Creating safe and inclusive public spaces for women

By Vanessa Czerniawski, Health Promotion Officer

This article was first published in the July 2020 edition of the Planning Institute of Australia’s Planning News.

My gym temporarily closed in March this year. The playgrounds that I regularly visited with my toddler also closed. Like many other Victorians, I had to re-think ways to use public spaces to maintain my fitness and entertain my very energetic 3-year old. I soon realised that, despite restricted access to areas I used to frequent, I was actually interacting with public spaces more often overall and in so many different ways than I could have ever expected. And I wasn’t the only one.

Public spaces foster social connections, encourage physical activity and recreational pursuits, and play a significant role in community life. Being able to occupy public space can positively impact on social, mental and physical health. Experiencing public spaces in new ways also really highlighted the importance of ensuring all public spaces are designed to be enjoyed by everyone within the community. Good design is crucial to creating spaces that are safe and inclusive for everyone – particularly for women and girls.

My area of work is health promotion, at a women’s health organisation, where we work with our partner organisations to ensure they consider the unique needs of women and girls when making program planning decisions. Putting a ‘gender lens’ on everything is what we do, which means we support state-wide and local bodies to consider how gender inequality impacts on women’s experiences. This approach can be applied across all disciplines – including urban planning and design.                                                                                             

The evidence shows that women are more likely than men to feel unsafe in public spaces, and are also more likely to feel as though a space is not designed with them in mind. This is particularly true for women who experience other intersecting forms of marginalisation, such as those who identify as LGBTIQ, women from migrant backgrounds, older women, Aboriginal women and women with a disability. Only 61% of Australian women reported feeling safe when walking alone at night, compared to 77% of men (Safety – Australia, OECD Better Life Index 2020). These perceptions of a lack of safety in public spaces can make women feel anxious and make them less likely to occupy these spaces, which means they are also missing out on the many benefits that public spaces bring. What is it about public spaces that can make women feel as though they are not made for them, and how can this be addressed through design?

Use and perception unique to lived experience

Women use and perceive public spaces in ways that are unique and specific to their lived experience, and much of this is influenced by the roles that they have historically taken on within our society. For example, women are more likely to take on care taker roles, and specific design considerations to make spaces useable and safe for young children and the elderly can make them more engaging for women. This could include designing walking paths with wide footpaths for prams, wheelchairs and walkers and accessible toilets with baby change facilities. Playgrounds are another key public space used by women, and thoughtful design can hugely impact on whether these are utilised. Ensuring that playgrounds have clear lines of sight to, that toilets and change facilities are within the vicinity and the provision of adequate seating are basic, yet key design aspects to ensure playgrounds are regarded as safe and accessible.

Other physical infrastructure, such as easy to read signs and directions, adequate lighting and well-maintained paths can influence women’s decision to engage with spaces. Additionally, mixed use areas where people can walk, play, eat and exercise at different times of the day ensure that the area is used at all times, encouraging community members to linger, which has the flow on effect of increasing women’s perceptions of safety and time spent there (Safe Public Places: Rethinking Design for Women Safety, Soraganvi, AS, 2017).

Subjective elements of the environment can also impact on women’s willingness to engage with spaces. A predominance of male named businesses, statues and artwork by men, and sexist and provocative ads can make women and girls feel excluded (Research project highlights the varied ways a woman can feel unsafe in a city, Kalms, N, Matthewson, G and Salen, The Sydney Morning Herald, 2017). It’s therefore key that, along with addressing physical safety, planners consider how women are represented and recognised in public spaces. An example from Spain is the conscious effort of naming streets after women (in Barcelona, the number of streets named after women went from 7% in 1996 to 27% in 2010) and encouraging public art to remember the contribution that women have made to Spain (Designing cities for women: lessons from Barcelona’s ‘Feminist City’, Abbey Seitz, streets.mn, May 22 2020).

In order to create safe and inclusive public spaces for all women, their voices and expertise must be front and centre in every stage of planning through a co-design approach. Firstly, it is about ensuring that women are working in urban design leadership positions so that they are able to bring their perspectives and experiences to the table. It is also about listening to the voices of women within a community in order to gather rich, real world data that can be used to guide the design and development of useable, inclusive and accessible public spaces.

By placing that ‘gender lens’ over public spaces, and by considering the unique needs of the whole community, planners have the opportunity to create spaces that are attractive, active, healthy, safe and inclusive – for everyone.

Women’s mental health and COVID-19

COVID-19 has highlighted the importance of mental health and wellbeing, as well as its vulnerability to external or societal threats and its gendered nature. While there has been no shortage of clickbait on how to maintain mental health during the pandemic and lockdown (“Exercise regularly! Get adequate exposure to natural light! Stay hydrated!”), mental health and mental health challenges are complex, dynamic issues that require holistic, whole-of-population health interventions.

The social and economic repercussions of COVID-19 has significant implications for mental health because it has increased. The stress and anxiety associated with insecurity, social isolation, a loss of routine and a sense of losing control are all exacerbated by ubiquitous exposure to the news and disaster stories through television, press conferences, radio, print media and social media.

While these issues are affecting most people, COVID-19, the lockdown and temporary closure of workplaces, schools and other services have highlighted existing social disparities, including those related to gender. Women have been more likely to be made redundant as a result of COVID-19. Women are more likely to be frontline workers in healthcare, food service and other essential industries and thus are more likely to be exposed to the virus. Women are also more likely than men to shoulder additional childcare or schooling supervision as a result of school closures. Experts have raised concerns that COVID-19 may increase the rate or severity of violence experienced by some women in the home, and limit opportunities to seek help, as perpetrators are more likely to be at home now than before the outbreak of COVID-19. Job losses, financial stress, parenting stress and experiences of violence or abuse are all risk factors for poor mental health outcomes that disproportionately impact women. Some women are particularly vulnerable due to intersectional and multidimensional experiences of disadvantage such as women with disabilities, refugee and migrant women, women in the LGBTIQ community and Aboriginal and Torres Strait Islander women who already have reduced access to employment, education and housing for example, thus intensifying the impact of gendered risk factors.

The federal and state governments have responded with additional funding to maintain optimal mental health and to address mental health challenges, including funds for women’s health organisations. However, it is important to acknowledge that COVID-19 has merely exacerbated an existing trend: in pre-COVID contexts, women already experienced higher rates of mental illness and distress, and most mental health prevention efforts or services for people with mental challenges inadequately addressed women’s unique risk factors or barriers to accessing care. It is true that boys and men are often socialised to repress sadness, to avoid expressing emotion or discussing their feelings, to avoid seeking professional help, and that as a result, men have higher rates of suicide.

While this is alarming and urgently needs to be addressed we must also acknowledge that mental illness is more prevalent among women. Girls and women are significantly more likely to meet the criteria for a probable serious mental illness or be diagnosed with anxiety or depression. Women are also more likely to develop an eating disorder or poor body image, and to be diagnosed with obsessive compulsive disorders, particularly those related to cleaning or cleanliness. While suicide is more prevalent among men, self-harm is substantially higher among girls and women, and increasing. Women who experience racial discrimination, ableism, homophobia or transphobia and other forms of bigotry are at greater risk – post-traumatic stress disorder, depression, self-harm and suicide ideation are higher among women from culturally and linguistically diverse backgrounds, people from the LGBTIQ community, women who are incarcerated or in contact with the criminal justice system, and Aboriginal and Torres Strait Islander women. Women who have reduced access to primary prevention services or mental health support also experience poorer mental health outcomes, including women from low socioeconomic backgrounds or those living in regional or remote areas.

