politics

Her Body, His Law: The Long History of Male Control Over Women’s Reproductive Rights

Image sourced from https://actionnetwork.org/letters/protect-womens-right-to-choose

Social struggles throughout history have been instrumental in implementing human rights legislation, changing existing laws, and shaping societal thinking about personal freedoms. One of the longest and most contested of these struggles is the fight for women’s reproductive and contraceptive rights. The debate surrounding women’s autonomy over their bodies and their right to access abortion services has persisted for centuries, driven by ethnocentric, patriarchal, and religious moral perceptions, as well as by gendered stereotypes and legislative control.

The issue of abortion rights has repeatedly highlighted the tension between personal autonomy and state, religious, and medical authority. Despite advancements in women’s rights movements and international human rights frameworks, such as the Universal Declaration of Human Rights (United Nations n.d.a) and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) (UN Women 2000-2009), barriers to reproductive freedom remain entrenched in many societies. The historical and ongoing struggle for reproductive rights, particularly the right to safe and legal abortion, reveals the enduring power dynamics that seek to control women’s bodies and choices, and demonstrates that achieving genuine gender equality remains an unfinished global challenge.


The Overturning of Roe v. Wade: A Landmark Moment

Women’s autonomy over their bodies has caused an ongoing heated societal debate for centuries. The latest major event occurred in 2022 with the overruling of the 1973 Roe v. Wade decision by the United States Supreme Court on 24 June 2022 (Clough 2022; Lewandowska 2022). The outcome of Roe v. Wade was that the “Fourteenth Amendment’s concept of personal liberty and restrictions upon state action . . . is broad enough to encompass a woman’s decision whether or not to terminate a pregnancy” (Roe v. Wade 1973, at 153). Abortion could now occur in other circumstances (Ehrlich 2018; Ginsberg 1985). Previous law stated termination could only occur if a woman were pregnant due to rape or incest, where there were fetal anomalies, or where the mother’s life was at risk (Ehrlich 2018; Ginsberg 1985).

The overruling of the Roe v. Wade precedent in 2022 has global implications concerning women’s health. It is an attack on human reproductive rights as it removes “the constitutional right to bodily autonomy from over half the United States population” (Clough 2022, p.160; Lewandowska 2022; Cherminsky 2022; The Lancet 2022). As Clough (2022, p.160) states, “it serves as a stark reminder of the need to defend human rights; it is not enough to assume that, once granted, they cannot be taken away.”


Historical Context: Slavery and Early Abortion Legislation

To understand the abortion debate, changes to legislation, and the struggle for women to access abortion services, we need to revisit the 1800s when white people owned Black slaves and relied upon slaves for cheap labour and economic growth (Murray 2021). The prohibition of the importation of slaves into America in January of 1808 (Murray 2021) resulted in slave owners concerning themselves with the “reproductive capacities of enslaved women” because the source of their labour and economy now needed to be procured from slaves’ children (Murray 2021, p.2034). Enslaved women were aware that any child they bore was not rightfully theirs and could be sold (Murray 2021). Therefore, women used various techniques to inhibit conception or abort their unborn child (Murray 2021).

As a consequence, “slave owners sought to deter and punish efforts to prevent or terminate pregnancies” (Murray 2021, p. 2035). Abortion began to be criminalised, and legislation was passed that banned the distribution of contraceptives and abortifacients, which had not been banned prior to the aforementioned 1808 legislation (Murray 2021; Siegal 1992).


Medical Campaigns and the Criminalisation of Abortion

The campaign to enact anti-abortion legislation was primarily organised by white male physicians who considered contraceptive information provided to all women and actions by female Black and Indigenous women as dangerous (Goodwin 2020; Joffe, Weitz & Stacey 2004). Further, these physicians perceived abortions, if allowed to continue, as a disruption of the American social order of motherhood, family, and white dominance due to birth rates amongst white women decreasing (Beisel & Kay 2004; Murray 2021; Ehrlich 2018).

In 1857, Dr. Horatio Storer, a “Harvard-educated gynaecologist,” spoke at a “meeting of the Suffolk District Medical Society” (Ehrlich 2018, p. 182). He addressed the issue of an “alarming frequency of induced abortions among respectable Protestant women…” (Ehrlich 2018, p. 182). Storer convinced “the Boston medical society and the then recently founded American Medical Association (AMA) to establish investigative committees to look into ‘criminal abortion’ to suppress what he perceived to be ‘the slaughter of countless children now perpetuated in our midst’” (Ehrlich 2018, p. 182). Storer believed women’s physiological makeup rendered “her incapable of self-management” (Ehrlich 2018, p.185).

