WWorking in community palliative care, I have the privilege of being welcomed into the lives of a wide range of families as they navigate the dying process. As a social worker, every time I enter a client’s home, I try to understand their worldview through the glare of blinding grief and often disenfranchised trauma.
Palliative care is not intended to prolong life, nor is it intended to hasten death. Specialist palliative care looks at a person with an incurable disease and recognizes that it is not entirely their diagnosis. Good palliative care supports a person physiologically, spiritually, psychologically and socially. By helping people achieve a greater quality of life beyond their illness, research has shown that the cohort referred to palliative care can actually live longer and happier than their initial prognosis might have suggested.
There is a certain group of cancers that are synonymous with the gender of a person who biologically carries breasts, a uterus, ovaries, fallopian tubes, a cervix and a vulva. In 2023 Breast malignancies were recorded as the leading cause of women-identifying cancers diagnosed in Australia. In the same year, it was estimated that ovarian and fallopian tube carcinomas accounted for approximately a quarter of gynecological cancers diagnosed in Australia, but almost half of recorded deaths. Such health data is still largely derived from the constructed gender binary of men and women, although we know that these diagnoses affect women as well as transgender men and non-binary people assigned female at birth.
Being a woman or identifying as a woman comes with a whole host of disadvantages that our male counterparts do not face to the same extent. Many women in Australia continue to live and die with unjustified and avoidable suffering. An essential but difficult part of identifying holistic care needs and advocating for women is recognizing the incomprehensibly higher prevalence of trauma that occurs in this group.
The systemic oppression perpetuated by a society must be highlighted to recognize that inequality is not created equally. The life expectancy of First Nations women remains eight years lower than that of non-Indigenous Australian women. The growing diagnosis of breast and gynecological cancers – with the latter seen in increasingly younger cohorts – is responsible for a persistent gap between knowledge and access to culturally safe healthcare. Barriers are also greater among women from culturally and linguistically diverse backgrounds, with new migrants and refugees finding that language and religious factors contribute to widening gaps in access to supportive and informed healthcare.
There is a growing social conversation about understanding the historical disenfranchisement of women’s pain and erasing such causes in our healthcare system. It’s a step in the right direction, although I wonder how long it will take before our systems allow women to unlearn the inherent gaslighting we’ve become accustomed to. Gynecology, as a privatized industry to avoid having to rely on a growing public health waiting list to be seen in hospital, is itself a barrier so financially impenetrable that it is no wonder women often ignore their needs postpone until the cancer crisis is over. already mutated. Minimizing our pain, our experience, is sometimes embedded in our unconscious response to it. It’s easier to stay quiet; it’s expected.
Something I hear in this cohort is how the experience of illness influences a sociocultural ideology of womanhood and its inimitable link to identity. What does it mean when the organs most involved in creating and sustaining life evolve into organs directly responsible for its antithesis? How a person perceives these parts of their body is uniquely personal. The way their own story is informed by society is often at odds with the reality of a body under duress.
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In the latest federal budgetthe government recognized the complex and systemic biases women face in healthcare. With more than $160 million invested in women’s health, our experience is finally being recognized. However, I wonder what narrative is embedded in our social conscience if approximately $105 million of that share is spent on maternal and reproductive health. We are certainly more than our womb.
I look forward to the day when our budget will fund health literacy, broader access to screening, culturally safe care and psychosocial support for all people adversely affected by their health and the systems designed to support them.
Death comes slowly and then quickly – as you see the wind change before you feel it. While it gives goosebumps over the ocean. While it confuses the treetops above your head. Perhaps it is the inevitable authenticity of this period that allows us to rewrite our own story. Look at our lives, all its wonders, all its pain, all its lessons, and make meaning out of it. See ourselves in a different light, from a different angle. The universal experience of women finding meaning in their bodies, their roles, their relationships, is sacred.
It is our responsibility as health care providers and as people to advocate for their experience, their life, their choice, their death. For those dealing with breast and gynecological cancer, and for the outliers. It is our responsibility as a society to view natural death as part of life, and not separate from it. While it’s always painful, sometimes it’s also a strange relief. A long exhalation. A love that changes.