Milica Markovic

Measuring the health impact of human rights violations related to Australian asylum policies and practices: a mixed methods study

BackgroundHuman rights violations have adverse consequences for health. However, to date, there remains little empirical evidence documenting this association, beyond the obvious physical and psychological effects of torture. The primary aim of this study was to investigate whether Australian asylum policies and practices, which arguably violate human rights, are associated with adverse health outcomes.MethodsWe designed a mixed methods study to address the study aim. A cross-sectional survey was conducted with 71 Iraqi Temporary Protection Visa (TPV) refugees and 60 Iraqi Permanent Humanitarian Visa (PHV) refugees, residing in Melbourne, Australia. Prior to a recent policy amendment, TPV refugees were only given temporary residency status and had restricted access to a range of government funded benefits and services that permanent refugees are automatically entitled to. The quantitative results were triangulated with semi-structured interviews with TPV refugees and service providers. The main outcome measures were self-reported physical and psychological health. Standardised self-report instruments, validated in an Arabic population, were used to measure health and wellbeing outcomes.ResultsForty-six percent of TPV refugees compared with 25% of PHV refugees reported symptoms consistent with a diagnosis of clinical depression (p = 0.003). After controlling for the effects of age, gender and marital status, TPV status made a statistically significant contribution to psychological distress (B = 0.5, 95% CI 0.3 to 0.71, p ≤ 0.001) amongst Iraqi refugees. Qualitative data revealed that TPV refugees generally felt socially isolated and lacking in control over their life circumstances, because of their experiences in detention and on a temporary visa. This sense of powerlessness and, for some, an implicit awareness they were being denied basic human rights, culminated in a strong sense of injustice.ConclusionGovernment asylum policies and practices violating human rights norms are associated with demonstrable psychological health impacts. This link between policy, rights violations and health outcomes offers a framework for addressing the impact of socio-political structures on health.

Endurance and contest: Women's narratives of endometriosis

Endometriosis is an often painful medical condition in which, in response to hormones associated with the menstrual cycle, the uterine lining grows in the peritoneum and other organs, bleeding into the surrounding organs and tissues. Diagnosis is not always straightforward, and women and health professionals alike may have difficulties recognizing period pain as a sign of anomaly, considering it instead as an inevitable part of menstruation. This article describes the illness narratives of Australian women with endometriosis, drawing on data collected during a study conducted in Victoria in 2004—5. Thirty women (aged 20—78 years) from various socio-demographic backgrounds participated in in-depth interviews. We explore the influence of socio-demographic background and social and family norms on womens illness narratives of endurance and contest. Narratives of endurance are characterized by the normalization of period pain by young women, their families and health professionals, and, with diagnosis, long-term exposure to biomedical treatments. In contrast, narratives of contest are dominated by how womens subjective experience is challenged by doctors, their requirements for a patient-centered approach, and their desire to have access to complementary treatments.

The health of immigrant women: Queensland women from the former Yugoslavia.

A study of the social and health status of women from the former Yugoslavia was conducted in Queensland, Australia. Study participants were predominantly refugee women who had migrated to Australia between 1991 and 1996. A significant number of the women rated their health status as poor or fair. Most women did not perceive any change in health following migration, but more felt that their health had deteriorated than improved. Applying a social model of health, we explored the social contexts of countries of origin and destination that impact on womens health. We analyze how preimmigration trauma, settlement problems, health risk behaviors, and participation in screening programs affect womens health status and health needs. Data analysis indicated that government and nongovernment services can reduce the impact of preimmigration experience on health risk behaviors and poor health outcomes only to a limited degree. Since the low socioeconomic status of immigrants following immigration was identified by women as a main contributing factor to their poor health status, government support in tackling structural barriers in accessing the Australian labor market is essential to achieve positive health outcomes.

Analyzing Qualitative Data: Health Care Experiences of Women with Gynecological Cancer

This article describes the process of writing up qualitative research and developing and testing a grounded theory. The article is based on data collected from in-depth interviews conducted in Australia with women with gynecological cancer. Thematic analysis of the data identified issues pertinent to womens experiences. The article describes the discovery of themes in women’s stories and develops a grounded theory on women’s health care experiences on the basis of interview data.

