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Reproductive Justice and Culturally Safe Approaches to Sexual and Reproductive Health for Indigenous Women and Girls

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Reproductive justice and culturally safe approaches to sexual and reproductive health for In-
digenous women and girls: An Australian example
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Pat Dudgeon and Abigail Bray
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We recognize the impacts and tragedies that have occurred because of environmental violence,
but we also celebrate our victories, strength, resilience and resistance. We commit to continue
our struggles and fulfill our responsibilities to our children and the generations still to come. We
commit to continue revitalizing our traditional ways of life, languages, and cultures, and to im-
plement solutions in our own communities based on our traditional knowledge, practices and
ways of knowing. We commit to reclaim our wellness and power as Indigenous women and Peo-
ples and reaffirm that our children have a right to be born healthy and to live in a clean environ-
ment. To heal our Peoples and Mother Earth, we must continue to heal ourselves, tell our stories,
build our unity, defend out rights and be who we are.
—3rd International Indigenous Women’s Environmental and Reproductive Health Symposium,
2018
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In this chapter we take a de-colonising strengths-based approach to the subject of Indige-
nous women and girls sexual and reproductive health. Indigenous strengths-based approaches are
asset-based, focused on resilience, protective factors, and capacity building, culturally safe, engaged
with social and cultural determinants, and governed by Indigenous research methodologies and
concepts of wellbeing (Fogarty, Lovell, Langenberg & Heron, 2018). The importance of strengths-
based culturally safe comprehensive primary health care has long been recognised by Indigenous
communities, is enshrined in the United Nations Declaration of the Rights of Indigenous Peoples,
and is an emerging best practice across many neo-colonial states (Ramsden,1990; Brascoupe, 2009;
Taylor & Guerin, 2010). However, there is limited research on how Indigenous health sciences can
inform a culturally safe strengths-based approach to Indigenous women and girls sexual and repro-
ductive health (Bell, Aggelton, Ward & Maher, 2017).
Here we describe an innovative Aboriginal and Torres Strait Islander model for strengthen-
ing the sexual and reproductive health of Aboriginal and Torres Strait Islander women and girls.
Composed of seven inter-related Indigenous domains of wellbeing Country, spirituality, culture,
community, family and kinship, mind and emotions, and body Social and Emotional Wellbeing
(SEWB) is widely recognised as a culturally appropriate Indigenous health model within Australia
(Dudgeon, Bray, Walker, & D’Costa, 2017). This holistic model of health was refined by Gee, Dud-
geon, Schultz, Hart, and Kelly (2014) after substantial community consultations, further developed
by Dudgeon and Walker (2015) and informs important state and federal health policies and strate-
gies such as the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’
Mental Health and Social and Emotional Wellbeing 2017-2023.
Before this Indigenous model is explored it is necessary to provide some context. In what
follows we present an over-view of dominant findings about Indigenous women and girls sexual
and reproductive health with a concentration on population health data from the neocolonial states
of Australia, New Zealand, North America and Canada. We then describe some of the major Indige-
nous health models emerging out of the global resurgence of Indigenous self-determination in pri-
mary health care. The Aboriginal and Torres Strait Islander model of SEWB is then explored, with
a focus on how each of the seven domains contribute to the strengthening of women and girls sexu-
al and reproductive health.