An intersectional feminist analysis of the social determinants of mental health and illness is critical to understanding the disproportionate prevalence of mental illness among girls and women. We may be some generations away from a time when Australian women were considered the property of their fathers or husbands, when they couldn’t vote or file for divorce, when they weren’t entitled to equal pay for the same work. But sexism is still built into structures and institutions at every level of society, and reflected in widespread social attitudes that attribute certain behaviours, roles, and expectations to women and men based

on their gender. These social or environmental factors can play a role in mental health outcomes. For example women are still expected to assume primary carer responsibilities for children, sick or elderly family members while maintaining paid employment, often at a lower pay grade than their male counterparts. Unequal carer responsibilities and unequal access to economic resources cause stress, and are risk factors for mental illness. Women’s bodies continue to be objectified and sexualised in the media and public spheres, and women’s value is still linked to the extent to which they adhere to narrow ideals of “beauty.” Women are more likely to be exposed to male violence, to be subjected to sexual harassment and gender-based discrimination, all of which are risk factors for mental illness.

It goes further. Just as gender is a social determinant of mental illness, it also influences the kind of care women are able to access to treat mental illness, and the way in which people respond to their diagnosis. Limited access to financial resources and time away from work or unpaid caring responsibilities restricts the ability of women to seek professional support. Additionally, research suggests that girls and women who engage in self-harm or attempt suicide are more likely to be dismissed as attention-seeking, insincere or manipulative than boys and men, and less likely to be taken seriously.

What is the solution? There is an undeniable need for greater resourcing of primary prevention and early intervention to improve mental health across the board. But we also need a feminist analysis of mental health and illness that seeks to address the social determinants of women’s mental health outcomes, and reduce the disparity between women and men in mental health. In order to really impact women’s mental health though, we need gender equity.

National Reconciliation Week

National Reconciliation Week is commemorated each year from 27 May–3 June, and encompasses two significant milestones in Aboriginal history —the successful 1967 referendum (27 May) and the 1992 High Court Mabo decision (3 June). The 1967 referendum amended the constitution to include Aboriginal people in the census and allow the Commonwealth to create laws for them. In many states across Australia prior to the referendum, Aboriginal people did not have the same rights as non-Aboriginal Australians, including the right to own property, be the legal guardian of their own children, receive equal pay to non-Aboriginal Australians and drink alcohol. The referendum led to the introduction of affirmative action, high-profile land rights cases and the erection of the Aboriginal Tent Embassy in Canberra.

On 3 June 1992, the High Court of Australia decided that terra nullius, or land belonging to know one, should not have been applied to Australia, acknowledging that Aboriginal people have claim to the land that predates European colonisation. The Mabo decision was named after Torres Strait Islander Eddie Mabo, who led the fight to change land laws to recognise traditional ownership of land in Australia. Both events are significant moments for the Aboriginal civil rights movement, and are important steps towards a reconciled Australia.

Attending National Reconciliation Week events has always been important for Women’s Health East to champion unity and show our respect for Aboriginal people and demonstrate solidarity with our Aboriginal partner organisations in the Eastern Metropolitan Region. Mullum Mullum Indigenous Gathering Place and Maroondah City Council hosted a live streamed musical performance on Thursday 28 May. One of our Health Promotion Officers attended the performance and was moved by the melodic storytelling of proud Mutti Mutti man and singer songwriter Kutcha Edwards. His lyrics in Aboriginal and English language reflected on his birth on Country, his parents and eleven siblings, and his experience as a child who was forcibly removed from his family. During an interlude, Edwards informed the audience of the local history of dispossession: the Eastern Metropolitan Region was once a corridor of “homes” or institutions for Aboriginal boys and girls stolen from their families. This was followed by an evocative and emotional performance: “Is this what we deserve? We’ve been here since time began… we are the caretakers of this ancient land, but you still don’t understand.” Kutcha Edwards and his supporting guitarist and Venezuelan expat Daniel J. Marquez also noted the shared histories of Australia and Latin America, both places rich with Indigenous culture prior to European colonisation, and the resilience and survival of these communities.

The Yarra Ranges Shire also hosted an online event on Wednesday 27 May, Our Country, Our Future – Igniting a Shared Responsibility that included a smoking ceremony, cultural dance and music performance and keynote speakers Stan Grant and Uncle Jack Charles. One of our Health Promotion Officers in attendance noted that she found the stories from the Yarra Ranges Shire particularly compelling, as she is currently working remotely from the region at the moment.

This year, National Reconciliation Week occurred alongside a renewed focus on institutionalised racism, with the death of an unarmed Black man, George Floyd, in the United States while apprehended by Minneapolis police officers. Public anger has spilled into protests of tens of thousands in major cities across the US and the world, to demand justice for George Floyd. While the experiences of people of colour in the US and Australia are different, Aboriginal leaders have drawn attention to the commonalities in relation to policing, specifically disproportionate incarceration rates and deaths in police custody. Between 1991 and 2019, at least 424 Aboriginal people have died in police custody and unfortunately, this has not resulted in charges being brought against those responsible, or institutional changes being implemented to prevent further bloodshed. It is a sobering reminder of the need to learn about and counter racism in all its forms.

There are a number of measures that can and should be taken to remedy the disparities between Aboriginal and non-Aboriginal people, and the devaluing of Aboriginal people and culture including: increasing representation of Aboriginal and Torres Strait Islander peoples in policy development and governmental decision-making bodies; guaranteeing long-term funding for Aboriginal community-controlled organisations; protecting language and cultural rights including the provision of bilingual educational staff in schools for Aboriginal students; introducing reparations for the Stolen Generations; and implementing recommendations contained in the Unfinished Business: Indigenous Stolen Wages report, including a national compensation scheme.

But to bring about systemic change we must first commit to learning about the history of colonisation, resistance and the fight for self-determination for Aboriginal and Torres Strait Islander. .Everyone has a role to play in building relationships and communities that value Aboriginal and Torres Strait Islander peoples, histories

and cultures. Against a global backdrop of racial divide and civil unrest, we must listen to and elevate the voices of Aboriginal people and recognise Aboriginal people as experts of their own experiences.

Here are some ideas of where to begin the journey to reconciliation:

CELEBRATE the achievements of Aboriginal people

READ books about Aboriginal history, people and culture or more books 

WATCH movies created or inspired by Aboriginal and Torres Strait Islander people

LISTEN to Indigenous podcasts

DONATE to organisations that have a positive impact on Indigenous communities in Australia

Pregnancy, infertility, assisted reproductive technology (ART) and COVID

Laura Riccardi

The outbreak of COVID-19, an infectious disease that causes flu-like symptoms and has resulted in the deaths of over 125,000 people at the time of writing, has rapidly overwhelmed the healthcare system, shut down industries and international travel, and prompted sweeping changes to legislation and law enforcement. In addition to these sweeping changes, COVID-19 is having a significant impact on the lives and health of individuals. This includes the sexual and reproductive health of women across Australia, where we have been relatively inoculated against some of the worst outcomes, compared to countries like China, Italy and the United States.

While many individuals and organisations have alerted us to the risks of reducing access to contraception and abortion during the current public health crisis, less widely known is the impact of the virus on those who are trying to conceive. In Australia each year roughly 300,000 babies are born. This means there are a considerable number of women currently pregnant or with newborn babies that are experiencing significant physical, emotional and social changes in the context of a public health crisis. Additionally, COVID-19 has disrupted assisted reproductive technology procedures. With an estimated one in 25 Australian babies born via IVF, COVID-19 is a major threat to women’s reproductive autonomy and family planning. This article will explore the impacts of COVID-19 and subsequent restrictions on access to healthcare on pregnancy and infertility for women in Victoria.

Pregnancy and postpartum period during COVID-19

At present, there is limited evidence of vertical transmission of COVID-19 between a mother and foetus. Encouragingly, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists suggests that the majority of pregnant women who become infected will only experience mild to moderate symptoms.

