O&G · Professional practice — equity, culture and communication
Cultural safety for culturally and linguistically diverse communities
Also known as CALD maternity care · Migrant women's health · Refugee maternity care · Asylum seeker women's health · Interpreter-mediated consultation · Inclusive maternity care · Cross-cultural obstetric care
Exam-exhaustive FRANZCOG professional reference on culturally safe care for migrant, refugee, asylum-seeking and other culturally and linguistically diverse communities: qualified interpreter use, trauma-informed maternity care, inclusive language, equitable service design, consent, screening, continuity and RANZCOG positions.
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8 MCQs with explanations
Target exams
Red flags
It is 02:00 in birth suite. A recently arrived Dari-speaking woman is 8 cm dilated. Her husband answers every question; an urgent caesarean may be needed. Everyone is kind, but kindness alone will not create valid consent. You need a qualified interpreter, direct communication with the woman, privacy, a trauma-informed examination and a plan that does not make her migration history the diagnosis.[5][12][12]
Cultural safety is an outcome, not a badge
The patient decides whether the encounter was culturally safe. Cultural awareness notices difference. Cultural sensitivity tries not to offend. Cultural competence builds knowledge and skills. Cultural humility adds lifelong self-critique. Cultural safety goes further: it asks whether power, racism and service design allowed the person to participate without losing identity, dignity or authority.[5][5][5]
Awareness
- I notice culture may matter
- Necessary but passive
- Does not test power or outcome
Competence
- I build communication and clinical skills
- Individual, organisational and systemic
- Can become a checklist if unreflective
Humility
- I examine my assumptions and limits
- Patient is the expert in their life
- Lifelong reflective practice
Safety
- The patient experiences respect and control
- Racism and inequity are addressed
- Services are accountable for outcomes
“CALD” can describe populations for service planning, but it is a poor bedside diagnosis. A Mandarin-speaking international student, a Rohingya refugee, a second-generation Lebanese Australian and a Māori woman living in Sydney do not share a single risk profile. Ask preferred language, identity, support people, priorities and barriers. Never infer them from appearance or surname.[5][5][9]
The consultation starts with ASK, not ASSUME
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Obstetrics & Gynaecology fellowship atlas.
References16Show ledgerHide ledger
- [5]Jameel A, Pope C, Hearn F, et al. Understanding equity-oriented maternity care for women of refugee background in high-income countries: a qualitative systematic review Int J Equity Health, 2026.PMID 42010559
- [6]Eslier M, Azria E, Chatzistergiou K, et al. Association between migration and severe maternal outcomes in high-income countries: Systematic review and meta-analysis PLoS Med, 2023.PMID 37347797
- [7]Yeshitila YG, Gold L, Abimanyi-Ochom J, et al. Effectiveness and cost-effectiveness of models of maternity care for women from migrant and refugee backgrounds in high-income countries: A systematic review Soc Sci Med, 2024.PMID 39186841
- [8]Khaw SM, Zahroh RI, O'Rourke K, et al. Community-based doulas for migrant and refugee women: a mixed-method systematic review and narrative synthesis BMJ Glob Health, 2022.PMID 35902203
- [9]Rogers HJ, Homer CSE, Henry A, et al. Perspectives of women from migrant and refugee backgrounds accessing the Cross Cultural Worker Service in maternity and early childhood services-a qualitative study Front Glob Womens Health, 2025.PMID 40115387
- [10]Dube M, Bromley A, Ireland S, et al. A better service promoting better experiences: Midwives' experiences working in a caseload service for women of refugee backgrounds Women Birth, 2025.PMID 40403604
- [11]Toke S, Correa-Velez I, Riggs E, et al. Exploring Trauma- and Violence-Informed Pregnancy Care for Karen Women of Refugee Background: A Community-Based Participatory Study Int J Environ Res Public Health, 2024.PMID 38541256
- [12]Lauridsen IG, Terkildsen MD, Sørensen K, et al. A systematic review of whether the number of linguistic errors in medical interpretation is associated with the use of professional vs ad hoc interpreters Arch Public Health, 2024.PMID 39696623
- [13]Diamond L, Izquierdo K, Canfield D, et al. A Systematic Review of the Impact of Patient-Physician Non-English Language Concordance on Quality of Care and Outcomes J Gen Intern Med, 2019.PMID 31147980
- [14]Luan-Erfe BM, Erfe JM, DeCaria B, et al. Limited English Proficiency and Perioperative Patient-Centered Outcomes: A Systematic Review Anesth Analg, 2023.PMID 36066429
- [15]Biggs LJ, Yelland J, Due C, et al. Conversations about stillbirth prevention during pregnancy care from the perspectives of recent parents of refugee and migrant backgrounds, health professionals, and interpreters: A qualitative study Womens Health (Lond), 2025.PMID 40878934
- [16]Hearn F, Brown SJ, Szwarc J, et al. Perceptions and Experiences of Inequity for Women of Refugee Background Having a Baby during the COVID-19 Pandemic in Melbourne, Australia Int J Environ Res Public Health, 2024.PMID 38673392
- [17]Royal Australian and New Zealand College of Obstetricians and Gynaecologists Cultural Competency (WPI 20) RANZCOG, 2018.Source
- [18]Royal Australian and New Zealand College of Obstetricians and Gynaecologists Cultural Safety Statement of Intent RANZCOG, 2023.Source
- [19]Royal Australian and New Zealand College of Obstetricians and Gynaecologists Health of women seeking asylum, refugees and women held in detention RANZCOG, 2016.Source
- [20]Royal Australian and New Zealand College of Obstetricians and Gynaecologists Consent and provision of information to patients regarding proposed treatment (C-Gen 2) RANZCOG, 2026.Source