Townsville Mums and Babies Program: An Actualization of Indigenous Self-Determination and Women’s Empowerment

After years of state management and control, Australian Indigenous people are still fighting for a self-deterministic approach in legislative processes pertaining to areas of Indigenous concern. In spite of the Rudd Government’s heavily advertised ‘Close the Gap’ Campaign, Indigenous Australians are still among the most disadvantaged groups within Australian society (ANTaR, 2010). Nonetheless, sources of financial support that allow for the possibility of alleviation of such disadvantage associated with Indigenous affairs are tied to political power discourses, which continue to impede progress with regards to Indigenous rights. The Rudd government’s 2008 official Apology to Indigenous Australians, an important symbolic gesture for reconciliation purposes, saw Aboriginal affairs briefly thrust under the scrutiny of mainstream political discourse after years of marginalization under the Howard Government. However, Indigenous self-determination has failed to be supported by many non-Indigenous members of the Australian public as indicated in the Australian Reconciliation Barometer’s measurement of a low level of trust between Indigenous and non-Indigenous Australians (Australian Reconciliation Barometer 2008). Many felt skeptical about the Howard Government’s support of the notion of ‘practical reconciliation’. Practical reconciliation places an emphasis on funding being funneled into areas of visible practicality, and Indigenous services being mainstreamed into control by public welfare organizations (Hollinsworth 2006:167). This mainstreaming sees areas of Indigenous disadvantage attempted to be ‘fixed’ with quick solutions to complex issues, as a result of pressure for visible outcomes, but diverse Indigenous needs are lost in generalized mainstream services and such quick-fix solutions often fail. The Rudd Government remained relatively quiet on the notion of self-determination, preferring instead to focus on the practicalities of the ‘Close the Gap’ campaign (ANTaR 2010). The recent Australian election was notable in the absence of discussion of Indigenous issues on behalf of both major parties (Koori Mail 2010). The formation of the Gillard minority government saw Indigenous Affairs Minister Jenny Macklin promise to focus on Indigenous employment and education, with an emphasis on ‘practical reforms’ and no mention of self-determination (Robinson 2010:2).

This paper will discuss Australian Indigenous women’s empowerment as actualized in the self-deterministic approach of the Townville Mums and Babies Program. The United Nations Declaration of the Rights of Indigenous People [UNDRIP] specifically endorses the language of self-determination pertaining to the actualization of the rights of Indigenous peoples. UNDRIP defines self-determination as the right to “freely determine… political status and freely pursue… economic, social and cultural development” (” (UNDRIP 2008:4). Behrendt (2002) outlines a form of self determination based on such rights and specific to the Australian Indigenous context. The 2010 Millennium Development Goals Report for the United Nations states that women’s empowerment is “at the heart of the Millennium Development Goals” specifically with regard to improving world-wide maternal health and obstetric outcomes (2010:2). Australian Minister for Foreign Affairs Kevin Rudd attended the UN summit and endorsed this statement. The aim is to increase awareness of the role of Indigenous women in improving their own maternal health outcomes, and to empower women through a self-deterministic approach in processes pertaining to Australian Indigenous mothers. This rights-based framework was endorsed at an international level by the UN. In this paper Larissa Behrendt’s explanation of self-determination (2002) is used to discuss how a tentative move towards self-determination has been put into place by the Townsville Mums and Babies Program.

Hollinsworth’s (2006) discussion of the concept of self-determination with regards to Indigenous affairs highlights the contentious nature of the term within recent Australian political discourse. Since 1972, when Indigenous affairs were thrust into the political spotlight by the newly-elected Labour government (Hollinsworth 2006:149), the progression of Indigenous rights have been frustrated by the yo-yoing nature of the perceived opinions of the non-Indigenous Australian public (Hollinsworth 2006; Donovan 2002; Behrendt 2002; Hunt 2008). This lead to the rejection of self-determination by the Liberal Howard government and an endorsement of the notion of ‘practical reconciliation’ (Hollinsworth 2006:165). As mentioned earlier, practical reconciliation places an emphasis on funding being funneled into areas of visible practicality, and Indigenous services being mainstreamed into control by public welfare organizations (Hollinsworth 2006:167). Therefore, funding for government-sponsored organizations attempting to address Indigenous disadvantage requires stringent bureaucratic checks and measures. As demonstrated through the agonizing slowness of political intervention in addressing Indigenous disadvantage reflected in continually demoralizing disadvantage statistics (ANTaR 2010), the best hope for any steps towards positive outcomes appears to remain with funding from private corporations. This type of funding is free from political baggage as it is unassociated with such political discourses as practical reconciliation.