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Indigenous women’s reproductive oppression
International Indigenous women’s groups have become increasingly vocal about the impor-
tance of achieving reproductive justice through self-determination. While self-determination has
long been recognised as the solution to overcoming the stark health disparities between Indigenous
and non-Indigenous people, and vital in combating the destructive impacts of the main social de-
terminant of this disparity, namely colonisation (International Symposium on the Social Determi-
nants of Indigenous Health, 2007) the relationship between reproductive justice and self-determina-
tion is a relatively new focus. The concept of reproductive justice comes out of research and ac-
tivism conducted by women of colour committed to expanding culturally safe access to comprehen-
sive primary health care and ending reproductive oppression (Ross & Solinger, 2018). Reproductive
oppression is intersectional, mobilised by shifting forces of racism, sexism and classism which con-
trol and exploit women and girls bodies, sexuality, labour, and reproduction. The reproductive op-
pression of Indigenous women is now well documented both in Australia (Behrendt, 2001; Sykes,
1975; Watson, 2009), and internationally (Stannard, 1992) with groups such as SisterSong, a Native
American women’s health lobby, campaigning for reproductive justice. The reproductive oppression
of Indigenous women and girls includes rape, the forced removal of children, involuntary sterilisa-
tion, coerced abortions, lack of access to culturally appropriate health care and education, including
delivery care for pregnant women, and the exclusion of Indigenous women’s traditional health sys-
tems and culture. There is an emerging movement against the colonial contamination of Indigenous
waterways, land and air: the concept of environmental reproductive justice (Hoover, 2018) is being
increasingly used by Indigenous women. The impact of reproductive oppression is complex, cross-
generational, inter-generational and entrenched, and can be understood as an underlying driver of
the health gap between Indigenous and non-Indigenous women and girls across the world.
First Nations, Inuit and Metis females in Canada suffer higher maternal mortality, coercive
sterilisation, gestational diabetes, smoking during pregnancy, STIs and reproductive cancers
(Halseth, 2013). Native American females have less access to safe antenatal care, maternity hospi-
tals and family planning (Gurr, 2012), endure the trauma of sterilisation (Torpy, 2000), STIs, and
are at greater risk of death from cancers of the reproductive system. In New Zealand/Aoreta, Maori
women and girls suffer higher levels of STIs, (Tipene & Green, 2017), have less access to antenatal
care, birth more premature babies, smoke during pregnancy more often, have greater maternal and
neonatal mortality, and higher levels of fatal cervical and breast cancer (Parton, 2015). In Australia,
Indigenous females experience higher rates of maternal sepsis and gestational diabetes, perinatal
morbidity, give birth to more low weight babies, suffer from maternal smoking and STIs (Bell, et al,
2017; Lowell, et al, 2015), and have higher mortality rates from reproductive cancers (Tapia, et al.,
2017).
Indigenous women and girls across the world are also subjected to chronic levels of trauma-
tising and fatal sexual violence. The plight of First Nations missing and murdered females in Cana-
da and sexual violence against Native American women is an internationally recognised crisis (Le-
gal Strategy Coalition on Violence Against Indigenous Women, 2018). The ongoing trauma of
colonisation (cross-generational, inter-generational, and historical trauma) also results in significant
numbers of pregnant Indigenous women experiencing mental health challenges (Mah, et al. 2017).
Indigenous females, especially those who live in rural and remote areas, often do not have
access to culturally safe comprehensive primary health care services one consequence is that
girls and women are not adequately screened for cancers impacting their sexual and reproductive
health (Hutchinson et al., 2018). There is a consensus across the health literature in the field that
access to culturally informed culturally safe health services is vital to the strengthening of Indige-
nous women and girls sexual and reproductive heath (ibid.). This access is also upheld by Article 24
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(1) in the United Nations Declaration of the Rights of Indigenous Peoples: ‘Indigenous people have
the right to their traditional medicine and to maintain their health practices, including the conserva-
tion of their vital medicinal plants, animals and minerals. Indigenous people also have the right to
access, without any discrimination, to all social and health services’ (UNDRIP, 2007).
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Self-determination, cultural safety and Indigenous health models
There is substantial evidence that Indigenous self-determination restores health and wellbe-
ing (Oster, et al. 2014; King, Smith & Gracey, 2009; Chandler & Lalond, 1998). Indigenous control
over the governance of communities, and in particular control over comprehensive primary health
care services is emerging as a strong solution to over-coming the health gap between Indigenous
and non-Indigenous women and girls. A clear reason is that Indigenous women are best placed to
provide culturally safe (knowledgable and non-racist) services to Indigenous women and girls. For
many Indigenous women, long histories of severe institutionalised racism and sexism within the
colonial health care sector have led to an understandable reluctance to experience further punitive
contact (Bradley et a.l 2015; Dietsch et al. 2010). In this context, Indigenous controlled health care
practices which support ‘cultural safety’ can be understood to be forms of counter-colonial resis-
tance and ways of fighting for Indigenous women’s reproductive justice. In Australia and other
colonised countries, Indigenous women and girls wellbeing has benefited from Indigenous con-
trolled comprehensive primary health care services (Lowell, et al. 2015; Howell, et al. 2016). Cen-
tral to the global project of Indigenous healing through self-determination is the restoration of In-
digenous health systems.
