PRESS RELEASE BY THE OFFICE OF THE PRESIDENT: Opening Speech by the President of Malta, Marie-Louise Coleiro Preca, during the Women Political Leaders Global Forum High-Level Meeting on Maternal Health and Refugee Women

“Maternal health is not simply a women’s issue it is an issue of fundamental human rights.”

It is my pleasure to address this meeting of the Women Political Leaders Global Forum, tackling issues of maternal health of migrant and refugee women.

This high-level meeting provides us with a unique opportunity. We will focus our discussions, on the difficulties faced by women who are pregnant, or raising newborn children; particularly, the added challenges, faced by women by displacement and migration.

The phenomenon of human movement has always been part of our global history. Today, more and more people are migrating to escape poverty or to flee conflict.

According to last year’s indicators from the UN General Assembly, women represent:

� almost half of the world’s 244 million migrants; and

� half of the 19.6 million refugees worldwide.

Reports from the United Nations Economic and Social Council tell us that:

� 60 percent of preventable maternal deaths take place in humanitarian settings; and

� at least 1 in 5 refugees or displaced women are estimated to have experienced sexual violence.

According to data from the Internal Displacement Monitoring Centre:

� women living in long-term displacement slightly outnumber men, and their hardships get worse over time.

For these reasons, it is unacceptable that the voices of refugee and migrant women, are rarely heard during the design or implementation of policies that should address their needs.

These indicators must make us more resolved to give visibility, to the plight of migrant and refugee women, in their essential needs.

We must continue to work together, to create opportunities, and to support all women, to take up active roles in decision-making.

We need women to be present, as essential stakeholders, in our efforts to achieve effective and sustainable responses, to global migration.

Undoubtedly, women’s participation is essential at all times and in all sectors.

This is further emphasised by the UN Committee on the Elimination of Discrimination Against Women, and I quote;

“To understand the specific ways in which women are impacted, female migration should be studied from the perspective of gender inequality, traditional female roles, a gendered labour market, the universal prevalence of gender-based violence, and the worldwide feminization of poverty and labour migration.” End quote.

Each of these issues can be best spoken about, by the people who are affected the most. In this case by migrant and refugee women themselves.

Therefore, we must call upon our authorities, and our policy makers, to place more focus on the intersectional forms of discrimination which refugee women often face, including, discrimination on the basis of ethnicity, of race, and of poverty.

Furthermore, legal and social barriers can prevent vulnerable women, from accessing essential health services. These obstacles are often compounded by a lack of sensitivity to differences of custom or culture.

A joint report on migrant women’s health, released last year by the European Commission and the World Health Organisation, states plainly, that, and I quote, “refugee women who are unable to speak the native language, or who come from less affluent parts of the world, are at an increased risk of higher maternal morbidities, mortality and poor perinatal outcomes.” End quote.

Therefore, it is imperative to create stronger synergies, between the relevant stakeholders involved in the care of pregnant women and their infants, and to value the voices of migrant and refugee women themselves.

In this way, we can create effective coordinated strategies, for the provision of the necessary care, for these women.

In this way, also, we can formulate, and implement higher levels of quality care, for the benefit of migrant and refugee women, their families, their communities, and our societies as a whole.

We must ensure that the safety and the dignity of migrant and refugee women are at the heart of all policies, which tackle issues of maternal health.

Our policies must reflect a united and unwavering commitment to universal human rights, which must be applied equally, and equitably, to all.

There is a clear need to safeguard all aspects of an expectant mother’s experience. This is especially necessary, because of the vast differences in approach and practice, which characterise the maternal health systems of our different countries. These differences are even present across the member states of the European Union.

Accessing effectively, maternal care is made all the more difficult for women migrants, refugees and asylum seekers. We must continuously remember that these women are also coping with the complex traumas of their horrific journeys.

Migrant and refugee women are dealing with the loss of their families and communities. Many are even struggling to overcome the effects of war, violence, torture, or rape.

The physiological, psychological, and social experiences of migrant and refugee women during pregnancy, must therefore, be addressed holistically. Their mental and emotional health must be an integral part of a united, powerful, and far-reaching approach to address the needs of maternal health of migrant and refugee women.

A briefing paper from the UK-based Race Equality Foundation, entitled “The Maternal Mental Health of Migrant Women”, makes it clear that issues of mental health among refugee women must receive more focus.