Practical reconciliation has led to “racialised and culturalist discourses of essentialised difference to establish categories of merit and blame” (Augoustinos et al., 2005: in Hollinsworth 2006:194). In direct contrast to practical reconciliation, self-determination continues to be a concept that Indigenous rights activists and academics emphasize as tantamount to the progression of resolving issues of Indigenous disadvantage. Practical reconciliation, with an emphasis on continued governmental management and control as demonstrated through the mainstreaming of Indigenous services, has the effect of further marginalizing the Indigenous population. Practical reconciliation is essentially culturally imperialist; as encompassed in the concept’s practicalities is the power to fully control and dictate the direction of Indigenous affairs. Further discussion of the concept of self-determination as defined by Behrendt (2002) and contrasted with practical reconciliation will illuminate the politically charged nature of self-determination and provide a more effective, and feminist, framework.

Behrendt outlines a definition of self determination as, “everything from the right not to be discriminated against, to the rights to enjoy language, culture and heritage, our rights to land, seas, water and natural resources, the right to be educated and to work, the right to be economically self sufficient, the right to be involved in decision-making processes the impact upon our lives and the right to govern and manage our own affairs and own communities” (Behrendt 2002:26). Her definition encompasses a meaning focused on access to rights, as endorsed by UNDRIP (2008). Contrast this definition with practical reconciliation, where management of such access is given over to governmental control and it can be seen that self-determination has very little chance of being actualized within the framework of practical reconciliation policy. Instead, Behrendt states that self-determination will only be realized with, “multifaceted solutions that will have to match short-term issues with long-term strategies” (2002:27). The Townsville Mums and Babies Program moves towards this practical notion of self-determination by freeing itself from initial government funding and emphasising long-term solutions, attempting holistic community mobilization and empowerment of Indigenous mothers.

An examination of successful Indigenous community-controlled programs can produce strategies for further implementation in the broader Indigenous community and allow potential for positive outcomes in addressing the disadvantages Indigenous people continue to face. The Townsville Mums and Babies Program has rendered positive outcomes for Indigenous mothers and infants (National Aboriginal and Torres Strait Islander Child and Maternal Health Exemplar Site Initiative: Site Reports 2005, Department of Health and Aging 2009). These outcomes are further demonstrated by Panaretto et al. (2005) where research indicated an increase in service usage, antenatal attendance and care, mean birth weight by 200g, and a reduction in preterm births from 17 per cent in 1998 to 9 per cent in 2000. An examination of this program according to UNDRIP (2008), Hollinsworth’s (2006) and Behrendt’s (2002:26) definitions and discussions of the notion of self-determination will show that self-determination and the empowerment of Indigenous mothers is being achieved as a result of the strategies of implementation and the on-going community-controlled nature of the program. The model of the Townsville Mums and Babies Program has since been cited for replication in health clinics around Australia (Department of Health and Aging 2008), and outcomes continue to remain positive. The strengths within the model of the clinic are an emphasis on community consultation and empowerment through self-determination for the patients of the clinic. The Townsville Mums and Babies Program is evidence of actualization of self determination in achieving positive outcomes in addressing Indigenous disadvantage and empowering Indigenous mothers to take control of their health.

Indigenous disadvantage with regards to health outcomes remains a problematic issue within Indigenous affairs. The Australians for Native Title and Reconciliation [ANTaR] website (2010) states that, “The Indigenous health emergency is Australia’s gravest national crisis. An Aboriginal child born in 2008 will still, on average, live for 17 years less than a non-Aboriginal child”. Aboriginal infants face alarming disadvantage as reflected in “demoralizing Indigenous perinatal statistics, with rates of preterm birth, low-birthweight and perinatal mortality remaining more than twice that of the non-Indigenous population over the past decade” (Panaretto et al. 2005:514). These poor obstetric health outcomes have been related to, “late antenatal attendance, maternal malnutrition and high rates of tobacco and alcohol use” (Panaretto et al. 2005:514). However, the Townsville Aboriginal and Islander Health Service, a community controlled organization originally funded by the private corporation Rio Tinto and the Ian Potter Foundation, have sought to improve obstetric health by implementing programs like the Mums and Babies Program. Like government funding bodies, private and philanthropic organisations maintain control over programs, however the measures provided seem preferable to more strict governmental controls. While such funding grants are imperfect, in that self-determination in the truest sense remains unachieved, private and philanthropic organization provide a more definitive move towards self-determination than government funding.