Culturally safe Indigenous healing systems are being used by communities to de-colonise
health discourses and practices across the world. For example, the Cree model of Being Alive Well
or miyupimaasisiiun (Adelson, 2000), the Maori models of wellbeing, Te Whetu The Star (Mark &
Lyons, 2010), Whare Tapa Maori The Four-Sided House (Durie, 2001) and Te Wheke The Octopus
(Pere, 1995), the Matsigenka of the Amazon jungles model (Izquierdo, 2005), and Native American
wellbeing models founded on traditional Medicine Wheel teachings (Rountree & Smith, 2016;
Canales, 2004), represent some of the emerging Indigenous health discourses. For Indigenous peo-
ple, health is a holistic concept that ‘encompasses everything important in a person’s life, including
land, environment, physical body, community, relationships, and law’ (Burns, Maling & Thomson,
2010, p. 1). Indigenous sexual and reproductive wellbeing is holistic and relational, collective and
ecocentric. Land is central to Indigenous wellbeing and is emerging as a topic of research in the de-
terminants of health literature (de Leeuw, 2018).
Aboriginal and Torres Strait Islander led holistic de-colonising approaches which support the
empowerment of women, their families and communities have existed since at least the 1970s when
the self-determination movement successfully mobilised for Aboriginal Community Controlled
Health Organisations (Foley, 1991). As of 2018 there are roughly 150 such organisations across
Australia. Similar processes have occurred in other Indigenous cultures across the world. One result
of the Indigenous self-determination movement in Australia has been the development of nine guid-
ing principles of Aboriginal and Torres Strait Islander Social and Emotional Wellbeing. In brief, the
1989 National Aboriginal Health Strategy identified nine engagement principles which were devel-
oped by the landmark Ways Forward (Swan & Raphael, 1995), and also contained in the National
Strategic Framework for Aboriginal and Torres Strait Islander Peoples Mental Health and Social
and Emotional Wellbeing 2004–2009. These nine principles inform a central text in the field, Work-
ing Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing: Principles and
Practice (Dudgeon, Milroy & Walker 2014). The revised 2017-2023 national SEWB Framework
promotes these principles which are underpinned by a recognition that self-determination in the
health sector is the solution to over-coming the complex burdens of colonisation (Dudgeon, Bray,
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D’Costa & Walker, 2017). These nine guiding principles embody a holistic and whole-of-life view
of health held by Aboriginal and Torres Strait Islander people, and emphasise that SEWB is a
strengths-based understanding of health.
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Aboriginal and Torres Strait Islander women and girls social and emotional wellbeing
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It is the right of Aboriginal and Torres Strait Islander women to determine what their health sys-
tem will look like. Aboriginal and Torres Strait Islander women and their organisations must
have a pivotal role in consulting, designing, developing, implementing and evaluating health
services for Aboriginal and Torres Strait Islander women (Fredericks, Adams, Angus & the Aus-
tralian Women’s Health Network Talking Circle, 2011, p. 25).
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The social and emotional wellbeing of Aboriginal and Torres Strait Islander women and
girls is acknowledged to be an under-researched area, for example the minimal amount of research
into motherhood has tended to be epidemiological and child outcome focused (Ussher, Charter, Par-
ton & Perz, 2016). Moreover, ‘initiatives in which Indigenous approaches and the role of culture are
integrated into women-centered, trauma-informed approaches are scarce’ and ‘[p]rograms generally
tend to focus on only one or two elements of women’s wellbeing and few have explicitly and/or ef-
fectively embraced the intersection of culture, gender and trauma to support recovery’ (Wyndow,
Walker & Reibel, 2018). Furthermore, as Bell, Aggelton, Ward and Maher (2017) conclude in their
review of young Indigenous women’s sexual health in Australia, there is a lack of acknowledgement
of the strengthening power of women’s culture in peer-reviewed articles in the area. They identify a
‘major gap in understanding how indigenous cultural values and practices support, rather than in-
hibit, young people’s sexual health and promote, rather than constrain, practices of harm
reduction’ (Bell et al., 2017, p.14). Action is also urgently needed to improve the dire conditions of
Indigenous women’s everyday life .