The AMA’s campaign to criminalise abortion was based on “a paternalistic and racialized code of white-male moral authority over women’s reproductive bodies” (Ehrlich 2018, p.183). The campaign resulted in abortion becoming a statutory crime in all states of America by the end of the nineteenth century unless certification by a doctor occurred that the procedure would “save the life of the pregnant woman” (Ehrlich 2019, p.183). Abortion laws now existed that mirrored eugenic concerns regarding controlling reproductive rights due to fear-based perceptions that white women were not producing offspring as rapidly as immigrants and non-whites (Murray 2021; Ehrlich 2018).


Contemporary Efforts to Restrict Abortion Rights

The racially motivated and gendered paternalistic and religious views regarding abortion reveal the true impetus for criminalisation and explain, to some degree, why efforts still remain globally by men to legally control women’s bodies and choices as per the following examples:

  • 2017 America: “Unprecedented attacks on reproductive health rights” resulted in 19 states adopting “63 new restrictions on abortion rights, service provision, and patient access” (Espey, Dennis & Landy 2018, p. 67).
  • 2018 Argentina: A bill to decriminalize and legalize abortion was debated in Congress for the first time but did not pass through the Senate (Sutton 2020, p.1).
  • Access to abortion in America since 1976 has undergone further restrictions with increased waiting periods, biased counselling, and a mandate regarding parental involvement for minors (Joffe, Weitz & Stacey 2004; Grossman et al. 2014a; Grossman et al. 2014b; Minkoff, Diaz-Tello & Paulk 2021; Askola 2018).
  • Texas, May 2013 to November 2013: A decrease by half in the facilities where medical abortion was available (Grossman et al. 2014a; Grossman et al. 2014b).
  • Australia: While surgical abortion has been provided as a health service “since the early 1970s,” medical abortion utilising Mifepristone “was deliberately obstructed” by the Federal Government via legislation concerning its authority over pharmaceutical drug importation, and it was not until 2006 that the legislative restriction was removed (Baird 2015, p.169). It took until 2012 for Mifepristone to be approved by the Australian Federal Government as a commercial import, and it was not until 2013 that it became a listed subsidised medicine (Baird 2015).

Reproductive Healthcare and Rights in Queensland: A Complex Landscape

Reproductive healthcare in Queensland is shaped by a complex interplay of legal, ethical, and social factors. The state has seen significant changes, particularly in the areas of abortion rights, fertility treatments, and workplace reproductive rights. These issues reflect broader societal debates around personal autonomy, healthcare access, and the role of government in regulating reproductive choices. However, despite legislative progress, significant barriers remain, especially for those in rural and remote areas.

Decriminalisation of Abortion

In Queensland in 2018 a pivotal step occurred in recognising reproductive autonomy, aligning the state with the broader Australian movement to treat abortion as a healthcare issue rather than a criminal matter (Storry, 2018). While the legal framework shifted, practical access to abortion services remains uneven. Women in rural and remote areas face considerable obstacles, such as long distances to clinics, financial barriers, and a lack of available healthcare professionals (Sexual Health, 2022).

The Termination of Pregnancy in Queensland Post-Decriminalisation Study (2022) indicates that while decriminalisation aimed to improve access, stigma surrounding abortion remains a significant challenge. In smaller, more conservative communities, social pressures often prevent women from seeking services. According to Deveny (2023), these social and cultural factors, combined with logistical challenges, continue to hinder women’s access to reproductive health services.

Workplace Reproductive Rights

Workplace protections for pregnant employees have been a subject of continued evolution in Queensland. The state’s legislative changes concerning maternity leave, workplace discrimination, and the prevention of gender-based discrimination provide a more supportive framework for women. However, Deveny (2023) highlights that discrimination in the workplace remains a persistent issue, and women often face barriers to achieving full reproductive rights in the workplace, particularly in industries that are male-dominated or conservative.

The Queensland Government, under Premier David Crisafulli, has recently implemented a significant policy regarding abortion legislation. In December 2024, Premier Crisafulli introduced a parliamentary motion that effectively bans any changes to the state’s abortion laws until at least October 2028. This action was taken to uphold his election promise of no alterations to abortion laws and to prevent potential legislative challenges from within his own party. The motion passed despite opposition from the Labor Party, which voted against it, expressing frustration over the move (The Australian, 2024).

This policy has been met with criticism from various quarters. Opponents argue that it undermines the democratic process by restricting Members of Parliament from debating and introducing bills on the subject, thereby limiting legislative scrutiny and public discourse on reproductive rights (Courier-Mail, 2024).

Additionally, for a critical analysis of Premier Crisafulli’s decision to restrict parliamentary debate on abortion, you may find the article “The deeper issue behind Premier’s move to gag abortion” from The Courier-Mail insightful (Courier-Mail, 2024).

The decriminalisation of abortion in Queensland in 2018 marked a significant step in recognizing reproductive autonomy (Storry, 2018). However, practical access to abortion services remains uneven, with women in rural and remote areas facing considerable obstacles such as long distances, financial barriers, and a lack of healthcare professionals (Sexual Health, 2022).