The Mums and Babies Program operates on community health care principles and seeks to offer “comprehensive and integrated primary health care for young families” (National Aboriginal and Torres Strait Islander Child and Maternal Health Exemplar Site Initiative: Site Reports 2005). After the program concept was developed through a community-based forum that identified a need in Townsville for maternal health care, funding was sought and secured from the philanthropic sources of Rio Tinto and the Ian Potter Foundation (National Aboriginal and Torres Strait Islander Child and Maternal Health Exemplar Site Initiative: Site Reports 2005). As the sources of funding were private, there was little need for immediate visible outcomes as entailed in political notions of practical reconciliation previously discussed, though these grants too required outcomes. Therefore, the program was better able to engage with community consultation at a pace suitable for commitment to long-term outcomes, the benefit of which is evident in its subsequent success. The program began with two Aboriginal Health Workers, one childcare worker, one driver and two female doctors who all worked in partnership with the Townsville hospital and midwives to offer women individual antenatal care and nutritional counseling (National Aboriginal and Torres Strait Islander Child and Maternal Health Exemplar Site Initiative: Site Reports 2005). This integration of health services has allowed the provision of “comprehensive primary health care, antenatal care and postnatal care for Indigenous women, along with immunizations, growth monitoring, developmental screening and hearing screening for the infants and children attending the clinic” (National Aboriginal and Torres Strait Islander Child and Maternal Health Exemplar Site Initiative: Site Reports 2005). The implementation of the program has resulted in an increase in Indigenous women receiving antenatal care (from 23.8% in 2000 to 61.2% in 2003), significant reductions in preterm births (from 17 percent to 9 percent over two years) and an increase in average birth weights (a mean increase of 200g per birth) (Department of Health and Aging 2008, Panaretto et al. 2005:514, ANTaR 2010). The Mums and Babies Program model was cited by the Rudd government as a model fit for replication in other Indigenous communities (Department of Health and Aging 2008). This is an indicator of its continued success.

The Mums and Babies Program moves toward self-determination in several areas. The right to be educated (Behrendt 2002:26) is demonstrated through the availability of nutritional counseling and antenatal care clinics. The “right not to be discriminated against” (Behrendt 2002:26) has been actualized in the provision of Aboriginal health workers and continued training of Aboriginal health workers within the program (National Aboriginal and Torres Strait Islander Child and Maternal Health Exemplar Site Initiative: Site Reports 2005). The “right to be involved in decision-making processes that impact upon our lives” (Behrendt 2002:26) was realized through the community-based forum that originally identified the need for a maternal health clinic. The “right to govern and manage our own affairs and own communities” (Behrendt 2002:26) was realized through the philanthropic nature of the secured funding, thus bypassing government management and control. The empowerment of Indigenous mothers is clearly evident in the community-controlled nature of the program, the provision of access to education and the creation of a safe space for such self-determination for Indigenous women to take place. The Mums and Babies Program, through its long-term vision and subsequent success as reflected in positive obstetric health outcomes, moves one step closer toward a “vision of increased Indigenous autonomy within the structures of the Australian state” (Behrendt 2002:26).

The program also assists in overturning the racial discourse surrounding Indigenous affairs. The Mums and Babies Program demonstrates that Indigenous affairs are best facilitated through a practical dialogue between Indigenous people of the given community and non-Indigenous people directly involved in the given area of concern. Through its community-based nature, the program allows for the incorporation of dynamic and contradictory understandings of Indigenous identity (Hollinsworth 2006:146), with particular emphasis on such understandings with regards to Indigenous women, into a broader non-Indigenous social sphere. The Mums and Babies Program engages in the mobilization and empowerment of Indigenous woman and subsequent community, and continued successful healthcare outcomes.

An examination of successful Indigenous community-controlled programs can produce strategies for further implementation in the broader Indigenous community. The Townsville Mums and Babies Program continues to achieve positive outcomes for Indigenous mothers and infants. An examination of this program using Hollinsworth’s (2006) and Behrendt’s (2002) definitions of self-determination has shown that political self-determination and the empowerment of Indigenous women is achievable as a result of the strategies of implementation and the on-going community-controlled nature of the program. If the notion of self-determination, as endorsed by UNDRIP (2008) were extended to all aspects of Indigenous issues the chance for positive outcomes to become the norm rather than the exception would be far higher.

References

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