Some health experts have speculated about COVID-19 and pregnancy; based on the impact of similar respiratory viruses, such as Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS). In both instances, although the sample size of the studies was small, evidence suggests that MERS and SARS diagnoses in pregnant women were associated with severe maternal illness and mortality, spontaneous abortion, pre-term birth and stillbirth. Information regarding breastfeeding with COVID-19 is conflicting: the Victorian Maternal and Child Health Service, Royal Women’s Hospital and Unicef have stated that there is no evidence that COVID-19 is transmitted via breastmilk so symptomatic mothers who are well enough should continue to nurse their babies and toddlers; while an article published in The Lancet has advised against it.

Additionally, social distancing rules limit access to the usual support networks for women in pregnancy and the postpartum period following childbirth, periods that can be challenging for many women. As many as 1 in 5 mothers of children aged 2 years old or younger are diagnosed with depression, and more may experience symptoms but may not be diagnosed due to stigma or limited access to primary and specialist care, even in pre-COVID-19 times. Usual sources of support, such as maternal and child health services, breastfeeding support services, mother’s groups, and private care options, such as nannies and sleep schools, have likely been disrupted due to COVID-19. While the fear, uncertainty and isolation associated with COVID-19 and social distancing regulations are expected to have far-reaching impacts on mental health outcomes, there are some groups, like expectant and new mothers, that may be more at risk.

Assisted reproductive technology

Infertility is defined as the inability to conceive a pregnancy after twelve months of unprotected vaginal intercourse. It affects 1 in 6 couples in Australia, and is increasingly common due to a range of social, environmental and biological factors. Many women delay children either by choice or by default, due to lengthy formal education, increasing household debt, entering a marriage or partnership later or desire to establish a career or purchase a home. For some women, their fertility is affected to health factors such as smoking, alcohol or other drug use, weight and fitness, age and conditions such as polycystic ovary syndrome or endometriosis. Infertility is also equally related to male fertility factors, such as low sperm production, abnormal sperm production, or genetic factors.

For lesbian, bisexual or transgender women, there are different barriers. Many Australian women in same-sex relationships conceive using home-based self-insemination with a known donor, rather than going through clinical insemination or assisted reproduction.  However, home-based self-insemination can be unreliable and even clinical assisted reproductive methods can yield variable results.

Infertility in Australia has resulted in a growing number of couples seeking the assistance of assisted reproductive technology (ART). ART can include one or more of the following:

In vitro fertilisation (IVF), where an ovum is combined with sperm outside the body to create a fertilised egg or zygote, after which it is implanted in a uterus.

Intracytoplasmic sperm injection is similar to IVF, but involves the injection of a single sperm cell injected directly into an ovum.

Cyropreservation of gametes, where male and female sex cells (sperm and ova respectively), are preserved by freezing.

Use of fertility medication involves taking pharmaceutical drugs to enhance fertility, sometimes by stimulating the ovaries or inducing ovulation.

Ordinarily, many women experience barriers to accessing these services; for some, ART can be prohibitively expensive. However, COVID-19 has exacerbated difficulties in accessing assisted reproductive technology.

An estimated ten percent of Australians have lost their jobs due to COVID-19. Economists from Australia’s second largest bank, Westpac, have warned “these widespread disruptions to the economy are on a scale that we have not experienced in recent times – which has important implications for the labour market.” Job losses, reliance on welfare and limited savings may mean that many eligible candidates for ART can’t afford fertility procedures, or the cost of raising a child.

Social distancing regulations to prevent community transmission of COVID-19 mean that in Victoria, residents are prohibited from leaving the house for reasons other than to attend work or education; to shop for food and other necessary goods and services; to provide care for an unwell or disabled relative or friend; to exercise; or if otherwise required in accordance with Victoria’s state of emergency restrictions. This resulted in the temporary closure or suspension of many services. IVF Australia, for example, announced that patients who were midway through treatment or have extenuating medical circumstances may continue; but all facilities were mandated to suspend treatment for patients who have not yet commenced.

Additionally, governments and hospitals in Australia and internationally proposed that non-urgent elective surgeries and procedures be temporarily suspended, in order to stockpile resources such as personal protective equipment, ventilators, intensive care unit beds, anaesthetists and nurses, for the management and treatment of COVID-19.

Although there was a legitimate public health rationale for minimising non-urgent medical procedures, this decision nonetheless had a devastating impact on many women across Australia, particularly older women or those with a lower egg reserve. The ban was an impediment to women’s reproductive autonomy, which recent advances in research and technology have enabled.

More recently, the National Cabinet has reviewed restrictions on elective surgeries, in light of the diminishing number of COVID-19 cases reported in Australia, and announced that IVF services will resume from April 27 onwards. This is a welcome announcement for women seeking assistance to conceive, and those waiting to have surgery for endometriosis.

It is only through women having the right to choose the timing and number of children they wish to have, if they want them, that it is possible for women to exert their reproductive autonomy, and thus, address some of the inequalities between men and women.


Love in the time of COVID-19

COVID-19 has universally disrupted people’s day-to-day lives, including working, shopping, leisure and travel. But what does it mean for sex, relationships and dating? When you’re supposed to maintain a distance of 1.5 metres from other people, how can you have sex, date or spend time with your partner? This article explores the implications of COVID-19 on women’s sexual health and sex lives. Women have distinct sexual and reproductive health needs, however, these are not always addressed by healthcare services or health promotion. Much of the advice regarding COVID-19 and sex, for example, has been targeted at men who have sex with men, which reinforces assumptions about women not engaging in casual sex and thus, not being at risk of COVID-19 through sexual contact.

While COVID-19 is not a sexually transmissible infection like chlamydia, HIV or gonorrhoea, it is possible to spread the virus through close physical contact. As an infectious disease, it spreads through small droplets from the nose or mouth which are transmitted when a person with COVID-19 coughs or exhales. This means COVID-19 can be transmitted through kissing, hugging, touching and sex. In order to reduce the risk of community transmission, many experts and organisations like Thorne Harbour Health, ACON and New York City Health are advising people to abstain from casual sex during this time.

The spread of the virus and potential strain on the healthcare system has resulted in the imposition of a State of Emergency and social distancing regulations that are enforceable by law in Victoria. This means that businesses such as restaurants, bars, live music venues, cafes, movie theatres and other public areas are closed, and many states across Australia have restrictions prohibiting close contact with people outside your household. In this context, dating is not only near-impossible, but risks a fine or imprisonment.

People in relationships are still permitted to visit each other in their homes, after the Victorian government reneged on an initial ban. However, you are advised to avoid sex or close contact with your partner if they’re experiencing symptoms, have recently returned from overseas or have had contact with a confirmed case.

It’s important that people continue to practice safe sex, particularly if they wish to avoid pregnancy. Access to contraception may be limited at the moment: condom production has been halted due to lockdowns internationally, and hormonal birth control and emergency contraception (the “morning after pill”) may be harder to access. Women and people with a uterus may wish to consider long-acting reversible contraceptive options, such as an implant or intrauterine device as alternatives. There are benefits to long-acting reversible contraception that are particularly evident during COVID-19: they are more effective and overall economical contraceptive options that don’t interfere with sex or require users to remember to take them, as with condoms or birth control pills. Once an implant or intrauterine device is removed, fertility resumes quickly. Furthermore, users of long-acting reversible contraception can keep their reproductive choices private: it is generally not possible for others to see that you’re using contraception, which makes it a good option for women experiencing abuse or reproductive coercion. In the context of COVID-19, where condoms are in short supply, and women may experience difficulty getting appointments with prescribers or be restricted in the number of repeat scripts they can claim at a time; long-acting reversible contraception may be a better option for some.

While relationships can provide people with emotional support during the disruptions, COVID-19 may increase strain: many people are working from home; experiencing redundancies or loss of income; or re-organising childcare, schooling or care for other dependents, for example.