As The Birthing on Country Position Statement (2016), which addresses strengthening
sexual and reproductive well-being, puts it, women’s health disadvantage is:
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underpinned by the inequity across all of the ‘Social Determinants of Health’ (SDH) such as,
poor housing, insecure employment, lower educational outcomes and access to health care, in-
cluding care during pregnancy. Alongside the SDH, there are many other factors, which influ-
ence an Aboriginal and/or Torres Strait Islander women’s engagement with, and early presenta-
tion for, care in pregnancy. Specifically, those include the availability of culturally safe services,
institutional racism in our health services, the frequency (or absence) of local services (p. 1).
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These SDH are recognised in the numerous Indigenous health policies which promote SEWB, and
are an integral part of SEWB which recognises the influence of social and historical determinants
which is depicted below is Figure 1 adopted from Gee et al. (2014).
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Figure 1: Social and emotional well-being framework depicting the interplay of social and historical
determinants.
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In what follows, each strengths-based domain of SEWB is discussed in terms of Indigenous
women’s sexual and reproductive well-being. This is not meant to be prescriptive. How might sexu-
al and reproductive health be strengthened by connections to the seven domains of SEWB?
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Connection to Country
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Indigenous women are the traditional custodians of the land and waterways of Australia. Re-
lationship to Country is vital to the strength of women and to the ecocentric concept of subjectivity
that underpins Indigenous ontology. Country is often respected as female, as mother, or as the
Noongar people call her, ‘“Boodjar” or “nourishing terrain," a nurturing, creative, fertile
place’ (Wooltorton, Collard, & Horwitz, 2017, p. 1). There is robust evidence that links connection
to Country to improved SEWB (Burgess et al. 2009; Burgess, et al. 2008; Biddle, 2011; Biddle &
Swee, 2012). Indigenous health programs for girls and women take pregnant women onto Country,
to get exercise, learn about healthy bush tucker, and visit culturally importance places with other
females (Lovell, et al., 2015).
Connection to Country is important for caring for sacred women’s sites, where women’s business
can occur, and central to initiation ceremonies that celebrate transitions in sexual and reproductive
wellbeing. Country is a place where one can be nourished, strengthened, replenished, and seek
guidance. Within classical Indigenous culture, great importance was placed on where women gave
birth, and in recent years there has been strong movement to reclaim the power of this SEWB prac-
tice, termed Birthing on Country (Kildea et al., 2018). Giving birth is an important right of passage.
‘Many Aboriginal women living in rural and remote areas want the opportunity, in low risk situa-
tions, to be able to birth ‘on country’ with the knowledge and support of their Elders’ (Dudgeon &
Walker, 2011, p. 116). Culturally and spirituality, this birthing is linked to strengthening and pro-
tecting infants and mothers, and barriers to being able to do so are argued to lead to a ‘weakened
spirit in baby and higher rates of infant mortality’ (Dudgeon & Walker, 2011, p. 116; see also
Wardaguga & Kildea, 2004) as well as the breakdown of the protective qualities of culture and sub-
sequent disharmony in communities. The right to birth on country is supported by SNAICC: Na-
tional Voice for Our Children, a powerful, community-controlled organisation dedicated to protect-
ing children, young people, and families and strengthening self-determination through cultural iden-
tity (SNAICC, 2018).