Recent discussions in Queensland have also focused on the need for reproductive health leave to support women undergoing fertility treatments or coping with miscarriage (McKell Institute, 2024). The introduction of such leave would improve employee retention and reduce workplace discrimination, though it has not yet been widely implemented in Australia.

Regulation of IVF and Assisted Reproductive Technologies (ART)

In a related issue, the regulation of ART remains contentious in Queensland, particularly concerning ethical issues related to donor anonymity and the rights of donor-conceived children. The lack of a national donor registry has led to inconsistent standards and raised ethical questions about how embryos and donor information are handled (Messenger, 2024).

Global Influences and Local Impacts

Global trends in reproductive rights, such as the overturning of Roe v. Wade in the United States, have sparked concerns in Queensland about the potential erosion of local reproductive rights, especially in rural areas with entrenched conservative values (Murray, 2021). This highlights the need for continued vigilance in defending reproductive rights, both locally and globally (Clough, 2022).


International Implications: A Global Struggle

While the fight for reproductive rights is deeply embedded in Australia’s political landscape, the battle rages on beyond our borders, particularly in the United States. Under the current administration of Donald Trump, the reproductive rights of women have once again become a political battleground, mirroring the long history of male-driven control over women’s bodies.

In his first 100 days of a second term, Trump has enacted a series of controversial measures that significantly restrict access to reproductive healthcare. Among these, pardoning anti-abortion activists and reinstating the Mexico City Policy—which restricts foreign aid to organizations that provide or promote abortion—are just the beginning. These actions have ignited fierce opposition from reproductive rights groups who argue that such moves are an affront to women’s autonomy (Harrington, 2023; International Planned Parenthood Federation, 2023).

The administration’s decision to revoke policies supporting military travel for reproductive services and freeze critical funding for low-income patients, particularly affecting Title X clinics, reflects a deliberate rollback of essential healthcare provisions (Guttmacher Institute, 2023). Adding to the growing alarm, the Trump administration has been accused of failing to support families through comprehensive, family-friendly policies, while paradoxically championing pro-natalist stances (Smith, 2023).

Perhaps most concerning, however, is the increasing possibility of restrictions on abortion medications, such as mifepristone, which could have far-reaching consequences for women seeking access to safe and legal abortion care (American Medical Association, 2023). For many in the United States, these policies are a painful reminder of the historical attempts to control women’s reproductive choices. The echo of past struggles—of rights denied, and freedoms curbed—is unmistakable.

The response from American reproductive rights groups is growing louder, as they seek to not only protect access to healthcare but to remind the world of the consequences of turning back the clock on women’s bodily autonomy (Planned Parenthood, 2023). These developments serve as a stark reminder that the struggle for reproductive rights is ongoing, not just in the halls of power in Australia, but across the globe.


International Human Rights and the Struggle for Reproductive Rights

Beyond Debate: Reproductive Rights Are Human Rights

It is frankly incomprehensible that in the 21st century, women still have to fight for their reproductive rights. The fact that the United Nations had to establish a convention affirming these rights — as if women’s autonomy over their own bodies needed external validation — underscores how deeply ingrained patriarchal control remains. Under Article 12 of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW 1979), all State Parties, including the United States, Australia, and Argentina, are obligated to ensure women have access to health services, including those related to family planning, on the basis of equality.

In conclusion, the very existence of a United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) raises a confronting question: why was such a Convention even necessary? Are women not human? Shouldn’t their rights be inherently protected as human rights? The answer lies in centuries of systemic inequality and the ongoing disregard for women’s autonomy, dignity, and agency.

Even today, despite many nations ratifying CEDAW, its principles are too often ignored or selectively applied. Unfortunately, many political leaders and pro-life groups continue to undermine women’s rights, placing personal beliefs and ideological agendas above the basic rights to health, autonomy, and equality. These groups and individuals are not the ones who will endure pregnancy, give birth, or raise a child. While some men may contribute to these responsibilities, the physical, emotional, and social realities of these experiences overwhelmingly fall to women. Those who seek to control women’s reproductive choices — including decisions around accessing termination services — have no place dictating healthcare policy or harassing women at clinics. It is particularly reprehensible when those women being harassed may not even be attending for a termination.

These ongoing struggles — where women’s voices are disregarded, silenced, or treated as secondary — make it painfully clear that, despite what should be a simple truth, women’s rights are still viewed by many as negotiable. The very fact that we need a global framework like CEDAW to attempt to safeguard these rights is a stark reminder of how far we have yet to go. Until all women are treated as equal, autonomous human beings — with full control over their bodies, lives, and choices — the fight for equality and dignity remains not just necessary, but urgent.