With tensions running high, there are some strategies you can implement to help maintain a healthy relationship:

  • Ensure you’re taking care of your own mental health by engaging in self-care practices such as journaling, meditating, getting enough sleep, staying hydrated, eating balanced meals and exercising regularly. Try to establish boundaries between your work and leisure time, although this may be more difficult while working from home. Reduce your use of alcohol and other drugs. Engage in creative or fun hobbies from home.
  • Connect with your friends and family members via video chats, apps or regular phone calls, to ensure you have adequate support and social connections outside your relationship.
  • Discuss your schedules. If you are both working during regular business hours, arrange separate workspaces that will enable you to do your jobs without interfering with the other. If you are parents, discuss how you’ll share childcare responsibilities with your workload.
  • Communicate. Check in with each other regularly. Acknowledge that your partner may be coping with the situation differently. Show gratitude or appreciation for acts of kindness. Use “I” statements to express anxiety or frustration, such as “I feel…” rather than “You…”
  • Respect each other’s need for time alone. Perhaps demarcate a part of the living space for “time out” or privacy, or schedule a 30 minute window of time to yourself each day and ensure your partner also has that opportunity.
  • Ensure that your time spent together is “conscious” time where possible. Log off social media, mute your phone, and spend your lunch break together.

The outbreak of COVID-19 and imposition of a State of Emergency in Victoria is a new and challenging experience for everyone; predicted to have far-reaching and long-term impacts on public health, the economy, local and international governance, travel, and potentially, civic rights. Most people have little control over how the situation unfolds; however, we can exert some control in how it affects our own health and wellbeing, including our sexual and reproductive health, and our relationships.

COVID-19 and access to abortion

The compounding nature of COVID-19: How the global pandemic exposes longstanding barriers to women’s optimal reproductive health and further restricts access to abortion

Autumn Pierce

I’m pretty familiar with the link between natural disasters and gendered violence. As part of my IMPH I took a unit of study called Health Issues & Humanitarian Emergencies specifically so I could examine the staggering increase in intimate partner violence following Hurricane Katrina in the United States (the numbers I heard on TV in 2005 have always stuck with me).

I have also seen Women’s Health East’s sister organisations present on their Gender & Disaster (GAD) Pod initiative in several different forums. The initiative addresses the research gap in Australia relating to the gendered impacts of disaster and the link between disaster and violence against women, with a specific focus on transforming emergency management practices as they relate to bush fires. Their work however is directly applicable to many emergency situations, including global pandemics, as the current coronavirus context is also one of anxiety, uncertainty, stress, fear and lack of control – factors we know to increase the likelihood and severity of violence.

The growing evidence is still limited, but Australia expected a spike in violence as COVID-19 spread and lockdowns were imposed. Local police stations in China, the epicentre of coronavirus, saw reports of domestic violence almost triple in February during isolation. Unsurprisingly, in March the Australian Government reported Google searches about domestic violence had almost doubled in the wake of coronavirus, and demand for family violence services has surged around the nation (reflecting worldwide patterns). Keep in mind these numbers represent only the women who are able to reach out – we can assume there are many deterred by the risk of being overheard on the phone or forcibly stopped from leaving home. Refuges, overstretched at the best of times, are scrambling because they’re not equipped to act as quarantine facilities or to respond to emergencies of this scale.

The thought of women being trapped in isolation with their abusers, of a perpetrator weaponising COVID-19 to terrorise his victim, of a crisis situation being used to justify relegating women to subordinate roles, is alarming. But leadership’s acknowledgement of and response to the issue has been encouraging. The federal government has pledged $150 million on top of what state governments have committed to domestic and family violence services.

It is equally important however, to recognise the widespread reverberations of coronavirus that are beyond, but exacerbated by, family violence and crisis responses. An increase in family violence, which includes sexual violence and reproductive coercion, goes on to increase other risks, such as poorer sexual and reproductive health outcomes for women. A state of emergency instils in government the power to override rights to liberty, freedom of association and freedom of movement, which may help contain COVID-19, but disproportionately disadvantages women and has serious implications for access to essential sexual and reproductive health (SRH) services, including contraception, emergency contraception and abortion.  

Growing up in America, my knowledge of SRH rights is defined by Roe v Wade, the landmark decision handed down by the US Supreme Court in 1973 affirming the right to abortion in the first 12 weeks of pregnancy. The decision is just as polarising now as it was then. Roe v Wade won a hard-fought battle for abortion rights, but almost four decades later the war wages on. The security Roe v Wade intended to bring about has never been realised. The attacks on abortion access have been constant and unrelenting, and last year saw an unprecedented wave of the most restrictive anti-abortion laws in decades, many blatantly unconstitutional by design. The 1973 Supreme Court decision has been challenged over and over – in Supreme Court no less – and while there has not yet been a reversal, the very fact that the Supreme Court hears the cases validates the attacks and sends a clear message to women that their ‘right’ is no guarantee. Weaponised language such as ‘partial-term abortion’ and ‘heartbeat bill’ shape the narrative around the abortion debate, and provide the moral justification for efforts to undermine, dismantle, control and ultimately reverse women’s right to bodily autonomy.

(I could write a whole other article just on the language wars of the abortion debate. At Trump’s first re-election campaign rally this year in Toledo, Ohio, he told supporters: ‘Virtually every top Democrat also now supports late-term abortion, ripping babies straight from the mother’s womb right up until the moment of birth.’ At the 2019 State of the Union address, when asked to comment on a law passed in New York that removed some restrictions on later abortions, Trump replied: ‘These are living, feeling, beautiful babies who will never get the chance to share their love and their dreams with the world.’ Trump and other politicians use illustrative rhetoric like this often, despite the misleading and inaccurate nature of the claims. Partial- or late-term abortion is not a medical term – it is a political construct. It overstates the frequency and misrepresents the circumstances of later abortions, while also ignoring how systems and structures disproportionately hinder women based on race, socioeconomic status, education, state of residence, and rural or metro location. In reality, 11% of abortions are performed after the first trimester and slightly more than 1% of abortions in the US are performed at 21 weeks or later.

Heartbeat bills ban abortion at six weeks, before most women know they are pregnant, conveniently overlooking the fact that at six weeks a heart has yet to form. The detected rhythm is electrical activity coming from a 4-millimetre-wide growth called the foetal pole. The first heartbeat bill was introduced in 2011. In 2019 four states actually passed heartbeat bills with the state of Alabama passing a near total ban on abortions. Not one state has yet managed to enact heartbeat legislation long-term, but peddling the illusion of a child in need of protection has damaging effects for women exercising their reproductive rights.)

The Australian anti-choice movement is tiny compared to the US, but their views ‘have an outsized place in the abortion debate because of their vocal political and religious allies.’ Protest groups that target local abortion clinics here in Australia such as Helpers of God’s Precious Infants and 40 Days for Life, are chapters of US organisations. After South Australian Greens MP Tammy Franks introduced a decriminalisation bill in SA’s Legislative Council in 2018, anti-choice activists from the US, including the chair of 40 Days for Life, brought their lobbying efforts directly to Adelaide. They met with several MPs to discuss ways they might assist in the fight against a bill to fully decriminalise abortion in the state.

Without an overriding federal decision, abortion in Australia is dictated by state and territory governments, all of which have different rules and regulations. In Victoria, abortion is legal to 24 weeks, and post-24 weeks with the approval of two doctors. In Western Australia abortion is very restricted after 20 weeks, and in the Northern Territory it is only legal to 14 weeks with one doctor’s approval, and at 14-23 weeks with an additional doctor’s approval. It is not legal after 23 weeks unless it is performed to save a pregnant person’s life. South Australia is the only state to not offer medical abortion via Telehealth, meaning South Australia patients can only access abortion care if they leave their house. That being said, to access abortion telemedicine even where it is available you must live within two hours of a medical facility and be less than nine weeks pregnant.

