FEATURE
REFUGEE RESETTLEMENT IN AOTEAROA NEW ZEALAND: GUIDE FOR COMMUNITYBASED MIDWIVES AND THE WIDER MATERNITY TEAM CLAIRE MACDONALD MIDWIFERY ADVISOR CAROL BARTLE POLICY ANALYST
The Ministry of Health first published a handbook for health professionals on refugee health care in 2002, designed to support those working in the field to provide culturally safe and effective care across a range of healthcare settings. The handbook was last updated in 2012, and since then Aotearoa has increased its refugee quota, expanding the number of resettlement locations from eight towns/cities to fourteen. Until now, midwifery care of former refugee women has largely been provided by DHB community midwives, but with the quota increase, more LMC midwives will also become involved. In 2020, the Ministry approached the College to research and develop a dedicated chapter about midwifery and maternity care for the 2021 handbook update. Each year, Aotearoa accepts and resettles refugees who have been referred by the UN Refugee Agency (UNHCR) and assessed as having met the appropriate criteria (Government of New Zealand 2018). Under the Refugee Convention, Aotearoa has an obligation to accept refugees, and the annual quota increased from 1,000 to 1,500 places in July 2020. In addition, a smaller number of asylum seekers arrive each year. The human rights of refugees are specified in the 1951 United Nations Convention Relating to the Status of Refugees (the Refugee Convention) and its 1967 protocol. The International Covenant on Civil and Political Rights (ICCPR) and the Convention Against Torture and Other Cruel, Inhumane or Degrading Treatment or Punishment 1984 (CAT) also contain provisions relevant to refugees and New Zealand has ratified all three treaties (Human Rights Commission, 2010). Once people are accepted into Aotearoa as refugees, they become residents and ultimately citizens. Because of their status as New Zealanders, the chapter refers, in most cases, to ‘former refugees’ rather than ‘refugees’.
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Our approach to this work was to consult closely with members of the former refugee community and share the development of the chapter as it came together. We undertook focus groups with former refugee women who had experiences of receiving and providing midwifery care in Aotearoa, and they provided feedback on the drafts. We were supported and advised by Sahra Ahmed, Refugee Health Nurse from Pegasus Health, as well as Isabella Smart, Midwife Manager at Counties Manukau Health, who provided valuable insight into the provision of midwifery care to women at Te Āhuru Mōwai by the community midwifery service. The College also engaged a peer reviewer: respected academic Dr Ruth De Souza, who has extensive experience in the areas of cultural safety, maternity, migration and health, and social inclusion. The chapter aims to provide useful information to midwives and other people who might be supporting women from refugee backgrounds. It explores the frameworks and principles for maternity care in Aotearoa as they apply to care for former refugees, follows the woman’s health care journey from offshore to Te Āhuru Mōwai (Mangere Refugee Resettlement Centre), and on to her resettlement region. It identifies the midwife’s role and the specific additional aspects of care and considerations for former refugee women, including interpreting services, clinical assessment, health promotion, cultural considerations and specific health issues. While the chapter is focused on maternity care for women from refugee and asylum seeker backgrounds, much of this information will also be relevant to women who have similar backgrounds to former refugees, for example family reunification migrants, as well as women from other migrant backgrounds and the wider maternity population. People have refugee status for two years after arrival in Aotearoa, during which time former refugees have the support of refugee resettlement services to facilitate their access to necessary services. For a pregnant woman arriving in Aotearoa on humanitarian grounds following forced migration as a refugee or asylum seeker, maternity care may be the first engagement with the health system in this country. Midwives understand that pregnancy involves significant changes in the lives of women and their families. The growth of a family can signal a new start in a new home for former refugees, but it may also involve the expression of physical, emotional or mental health difficulties reflecting the circumstances that led to the woman’s arrival in Aotearoa. Continuity of midwifery care provides an opportunity for the woman and her family to gain confidence, trust and self-efficacy through positive experiences of the health system in their new home country. All quota refugees spend time at Te Āhuru Mōwai in Mangere, Auckland, when they arrive in Aotearoa. A health check may have been undertaken offshore prior to arrival, but questions about pregnancy are limited to the estimated due date. A midwife from the Counties Manukau Health
