priority Area 2 - Raising awareness and strengthening education

18. Are the action areas appropriate for Priority Area 2 - Raising awareness and strengthening education.

Please select one item
Yes
No

19. Are the goals appropriate for Priority Area 2 - Raising awareness and strengthening education?

Please select one item
Yes
No

20. Are the implementation tasks appropriate for Priority Area 2 - Raising awareness and strengthening education?

Please select one item
Yes
No

21. Please outline any changes you consider should be made to the existing action areas, goals or implementation tasks that would be relevant to and Priority Area 2 - Raising awareness and strengthening education.

(answer in dot point format, maximum 200 words)
• The development of education and awareness programs for community and health professionals should acknowledge and address the stigma associated with stillbirth in many communities, and risk of neglect, abuse and violence against women related to stillbirth. In particular, women who have experienced multiple stillbirths may be at a higher risk of abuse and violence perpetrated by their partners and/or extended families.

22. Please identify any additional action areas, goals or implementation tasks that would be relevant to Priority Area 2 - Raising awareness and strengthening education.

(answer in dot point format, maximum 200 words)
• Ensure that education programs for health professionals include a component on the risk of family and domestic violence associated with stillbirth. Health professionals should also be provided training to assess risk and to respond to disclosures of family and domestic violence.

Priority Area 3 - Improving holistic bereavement care and community support following stillbirth

23. Are the action areas appropriate for Priority Area 3 - Improving holistic bereavement care and community support following stillbirth?

Please select one item
Yes
No

24. Are the goals appropriate for Priority Area 3 - Improving holistic bereavement care and community support following stillbirth?

Please select one item
Yes
No

25. Are the implementation tasks appropriate for Priority Area 3 - Improving holistic bereavement care and community support following stillbirth?

Please select one item
Yes
No

26. Please outline any changes you consider should be made to the existing action areas, goals or implementation tasks that would be relevant to and Priority Area 3 - Improving holistic bereavement care and community support following stillbirth.

(answer in dot point format, maximum 200 words)
• An enhanced focus on mental health issues experienced by bereaved mothers and families due to loss, stigma, fear, and sometimes abuse.
• Provision of affordable, safe, accessible, and culturally responsive mental health services to bereaved migrant and refugee women and their families
• Inclusion of mental health support within the prevention and care programs for high risk groups and in subsequent pregnancies for women who have experienced stillbirth
• Community education and awareness campaigns to enhance understanding of mental health impacts of stillbirth and specific needs of bereaved mothers and their families from migrant and refugee backgrounds

Priority Area 4 - Improving stillbirth reporting and data collection

28. Are the action areas appropriate for Priority Area 4 - Improving stillbirth reporting and data collection?

Please select one item
Yes
No

29. Are the goals appropriate for Priority Area 4 - Improving stillbirth reporting and data collection?

Please select one item
Yes
No

30. Are the implementation tasks appropriate for Priority Area 4 - Improving stillbirth reporting and data collection?

Please select one item
Yes
No

31. Please outline any changes you consider should be made to the existing action areas, goals or implementation tasks that would be relevant to and Priority Area 4 - Improving stillbirth reporting and data collection.

(answer in dot point format, maximum 200 words)
• There is very limited data available about migrant and refugee women’s rates and experiences of stillbirth in Australia. A recent study of stillbirth in Victoria by Davies-Tuck, Wallace and Davey (2017) showed that women born in South Asia have significantly higher rates of stillbirth in Australia. This study revealed the need for more comprehensive data collection on country of birth and ancestry in relation to stillbirth.
• Comprehensive national-level data collection initiatives should be taken to capture the correlations between country of origin and stillbirth. This will enable a better understanding of risk factors—and subsequent provision of healthcare—for women from migrant and refugee backgrounds.

Priority Area 5 - Prioritising stillbirth research

33. Are the action areas appropriate for Priority Area 5: Prioritising stillbirth research?

Please select one item
Yes
No

34. Are the goals appropriate for Priority Area 5: Prioritising stillbirth research?

Please select one item
Yes
No

35. Are the implementation tasks appropriate for Priority Area 5: Prioritising stillbirth research?

Please select one item
Yes
No

36. Please outline any changes you consider should be made to the existing action areas, goals or implementation tasks that would be relevant to Priority Area 5: Prioritising stillbirth research.

(answer in dot point format, maximum 200 words)
• There is a significant gap in research on why certain groups of women—such as those born in South Asia—have higher rates of stillbirth than others. Under this priority area, the Plan should prioritise and explicitly include research on high risk factors that impact migrant and refugee women in the research agenda.