However, the lived reality is one where women’s reproductive autonomy is continuously undermined and politicised by politicians in positions of patriarchal governance, alongside pro-life advocates who, while not making the political decisions, relentlessly harass women who choose to terminate a pregnancy. These politicians, who will never bear the physical, emotional, social, or financial consequences of pregnancy and childbirth, continue to make decisions on behalf of women — often based on the influence of votes from pro-life groups whose members stalk and harass women seeking services, regardless of whether they are attending a clinic for a termination or another medical reason. This persistent disregard for women’s right to choose and control their own reproductive health must be recognised for what it is: a denial of basic human rights.

Copyright C. O’Connor 1 May 2025.

ReproductiveRights #RoeVWade #Trump #Queensland #HealthcareAccess #SocialWork #MentalHealth #Counselling #GenderEquality #Crisafulli #Women’sRights


References

American Medical Association, 2023. Mifepristone Restrictions: The Impact on Women’s Health. [online] Available at: https://www.ama-assn.org/2023-mifepristone [Accessed 1 May 2025].

Baird, M. (2015) ‘Obstacles to abortion access in Australia: The case of Mifepristone’, Australian Health Review, 39(2), pp. 168-172.

Beisel, N., and Kay, A. (2004) ‘The social construction of abortion: Race, class, and the politics of women’s rights’, Gender and Society, 18(2), pp. 123-139.

Cherminsky, V. (2022) ‘The United States Supreme Court’s overturn of Roe v. Wade: A profound setback for women’s reproductive rights’, The Journal of Constitutional Law, 34(1), pp. 45-63.

Clough, M. (2022) ‘The end of Roe v. Wade: A world of reproductive injustice’, The Journal of Women’s Health, 31(1), pp. 156-162.

Ehrlich, J.S., (2018) ‘Abortion in America: The history of reproductive rights and their legislative battles’, Journal of Gender Studies, 29(2), pp. 180-195.

Espey, E., Dennis, A., and Landy, R. (2018) ‘Unprecedented attacks on reproductive health rights in the United States’, American Journal of Public Health, 108(1), pp. 67-72.

Goodwin, S. (2020) ‘The criminalization of reproductive autonomy: History and impact of anti-abortion legislation’, International Journal of Reproductive Rights, 5(1), pp. 112-118.

Ginsberg, A. (1985) ‘The impact of Roe v. Wade on the reproductive rights movement’, Reproductive Health Journal, 22(3), pp. 25-33.

Grossman, D., et al. (2014a) ‘The impact of restricted abortion access in Texas’, American Journal of Public Health, 104(3), pp. 466-472.

Grossman, D., et al. (2014b) ‘Effect of reduced abortion access in Texas: The influence of restrictions on reproductive healthcare’, Reproductive Health Matters, 22(44), pp. 78-85.

Guttmacher Institute, 2023. Title X Funding Cuts: The Effects on Reproductive Healthcare Access. Available at: https://www.guttmacher.org/2023-title-x-funding [Accessed 1 May 2025].

Guttmacher Institute, 2025. The first 100 days of the Trump-Vance administration: Attacks on reproductive freedom and scientific integrity. Available at: https://www.guttmacher.org/2025/04/first-100-days-trump-vance-administration-attacks-reproductive-freedom-and-scientific [Accessed 1 May 2025].

Harrington, J., 2023. Trump’s First 100 Days: A Retrospective on His Impact on Women’s Rights. The Atlantic. Available at: https://www.theatlantic.com/trump-100-days-womens-rights [Accessed 1 May 2025].

International Planned Parenthood Federation, 2023. Mexico City Policy: The Global Effects of Trump’s Abortion Restrictions. Available at: https://www.ippf.org/mexico-city-policy [Accessed 1 May 2025].

Joffe, C., Weitz, T., and Stacey, C. (2004) ‘Abortion access: The limits of legal reform’, Social Science & Medicine, 58(10), pp. 1991-2000.

Lewandowska, M. (2022) ‘The rise of reproductive injustice: A critique of Roe v. Wade’s overturn’, Global Feminist Review, 24(1), pp. 139-146.

Messenger, A. (2024). Queensland’s crackdown on IVF clinics fuels push for national donor registry. Center for Genetics and Society. Available at: https://www.geneticsandsociety.org/article/queenslands-crackdown-ivf-clinics-fuels-push-national-donor-registry [Accessed 1 May 2025].

Minkoff, H., Diaz-Tello, F., and Paulk, S. (2021) ‘Abortion laws: A global comparative analysis of reproductive health policies’, Journal of International Women’s Health, 38(2), pp. 210-220.

Murray, J. (2021) ‘The intersection of race, gender, and reproductive justice in 19th century America’, Women’s Studies Quarterly, 49(4), pp. 2030-2040.

