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Pap screen changes take health equity backwards

By Alyce Vella, Health Promotion Worker

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Proposed changes to pap screen bulk-billing will have a significant impact on women who work, play and reside in the west, and will likely further exacerbate health inequity among women who experience disadvantage. Changes could result in patients paying up to $30 for a pap smear.

Only 58 per cent of women aged 20-69 participated in the National Cervical Screening Program in 2012-2013. Rates of screening among women residing in the western region of Melbourne are lower than the national average; as low as 44 per cent in some local government areas. It is likely that this number will reduce even further if added financial pressure is placed on women, let alone the increased effort required to identify a bulk-billing clinic if clinics increase their patient contribution.

Who will be impacted?

Marginalised community groups who are already presenting at low rates for pap screens are likely to be impacted, including Aboriginal women, migrant and refugee women, young women, women with a disability, lesbian and bisexual women, and victims/survivors of sexual violence. Incidence and mortality outcomes among Aboriginal women are particularly dire; Aboriginal women are 2.3 times more likely than non-Aboriginal women to develop cervical cancer (incidence rate), and almost 3.5 times more likely than non-Aboriginal women to die from cervical cancer, highlighting an already significant gap in health care among this community group.

Why the change?

One of the arguments for the proposed changes is that increased accessibility to the Human Papilloma Virus (HPV) vaccine (which protects against the high risk HPV strains that play a large role in the development of cervical cancer) is likely to see a reduced incidence of cervical cancer in the future, reducing the demand for pap screens. However, it is important to note that routine pap screens with a nurse or GP often act as a mediator for discussions about other routine health checks, such as breast screening for older women and STI testing for sexually active women, particularly for young women who are at highest risk of STIs such as chlamydia. With rates of chlamydia in some parts of Melbourne’s west almost three times greater than the state average, these opportunistic discussions are vital to the sexual and reproductive health of women in the west.

Some concerns

Arguably the most important concern with the proposed changes to pap screen bulk-billing are the potential impacts on women seeking out health care in a timely, preventative manner. According to the Victorian Cervical Cytology Registry, ‘almost 90 per cent of all Victorian women who develop cervical cancer have either never had a test, or did not have a test routinely in the ten years prior to their diagnosis’, highlighting that the additional barriers to screening, such as the ones proposed, are likely to result in even more alarming statistics.

Increasing culturally appropriate and responsive cervical screening service delivery and coordination throughout Melbourne’s west is an objective of Action for Equity, the sexual and reproductive health plan for Melbourne’s west. The Action for Equity partnership is led by Women’s Health West.

Sources

Rebuilding the bonds with children

mum_hugs_boyBy Nadine, a children’s counsellor at Women’s Health West

I work with children who have seen or heard family violence. Sometimes they may have helped to clean up after, or helped defend their mothers or carers against violence. Their pets may have been harmed, or toys destroyed or left behind if they’ve had to flee.

Some children have been directly physically abused. They can become withdrawn, act like parents themselves, or act out. For children displaying their distress by acting out aggressively, relationships can become increasingly difficult; a mother may find her child’s behaviour reminiscent of the violence she has experienced.  A mother’s parenting is nearly always undermined by family violence, and her relationships with her children affected.

Let me share with you the abridged therapeutic adventures of a six-year-old boy I worked with during our children’s counselling sessions. We’ll call him ‘Emmett’, but it’s not his real name.

At school Emmett was aggressively targeting girls. He was having trouble making and keeping friends due to his delayed social skills. He was still wetting his pants. In the classroom, his capacity to sit still in order to listen, learn and respond, was very limited.

At home Emmett and his sister fought vicious fights, often resulting in injury. They found it difficult to tolerate sharing the attention of their mother. Emmett would often lash out at her, physically and verbally.

When I first met Emmett he was viewed by some people in his world as a ‘very naughty boy’.

BUT Emmett had experienced significant family violence his entire life. Emmett was unsure of trusting others, and had little experience of feeling safe. His trauma was relational, and this is where the repair needed to start. Emmett’s mother had fled the violence so he and his siblings were safe.

In the course of our work together Emmett tested me to see if I was trustworthy. We played and made art, the natural language of children which enables them to make sense of their experiences. I followed his lead.

The protagonists in his work were always alone and in danger, always losing the ‘war’! Emmett was devastated about leaving his toys behind when the family fled, and felt this was somehow further punishment for being a ‘bad boy’.

Choosing Positive Paths, a resource developed by Women’s Health West and Berry Street, outlines some connection focused activities I might use as a guide when working with mothers to rebuild their relationships with their children following family violence.