Although more subtle, attempts to wind back women’s reproductive health rights at a structural level are launched in Australia the same way they are in America. For example, the Exposure Draft of the Religious Discrimination Bill was introduced in August 2019 and, on its surface, is designed to have positive implications for society by improving protections against religious discrimination for all people in Australia. In practice however, this bill provides the legal framework to advance the anti-choice movement. For example, the bill would sanction anti-choice activists’ intimidation of women outside of health clinics that provide abortion services, in states where legislated safe access zones have not yet been established.

The bill would also extend existing protections for health practitioners who conscientiously object to the provision of abortion. This is problematic because objections and non-compliance with current laws and policies are already high, which limits women’s access to reproductive health services. This has more severe consequences for some women over others, for instance women living in rural and regional areas. Rates of conscientious objection are particularly high in some rural and regional areas. A 2017 survey of GPs and Practice Nurses in the Grampians Pyrenees and Wimmera regions in western Victoria showed 38% of GPs ‘sometimes’ or ‘always’ referred women to a colleague because they held a conscientious objection, with the proportion increasing to 62% for GPs trained overseas. Non-compliance with these provisions is also widespread. A study conducted in 2015 involving interviews with abortion experts found that doctors had: directly contravened the law by not referring; attempted to make a woman feel guilty; attempted to delay women’s access; or claimed an objection for reasons other than conscience. This information and more can be found in Women’s Health Victoria’s submission on the Religious Discrimination Bill Second Exposure Draft, endorsed by the women’s health sector, which further outlines how the bill will delay women’s access to abortion and lead to unwanted pregnancies, more complex abortions, financial loss and negative mental health impacts for women.

Access to abortion in already inequitable in Australia and the Religious Discrimination Bill would only exacerbate this disparity. In the US, the same patterns emerge. Between 2011 and 2017, 4% of abortion clinics closed in America. This may seem insignificant, but the reality is that clinics are closing in large numbers in the south and Midwest and opening on the coasts, leading to expensive logistical nightmares for many women. A 2014 analysis revealed women who live at least 50 miles away from an abortion facility were more likely than those who lived less than 25 miles away to seek a second-trimester abortion. In addition, 25% of women who lived in states that require an in-person counselling visit before an abortion procedure obtained an abortion within seven weeks after their last menstrual period, compared with 40% of women who lived in states without waiting periods. The current intrastate travel restrictions in Australia present a similar barrier, further limiting women’s options during a time critical situation. The travel bans restrict women’s freedom of movement and the isolation periods impact on doctors’ readiness to fly interstate to perform later gestation abortions (there are a very limited number of specialised doctors who can provide these types of terminations).

It is important to understand the influence America has had on our conversations about abortion in Australia because it without a doubt shapes our interpretation of what is and isn’t an ‘essential’ service – a distinction in the COVID-19 context that has significant implications. As part of the COVID-19 response, DHHS has developed guidelines about the provision of medical procedures based on whether they are deemed essential or elective. (More information on COVID-19 and IVF services). Non-essential services have been temporarily suspended, and whether or not abortion has been temporarily classified as essential given the circumstances depends on not just the state or territory but on the particular medical board, hospital and even doctor.

Marie Stopes has recently updated their Situational Report: Sexual and Reproductive Health Rights in Australia A request for collaboration and action to maintain contraceptive and abortion care throughout the SARS-COV-2/COVID-19 pandemic. The report implores the Morrison Government to make contraceptive and abortion care a priority. Among other calls to action, Marie Stopes recommends:

  • All Governments, health and hospital services, and health clinics to consider abortion an essential service with Category 1 classification
  • Medical abortion via telehealth to be provided for people living in South Australia
  • The provision of medical abortion to be increased to 70 days/10 weeks gestation, supported by the Pharmaceutical Benefits Scheme (PBS)
  • Women and pregnant people who attempt unsafe abortion during the pandemic will not be criminalised
  • Safe Access Zones to be established in South Australia and Western Australia

These measures aim to maintain sexual and reproductive health rights in Australia by acknowledging the compounding nature of global pandemics on an already precarious situation and advocating for appropriate allowances. Against the backdrop of inequitable sexual and reproductive health rights and within the context of increased unplanned pregnancy and reproductive coercion, as well as increased barriers to accessing safe and affordable abortions, we cannot consider regression an option.

Gender equity organisations unite on COVID-19 disaster

The peak body for gender equity, women’s health and the prevention of violence against women GEN VIC have made a joint statement calling for State and Federal Governments to recognise the gendered impacts of COVID-19. Women’s Health East is one of more than 50 organisations who have endorsed this statement.

Women’s Health East strongly supports the need for a gendered approach to understanding and responding to the impacts of the coronavirus pandemic. We recognise and value the important work of the women at the front line, delivering essential services across traditionally female dominated industries such as health care, childcare, education, family violence, housing and homelessness, social support and retail. We acknowledge the financial challenges for women who are overrepresented in the casual workforce, and those women who are juggling caring and work responsibilities while working from home. We highlight the need for women to have access to safe services for their sexual and reproductive health, and advocate for termination services to be assessed as an essential service at this time. We are very concerned about the increased risk of gendered based violence at this time.

We are committed to advocate for State and Federal Governments to recognise the gendered impacts of COVID-19.

The statement is accompanied by a list of 10 Things Government Can Do Now to address the impacts of COVID-19 on women and gender diverse people.

View the full statement

The gender divide in social inclusion: The unheard story of older women

Originally published by Susan Maury on the Power to Persuade site

Social inclusion is a determinant of mental health and wellbeing. In today’s analysis, Autumn Pierce (@otonoenespanol) of Women’s Health East (@WHEast) shares highlights from their important new report The Unheard Story: The Impact of Gender on Social Inclusion for Older Women, which explores how inequalities accumulate across the lifespan to increase the risk and impacts of social exclusion for older women.

Within the last few years elder abuse has come into focus in Victoria after being recognised within a family violence context as part of the 2016 Royal Commission into Family Violence findings. Women’s Health East’s primary prevention approach means that within this space, rather than addressing risk factors such as dependency and social isolation, we ask – What are the norms, practices and structures that enable abuse against older people to occur? And how does gender influence the risk and impacts of elder abuse?

The absence of a gender lens in the presentation of leading elder abuse data and the conversations within the sector at the time made it clear we had an important advocacy role to play in the prevention of elder abuse against older women. The manifestations and implications for women and gender inequality in Australia – the wage gap, lower superannuation balances and greater risk of sexual and physical violence and workplace harassment, to name a few – aren’t exchanged for Seniors Cards. If anything, where these experiences of discrimination intersect with ageism, their effects are further compounded.  

This is a key point missing in the approach to most issues affecting older women, and nothing gets us more fired up than a story only half told. Recognising the interconnectedness of issues disproportionately affecting women, we started investigating opportunities to influence not only the narrative around elder abuse, but around older women’s experiences more broadly.

Understanding social inclusion

We honed in on social inclusion, leveraging the expertise of a partner organisation working in the social inclusion and healthy ageing sectors. For older populations, social inclusion is recognised as an enabling contributor to healthy ageing. However, when we started investigating, we found limited attention in guiding literature given to the intrinsic link between gender, social inclusion and healthy ageing. This is despite social inclusion being an indicator of healthy ageing, and gender being an established determinant of overall health.

The Unheard Story: The Impact of Gender on Social Inclusion for Older Women is the culmination of our investigative work to understand the current context and tell the ‘whole’ story of ageing. The Unheard Story explores women’s access to resources, capabilities and opportunities to learn, work engage and have a voice, in line with the Australian Social Inclusion Board’s definition of social inclusion. This gendered distinction not currently reflected in key international, national and local documents that guide contemporary practice in social inclusion and healthy ageing. 

