Researcher Highlights
Education is key to a better future for our most vulnerable women and children

Professor Elizabeth Sullivan is an international expert in maternal and justice health and an advocate for human rights for people in contact with the criminal justice system. She is a public health physician and champion for equity, diversity and inclusion in the education sector.

Professor Elizabeth Sullivan has committed her career to putting rare maternal conditions on Australia’s public health agenda.

For much of her career, her focus was on improving outcomes for women with rare and severe medical conditions during pregnancy, such as amniotic fluid embolism, rheumatic heart disease and cancer. Then one day, an image she saw on television shocked Professor Sullivan, prompting her to expand her approach to studying rare pregnancy conditions.

“On the news one night in the early 2000s, I saw footage of a woman manacled to a bed during labour. It was completely dehumanising and all I could think of was, why? And who in any likelihood was going to escape during labour?” Professor Sullivan asked.

“From that moment, I wanted to know the who, what, when, where, and why of pregnant and birthing women in prison. I saw this as a natural progression from my original research focus on rare pregnancy conditions, as I thought at the time pregnancy and mothering in prison were rare.”

Pregnancy and mothering in prison

Historically, Australia’s criminal system has largely overlooked the needs of incarcerated mothers, and attitudes towards mothering in prison have been steeped in prejudice.

“Too often women in prison aren’t perceived as mothers, but just as ‘people in gaol.”

Professor Sullivan has led a program of research on pregnancy and mothering in prison. One of her earlier collaborative studies with Aboriginal colleagues, named SCREAM, focused on investigating the social, emotional and physical wellbeing of Aboriginal mothers in prison. The project used a strengths-based approach and invited women to share their experiences and needs.

The study revealed “significant limitations to the ‘equal treatment’ principle for addressing the inequity of access to culturally safe health services for Aboriginal women in prison and outside”.¹ However, it also revealed women in prison were very resilient, yet, their voices and experiences were seldom heard nor given agency.

This research also found that “the cumulative impacts of intergenerational trauma and ongoing colonisation on Aboriginal mothers’ health and social and emotional wellbeing underlie incarceration and perpetuate intergenerational trauma” with more than 500 children directly impacted by the incarceration of mothers included in the study. ²

“The voices of participant women in SCREAM document their lived experience, highlight the impact of intergenerational trauma as a pipeline for contact with the criminal justice system and point to our failure as a society to care for children of incarcerated women.”³

Intergenerational incarceration is a major public health problem

The criminalisation of poverty remains a major public health problem in Australia. This phenomenon reflects systemic disadvantage, racism and marginalisation that is sustained across generations in Australia and globally.

In the Health Gap, Michael Marmot notes that – “the pollutant is not only poverty, but also social disadvantage”– and that – “health inequalities are perhaps the most damning indictments of social and economic inequalities”.⁴

A major outcome of the criminalisation of social disadvantage and poverty are the sequelae of intergenerational trauma and incarceration.

“Our recent in-depth snapshot of intergenerational incarceration in NSW was sobering in finding a high prevalence of intergenerational incarceration in NSW correctional settings, particularly for young people in juvenile detention centres and Aboriginal people in custody.”⁵

The incarceration of parents provides a perfect storm where criminogenic and health factors intersect to adversely impact their children. Professor Sullivan said this high prevalence of intergenerational incarceration observed in NSW reflected “our collective inability as a society to provide at a system level, community-based, integrated social, educational and health services to disrupt this pipeline.

“There remains an absence of targeted whole of government policy, services and investment in meeting the unique needs of children with incarcerated parents. This is unconscionable and starkly contrasts the almost $6 billion spent on corrective services in Australia in 2021-22.”⁶

Creating generational change and a better future

“Part of our research is about preventing the transmission of trauma that leads to high rates of contact with the criminal justice system and a cycle of incarceration.”

Supporting mothers both in and exiting prison has critical benefits for children. A whole of government approach is needed that meets the unique needs of children with incarcerated parents.