The report states, and I quote, “Existing mental health services may not provide appropriate support to migrant women. Tools which help to diagnose maternal mental health illnesses are often tailored to meet the needs of Western populations and are dependent on women self-reporting their symptoms to practitioners.” End quote.

Let me take one example of such symptoms. For example, the way postpartum depression manifests itself, can vary from culture to culture, and nation to nation.

The Race Equality Foundation’s report continues, and I quote, that “the risk of being stigmatised prevents [many] women from disclosing their real feelings to practitioners. Attitudes towards women’s mental health in some migrant communities were derogatory; women often believed if their mental health problems became public knowledge they would be exposed and stigmatised by families and communities.” End quote.

To help stimulate further thoughts for your deliberations during this conference, I would like to pose some questions:

What more can we do?

How can we ensure that paradigms of maternal healthcare become more inclusive?

How can we make such paradigms more accessible to the needs of migrant and refugee women, when they are still tailored for Western population?

How can we work together to prioritise the different social and cultural requirements presented by migrant and refugee women?

In what ways can we ensure that our nations are truly and effectively upholding the ideals of social justice and participative human rights?

How can we create a more equitable status quo, which is of benefit to all the members of our societies?

The practical barriers that prevent migrant and refugee mothers from accessing mental health service provision can include difficulties of language. A lack of social support and living in poverty or precarity, are factors which make such a situation of isolation and confusion even worse.

For this reason, while I agree that focusing on issues of language is vital, they are only one part of a more holistic approach. We must do more to understand the cultural complexities, which sometimes impede women from seeking professional help.

We must do more to investigate the needs of migrant, asylum seeking and refugee women, working hand-in-hand with these women themselves.

A 2010 study by the United Kingdom’s National Perinatal Mental Health Project noted that, service providers believed that they were ill-equipped to manage the range of diverse and complex needs of migrant and refugee women.

I believe that this level of complexity is still a major concern, as our different countries struggle, to find effective responses to the needs of an increasingly diverse population.

I truly believe that we must work together, in synergy with all stakeholders, to find a better understanding of cultural differences and attitudes towards maternal health.

While we must continue to promote programmes, that address practical barriers, focusing on issues like language or translation services, we need to place just as much emphasis, on the cultural factors, that can stop a woman accessing adequate health services.

Let me take this opportunity to commend the ongoing work of Malta’s Migrant Health Liaison Office in Primary Health Care. In particular, its focus on nurturing cultural sensitivities between service providers and service users.

For example, focus groups conducted with Somali and Ethiopian women in Malta, have explored the pressure that is placed by immediate family members on new mothers, to permit female genital cutting to be performed upon their daughters, at some stage during childhood.

The focus groups were assisted by a female cultural mediator, who engaged with the experiences of these women, sharing knowledge and moving forward together.

I hope that these efforts shall continue to bear fruit, and be paralleled by equally strong developments in other European countries, and around the world.

There is so much we can learn from one another, to further improve the wellbeing of our communities and our societies.

In conclusion,

� I believe that we must, first of all, commit ourselves to develop respectful policies, which target the diverse needs and requirements, of pregnant and postnatal migrant and refugee women, incredible and effective ways.

� Migrant and refugee women must be invited, to be at the table of discussion, so as to be active participants, in the development of such policies.

� Migrant and refugee women must be empowered to access services and treatments which are theirs, by right.

� A migration action plan of the European Union must embrace the issue of maternal health for migrant and refugee women.

� The European Union must have a harmonized set of policies.

� We must continue to create opportunities to share good practices.

� We must encourage more training on topics of cultural competence, offered to medical and allied health professionals, students, social workers, teachers, police personnel, and other stakeholders working with migrants and refugees, within the European Union, and across the world.

� We must invest in further research, to gain the necessary information about the particular needs of the migrant and refugee women population. In this way, we shall be in a better position to develop appropriate and culturally sensitive health care, while also supporting the maternal health practitioners in our countries to develop new skills.

� We must ensure that the intrinsic dignity, the fundamental human rights, and the holistic wellbeing of each and every woman, whether she is a migrant, an asylum seeker, a refugee, or not, is fully respected.

� Making motherhood safer for all women, for all families, and for all communities must be a top priority on the agenda of the international community.

Maternal health is not simply a women’s issue it is an issue of fundamental human rights.

Thank you and I look forward to learning the outcomes of your deliberations.

Source: Government of Malta