The Unheard Story highlights how current narratives continue to disadvantage women by failing to recognise the lifelong impacts of inequality that are further compounded in later years, and discusses the implications of this oversight on healthy ageing. The paper also captures insights from two focus groups held with practitioners working in both social inclusion and healthy ageing within the Eastern Metropolitan Region of Melbourne. These focus groups were designed to gauge practitioners’ understanding of the impact of gender on social inclusion for older women and to determine how to best support practitioners and organisations in this space.

ASIB’s defining elements of social inclusion are learn, work, engage and have a voice. The Unheard Story uses the following social inclusion indicators adopted by the ASIB to explore the different pathways to social exclusion for women and men:

  • Income

  • Access to the job market

  • Social supports and networks

  • Effect of the local neighbourhood

  • Access to services

  • Health

The paper also looks at another predictor of social exclusion specific to older people – elder abuse.

The data: Gendered disadvantage accrues across a lifetime

A gender analysis of the key social inclusion indicators reveals the specific, but largely ignored, barriers older women face to experiencing social inclusion, the consequences of which can be compounded over a lifetime. For example, older women are more likely than older men to live in poverty and are more likely to experience entrenched poverty. The reason for this disparity is multifaceted and accumulated over time. During their working life, women are likely to have earned less, due to the persisting gender wage gap, and are likely to have taken time out from the paid workforce to have children and take on full-time caring roles. This lower wage and gaps in employment mean that on average, women in Australia retire with about half the superannuation of men.

When considering access to the job market in later years, older women are more likely than older men to be perceived as having outdated skills, being too slow to learn new things, or likely to deliver an unsatisfactory job. But seldom acknowledged is the link between these perceptions of women in their older years and the gaps in their employment history during their younger years.

Financial insecurity caused by unequitable access to the job market is a significant contributor to poor physical and mental health. It is likely we are seeing the impact of the chronic stress of insecure income reflected in the higher rates of anxiety and depression, and more years of chronic illness experienced by older women.

Perceptions of safety and sense of trust in others also impacts on people’s physical and mental health, enabling or hindering their physical movements within their neighbourhood and social engagement with their community. It is significant that older men are more likely than older women to agree most people can be trusted, and feel considerably safer walking down their street alone after dark.

Access to services is significantly affected by the loss of a driver’s licence, which women experience sooner than men. Rates of a driver’s licence possession begin to decrease for women from the age of 65, but not until 70 for men. The proportion of women holding a driver’s licence between the ages of 65-69 is 85.1%, which significantly drops to 42.7% at 85 years. In contrast, 89% of men aged 70-74 hold a driver’s licence and this sees a much smaller drop during the older years, with 73.8% of men 85 years and older still possessing a driver’s licence. Loss of independence, social participation and ability to access services all have health and wellbeing consequences.

Much of the literature looking at social inclusion puts a strong focus on social isolation, a risk factor for social exclusion, and how to improve participation for those who are socially isolated. A breakdown of data by sex is most commonly provided in social inclusion literature when emphasizing the risk of social isolation amongst older men. Discussing gender only to suggest older men are more likely to be socially isolated fails to paint the whole picture and account for the complexities of the issue. Older women are in fact more likely to be socially excluded than older men, yet women are not identified as a priority population in any key social inclusion or health ageing documents reviewed for this paper. Women are overrepresented in many of the specific groups of people at risk of social exclusion. For example, women have a greater life expectancy than men, and make up the majority of the oldest population. Women also make up the majority of carers across most age groups, and are overrepresented in residential care.

All older people are at increased risk of experiencing social exclusion, but their needs are not homogenous. A failure to recognise the gendered drivers of social exclusion disadvantages everyone, including men.  

Practitioner insights

To gain better insights into practitioners’ knowledge of the impact that gender has on shaping older women’s social inclusion and how these unique needs are addressed at a service delivery level, Women’s Health East undertook two focus groups with practitioners working in Melbourne’s East. The focus groups were designed to answer the question: Do social inclusion and healthy ageing practitioners recognise gender as an impacting factor on older people’s capacity for social inclusion? In other words, we wanted to know if practitioners were make the connections the literature was not.

The answer – yes and no. The focus group discussions indicated there is great variation among practitioners’ understanding of how gender can impact on older women’s experiences of social inclusion, but certain themes did emerge. Participants spoke about barriers to optimal mental health, including grief and trauma, feelings of invisibility/not mattering, and the mental toll of caring. Participants also spoke extensively about the gender inequality women experience across their lifespan and how this can accumulate and become more pronounced in older age. These areas include education, jobs, caring, income, elder abuse, driving and literacy. The effects of declining physical health on an individual’s confidence and self-perception were discussed, as well as the different experiences of ageing for women and men, particularly relating to chronic illness. Failure to meet clients’ needs and the barriers that prevent certain groups of people from accessing services was another emerging theme, with participants identifying people with disabilities and LGBTIQ people with disabilities are at particular risk for exclusion.      

Interestingly, the practitioners used their own experiences to reinforce the points they made relating to their clients, demonstrating the pervasiveness of the issues.

‘It’s taken me three years to get a job; I came second all the time. I’ve coloured my hair now. Ageing is really tricky, you know. Society dismisses you a lot.’

‘In my family my mother had six brothers and four sisters, only the boys went to school past primary school.’ 

‘I feel at a loss because I don’t have the knowledge and understanding of dementia, how to work with it organisationally. You shouldn’t not come to a [community] class because you have dementia. We should be making things easier to be included while you’re going through that.’

The focus group discussions also explored how practitioners can be supported to build their capacity to improve social inclusion for older women. The main themes emerging from this facilitated discussion included a need for:

  1. Action to address societal attitudes that support gender stereotypes and do not recognise the social capital older women contribute

  2. Advocacy to elevate the voices of women and ensure sufficient funding for neighbourhood houses

  3. Localised data disaggregated by sex, age and other demographic characteristics to improve services

  4. Meaningful commitment from funding agencies to apply what is known about the impact of gender on women’s social inclusion, and adequate training to build services’ capacity around healthy ageing, dementia, inequality and mental health to meet the intersecting needs of their clients.

The necessity of a multi-pronged approach

Practitioners identified that services need more support, training and funding to meet the needs of women in the community, but they also reinforced the need to address the structural barriers to social inclusion outlined in the report. Cleary, a multi-pronged approach is one that recognises the interconnectedness and compounded nature of the issues. For example, if our aim is increase older women’s financial independence we must fund programs designed to improve financial literacy while also funding initiatives that address housing insecurity, personal safety and the impact of caring responsibilities. And this must be informed by women.    

In addition to challenging gender inequality, we also need to challenge ageism, which the World Health Organisation calls the most ‘normalised’ of any prejudice in that it is not widely countered like sexism or racism. All older people are exposed to ageism, but when we regard all older people’s experiences as homogenous, it benefits no one, least of all women.  

‘Respect the strength of women. Respect and honour who women are, what they’ve been through, and what they have to offer.’

(RE) Shaping Respect: What it means to the community

By Rhiannon — VFER Project Officer

The recent Voices for Equality & Respect Summit was the culmination of months of planning. I am so proud to have been involved in the project, and before departing Women’s Health East I wanted to share some of my reflections.

What I’ve found about preventing family and intimate partner violence in LGBTIQ spaces is that it’s confronting work. It’s not an easy thing to hear, to see, or to know about. It took me a whole day to finish reading the first draft of the (Re)shaping Respect research report, and by the end of it I felt drained. But I think it’s significant that this research and work is confronting and a little uncomfortable, because we humans don’t like to sit with discomfort – we’ll do anything to change it. So now, if you’re willing, we get to change things.

