Growing Up Fast: the sexual and reproductive health of young women in a remote Indigenous township Susan McMullen Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy Charles Darwin University 2014 Declaration This is to certify that this thesis comprises only my original work towards the PhD, except where indicated and that due acknowledgment has been made in the text to all other materials used. This thesis is less than 100,000 words in length, excluding figures, tables and appendices. Susan McMullen 2015 Acknowledgements I am deeply indebted to the women of the Borroloola, both Indigenous and non- Indigenous who shared their stories, concerns, insights, aspirations and knowledge with me as well as helping me to understand their endeavours in their working lives. In particular I would like to thank Lizzie Hogan and the women, past and present, who worked at the Safe House during my stays in Borroloola, for giving me a place to base myself from, a verandah to sit on and many cups of tea to drink during the long hot days. Without the help of these women, Lizzie Hogan in particular, I would not have been able to interview many women, young and old, and would have found it very difficult to arrange for group interviews and focus groups. The Safe House also gave me a comfortable place to be and to interview groups of young women. I am also very grateful to the chief investigator of the “Our Lives” project, Associate professor Kate Senior, and all the people who worked on that project, for financial support with my Borroloola expenses and who offered me many and varying forms of encouragement, office assistance and even a lift from Borroloola to Darwin. I am also thankful to the ARC scholarship, which supported me financially while attempting this project. My grateful thanks also go out to my supervisors; Associate Professor Kate Senior, Professor Victoria Burbank and Dr. Richard Chenhall who pointed me in the right direction when I frequently got off track, attempted to teach me how to write academically and helped me to arrange my material into a more coherent whole. Abstract This thesis is a study of the sexual and reproductive health and decision making of young women in the Borroloola community, explored in the context of their daily lives, their cultural norms, and their expectations and aspirations. The primary ethnographic work in Borroloola was undertaken over six months between 2011 and 2013. Borroloola is a remote township on the south western side of the Gulf of Carpentaria in the Northern Territory and its long term residents are Indigenous people of the Mara, Yanula and Gawara tribes. My thesis is guided by the following questions: • has enforced social change, both historically and in the present, influenced and changed young Indigenous women’s expectations for the future? • how have community norms and expectations, growing out of historical and traditional influences, affected the lives and sexual health of young Indigenous women in the Borroloola community? • have the expectations and aspirations of young Indigenous girls influenced their choices in relationships and sexual decision making? • what health related, educational or community development based services do Indigenous women see as being relevant and useful? The attitudes and expectations of women, both old and young, in Borroloola are examined in the context of a long history of disadvantage over the last two hundred years, brought about by invasion, dispossession of land, introduction of alcohol and welfare, and the resulting collapse of traditional Indigenous ways of life. Many women in the community have become concerned about the plight of young women but the community has as yet no pathway to support norms relating to sexual behaviour that would encourage young people to make appropriate and healthy choices in sexual relations. The evidence shows that levels of sexually transmitted diseases and early adolescent pregnancy amongst young Indigenous women are significantly higher than for non- Indigenous Australians, and have long been a priority with many interventions addressing these issues (Stark 2007). Despite this focus, Indigenous young women continue to bear a significant burden of reproductive/sexual ill health. The literature surveyed demonstrates that young people’s sexual health is affected by their cultural and social circumstances and that intervention in these areas must take cultural and social circumstances into account for best outcomes (Carson, Dunbar, Chenhall, & Bailie, 2007). I demonstrate that young women in Borroloola are growing up fast, in terms of their sexual development and forming sexual relationships in their early adolescent years with a view to forming a family unit, in line with community