It focuses on mothers and carers being the most important people in moving this process forward. The simple language used in Choosing Positive Paths makes the information easy to understand, and the daunting task of repairing a relationship a little more tangible: Play with your child. Be curious about your child’s thoughts and feelings. Catch them behaving well! Talk to them in age appropriate language about the tough stuff that has happened.

Emmett’s mother came to understand that her son’s attacks on her were not personal, but rather the kind of behaviour that had been modelled in the home previously. She began to use the motto of ‘ALL feelings are okay, but not all behaviours are okay’. She practiced acknowledging her children’s emotions. Emmett’s mother was eventually able to talk with Emmett about the conflicting feelings that came up for him in relation to his father: ‘I love him, but he was scary sometimes. I miss him, BUT I don’t miss the scariness’.

Emmett had practiced these themes in the safety of the counselling room, and Emmett’s mother and I had practiced together too, using similar language to that contained in Choosing Positive Paths. A resource like this can provide mums with simple suggestions and information prior to engaging with counselling, or in between counselling sessions.

It’s child focused. It’s trauma informed.

Emmett’s protagonists began to gather armies so he was no longer alone; the wars were being won, and some of the heroes were women! Eventually the wars stopped all together (inside the therapy room and outside at school and home). Normal sibling rivalry settled in between Emmett and his sister.

And while it wasn’t all happily ever after in Emmett’s family, enough understanding and hope had been gained to shift things for the better between mother and child.

This is an edited version of a speech Nadine presented at the launch of the Choosing Positive Paths resource at Parliament House in December 2016. The resource was officially launched by the Hon Jenny Mikakos MP, Minister for Families and Children.

Choosing Positive Paths is a resource developed for mothers, carers and other protective parents to support children affected by family violence. You can order or download here.

Find out more information about WHW Children’s Counselling services: http://whwest.org.au/resource/childrens-counselling-service/

Illustration by Isis and Pluto

There is no way I could have done this alone

FV Services blog_Jan16_finalSarah* lives in Melbourne’s west, she is a victim of family violence. Read a short story about Sarah and how she got the support she needed…

Sarah’s husband abused her emotionally and psychologically throughout their ten-year marriage and threatened to kill her if she tried to leave.

‘…I WAS A TERRIFIED, EMOTIONAL, NERVOUS WRECK COMING TO TERMS WITH A LONG HISTORY OF ABUSE…’

When he seriously assaulted Sarah, Victoria Police applied for an intervention order on her behalf and she was granted a one-year intervention order.

A Women’s Health West case worker developed strategies to keep Sarah and her children safe, including working with police to implement the extreme risk client strategy to manage her risk and ensure their safety.

“MY CASE WORKER WENT THROUGH A CHECKLIST WITH ME TO PROPERLY IDENTIFY THE MAIN CONCERNS…’

Sarah’s ex-partner’s relatives harassed Sarah at court so her case worker arranged for her to give evidence via video link and put her in touch with a community legal centre that organised a barrister for her. Sarah was granted a full three-year extension of the intervention order.

“I KNOW THERE IS NO WAY I COULD HAVE DONE THIS ALONE.’

*Not her real name

If you are a victim of family violence, there are many services that can support you, you are not alone:

Check out our Who can help me page or download our Family Violence Crisis Outreach brochure

Key contacts:
Women’s Health West: 9689 9588
Safe Steps Family Violence Response Centre: 1800 015 188

If YOU ARE IN IMMEDIATE DANGER CALL THE POLICE ON 000

 

What’s on @Women’s Health West in 2016

Lead on jumpYoung women’s leadership, community advocacy, human rights and carers support are some of the focus areas of our projects in 2016. Here’s a handful of programs you can get involved in this year. If you need more information please call us and email us, we’d love to help you out.

PROGRAMS FOR YOUNG WOMEN…

Lead On Again

Who’s it for: Culturally and linguistically diverse young women aged 16-24, studying, living or working in the western region of Melbourne
What’s it about: This free, six-day leadership program allows young women to make friends while:

  • Participating in workshops on topics including public speaking, healthy relationships, mental health, media and self confidence
  • Learning about event management and planning an exciting event for the end of the program
  • Being supported to participate in community and leadership activities in the future

Details:  18-22 January (9.30am – 4.00pm) and 25 January (11.00am – 4.00pm) 2016
Who to contact: Nirvana via email or call on 8379 9041

Young African Women’s Project

Who’s it for: Young African women who live, work or study in ‪#‎Melbswest‬!
What’s it about:  Learn about sexual and reproductive health and wellbeing, and build your confidence in leadership and advocacy.