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Connection to spirituality
Spirituality is recognised across the literature to be an important source of wellbeing (Yp-
inazar, et al.,2007; Greives, 2009; Yap & Yu, 2016). There are strong links to spirituality and well-
being across the literature and many concepts of Indigenous wellbeing are anchored in spirituality,
for example the Yawuru people speak of mabu liyan ‘a continuity and connection between the mind,
body, spirit, culture and land’ (Yap & Yu, 2016, p. 28).
Indigenous spirituality is a sophisticated ecocentric philosophy and a law that maps relationships
and obligations which are passed down in stories and ceremonies, and is a complex knowledge sys-
tem that includes women’s understandings of sexual and reproductive wellbeing from a holistic per-
spective. Traditional women healers, for example, draw on spiritual knowledge and classical mid-
wives are also often healers, counsellors, and Elders. For example, the powerful Ngaanyatjarra Pit-
jantjatjara Yankunytjatjara Women’s Council Aboriginal Corporation support traditional Ngangkari
women healers who strengthen the sexual and reproductive health of women and girls across central
Australia (Dudgeon & Bray, 2017).
Strengthening women’s sexual and reproductive well-being through the SEWB domain of
spirituality means, among other things, providing access to traditional women healers and midwives
and to sacred women’s birthing places and the stories they carry, as well as access to the cultural
knowledge systems that support women’s strength and power (Bell, 1982; Bell & Ditton, 1980).
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Connection to culture
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The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives Birthing on
Country Position Statement (2016) asserts that culture ‘underpins’ Indigenous health priorities ‘in-
cluding that mothers and babies get the best possible care and support for a good start to
life’ (CATSINaM, 2016, p. 1). Culture is also central to the successful Strong Women, Strong Ba-
bies, Strong Culture Program which recognises culture and cultural renewal as the wellspring of
health (Lowell, et al. 2015, p. 2). The Program has been supporting women and girls in the North-
ern Territory since 1993 and runs ‘culture camps’ for young girls and women’ (Lowell, et al., 2015,
p.3) to strengthen their cultural identity. The success of this Program depends on the continuation of
community control and self-determination.
Prior to colonisation women had a powerful, respected and central place and enjoyed free-
dom, security, rights to land, equality with men; they were a vital part of the governance of commu-
nities and active participants in cultural activities and the development and continuation of Indige-
nous knowledge systems in Australia. Indigenous ‘women were ‘bosses for themselves’, a self-per-
ception that was manifest in their economic, social, familial, spiritual and ritual roles’ (Dudgeon &
Walker, 2011, p. 98). As Elders, and women of High Degree, women had considerable power, were
integral to the handing on of knowledge and Lore to younger generations and enabling important
transitions from childhood and adolescent to adulthood, and had sovereign rights as custodians of
Country. Indigenous culture was highly structured, there were numerous laws in place to regulate
sexual relations and birth, and women were honoured. As Elder George Gaymarrangi Pasco put it:
‘[i]n our cultural Lore, it says we need to protect our women because she represents the earth.
Women are very special in this world and our customs and Lore says that we must protect
them’ (People Culture Environment, 2014, p. 46).
Indigenous women’s sexual and reproductive health is shaped by the Dreaming, sacred laws
passed down across thousands of years through story, ritual, and art, which, for example, honour
pregnancy as a sacred experience when a spirit child came into being. The health of pregnant
women was very important: There were various rules about what could and could not be eaten, and
the whole community cared for her (Dudgeon & Waker, 2011). The reproductive stages of a
woman’s life were marked by initiations, and when a girl entered womanhood she was instructed in
secret women’s business, rituals, songs, knowledge, and Lore about marriage by grandmothers and
female Elders. ‘An Aboriginal woman gained status after the birth of a child, becoming equal to
other women of the camp and enjoying certain freedoms and privileges’ (Dudgeon & Waker, 2011,
p. 100). There was strong solidarity between women that centred around a collective nourishing of
the sexual and reproductive health of other women.