Before I was given the opportunity to apply for the role as Project Officer for the Voices for Equality and Respect project, I was the Volunteer Young Leader tasked with facilitating the workshops held to elevate the voices of LGBTIQ young people. I was doodling around on my phone one night and my mother had sent me a Facebook post that read “WANTED: YOUNG LEADERS” in capital letters, on a rainbow background. I wasn’t looking for work or other opportunities at the time, but as we all know, life has a funny way of throwing things at us.

I read the flyer and it said that Women’s Health East needed someone to help create a resource about ‘equal and respectful relationships’.  Suddenly there was this little part of me who was sixteen years old again standing at my front gate, terrified, looking at this flower that had been tucked into the wire like a signature, and I knew exactly who has signed it. This dumb yellow flower gave me a panic attack on my own front lawn, because he wasn’t meant to be on my property anymore. It took me back to a time of constant anxiety because I spent three years of my life not realising why I should leave him.

Pulling back from this, looking at the Young Leaders flyer, I thought, ‘Yeah, no one else gets to live through that on my watch.’

So I emailed Women’s Health East and said, “Whaddup, I’m bi, and I wanna help however I can”. Verbatim, of course, and the rest is history.

I have met some truly amazing young people in this endeavour, from all different walks of life and some of the things they said really hurt to hear out loud. These young people told us stories of doctors who didn’t know that binding could be dangerous, about the impact of the lack of positive role-models, about schools who wouldn’t intervene when a queer student was sexually threatened but nearly expelled her for speaking about the ordeal online. 

But they also told us about this beautiful world they had found within the queer community, of love and acceptance (most of the time) where they had built long-lasting friendships and found self-love.

These young people have stories to tell. Stories worth telling.

It is time for us to sit down, get uncomfortable, and listen to them. 


Why we need to keep the gender focus on elder abuse

By Autumn Pierce, Health Promotion Manager

As seen in Croakey.org

Earlier this year, I attended the Victorian Government’s Elder Abuse Prevention Forum on behalf of Women’s Health East, and since then I’ve been particularly interested in conversations relating to the issue.

Elder abuse in itself isn’t a new issue, but it has come into focus more lately, especially in Victoria, where it is now recognised within a family violence context. In this year’s budget, in continuing response to the recommendations the Royal Commission into Family Violence released in 2016, the State Government announced  it would invest $6 million to tackle elder abuse by extending the trial of an integrated model of care – offering specialist clinical advice, family counselling and mediation services.

The majority of the prevention funding made available after the Royal Commission was allocated towards preventing men’s violence against their female intimate partners. Coupled with the data from Our Watch’s Change the Story framework, the findings from the inquiry paint a clear picture of the epidemiology of violence in Australia:

  • The primary driver of men’s violence against women is gender inequality.
  • The vast majority of violent acts – whether against men or women – are perpetrated by men.
  • Women are three times more likely than men to experience violence from an intimate partner.
  • Intimate partner violence is the greatest contributor to ill health and premature death in women aged 15-44 .

Within this heteronormative framework, violence against women is widely regarded as a gendered epidemic. But from the limited available data on elder abuse, we know these patterns of violence aren’t reflected among older people.

For example, most abuse is perpetrated by adult children rather than intimate partners and physical and sexual abuse are the least common types of reported abuse.

Importantly, the primary driver of elder abuse is ageism, but this in no way suggests the issue is not a gendered one.

On that note, let’s get one thing out of the way. Everything. Is. Gendered. Everything. According to the European Institute of Gender Equality, gender issues include all aspects and concerns related to women and men’s lives and situation in society, to the way they interrelate, their differences in access to and use of resources, their activities, and how they react to changes, interventions and policies. In other words, women and men experience and interact with the world around them differently, which is largely due to forces outside of their control.

Not everyone views the world through this lens, but given what we know about violence against women, I am genuinely surprised to have heard more than one respected colleague within the health promotion sector claim elder abuse is not gendered.

The manifestations and implications for women of gender inequity in Australia – the wage gap, lower superannuation balances and greater vulnerability to sexual and physical violence and workplace harassment, to name a few– aren’t exchanged for your Seniors Card.

If anything, where these experiences of discrimination intersect with ageism, their effects are further compounded.

But clearly the evidence is ambiguous enough to make some people assert the opposite. So I sat down to make a compelling case for why elder abuse is without a doubt a gendered issue. As my laptop booted up I envisioned authoring a ground-breaking piece. The high-level correlations I intended to make would surely land me in journals worldwide by the end of the month.

Consensus in the evidence

After spending 10 minutes on the Internet, my vision of winning an award for excellence was dashed. The Australian Government’s Australian Institute of Family Studies, Senior Rights Victoria, and the University of Melbourne and the Multicultural Centre for Women’s Health beat me to it.

Turns out there’s consensus in the evidence: Older women are significantly more likely to be victims of abuse than older men, and while women comprise a higher proportion of the older population than men, this alone does not explain the disparity. In other words, women experience elder abuse differently than men, which makes it – you’ve guessed it – a gendered issue.

In all the resources produced by the above institutes, gender is identified as a risk factor for elder abuse. The Institute of Family Studies’ report cites research pointing to ‘an association between gender roles and elder abuse, particularly financial abuse, because under traditional gender role paradigms, women have not expected, or been expected, to take responsibility for financial matters. In this respect, norms that support women’s relinquishment of financial control to others are also seen to be conducive to creating opportunities for elder abuse.’

The 2016 submission  to the Australian Law Reform Commission Inquiry on Elder Abuse by the University of Melbourne and the Multicultural Centre for Women’s Health highlights the following:

‘Compared to older men, older women are more likely to outlive their male spouses, live in poverty and rely on social welfare, and suffer chronic health conditions, disabilities, and limitations in activities of daily living. All of these factors marginalise older women in society, increase their risk of abuse and neglect, and limit their access to services and support.’

Why the different focus?

So I’m sitting here, genuinely confused. Where has anyone gotten the idea elder abuse is NOT gendered? What resources or evidence are they referring to? Reflecting once again on the elder abuse forum, why wasn’t the issue framed in a way that positioned elder abuse as gendered?

Perhaps it’s the male to female perpetrator ratio that has thrown everyone off. Across Australia, 95 per cent of victims of physical and sexual violence, including threats, reported a male perpetrator. This only encompasses reported violence, but for the purpose of this exercise, let’s assume 5 per cent of perpetrators of violence in Australia are women. When we narrow the scope to abuse against older people, the dynamics shift (financial and physiological abuse become more common than physical and sexual violence) and the proportion of women who perpetrate increases.

The Institute of Family Studies report describes three studies based on data and calls for elder abuse helplines. In all three studies (across Victoria, Queensland and New South Wales), calls were mostly in relation to female victims and the most commonly reported perpetrators were male. However, in the Queensland study, 45 per cent of perpetrators were reported to be female and, in Victoria, females made up 40 per cent of reported perpetrators. Although men still perpetrate at a significantly higher rate than women, the numbers look very different than the 95/5 split upon which we base most of our current initiatives that address men’s violence against their female intimate partners.

By all accounts, men are the most commonly reported perpetrators of elder abuse, but for a more accurate picture of the issue we also need to take into consideration the fact that women disproportionally assume (paid and unpaid) care taking responsibilities of older people. Access to a potential victim is a significant risk factor for abuse, and should be included in this discussion.

We don’t have enough data to calculate the adjusted perpetrator rate for gendered carer ratio (and I’d be lying if I said I could do that even if we did), but as health promotion practitioners we should be able to recognise when the numbers aren’t telling the whole story.

So I’ll ask again, from what we do know about elder abuse, how is it NOT gendered? Our understanding of the prevalence of elder abuse in Australia is limited, but our understanding of how the issue fits into the current framework of family violence is not, and that framework is one that allows for multiple, overlapping factors of influence.