As Marmot states in the Health Gap “the best time to start addressing inequalities in health is with equity from the start”.⁴ This ties in with the ‘best interests of the child’ principle that is reflected in the United Nations Rules for the treatment of women prisoners and offenders (the ‘Bangkok Rules’).⁷ It is essential we adopt nationally a child rights-based framework to meet the needs of children of mothers in prison – that prioritises the best interests of the child at all stages. There needs to be much greater investment in prevention and alternatives to custodial sentences with greater accessibility to diversion programs,  particularly for pregnant women, mothers and young people.

My core belief is that the transformative nature of education is central to addressing inequity and inequality, and to restoring social justice and affecting intergenerational change.

As Pro Vice-Chancellor of the College of Health, Medicine and Wellbeing, Professor Sullivan provides executive leadership to the Schools of Medicine and Public Health; Biomedical Sciences and Pharmacy; Nursing and Midwifery; and Health Sciences and the Department of Rural Health.

“It is a privilege to work with my colleagues at the University of Newcastle, which prides itself on having a place for everyone and its commitment to equity, diversity and inclusion. I am very proud of our commitment to delivering a world-class education in health and medicine that is both student focused, and engages with our community, enabling us to graduate the future leaders and health and medical workforce for Australia and beyond.”

Intergenerational change is a philosophy that Elizabeth also applies in her academic life, as a frequently invited speaker on gender equity and healthcare, and as a sponsor, mentor and supervisor for the next generation of health practitioners and leaders, researchers and higher degree students who share her passion for breaking down systemic barriers to education and opportunity.

“I have a strong personal commitment to equity, diversity and inclusion, as demonstrated in my previous university leadership of Athena Swan. I believe it is an essential component of excellence in education, research and innovation in the workplace and for creating a diverse health workforce.”

At the College, we are committed to diversity and equity of access to our health and medical education. We are proud of our pathway initiatives to enable access to medicine through our Excellence through Equity Pathway and our longstanding Miroma Bunbilla Program pre-entry pathway for Aboriginal and Torres Strait Islanders. Diversity is key to excellence and innovation as is education to addressing disadvantage and social inequalities.

Through research, knowledge dissemination and leadership, Professor Sullivan is determined to affect lasting change. As part of that change, she established the first Doctoral Training Centre in Health, Justice and Communities in Australia dedicated to solving the wicked problems of the criminalisation of poverty and its sequelae.

“I want children to grow up with an expectation of university rather than prison. I strongly believe in the power of education to disrupt social inequity and to provide opportunity and possibility, and with that, autonomy and agency – whether that’s for a mother in prison, a young researcher or student – and to impact not only their own lives but the next generation too.”

References

1. Kendall S, Lighton S, Sherwood J, Baldry E, Sullivan EA. Incarcerated Aboriginal women's experiences of accessing healthcare and the limitations of the 'equal treatment' principle. Int J Equity Health 2020; 19(1): 48.
2. Sullivan EA, Kendall S, Chang S, et al. Aboriginal mothers in prison in Australia: a study of social, emotional and physical wellbeing. Aust N Z J Public Health 2019; 43(3): 241-7.
3. Lighton SL. Mothering and trauma: Lived experiences of Aboriginal mums in NSW prisons; 2021. https://opus.lib.uts.edu.au/handle/10453/150777 (accessed 10/01/24)
4. Marmot M. The health gap: the challenge of an unequal world. Lancet 2015; 386(10011): 2442-4.
5. Remond M, Zeki R, Austin K, Bowman J, Galouzis J, Stewart KA, Sullivan E. Intergenerational incarceration in New South Wales: Characteristics of people in prison experiencing parental imprisonment. Trends and Issues in Crime and Criminal Justice 2023; (662): 1-24.
6. Productivity Commission. Closing the Gap Information Repository. 2023. https://pc.gov.au/closing-the-gap-data (accessed 12/08/2023 2023).
7. UN General Assembly. United Nations Rules for the Treatment of Women Prisoners and Non-Custodial Measures for Women Offenders (the Bangkok Rules) : note / by the Secretariat, 6 October 2010, A/C.3/65/L.5.