Labor mobility in the Pacific: let’s talk about sex

Improving the wellbeing of people participating in the Pacific Australia Labour Mobility (PALM) program is a priority for the Australian Government. Despite this, significant barriers remain for PALM participants in accessing sexual and reproductive health (SRH) services and information, including support for survivors of sexual and gender-based violence (SGBV).

Based on our collective experiences as researchers, service providers and educators, this blog outlines what we consider to be the key issues related to the sexual and reproductive health and rights (SRHR) of PALM participants during their time in Australia, along with five recommended actions.

Firstly, it is important to recognise that in most PALM countries, SRHR is a sensitive and taboo topic. Cultural, social and religious norms play a significant role in accessing SRHR care and information. Once in Australia, PALM participants may face a number of SRHR challenges, as listed below.

Access to SRH services among PALM participants is often hampered by factors such as lack of information, stigma, fear of judgement, limited access to technology or digital literacy, along with concerns about cost, language, transportation and confidentiality, for example when using translators. These issues are compounded by geographical and social isolation and cultural barriers.

It is difficult to find information about which SRH services are covered by PALM health insurance, or which providers offer free or subsidized services. For example, it is unclear whether termination of pregnancy is covered, so it is not surprising that PALM participants who receive abortion care have varied experiences with regard to cost, care, and navigation of service pathways.

There is also inconsistency around insurance coverage for pregnancy and childbirth. We know of PALM participants who have given birth in Australia with all antenatal and obstetric costs covered by their health insurance, while others have paid thousands of dollars for hospital birth care. Some participants have even been told by their employers that they have no option but to return to their home country to give birth, despite having already served the 12-month waiting period for maternity care.

Power imbalances within the program, including the responsibility placed on approved employers to ensure the welfare and well-being of their workers, can place PALM participants in a particularly vulnerable position. In the absence of independent support mechanisms, PALM participants may have little choice but to disclose sensitive, private information to their employers, such as their pregnancy status. At the same time, participants who have experienced SGBV in Australia may be reluctant to report violence and seek support, particularly if they are unsure about their visa eligibility or are concerned about breaches of their safety and confidentiality.

Through our work, we have seen the physical, emotional, and financial impacts of these challenges on PALM participants. Unintended pregnancies, including those caused by rape, have forced some women participants to make seemingly impossible decisions, sometimes even hiding their pregnancies for fear of losing their jobs. In many cases, women are ostracized by their families and communities because of their pregnancies and do not know where to turn for help. When participants do seek pregnancy and abortion care, they are often faced with exorbitant medical bills, often leaving them financially vulnerable.

With this in mind, we make the following recommendations to the Australian Government.

First, engage Pacific civil society organizations in providing standardized, comprehensive SRHR information to participants prior to departure. The International Planned Parenthood Federation has eight member societies in Pacific PALM countries, several of which offer PALM participants in-country pre-departure briefings and SRH screenings. However, the pre-departure process can be overwhelming, leaving participants with little opportunity to seek advice on important health issues. Engaging local organizations in providing standardized, comprehensive SRHR information to those in the “worker ready pool” phase would facilitate conversations about SRHR in a culturally sensitive manner and provide a point of contact for participants upon their return home.

Second, expand the programming delivered by Australian health care providers and organizations to provide culturally relevant SRHR education to PALM participants in Australia. True Relationships and Reproductive Health currently offers on-site educational sessions for PALM participants covering SRHR and respectful relationships, delivered by bilingual health educators, in single-gender groups and in a culturally safe environment. To date, they have reached over 1,500 PALM participants in Queensland, New South Wales, Victoria and Tasmania – with 98.5% of participants agreeing or strongly agreeing that they understood the information better when it was delivered in their own language. While this is an impressive number, tens of thousands of PALM participants have not yet received this information (there are currently 34,230 participants in Australia and 21% are women).

Third, empower PALM-approved employers to better support their employees’ SRHR. Approved employers are required to provide PALM participants with information about local services upon arrival, including access to appropriate sexual health advice and local SRH services. However, there is a need for employers to be better equipped to support PALM participants in accessing services and information related to SRHR, including reproductive health and SGBV. This could include training, standardised resources and tools that better enable employers to understand SRHR issues and refer their employees to services and support.

Fourth, provide PALM participants with up-to-date, accessible information about available SRH services and insurance coverage during their stay in Australia. PALM participants need to know what services are covered by insurance in relation to sexual health, pregnancy, termination of pregnancy and childbirth, and where to access them. While the Australian Government has developed a range of resources to assist participants in seeking support and information (for example here and here ), these need to be better contextualised, with an emphasis on free or insurance-approved services in each state.

Fifth, increase safeguards, confidential welfare and support channels, and the capacity for PALM stakeholders to identify and respond to breaches of safeguards. Establishing an independent, confidential reporting mechanism is important to ensure that participants can report SGBV, sexual harassment, exploitation or bullying and seek support. This should include involving more Pacific Islander women in welfare and social support roles and establishing clear referral systems with approved service providers and crisis centres.

Australian Minister for Employment and Industrial Relations Tony Burke claims that the wellbeing of Pacific and Timorese people in the PALM program is paramount. Sexual and reproductive health and rights are critical to wellbeing, and the solutions are there for the Australian government to act on.

The authors would like to acknowledge the contributions of Dolores Devesi and Tina Peau. This blog links to ongoing research into safety and wellbeing and the PALM programme, including a 2023 ANU DPA report co-authored and subsequent research by Lindy Kanan, and a Masters thesis by Keely Moloney. This blog also reflects the experiences of SRHR service providers in the Pacific region engaging with PALM participants.

This topic will be discussed at the Pacific Migration Workshop hosted by the Development Policy Centre on 3 September. Register now to attend online or in person at ANU’s Crawford School of Public Policy.

Revelation

This research was supported by the Pacific Research Programwith funding from the Department of Foreign Affairs and Trade. The views expressed are those of the authors alone.