While ageism is the primary driver of violence against older people, when we start talking about older women, we have to apply what we already know about the structures, norms and practices that disadvantage women of all ages.

At a national and state level, the drivers and risk factors have been identified and the issue has been framed as gendered. The context has been set, but it seems to not have resonated with the people analysing these reports and translating the information to the wider sector.

The way a social issue is framed should reflect the attitudes and beliefs of the intended audience, and what’s most disappointing here is that something has fallen short, and as a result we are missing an opportunity to respond to nuance and unpack complexities that could help us better understand and prevent elder abuse.

As a sector, nothing we do should support a one-size-fits-all approach, but everything we do should be with intersectionality at the forefront. It is up to us to expand upon what is currently available within the elder abuse space, to participate in research that quantifies the incidence of violence, to strengthen the replicability and validity of the evidence base, and to effectively respond to the intersect of all underlying drivers of violence, including gender inequality.


Women in Leadership

By Autumn Pierce, Health Promotion Manager


Given the recent federal election, it seems timely to talk about government. The 2019 federal election saw only an incremental rise in women’s representation in Parliament while Tanya Plibersek passed on the opportunity to succeed Bill Shorten as Labor leader. In her words, she could not ‘reconcile the important responsibilities I have to my family with the additional responsibilities (of) leadership.’ There’s a lot to unpack in that statement, one disproportionately echoed by women around the world on a trajectory to professional success. However, given the glacial progress in securing a gender balance at a federal government level, let’s go back to the basics, and focus on why women in leadership is not only important but also beneficial for all.

Women’s leadership is a key pillar of gender equality. The equal participation of women and men in politics is an important condition of effective democracy and good governance, but the tangible benefits of equality extend beyond concepts of balance and inclusivity. In Canada for instance, researchers have found that as the percentage of women in government has risen, total mortality rates have declined. Interestingly, no relationship has been found between the political leanings of Canadian women in government and Canadian mortality rates. Women in government, whether they belong to left-wing, centrist or right-wing parties, do in fact advance population health and improve the lives of both women and men.

So why is this? Turns out that compared to their male counterparts, female politicians are more likely to hold progressive attitudes (with regard to issues such as civil rights, social equality and egalitarianism) and substantively advance women’s rights in areas such as pay equity, violence against women, health care and family policy. This builds on evidence that has previously suggested women initiate the four types of provincial government spending that we know are key to lowering mortality rates: medical care, preventative care, other social services and post-secondary education.

The recent findings support the idea that women in government tend to work in more collaborative and bipartisan ways than men in leadership, which is positioned as a recipe for success within the context of this research. But is it? When you think about how to most efficiently scale the leadership ladder, are collaboration and bipartisanship the first words that come to mind?

It’s no secret the traits and characteristics we typically associate with effective leadership validate stereotypical masculine attributes such as assertiveness and ambition, while simultaneously discounting stereotypical feminine traits like collaboration and cooperation as ‘soft.’ Masculine stereotypes are synonymous with leadership and this bias means a man is more likely to be regarded as a potential and competent leader, while a woman is less likely to receive encouragement to pursue a leadership role. The handful who do put themselves forward often find themselves having to emphasise traits usually associated with men to convince the gatekeepers that they have what it takes.

But we know that in itself to be a double-edged sword – asking a woman to choose between meeting the expectations placed on her as a leader, or the expectations that are assigned to her gender. Nice and polite equates to weakness while assertiveness equates to the b word (bossiness), neither of which are desired professional nor personal qualities. Women are twice as likely to be told they need more confidence when applying for a promotion or leadership role, compared to their male colleagues, but also twice as likely to be called bossy. This is what gender inequality looks like in 2019. It’s a rigged game.

But the game is changing. Look no further than across the ditch. Leaders like Jacinda Ardern are breaking down narrow ideas of what defines a true leader. By employing all things feminine – compassion, empathy, teamwork, collaboration, kindness – she is challenging the idea that men, because of their ‘inherent’ leadership qualities, are more equipped to run countries. Or to be CEOs. Or to stand for local government.

Let’s remember – the end game isn’t to eliminate differences between genders. It’s to hold authenticity in the highest regard. It’s to afford all genders an equal voice, and to equally value all expression of gender and all expressions of leadership. But to achieve this we must throw our weight behind initiatives that create pathways, such as the Victorian Local Governance Association’s campaign Local Women Leading Change. The campaign officially launched on 7 March 2019, with the vision for the October 2020 local government elections – 50% women by 2020. The federal election may be decided, but we’re not done fighting.

A Reflection on NAIDOC Week 2018

By Jill Exon, Health Promotion Officer


Jill at Coogee Beach

As I reflect on the last couple of weeks of 2018 NAIDOC celebrations, I feel honoured to have represented Women’s Health East (WHE) at a number of key events across the eastern metropolitan region (EMR), in addition to attending a local community event with my family. This year’s national NAIDOC theme, Because of her, we can!, resonated with me on both a professional and personal level, and I’m excited to share the highlights.

On 5 July, I joined around 100 people across the east for a community NAIDOC afternoon tea held at the Memo Hall in Healesville. The event was hosted by Healesville Indigenous Community Services Association (HICSA), Boorndawan Willam Aboriginal Healing Service, Women’s Health East, Yarra Ranges Council and Eastern Community Legal Centre. The room was alive with speakers and images of local Aboriginal and Torres Strait Islander women who have paved the way in significant ways – both big and small. Among them, Miranda Madgwick (Chair of HICSA and founding member) spoke about Anne Jenkins and her significant contributions to the community as a founding member and CEO of HICSA.

On Sunday 8 July I took my two boys (aged 2 and 4) along to the Mullum Mullum NAIDOC Family Day. This was a fabulous opportunity for families to get involved. There were real-life reptiles and the chance to decorate your very own (working!) boomerang. Needless to say that I had two very excited boys, and even a bit of fun myself!

I also had the privilege of attending Day 2 of the national NAIDOC Conference in Sydney which included honouring and hearing from some of our First Nation women role-models, trailblazers and courageous leaders. There were so many stand-out speakers. Some of my personal favourites included: Linda Burney MP, Shelley Reys AO, Leila Gurruwiwi and our very own Melbourne based, Karen Milward. These women shared their own journeys to positions of leadership, whilst bringing a spotlight to the women – the mothers, aunties, sisters, grandmothers, elders and other First Nation women and leaders – who have walked before and inspired them to achieve what they have today.

In topping off a jam-packed week, WHE was invited to attend the EMR NAIDOC Ball. Thank you HICSA! Putting on my frock and heels, I joined in for more local celebrations MC’ed by HICSA’s Community Engagement Worker, Nikki Madgwick. What a brilliant night this was, shared with so many local leaders, partners and community members! A key highlight was when Aunty Janet Turpie-Johnstone presented Aunty Kim Wandin with an Elders Award. Kim was recognised as someone who is generous in sharing her culture as an artist and through schools, cultural days and community events.

From a personal perspective, I have found the week’s events both moving and incredibly inspiring.  This year’s theme, ‘Because of her, we can!’ was indeed celebrated well, honouring the women who are often the unsung heroes. So in a final reflection, I am so grateful to our First Nation women, who, as Leila Gurruwiwi noted: “built the bridges that [we] walk on today.”

As WHE continues to work toward equality, empowerment, health and wellbeing for all women, we recognise the resilience, strength and hard work of the First Nation women who have inspired and paved the way. Thank you!

Nikki Madgwick – MC at Eastern Metropolitan Region Ball

Karen Milward – Aboriginal Consultant

Local friends at the NAIDOC conference. Aunty Janet Turpie-Johnstone and Anne Jenkins, founding member and CEO of HICSA


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