General Enquiries: rphcm@crana.org.au
Women’s checks can be embarrassing (shame) for many women. They may conflict with strong cultural beliefs for some Aboriginal women. Work quietly and patiently with women and your understanding of cultural issues will slowly improve. It takes time to build rapport, be patient while the women get to know and trust you. Be careful about confidentiality and privacy, and understand that many women will be very shy.
Women more likely to come in for a check if it is done in a culturally sensitive way, and they understand what it's for, why it’s important, and how it’s done.
Give basic information about women’s issues, and use appropriate visual resources to illustrate key points (eg videos and flip charts).
In traditional culture, the genitals were not just private, but sacred, and were not even looked at or touched by birth assistants. An Aboriginal woman may need to overcome embarrassment and cultural conflicts to come to the clinic for women’s health issues or tests that involve examination of the genitals. Cervical screening in particular can cause feelings of violation. Be sure to explain carefully what is involved and what they should expect, as a part of gaining informed consent.
Remember these difficulties exist for Aboriginal women, but don't be overwhelmed by potential problems. Western culture, health care, health promotion, and high rates of disease have changed some attitudes. Aboriginal women are concerned about preventing STIs, infertility, and cervical cancer. Senior women often encourage younger women to attend for contraception, cervical screening, STI checks, and antenatal care.
Talk with older women and ATSIHPs, ACWs or SWSBSC workers about the best ways to give information. One option may be to visit 'women’s meetings' held for other reasons. Women often come for checks after these meetings. Talk with individual women when they come to clinic. It is important that you work with a female ATSIHP, ACW or SWSBSC worker when giving this kind of information. Check with the woman and the ATSIHP/ACW/SWSBSC worker that you have an appropriate match, as cultural issues may limit who can work together.
When a woman is due for a check, an appropriate female practitioner should remind her. Take her aside, tell her about it in a private area, and try to make arrangements for the check. Respect the woman’s privacy. Don’t talk out loud about women’s business if there are other people around.
National cervical screening register will send reminders to the women on their list, but this may not be helpful for some women.
Women’s checks are private business. Encourage and support female ATSIHPs to do the checks if they are trained, but be aware that skin relationships, kinship (eg avoidance relationships), or age differences may limit the scope of their work. It is important to be guided by the practitioner about how much they can be involved. They will know if the woman will let her do or help with the check.
Use a private women’s room for the examination and discussion. Remember, the first check can take a long time to do properly. Use visual aids to make things clearer.
Involve a female ATSIHP if they are comfortable helping and the woman gives informed consent. Be careful to use a step-by-step process for gaining consent so you are sure that the woman has agreed to each part. For example, ask for consent to do the check, if the woman agrees then ask for consent to have a specific person help you. Be aware of the women's body language when she responds, to check that you have consent and not just a 'polite' agreement.
Some women can be so shy they can’t go on with the examination. Their behaviour or body language may show that they are uncomfortable with the procedure. Interpret this as not having consent to continue. Stop and quietly explain things again. If the woman is still unhappy or afraid — ask her to come back when she has had time to think about it. Sometimes, seeing her after hours may be appropriate.
General Enquiries: rphcm@crana.org.au