Strengthening women’s sexual and reproductive well-being through the domain of culture
includes providing access to culturally safe services, including women treating other women and
woman-only services (Dudgeon, Cox, et al, 2014); celebrating the transition into womanhood to
deepen a connection to culture; participating in secret women’s business; respecting cultural ways
of caring for self when pregnant; birthing ceremonies and celebration of motherhood as a higher
status and a form of power and respect. Strengths-based women’s empowerment camps such as
those organised by the Kanyirninpa Jukurrpa Puntura-ya Ninti Program and Martu Rangers can be
understood within this context. In 2017 the Martu Rangers focused on the theme of the Jakulyuku-
lyu (Seven Sisters) Dreaming Story ‘to keep the story strong and to pass on elders’ knowledge and
culture to younger women’ (Country Needs People, 2018, p. 87). A number of cultural laws relating
to women’s sexuality are part of this narrative.
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Connection to family and kinship
Various studies have found that connecting to kinship networks improves the maternal health of
Indigenous women (Dietsch, et al. 2011). Women’s sexual and reproductive health is culturally
supported by other women in the family and kinship network. Older women, not just mothers, teach
girls about sexual and reproductive health when they are of age, and the transition from childhood
to adolescence is about learning how to build up knowledge and power as a woman and mother.
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The relationship between grandmothers, mothers, and daughters was particularly important;
grandmothers had a special relationship with, and responsibilities to, their grandchildren to assist
them in the transition to adulthood and motherhood. Grandmothers’ laws refer to the authority of
senior women when men and women held sovereignty over the land and Aboriginal women
shared equal rights and responsibilities with men to provide a safe and healthy environment for
women and children (Watson, 2008) (Dudgeon & Waker, 2011, p. 99).
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Sexual and reproductive well-being is also strengthened by culture knowledge of kinship rules,
support and guidance from other women, and a sense of pride in Indigenous identity. The destruc-
tion of these protective relationships, for example through the forced removal of girls from their
mothers across generations, is a well known source of complex trauma as the 1997 Bringing them
Home: Report of the national inquiry into the separation of Aboriginal and Torres Strait Islander
children from their families found (Australia., & Wilkie, M. 1997) proved.
Secure and appropriate long-term housing, food security, the material conditions to support thriv-
ing families, and access to non-discriminatory health care, welfare services, education, and em-
ployment, in effect, self-determination over the material conditions of everyday life would support
the sexual and reproductive wellbeing of women and girls in the SEWB domain of the family.
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Connection to community
As The Birthing on Country Position Statement (2016) asserts, access to community-con-
trolled health services that support women and girls strengthens sexual and reproductive well-being.
Among the benefits of such culturally safe services are access to cancer screening and the early de-
tection and treatment of breast cancer (Tapia, Garvey, McEntee, Rickard & Brennan, 2017). Sharing
experiences with other women in the community, especially with clients who are service users, has
also been identified as a protective factor (Jennings, et al. 2018). Studies have found that pregnant
women who were supported by woman Elders in the community had stronger neonatal and postna-
tal health (Andersson & Ledogar, 2008). Within Aboriginal and Torres Strait Islander communities
[a] female Elder had the power and responsibility to hand on knowledge, traditions, customs,
rights, and myths that underlay and sanctioned the social and political life of the group’ (Dudgeon
& Waker, 2011, p. 99). Access to Indigenous midwives who are embedded in the community has
been identified as a protective factor for childbearing women and their families (Kelly, et al. 2014).
Family and community involvement in the control of maternity services has been identified as a
recommendation to improve the wellbeing of women (Parker, McKinnon & Kruske, 2014). The
support of senior women in the community is one of the key reasons the Strong Women, Strong Ba-
bies, Strong Culture Program is successful.
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Connection to mind and emotions
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The discipline of Indigenous psychology has provided evidence that Indigenous self-deter-
mination over how Indigenous peoples mental and emotional health is strengthened is a best prac-
tice approach (Chandler & Lalonde, 2004). Healing the complex forms of trauma (i.e., historical
trauma, cross-generational trauma, intergenerational trauma) that are the result of the Australian
genocide through culturally safe healing programs designed by and for women would strengthen
women and girls wellbeing (Dudgeon, Cox et al. 2014; Wyndow, Walker, & Reibel, 2018). Within
Australia The Healing Foundation is a national Indigenous controlled organisation dedicated to
healing the survivors of the Stolen Generations (those impacted by the forced removal of children
from families). As they state: ‘healing programs for women have included the use of traditional
healing methods and bush medicines, and cultural renewal activities such as dance, song, craft and
rituals’. They support Coota Girls Aboriginal Corporation, survivors of the Cootamundra Domestic
Training Home for Aboriginal Girls, and women’s leadership in the domain of healing. There is ev-
idence that connecting to culture and country restores emotional and mental health (Biddle & Swee,
2012). !
