“We are sacred”: An intercultural and multilingual approach to understanding reproductive health literacy for Yolŋu girls and women in remote Northern Australia

Abstract

Issue Addressed Indigenous women continue to experience reproductive health inequities. While enhancing health literacy is suggested as an approach for reducing disparities and increasing equity, there is a paucity of literature exploring Indigenous women's conceptualisation of reproductive health literacy. This paper demonstrates one approach to developing a reproductive health literacy framework for Yolŋu (Indigenous) women in a remote Northern Australian setting. Methods Using a decolonising participatory action research approach, a senior Yolŋu researcher led interviews, group story sharing sessions, historic site visits and on‐country cultural demonstration sessions with participants on reproductive health topics. Data were collected in the participants’ first language(s) and occasionally in English. Data were digitally recorded on camera, Dictaphone, video and in handwritten notes. The senior Yolŋu researcher worked with a Yolŋu interpreter to translate the data into English. Data underwent a progressive verbal relational content analysis to map and build a framework. Results A reproductive health literacy framework that privileges Yolŋu reproductive knowledge, practices and language was successfully co‐designed. The framework was embedded in the metaphor of Pandanus mat and uses key cultural domains of Yolŋu identity as a connecting foundation to women's reproductive knowledges and ceremonial milestones. Conclusions The framework offers a culturally responsive and multilingual approach to sensitively discuss and operationalise reproductive health literacy. The framework empowers Yolŋu cultural identities; accounts for both Yolŋu and Western medical knowledges; and honours participants’ requests for “Two‐Way” learning. So What? This research demonstrates an innovative approach to co‐designing a culturally responsive framework for reproductive health literacy in a complex and multilingual context. Such approaches offer a promising way forward for empowering Indigenous women to define reproductive health literacy and contribute to improving their reproductive health outcomes.

A Comprehensive Review of Optimal Approaches to Co-Design in Health with First Nations Australians

“…Ideally, co-design projects should arise organically from within the community, but successful co-design can also emerge from externally pre-determined projects on the conditions that the project still meets a community-identified priority and meets the needs of the local community, as established through iterative dialogue and consultation [ 65 , 68 , 87 , 88 ]. This process may be expedited by pre-existing relationships with the community [ 43 , 65 , 69 ].…”

“…Labels for these groups vary and should be tailored to the project, community, and the specific functions of the group. Examples include Indigenous Reference Group, community reference group [ 91 ], Project steering committee [ 92 ], community Backbone committee [ 88 ] and Knowledge Circle [ 49 ].…”

“…The co-design approach needs to use and prioritise First Nations Australians knowledges and epistemologies, through grounding the co-design project in First Nations Australians ways of being, doing, seeing, learning and knowing [ 31 , 35 , 37 , 42 , 44 , 49 , 50 , 61 , 62 , 66 , 72 , 73 , 74 , 80 , 81 , 82 , 85 , 88 , 89 , 91 , 95 , 102 , 104 , 105 , 106 , 107 , 108 , 109 ]. This is foundational to building inclusive partnerships, knowing how to work together and in building a shared understanding [ 42 , 61 , 72 , 73 , 74 , 89 , 104 , 106 , 110 ].…”

“…The grounding of the co-design project within a First Nations Australians worldview will ensure that Indigenous knowledge systems are respected, and the outcomes are culturally valid [ 74 , 104 , 117 ]. This approach requires the emancipation of the project from the dominance of Western and biomedical hegemony, instead recognising the importance and validity of First Nations Australians ways of knowing, being and doing [ 35 , 37 , 41 , 82 , 88 , 116 , 117 ].…”

“…Place-based approaches to co-design can also be useful in offering community members a framework to use local knowledge to drive place-based initiatives and ensure that programs and services are appropriate to the local context [ 31 , 50 , 52 , 57 , 61 , 62 , 113 ]. Place-based approaches are important in empowering communities to drive initiatives that they identify as important to meeting the needs of their community, as well as to break down fear and stigma of participating by engaging community, family and children in their own environment [ 32 , 85 , 88 , 120 ].…”