In a mini-blog series ICM is highlighting the role of midwives in family planning. We have spoken to Sheryl Alexander and Bernadette Lack, who both have worked as outreach midwives and offer a tiny peek into their work around Family Planning with Aboriginal women. They face many challenges such as infrastructure, culture and geography.
Sheryl Alexander and Bernadette Lack have both worked as outreach midwives in the outback of central Australia. They are based in Alice Springs, a small town in the middle of the desert, around 1500 Kilometers away from the two major cities Darwin in the North and Adelaide in the South. Their catchment area is about as large as Alaska or Mongolia and to get to their clients they cover long distances from up to 700 Kilometers. Often, it is a tiring 8-10h drive on dirt roads, sometimes a flight in a tiny aircraft landing on a stretch of cleared land.
The geography is only one of the many challenges the outreach midwives face. Another issue is the lack of infrastructure as there is only one shop and it is very difficult to buy healthy food. “A bruised apple might cost 2 AUD, whereas a bag of frozen potatoes will be cheaper and feed the whole family” explains Bernadette. Families often consist of about 20 people all living in the same house. There aren’t many jobs – almost everyone is unemployed – and women tend to focus on being a mother. It is quite common to see women in their 20ies having their third and fourth child. “To be a mum is their role in society”, says Sheryl. But, with health care workers arriving in the communities several decades ago, contraception is now a widely used and accepted method of family planning. The families have now fewer children than they used to, but there is still plenty of work for the outreach midwives.
However, one of the issues is to establish trust. “I had to go to the Elders and ask them for permission to teach sexual education”, says Bernadette. But once they approved, she was able to start her work and the young women often brought their mothers and aunts to the workshops. Many of these women lack basic knowledge about menstruation, ovulation and contraception. “One day I demonstrated how to use a pad in underwear and how to wrap the wings around the pantie, so that the pad stays in place”, remembers Bernadette. She could read in several of the older women’s faces the eye-opening effect the demonstration had on them. On the other hand, she also experienced utter disinterest displayed by the women she was supposed to teach. Sometimes she would arrive in a community and the women would refuse to come and see her, saying they first had to shower or eat and then never showing up either way.
Sheryl has had similar experiences, where women have demonstrated their disinterest and just got up in the middle of a session and walked away. But more often it is about getting past the shyness of the women and girls, past what they call “Shamejob”. “To get past this shyness I have often used the wrap-up parcel game”, says Sheryl. She started with a model penis and then wrapped up a condom. She continued to wrap-up around eight contraception methods such as diaphragm and hormonal needles. Afterwards the girls would in turns unwrap the contraception methods and actively learn about them. “Even though most Aboriginal women use the hormonal needle for their life in the community, it is helpful for them to know about the different sorts of contraception methods”, explains Sheryl. Bernadette employed a similar playful method, called the condom race: “It was a lot of fun, the girls giggled and laughed when the condom broke or split”.
Such experiences are powerful motivators for Sheryl and Bernadette. They find it the most rewarding when they are recognized and properly greeted by their clients. “There is no word for Thank you in the Aboriginal languages and we don’t expect that”, says Sheryl. “But when I pull up my car in front of a health center in a community and the women are waiting for me, then I know I did my job right and they must like me for who I am”, adds Bernadette. The two midwives feel very privileged and honored to have been able to step into the world of these Aboriginal women and meet them, listen to them, learn from them and teach them.