Connection to body
Addressing poverty, and the associated ill-health and psychological stress poverty produces
across generations is urgent. The invading culture often targeted Indigenous women’s access to
food, by poisoning their supplies or fencing them off from land they gathered food from. Indige-
nous women and girls living in rural and remote experience food shortages which impact on their
health. Appropriate and safe housing is an important foundation for physical well-being along with
secure access to nutritious food. Far too many Indigenous women and girls do not have access to
these basic human rights despite the vast wealth of Australia.
Strengthening women’s sexual and reproductive well-being through the domain of the body,
and from an Indigenous standpoint also involves access to culturally safe health services and holis-
tic Indigenous health systems. The Indigenous Martu women rangers, for example, teach knowl-
edge of edible plants: ‘each plant has its own songs, places, stories and laws, and has special tech-
niques, tools, knowledge and skills to prepare them’ (Country Needs People, 2018, p. 88) Bush
medicine is used in the Strong Women, Strong Baby, Strong Culture Program to treat women.
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Conclusion
Culturally safe care for Indigenous women’s sexual and reproductive wellbeing which is
founded on holistic Indigenous knowledge systems and which is designed and delivered by Indige-
nous people is of central importance to closing the gap between Indigenous and non-Indigenous
health and to ensuring that future generations flourish. We have suggested an Indigenous model for
thinking through a strength-based understanding of sexual and reproductive well-being through the
domains of SEWB: Country, culture, spirituality, family and kinship, community, mind and emo-
tions, and body. Much of the suggestions here are related to the social determinate of the sexual and
reproductive health of Indigenous women and girls, of which colonisation is the over-arching de-
terminant. For reproductive justice to be achieved, self-determination and decolonisation is needed
across all sectors which impact on female wellbeing. We hope that this model will open up a decol-
onized space for thinking through the sexual and reproductive wellbeing of women from an Indige-
nous standpoint. The re-emergence of women-led ecocentric Indigenous health movements dedicat-
ed to strengthening sexual and reproductive well-being represents an urgently needed cultural re-
birth of women’s knowledge systems across the Earth.
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... The dominant social and cultural determinant of SEWB is colonization which subjected Aboriginal and Torres Strait Islander women to forms of reproductive oppression, such as the forced removal of their children across generations, dispossession from homelands, and the suppression of women's cultural practices surrounding pregnancy, birth and child-rearing. Restoring Aboriginal and Torres Strait Islander women's SEWB by strengthening kinship relations through the Birthing on Country models of care is a form of environmental reproductive justice (Hoover 2018;Dudgeon and Bray 2019) which supports the flourishing of culture through custodial kinship with the land. For example, women have mobilized against the destruction of sacred 800-year-old birthing trees on Djap Wurrung country (in Victoria, Australia), where over 50 generations of Indigenous people have been born (Hayman-Reber 2018). ...
... Birthing on Country can be understood as a form of reproductive justice (Dudgeon and Bray 2019) and pivotal to closing the substantial health gap between Indigenous and non-Indigenous women in Australia, for numerous studies have found that Birthing on Country is a culturally secure practice which results in increased SEWB for women and children (Coffin 2007(Coffin , 2018Kildea et al. 2018). According to the 2016 position statement of Birthing on Country, such models of care can be described as maternity services that are designed, developed, delivered and evaluated for and with Aboriginal and Torres Strait Islander women that encompass some (or all) of the following: Kinship connections, with, for example, land and country, are central to this holistic cultural practice and to the support of SEWB. ...
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