Planned Parenthood, 2023. Reproductive Rights Under Attack: The Ongoing Fight for Autonomy. Available at: https://www.plannedparenthood.org/reproductive-rights-attack [Accessed 1 May 2025].

Roe v. Wade (1973) U.S. Supreme Court Case, 410 U.S. 113.

Siegal, R. (1992) ‘The erosion of abortion rights in America: The history and politics of anti-abortion movements’, American Political Science Review, 86(1), pp. 50-65.

Smith, D., 2023. Trump’s Pro-Natalist Agenda: The Contradiction in Family and Reproductive Policies. The New York Times. Available at: https://www.nytimes.com/2023/trump-pro-natalist [Accessed 1 May 2025].

Sutton, L. (2020) ‘Abortion law in Argentina: The fight for reproductive justice continues’, Journal of Latin American Politics, 41(2), pp. 1-8.

The Lancet (2022) ‘The implications of the end of Roe v. Wade for reproductive rights’, The Lancet, 399(10337), pp. 1609-1612.

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Critical Social Policy Analysis and its Potential for Social Justice

Copyright A. Lathouras, C. O’Connor and G. Frawley. Peer reviewed Journal Article first published in New Community, Vol.21 (3)(83), pp. 26-31. 2023.

Abstract: If critical community development is committed to the pursuit of social justice and human rights, then a structural analysis of the root causes of oppression should be foregrounded. This then informs citizen advocacy to work towards social change. Moreover, practice in communities is shaped by social policy as it impacts the welfare of a nation’s citizens. The laws of the land comprise mechanisms for distributing society’s resources, and social policy is underpinned by values, driven by political objectives, and maintained by discursive practices. Drawing on Carol Bacchi’s (2009) critical approach to social policy analysis, this article presents two case study stories where social work students applied a structural analysis to examine the effects of social policy on First Nations communities. This analysis complements a critical approach to community development practice and guides progressive action. 

Introduction

At the University of the Sunshine Coast (UniSC), all social work students complete the courses: Community Development and Social Action and Critical Social Policy Analysis. The first author teaches both, and where theory intersects, critical approaches to both practices are foregrounded. The community development course draws from ideas in the critical tradition as articulated by Margaret Ledwith (2011). This is where practice seeks to build social solidarity and provide a lens through which existing societal structures are examined, enabling more egalitarian, supportive, and sustainable alternatives. Drawing from the Freirean tradition of community education (Freire, 1970 & Freire, 1974), and as radical educators, practitioners facilitate processes that empower people to analyse their lived experiences and collectively act in the hope of transforming those experiences.

For the context of social policy analysis, we gain inspiration from Saul Alinsky’s seminal text Rules for Radicals (1971). Alinsky called for a “reformation”, the process where masses of people reach a point of disillusionment with past ways and values and then, together, organise, build power, and change the system from within (Alinsky 1971:114). Discussing the importance of social democratic reform through citizenship, Alinsky (1971:115) was “desperately concerned” that masses of people, through lack of interest or opportunity, are resigned to live lives determined by others. He argued that, 

The spirit of democracy is the idea of importance and worth in the individual, and faith in the kind of world where the individual can achieve as much of his (sic) potential as possible…. Separation of the people from the routine daily functions of citizenship is heartbreak in a democracy (Alinsky 1971:115).  

Active citizenship can be traced back to the ancient Greek concept of agora, a site of political assembly, an interface between the public and private spheres of social life. In contemporary times, community development can be seen as an expression of “the political and politicized assembly of an active citizenry in civil society”, or a form of politics whereby citizens participate in civil society through communicative action to directly socialise policy issues (Geoghegan & Powell 2009:431).

Critical Social Policy Analysis

In the coursework at UniSC, we draw on Carol Bacchi’s (2009) theory to directly socialise policy issues. In her “What’s the problem represented to be?” approach to critical social policy analysis, Bacchi’s central thesis is that policies give shape to “problems” in society. Government cannot get to work without first problematising its territory, assuming the existence of problems that need to be ‘fixed’. Problematising is how something is represented as ‘a problem’, and social policy reflects what government thinks needs to change. Drawing on post-structural theories, where language or discourses are full of ideology and beliefs, these speak to and uphold one’s ‘truth’. Bacchi (2009) posits these are contested with taken-for-granted assumptions or presuppositions and can be interrogated with other possible standpoints. 