Circuit Breaking: Pathways of Treatment Seeking for Women With Endometriosis in Australia

Pain resulting from endometriosis is experienced as both a chronic, ongoing condition and an acute episode at time of menstruation, often occurring in association with diarrhea, vomiting, nausea, heavy bleeding, and other reactions. Women expect pain with menstruation, however, and even if they experience major disruptions as a result, they find it difficult to distinguish normal from pathological discomfort. Drawing on qualitative research conducted from 2004 to 2006, we describe the “circuit breakers” that lead Australian women to seek medical advice. These include outside intercession, major disruptions to everyday life, changes in embodied experience, and difficulties in conception and pregnancy. Womens ideas of menstrual pain as “normal” are shared by doctors, resulting in further delays before a definitive diagnosis of endometriosis is made. During this time, women move between doctors and in and out of medical care, which they described through particular narrative styles to highlight the complexity of help seeking. We explore the ways in which ideas of gender, informed by womens embodiment but also the quality of their reporting of symptoms, influence their interactions with health professionals.

Nowhere is as at home: adjustment strategies of recent immigrant women from the former Yugoslav Republics in southeast Queensland

This paper analyses adjustment strategies of women from the former Yugoslav Republics who have settled in Australia since 1991. The majority of these recent immigrants have been humanitarian settlers and refugees, and this has had specific implications for their adjustment strategies. In-depth interviews were conducted during 1996-97 with 52 former Yugoslavian-born women who resided in southeast Queensland. The womens assessments of their decision to immigrate resulted in three adjustment strategies: (1) loss orientation, (2) ambivalence and (3) future orientation. Described separately, this typology delineates only ideal types, but is predictive of the kinds of settlement and coping issues that are faced by individual immigrants. The adjustment strategies are primarily affected by the womens status as independent immigrants or refugees and humanitarian settlers, social capital and social constraints in the host country.

Social policies and refugee resettlement: Iraqis in Australia

In this paper, we analyse national social policies that mediate the experiences of Iraqi refugees in Australia. Drawing on qualitative in-depth interviews conducted with this population in Melbourne, the capital of Victoria in Australia, and a small town in country Victoria, we delineate how social policies can lead to visible (formal) and invisible (informal) exclusion of refugees. We use two Australian policies; temporary protection and regional resettlement of refugees, to demonstrate how official Australian government policies may negatively affect the integration experience of these new arrivals. Additionally, such policies have unintended consequences for support networks between refugees on different visa categories, and for social relationships between refugees and the broader Australian community.

Family caregivers: Russian-speaking Australian women's access to welfare support.

In Australia, rapid population ageing, and government efforts to support people who are chronically ill, elderly or with disabilities to live in their own homes, has led to the primary responsibility of care being undertaken by families. Through its social policies, the Australian government provides income and other types of support to informal caregivers. This article explores how Australian social policy and womens understanding of their roles impact on their access to welfare support. Qualitative research was conducted in Melbourne between February and June 2006. In-depth interviews were undertaken with eight Russian-speaking women involved in caregiving, purposively recruited through ethnic associations, and with four community service providers. Women based their expectations of the gendered and private nature of their role on the social policies in countries of their origin and, hence, did not attempt to access welfare support unless they were referred by health and welfare professionals. In addition, poor referral by professionals, influenced by past societal attitudes that caregiving is a gendered role, contributed to womens limited access to welfare benefits. Changes in the implementation of social policy are proposed to increase caregivers’ access to welfare support and efficient utilisation of existing resources.

Communications about cervical cancer between women and gynecologists in Serbia

SummaryObjective:The age-standardized incidence rate of cervical cancer in Serbia is 27.2 per 100,000 women, i. e., twice as high as in western European countries. This paper explores the communication which occurs between women and gynecologists in Serbia in relation to cervical cancer screening.Methods:Our study was conducted in two phases: a qualitative phase (focus group discussions and in-depth interviews with women) and a quantitative phase (community-based survey). This paper reports the findings from both phases, and in particular, the in-depth interviews with 22 women with different socio-economic backgrounds residing in the capital city and a regional town. To illustrate women’s experiences and attitudes, we used interview excerpts.Results:Our findings indicate that there is poor communication between women and gynecologists and an absence of proper counseling. Women’s lack of knowledge about reproductive health issues, poor attitudes of gynecologists, and personal barriers that women experience in accessing health care render preventive practices a low priority both for women and gynecologists.Conclusion:We recommend different educational and organizational strategies that may improve the counseling skills of gynecologists and ultimately reduce the prevalence of cervical cancer in Serbia.

Day Surgery in Australia Qualitative Research Report

The article explores the experiences of patients undergoing day surgery in an Australian public hospital for women. We draw primarily on interviews with these patients to identify the factors arising from the specific context which compromised their well-being.