expectations and norms. This can have significant impacts on their sexual and reproductive health, including a greater risk of contracting a sexually transmitted infection, and higher risk of underage pregnancy, and places them and their children at greater risk of experiencing negative long term outcomes. This also influences their developmental outcomes; they are sexually mature, but they disengage from education and often have minimal knowledge about life choices that are not linked to relationships and reproduction. The current strategies used to contain these risks include active surveillance to detect new cases, improved STI management, contact tracing, STI screenings, increased training of clinical staff, provision of good access to condoms, and health promotion (Stark & Hope 2007). In recognition of the continuing high rates of STIs and early pregnancies despite these strategies, the Northern Territory (NT) government initiated, and is committed to supporting research and implementing outcomes that may assist with the problem. This creates a challenge for current policy makers in the field of sexual health. Policy makers and educators need to make considerable effort to understand the lives of young Indigenous women in the context of their cultural norms and expectations, and design programs which would assist young women to overcome their disadvantage and their significant burden of reproductive/sexual ill health. These understandings along with the N.T. government’s commitment to implementing outcomes should increase the capacity of service providers to deliver effective services for these young women. Table of Contents Acronyms 10 Maps and Tables 11 Introduction 12 Growing up fast in Borroloola 13 Fast Life Strategies 17 Research Methods 18 Ethics and consent 23 Community involvement in the research 24 Constraints of the study 26 Chapter Outlines 27 Chapter One: The Context of the Study 30 Introduction 30 History of Borroloola 33 History of living places 38 Problem issues in Borroloola 40 Alcohol 40 Housing 46 Education 49 Employment 52 Violence 54 The Intervention and the Stronger Futures legislation 56 McArthur River Mines and its Trust 60 Summary 62 Chapter Two: The Daily Life of Young Women in Borroloola and Young Women in Numbulwar 64 Introduction 64 Pre European Contact 65 Borroloola girls in the 1960s 65 A Dying Shame - The grog years in Borroloola 68 Daily lives of young girls in Borroloola 2011-2013 71 ‘Poddy Girls’ 75 Numbulwar 2003-2007 78 Summary 79 Chapter Three: The Cultural Determinants of Young Women’s Sexual and Reproductive Health 81 Introduction 81 General remarks 81 Background to cultural determinants 82 Choices available for young women 84 Summary 95 Chapter Four: Social Determinants of Health and Access to Relevant Services 96 Introduction 96 Alcohol consumption 96 Ganja and other drugs 99 Family Violence 101 Health 105 Suicide 108 Gambling 110 Pornography 111 Access to global culture 112 Status in the community 113 Summary 115 Chapter Five: Boyfriends, Pregnancy, Partners and Children 116 Introduction 116 Boyfriends 116 Pregnancy 122 Marriage and Partners History of Indigenous Marriage 128 She all married up now - marriage in Borroloola 131 Babies and Children 133 Everybody knows 137 Summary 142 Chapter Six: Cultural Norms, Expectations and Aspirations 144 Introduction 144 My own expectations and aspirations 144 Expectations and aspirations of older women in Borroloola 148 Older women’s views on the expectations and aspirations of young women 158 Women in their 30s 159 Expectations and aspirations of young girls 161 Narratives 164 The Grandmother 165 The Mother 166 The Daughter 169 Discussion 170 Summary 171 Chapter Seven: Sexually Transmitted Infections and the Borroloola Context 173 Introduction 173 Cross cultural challenges 174 History of STIs in Indigenous Australia 177 STIs in the Indigenous population 179 The effects of sexually transmitted diseases 182 Issues contributing to prevalence of STIs in Indigenous populations 185 Policy, Practice and Action 192 Health promotion 197 What has been achieved so far? 202 Summary 203 Chapter Eight: Local Solutions, Government Interventions and Personal Responsibility 205 Introduction 205 Sexual health education 205 Health Services 208 Excessive use of Alcohol 211 Family violence 214 Social determinants 217 Education 218 Other Educational possibilities 220 Community responsibilities 220 Summary 222 Chapter Nine: Conclusions 223 References 231 APPENDIX 1 245 Acronyms ABC Australian Broadcasting Corporation ABS Australian Bureau of Statistics ACARA Australian Curriculum Assessment and Reporting Authority A & E Accident and Emergency AHW Aboriginal Health Worker AOD Alcohol and Other Drugs ARC Australian Research Council CDEP