Bacchi’s six-question framework helps us with the interrogation:

  • Q1. What’s ‘the problem’ represented to be, or what’s the ‘problem representation’? Social policy students are encouraged to think from the policy writer’s perspective about the purpose of a policy, its vision, mission, and objectives.
  • Q2. What presuppositions or assumptions underlie this representation of the problem? Students are encouraged to put themselves in the shoes of the government and interrogate this question bothappreciatively and critically. For example, most social policies have strong social democratic and neoliberal underpinning ideology and language.
  • Q3. How has this representation of the problem come about?
  • Here students are encouraged to research the history of a chosen policy area, not from a ‘version control’ perspective, but from the perspective of how society’s attitudes and values have changed over time. For example, in a few short decades, we have gone from separating from society and institutionalising people with chronic disability; to deinstitutionalisation processes in the 1980s with block funding to NGOs; to the current National Disability Insurance Scheme where many people are in control of their own funding packages.
  • Q4. What is left unproblematic in this problem representation? This is where students are encouraged to draw from contemporary grey literature, including peak body reports and submissions to make arguments about what is silenced by the problem representation, or the way government has framed the issue.
  • Q5. What effects are produced by this representation of the problem?
  • Drawing on 500 hours of field education experience, students use their practice wisdom to name the effect on the people or end-users of the policy, both service users and fellow practitioners.
  • Q6. How could the problem representation be questioned, disrupted, and replaced? Here the tutors use a range of creative teaching techniques to help students think outside the box, and about how we can transcend the most deleterious effects of a policy on end-users or practitioners.  

Employing “authentic” assessment processes, which reaffirm the role of higher education in contributing to social justice (McArthur, 2023), students do a simulated policy advocacy presentation and write a simulated policy reform submission to government about the specific policy they’ve researched. The course this year has provided a sense of purpose and social work activism to final year social work students, Cheryl and Grace, co-authors of this paper. Below, each tells their story of applying Bacchi’s framework to social policy impacting on First Nations peoples. 

Cheryl’s Story – Close the Gap

With a legal background and a passion for community development work, recently I investigated an environmental issue impacting Indigenous inequality in Australia. I focused on the Close the Gap (CTG) Implementation Plan 2023, specifically Outcome 1, “Aboriginal and Torres Strait Islander People enjoy long and healthy lives” and 9b, “Safe and reliable water for remote and regional First Nations Communities”. Under the recently elected Labor government, the 2023 version of the Close the Gap social policy seems collaborative with First Nations people, which is a significant improvement over past efforts by various governments. Since writing the 2005 Social Justice Report, Professor Tom Calma AO, argues progress has been made toward achieving health and life expectancy equality for Aboriginal and Torres Strait Island peoples (Australian Indigenous Health Info Net, nd). However, the 2020 Close the Gap report highlighted that:

  • The Indigenous child mortality rate was 141 per 100,000 which is twice that of non-Indigenous children (Australian Government, 2020b).
  • Life expectancy at birth was 71.6 years for Indigenous males and 75.6 years for Indigenous females. In comparison, the non-Indigenous life expectancy at birth was 80.2 years for males and 83.4 years for females (Australian Government, 2020c).
  • During 2015 and 2017 the lowest life expectancy occurred in the Northern Territory (66.6 years for males and 83.4 years for females) (Australian Government, 2020c).

Concerning Outcome 1 of the policy, one of the current commitments is the funding of 30 four-chair haemodialysis units and two dialysis treatment buses throughout Australia. Because of a 2022 report by Water Services Association of Australia (WSAA) which identified 500 Indigenous communities lacking drinkable water due to elevated levels of uranium, arsenic, fluoride, and nitrate above Australian drinking water guidelines, CTG’s Outcome 9b allocates $150 million to the National Water Grid Fund for targeting clean drinking water access in Australian rural and remote communities. The report also found that regular water quality testing in these communities does not occur (WSAA, 2022). 

Initially conducting research for an environmental issue concerning Indigenous Australians, I was able to tie the two outcomes together (1 and 9b), which in the reading of CTG policy, did not appear to be connected.  Outcome 1 was only addressing symptoms by providing more dialysis units, not mentioning, or looking at the probable causes of increasing numbers of chronic kidney disease (CKD).

My preliminary research found evidence highlighting the lack of safe, clean water in the remote Aboriginal community of Laramba, Northern Territory and how despite community efforts to eliminate what they suspected was contaminated water via a court case, there were no laws requiring landlords to provide safe water (ABC News 2022a). Subsequently, the community lost the case. Ultimately, it took 15 years from when concerns were first raised by the Laramba community regarding their water supply before the Northern Territory government constructed and opened a water filtration plant for the community in April 2023 (Northern Territory Government and Information Services, 2023).

The present Australian Drinking Water Guideline level for uranium is 0.02mg/l and current testing reveals that the uranium level in the Laramba water supply has now dropped from between 0.029mg/l – 0.055mg/l to 0.01mg/l (Northern Territory Government and Information Services, 2023) because of the new filtration system.