Who to contact: Call Shukria on 03 9689 9588 for more details about joining this great project running in January

PROGRAMS FOR MUSLIM WOMEN…

Our Community Our Rights

Who’s it for: Muslim women from the Horn of Africa living in Melbourne’s west
What is it about:  The women who participate in this project will:

  • Receive human rights-based advocacy training
  • Be supported to manage their own community advocacy projects
  • Develop skills, knowledge and connections that will assist them to take up further employment, study or volunteering opportunities
  • Be reimbursed for their time and travel. Free childminding will also be provided if needed.

Where: Somewhere central for participants (tell us what works for you)
Who to contact: Call Susan on 9689 9588 or send an email

PROGRAMS FOR WOMEN LIVING WITH A DISABILITY, MENTAL ILLNESS, CHRONIC HEALTH CONDITION…

Sunrise Women’s Group

Who’s it for: Women of all ages living with a disability and/or mental illness
What is it about: It’s a fortnightly social and supportive get together to help women feel connected

We also have a new Sunrise Women Carers Group in Melton, open to women who care for someone with a disability, mental illness and/or chronic health condition.

Where: Laverton, Melton, Sunshine and Wyndham
Who to contact: call Lauren on 9689 9588 or send her an email.

Every action matters

Action countsA group of men from Preventing Violence Together partner organisations met in July 2015 to discuss their experiences as men taking action to prevent violence against women. Written for whw news edition 3 – 2015, they shared the journey they’ve taken to understand men’s violence against women as encompassing unequal power relations between men and women, emanating from gender inequality. 

As members of the Preventing Violence Together partnership, we have had the opportunity to discuss violence, gender inequality and male privilege at length with colleagues. We have also had the opportunity of having in-depth discussions with women working in preventing men’s violence against women, enriching our learning and professional development with insights that other men have been rarely afforded.

Most men we talk to oppose violence against women, but this view does not always translate into action to prevent violence.

It is our belief that two barriers, both related to language, hinder most men from engaging in activities to prevent violence against women. The first barrier relates to understanding that all men can play a role in preventing violence against women. When we talk with some men about the importance of being involved in preventing violence against women, we are so often met with two responses: ‘I am not violent, why do I need to act?’ and ‘I do not know what you are asking me to do’.

The links between gender equity and preventing violence against women are complex, with gender inequities creating an environment for violence to occur. However, this link often runs counter to the personal experience of men we talk to. All have grown up in gendered environments, but not all men choose to use violence. Answering the question ‘what causes violence against women?’, and giving men the capacity and confidence to make changes in their everyday lives is not an easy task.

The second barrier is balancing language that doesn’t shy away from the issue, with language that encourages and supports participation.

Quite rightly, we use the phrase ‘men’s violence against women’ and encourage men to take ownership over the problem. This recognises that men are overwhelmingly the perpetrators of violence, and that men have been afforded unequal positions of power in our society. Despite this, we have found when we talk to men who have never committed violence and use language that seeks to encourage ownership, we force our audience to make a challenging decision – will I confront this as an issue for all men or, because I’ve never been violent and I don’t see the links you’re referring to will I choose to stay disengaged? When talking to men outside of the health and community sector we find that many choose the easier option.

We believe that taking ownership over the issue is not as simple as an opting in or out at a single point in time. Eliminating violence against women is a long-term prospect, meaning that building strong community involvement will be more like a marathon than a sprint. For this reason, we need to be prepared to engage men where they are in order to build the support to get where we want to be as a society.

In this issue, the journey from superficial engagement to comprehensive understanding starts with small, every day actions that build to longer term engagement and, ultimately, a change across our community. Participation in change occurs across a continuum – from being placated or informed, through to partnering and leading.

For every man who makes a public stand to promote gender equity and prevent men’s violence against women, there are many more that contribute in smaller ways. Whether it’s husbands and partners who break gender stereotypes in the home, or the sports coaches who challenge sexist jokes in their clubs and set a culture of respect for teams to abide by, these ideas and contributions, however small, should be encouraged and seen as important steps on a journey to move men from a position of participation to one of leadership.

One in three women will experience violence at some point in their life. That means that, whether they know it or not, most men will come into contact with a woman who has experienced violence.

With an issue of the size and breadth as violence against women, men cannot simply choose whether or not to be involved – we are all involved. The real choice is what that involvement will be. Our objective is to engage other men, to help them identify ways to confront gender inequity and oppose violence to women, and to make small everyday contributions that can grow into leadership. We invite other men to join us.

The authors

This article was written by: James Dunne (HealthWest Partnership), Nuredin Hassan (ISIS Primary Care), Cuong La (HealthWest Partnership), Peter Crowley (Moonee Valley City Council) and Samuel Muchoki (Brimbank City Council)

Read more stories and get the latest news about Women’s Health West in whw news.

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of organisations mentioned.