Introduction by Croakey: The pandemic has laid bare systemic shortcomings when it comes to the health care of refugee and migrant populations, who are again bearing the brunt of punitive responses in a vacuum of appropriate messaging and community-led responses.
Hopelessly out-of-date and poorly conceived and communicated government messaging was a recurring theme in this week’s coverage of Sydney’s COVID-19 outbreak which, at 345 new cases on Thursday, showed no sign of abating. More than 80 percent of New South Wales is now in lockdown as the virus seeds out into the regions.
Systemic barriers and entrenched inequity for culturally and linguistically diverse populations in health care were highlighted in a recent report by the Multicultural Centre for Women’s Health and an accompanying plan for action.
Bonney Corbin, who is chair of the Australian Women’s Health Network and head of policy at Marie Stopes Australia, spoke at an event last week to launch the report.
She told attendees any form of discrimination, whether on the basis of race, citizenship, visa class, gender, language spoken or “any other intersectional aspect…compromises the right to health.”
“We have international obligations to provide safe and quality health care without barriers and without borders,” Corbin told the forum.
Rather than progress, Corbin said women’s health equity was at risk of regressing, with the pandemic worsening divides.
In this piece for Croakey, Corin examines the report’s findings and how COVID-19 is squeezing migrant and refugee populations who are already living on the edge.
Bonney Corbin writes:
As a dual citizen with family living across the world, I have accessed government-funded healthcare across multiple countries.
Today I am fully vaccinated against COVID-19, am a participant of ground-breaking clinical trials, and receive world-class care at the Peter McCallum Cancer Centre.
Meanwhile, some of my family members are living in Australia on temporary visas.
Throughout the pandemic, I have witnessed firsthand how the healthcare barriers for people on temporary visas have progressively increased.
While I may assist with childcare or medical costs, this does not erase the chasm of health inequity between us.
My family’s situation is not unique. Healthcare discrimination on the basis of citizenship, visa status, race, gender, disability and other intersectional factors is a global issue, magnified during the pandemic.
Women’s health services I work with throughout Australia have been reporting the difficulties being faced by women on temporary visas, including working and student visas.
This is due to financial hardship, movement restrictions related to lockdowns, border closures, and a lack of access to in-language, accurate and timely information related to COVID-19.
They are working with women who are facing eviction, mounting debt (including medical debts), lack of access to childcare or income and increased rates of family violence.
Migrant and refugee women have experienced fear of persecution for movement when accessing abortion care, linked to overpolicing and police discrimination.
Considerable gaps
The community sector continues to fill gaps in public health funding. Women’s health services, domestic, family violence and sexual violence support services use various methods of fundraising and philanthropy to cover client’s medical costs.
During the pandemic, the number of regular donors, philanthropists and the size of their donations has dramatically reduced across Australian charities and not-for-profits. This particularly impacts migrant and refugee women, who often experience financial hardship and fall through the gaps.
There is also the significant issue of unfunded perinatal care. International students, for example, are ineligible for Medicare.
As a visa condition they are required to purchase Overseas Students Health Cover (OSHC) for themselves and their dependants to cover medical costs for the duration of their stay in Australia. They are covered for basic medical treatment but can be liable to considerable medical expenses.
The OSHC Deed, the legal agreement between the Department of Home Affairs and a registered private health insurer that provides the health cover, sets the minimum coverage requirements that OSHC providers are required to meet for all kinds of OSHC policies.
The Deed was changed by the Labor Government in 2011 to preclude OSHC providers from paying benefits to overseas students or their dependants for the treatment of pregnancy-related conditions in the first 12 months after arrival in Australia, except when emergency treatment is required.
However, 73 percent of all claims for pregnancy-related treatment for all international students and their dependents occur in the first 12 months of cover and between 33-48 percent of claims for all hospital items relate to pregnancy.
This means that people on temporary visas whose health insurance does not cover costs associated with pregnancy are confronted with the full cost of antenatal and postnatal care.
Concerningly, this can result in women rationing their antenatal care, avoiding screening checks, and discharging themselves from hospital early.
There are high levels of anxiety and stress among young mothers, who are cut off from their families’ support by state, territory and international border closures.
Evidence shows that migration related stressors such as family separation, financial insecurity and precarious immigration status are risk factors for perinatal mental health conditions for migrant women.
Issues around the human rights of people on temporary visas were being raised prior to the pandemic.
Demonstrated divide
The Multicultural Centre for Women’s Health has long been advocating for equitable health access for migrant and refugee health equity, including advocacy for women on temporary visas.
This month they launched two publications, the 2021 Sexual and Reproductive Health Data Report with an accompanying paper called Act Now.
Despite the lack of data on migrant and refugee women’s sexual and reproductive health, the 2021 Sexual and Reproductive Health Data Report shows that compared to Australian-born, non-Indigenous women, migrant and refugee women:
- Are less likely to have access to evidence-based and culturally relevant information which will enable them to manage their own fertility, contraceptive choices and menstrual health.
- Participate less in preventative health service access, for example, migrant and refugee women have lower screening rates for breast and cervical screening.
- Are at greater risk of contracting a sexually transmitted condition such as HIV or hepatitis B.
- Tend to access antenatal care later, and experience higher rates of stillbirth.
- Are at higher risk of experiencing pregnancy-related conditions such as preeclampsia and gestational diabetes.
- Are more likely to experience perinatal mental health conditions, often linked to social isolation and socioeconomic or financial insecurity, compounded by migration-related stressors.
- Are more likely to experience barriers to sexual and reproductive health care, including abortion care.
Despite some national investment in supporting women on temporary visas who are experiencing violence, it’s not enough. Investment in migrant and refugee women’s health will not only ensure better health outcomes, it will prevent violence and increase gender equity.
State and territory action for equitable health access is urgently called for, as is Federal action to prevent precarious financial situations, for both women on temporary visas and for migrant and refugee women’s health services.
Bonney Corbin is the Chair of the Australian Women’s Health Network and Head of Policy at Marie Stopes Australia
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