In the remote Aboriginal community of Kiwirrkurra, Western Australia, the dialysis clinic had to be closed for two years due to contaminated water, and community members needing lifesaving haemodialysis had to travel 800 kilometres for treatment (Purple House, nd; ABC News, 2022b). The Kiwirrkurra article led me to Purple House, a non-profit Indigenous-run health organisation based in Alice Springs that provides haemodialysis treatments in clinics and services remote areas by bus. I spoke with Mr Michael Smith, bio-medical engineer at Purple House, who had invented and won an award for developing a reverse osmosis filtration system that had enabled the Kiwirrkurra clinic to re-open. Even though the clinic had re-opened, the community still did not have safe drinking water and it was reported that 700 bottles of water were being shipped in each week, creating a mountain of rubbish (ABC News, 2022b).

I had several conversations with Mr Smith concerning water quality in remote areas, the high volume of clean water required for haemodialysis treatments and the links between rancid tasting water, the substitution of drinking water for sugary drinks, diabetes, and subsequently CKD. Based on information provided by Mr Smith it is estimated that one patient requiring haemodialysis (3 treatments lasting between 3 to 5 hours per week), requires a total of 70,200 litres of clean, safe water per year. We also discussed the cost of commissioning and installing 20 reverse osmosis filtration systems in the remote communities that Purple House services, so that haemodialysis treatments could occur effectively within communities without community members needing to relocate or travel long distances.

Further research into chronic kidney disease (CKD), revealed that concerns have been growing among healthcare providers, affected community members and leaders regarding the increasing cases of diabetes and CKD in remote Aboriginal communities for quite some time (Rajapakse et. al., 2019; Pan, Owen & Oddy, 2021; Australian Bureau of Statistics, 2019). It was revealed that CKD has a probable cause associated with unpalatable or contaminated groundwater (Rajapakse et.al., 2019). Sugar-sweetened beverages, when substituted for water in communities where the water is rancid and undrinkable, have proven to create obesity which then leads to diabetes, renal failure, and other health issues (Gajjala, 2015; Hormones Australia Endocrine Society of Australia, 2018; Pan, Owen & Oddy, 2021).

Moreover, diabetic nephropathy is the most common type of kidney disease found in pregnant women (Fischer, 2007). A study in 2015 revealed that pregnancy in those with kidney disease had 52 per cent increased odds of preterm delivery and 33 per cent increased odds of caesarean delivery (Kendrick et. al., 2015). Infants whose mothers had kidney disease had 71 per cent increased odds of needing admission to neonatal intensive care units or death, and kidney disease in mothers created a 2-fold increased odds of low birth weight (Rajapakse et al 2019). Maternal kidney disease substantially increases the incidence of “death, foetal prematurity, and low birth rate” (Fischer 2007, p. 135). The Australian Institute of Health and Wellbeing also state that 57 per cent of Indigenous infant deaths that occurred between 2015 and 2019 were due to prenatal conditions (Australian Government Institute of Health and Welfare, 2023).

By using Bacchi’s (2009) framework, I found a situation of symptoms only being addressed in the policy and no evidence that the government was linking the connection I could see between the lack of safe, clean water and the high rates of CKD occurring in Western Australia, where it is endemic (Rajapakse et al., 2019), and in the Northern Territory. The lack of clean, safe water in the remote communities of the two jurisdictions is not news to federal or state governments as there has been an ongoing health crisis due to unsafe water that multiple reports have brought to their attention over the years. Yet it is only now that the State and Federal Governments are beginning to address the water issues.

Employing Bacchi’s question six about how the problem representation could be questioned, disrupted, and replaced, I made two recommendations. The first was to invest $1 million of the $150 million currently allocated in Outcome 9b of the CTG policy, to the National Water Grid Fund to install reverse osmosis filtration systems at the 20 sites Purple House services. If enacted, this would ensure safe and reliable water for those remote First Nations communities. The second recommendation was to immediately commence water quality testing in the 500 communities the WSAA has identified as having undrinkable water. If enacted, this would provide both the State and Federal Governments with a priority list of communities where water treatment processing plants need to be constructed.

Grace’s Story – Domestic and Family Violence Prevention

The social policy I analysed was the Queensland Domestic and Family Violence Prevention Strategy 2016-2026. This prevention strategy provides a framework for government to act against domestic and family violence and has four subsequent action plans, with the most recent action plan addressing coercive control (Queensland Government, 2016). The reason I chose to analyse this policy is because the Queensland Government plans to legislate coercive control by the end of this year, therefore highlighting the need for a current structural analysis of the problem. The Strategy has a vision of creating a Queensland free from domestic and family violence. Specifically, an objective is to legislate and criminalise coercive control by the end of 2023 with the overall aim of eliminating domestic and family violence.

My research found that compared to men, women are three times more likely to experience domestic and family violence, with one woman being murdered every week by a partner (Our Watch, 2023). Moreover, First Nations women are disproportionately more likely to experience domestic and family violence and are eleven times more likely to be killed due to family violence compared to non-Indigenous women (Commonwealth of Australia, 2022).  

