Why we must recognise the injustice of Australia's medical history

Australia’s medical history is rooted in colonialism and it needs to be acknowledged, writes Jamal Hakim.

Australia is a country that was built on reproductive injustice.

Historically, to imagine that someone’s reproductive choices were being made for them, because of their race, is horrible. It is eugenics and genocide. 

This month, we apologised. 

As Australia’s only national and not for profit provider of medical and surgical abortion, contraception, tubal ligation and vasectomy services, we have a role in acknowledging history.

We must recognise our position in a broader context of health system discrimination and bias, and that starts with naming the injustices of the past.

Since colonisation, Aboriginal and Torres Strait Islander people have experienced displacement, genocide, sexual violence and medical trauma.

Some people have experienced forced contraception, abortion and sterilisation. Other people have been denied access to their choice of healthcare. 

I was born in Kuwait, and am of Lebanese heritage. I grew up on Ngunnawal country and now live and work on Wurundjeri and Boon Wurrung country.

As a gay man, and as a person of colour, I am surrounded by family and community who have experienced discrimination based on race, age, gender and sexuality.

Children in my family have been forcibly removed. Women in my family have experienced forced sterilisation. I have relatives who live in Australia, who have been denied informed consent processes. They have been denied access to their choice of sexual and reproductive healthcare.

Whether we are forced towards or away from our choice of healthcare, the common thread is institutional and systemic racism. 

Australian health systems have been designed by, and for, a white lens.

In the past, when MSI Australia had opened clinics, the clinic design prioritised regulatory needs. It was about meeting a raft of regulations and accreditation requirements. Community engagement was a bonus, a ‘nice to have’ rather than a must.

In recent years we have tried to reshape our clinics with extensive consumer engagement and co-design.

Our health consumer advisors identified a series of important factors, such as spaces for ritual, soft furnishings, all gender toilets and ample recovery spaces. These important community based needs are “non-compliant”. Non-compliant with whose lens? 

Non-compliant with planning regulations. Non-compliant with building codes. Non-compliant with infection control and occupational standards, to name a few. 

As an abortion provider under constant attack from anti-choice groups, regulatory compliance is essential.

It is not-negotiable to meet accreditation standards, satisfy codes and meet regulatory requirements. It is then however, near impossible to incorporate heartfelt and beautiful design ideas from people who need access to care.

With each review of the standards, we see changes that are increasingly meaningful for communities. In recent years quality standards have begun to integrate concepts of cultural safety. It’s a good starting point.

The rubber hits the road on implementation. 

We’ve struggled to maintain access to surgical abortion clinics due to over regulation. Abortion by manual vacuum aspiration can be a straightforward procedure, that in other parts of the world is performed in small community led outreach clinics. In Australia, regulations stipulate that surgical abortion can only be conducted in a day hospital setting. 

A regulatory environment riddled with unnecessary complexity shifts the focus away from health consumers and towards ticking boxes.

We need much deeper systemic change to embed cultural safety across our health systems.

Health leaders, and politicians who control healthcare funds, are yet to resource change that will reshape clinical care. It comes back down to the concept of equity. 

In a world where some people matter more than others, the phrase ‘person centred care’ has become increasingly meaningless.

The impact of racism and healthcare discrimination is profound. 

There are still some clinicians who don’t believe that. They’ve never experienced it themselves. They are of an era where patients were told to ‘toughen up’, particularly when patients are people of colour, women, LGBTIQ people and people with disability.

Aboriginal Community Controlled Health Organisations are part of the answer, but they need to be supported by broader health system reforms.

Health regulators and mainstream health providers need to take stock.

We must stop re-traumatisation. Drop the colonial lens. Tell truths. Action things that make a difference. 

People of all genders, sexualities, religions and races each live their lives in profoundly different ways. 

Our similarities can be great, but so can our differences. This fact needs to inform health regulation, clinic design, resourcing and care.

It will take more than a generation that to heal the trauma that has been created. 

It could, and should, take less than a generation to fix the gaps in our health system.

Before moving forwards, we must speak truth to the past.