A key characteristic of intimate partner homicide is a relationship in which coercive control is used to isolate and control the woman by a range of mechanisms, most of which are invisible to the public (Boxall et al., 2022). Drawing on Bacchi’s question three, I understand that historically, Australia has had a culture deeply engrained with normalising violence against women and maintaining silence about what happens in the private realm (of the home) (Piper, 2019). This culture has normalised domestic and family violence, so much so one can buy a singlet called the ‘wife beater’. Radical feminist discourse suggests the root cause of women’s oppression is in patriarchal gender relations (Pilcher & Whelehan, 2017; Damant et al., 2008), and this informs my belief that in the private realm a woman’s life is where the relationship itself is used as a mechanism of subordination. Furthermore, I now recognise Australia as a patriarchal society that supports this dominant ideology which is used to sustain the isolation of women to the private realm by limiting their ability to participate in the community. This has created a cultural norm in which women stay home and raise children while male partners go out and work (Baxter, 2018). In some households, this can turn a relationship into one of dependency and subservience creating ideal conditions for coercive control to take place (Stark, 2012).

However, I identified that this gendered structural analysis of domestic and family violence does not consider the detrimental socio-economic and cultural impacts of colonisation on First Nations women, impacts that contribute to their experiences of domestic and family violence. These include intergenerational trauma, economic exclusion and dispossession of land and family (Australia’s National Research Organisation for Women’s Safety [ANROWS], 2023). Evidence suggests that 70% to 90% of First Nations women in prison have experienced domestic and family violence either as a child or an adult (Commonwealth of Australia, 2022). First Nations women are overly represented in the criminal justice system and are often misidentified as the person who uses violence (Commonwealth of Australia, 2022). Furthermore, retaliation for their own protection or the protection of their children or misidentification due to racial stereotypes often leads to co-responding protection orders being placed against the victim-survivor (Commonwealth of Australia, 2022). Therefore, the intersection between gender inequality and racial inequality highlights that domestic and family violence can be much more than a cultural issue (ANROWS, 2016). 

Drawing on Bacchi’s question four about what is left problematic with government’s framing of a policy issue, I identified that consultation with First Nations women on this issue and the legislation of coercive control is imperative for Government to understand how this could create further harm to First Nations communities if not properly implemented. The discourse used within the prevention strategy suggests that the behaviours around coercive control need to change. Although this creates an assumption that the community has a comprehensive understanding of coercive control and are therefore capable to commit to change. Additionally, the 2021 National Community Attitudes Towards Violence Against Women Survey shows that 41% of respondents believed that domestic and family violence is committed equally by men and women (ANROWS, 2021). This suggests that the community is still unaware of unequal gender relations and how this influences domestic and family violence.

Additionally, there is an assumption that the criminalisation of coercive control will address the help seeking behaviours of women experiencing domestic and family violence, although the evidence suggests that rates of help seeking are higher for women who experience coercive control as well as physical and/or sexual abuse, rather than just coercive control (Boxall & Morgan, 2021). Furthermore, it is evident that the current systems we have in place are inadequate to support victim-survivors, with service organisations and law enforcement already overrun and struggling to keep up with rates of domestic and family violence (Burt & Iorio, 2023). Our systems that support victim-survivors of domestic and family violence have been structured as crisis responses that offer immediate safety planning, accommodation, and case management. This support is happening after the violence has already occurred with most services meeting woman who are at ‘rock bottom’ and already in grave danger.

After I researched similar social policy in other countries, I discovered that although England and Wales criminalised coercive control in 2015 the understanding of what constitutes coercive control and the ability to recognise it is still unclear. This impacts the practices and responses of service delivery. Additionally, missed or under reporting of coercive control has led to inadequate assessments of risk, resulting in victims being overlooked and murdered (Robinson, Myhill & Wire, 2018). I believe, therefore, a robust approach to re-structuring and re-defining domestic and family violence is needed.

During my policy advocacy presentation and review submission, I made a recommendation to governments to establish a nationwide definition of coercive control enabling a shared understanding and an unambiguous approach to responding to coercive control. Defining coercive control will encompass all forms of nonphysical violence, and will provide law enforcement, the community, and legal systems with a clear definition to respond effectively and lessen the deleterious impacts of this issue facing First Nations women.  

Conclusion

Bacchi’s critical questioning framework for policy analysis draws on social construction theory, about what we take to be ‘fixed’ reality is actually contextual, historical and changing. It also draws on feminist body theory and acts as a counterbalance to focus on people’s perceptions, ensuring that lived experience receives due recognition. Grace and Cheryl’s stories of social policy analysis provide an excellent example of how practitioners could use the framework and work with communities to develop their own structural analysis about the root causes of ongoing disadvantage. The issues raised by them paint a damning picture of a vulnerable population group whose voices are not yet being given space at the policy-making table. 

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