non-Indigenous Women Research Articles

Indigenous and Ecofeminist Reclamation and Renewal: The Ghost Dance in Silko’s Gardens in the Dunes

Early in the development of ecofeminist literary criticism, white feminists borrowed shallowly and unethically from Indigenous cultures. Using that underinformed discourse to interpret Native American women’s literature resulted in idealizing and silencing Indigenous women’s voices and concerns. Native American feminist literary critics have also asserted that a well-informed, inclusive “tribal-feminism” or Indigenous-feminist critical approach can be appropriate and productive, in that it focuses on unique and shared imbalances created by white patriarchal colonization, thinking, and ways of being that affect Indigenous and non-Indigenous women and cultures and the environment. In her third novel, Gardens in the Dunes, Leslie Marmon Silko interweaves an ecological critique of white imperialist botanical exploitation of landscapes and Indigenous peoples globally with both a celebration of Native American relationships to the land and Indigenous women’s resourceful resistance and an ecofeminist reclamation of European pagan/Great Goddess iconography, sacred landscapes, and white feminist autonomy. Expanding on earlier Indigenous-feminist readings, this ecofeminist analysis looks at a key trope in Gardens, the Ghost Dance, an environmentally and ancestrally focused nineteenth-century sacred resistance and reclamation rite. Silko’s is a late-twentieth-century literary adaptation/enactment in what is the continuing r/evolution of the Ghost Dance, a dynamic figure in Native American literature and culture.

Pregnancy and childbirth outcomes among indigenous adolescents in Guatemala: a cohort study

ObjectiveTo assess some characteristics and outcomes associated with pregnancy among Indigenous adolescents and compare them with other women who gave birth in a public hospital in Guatemala.MethodsWe conducted a retrospective cohort study of 8048 cases. Sociocultural variables, gynecological and obstetric history, childbirth, and perinatal outcomes were compared among women who gave birth at San Juan De Dios Hospital between January 2018 and June 2019. They were classified into four groups according to age and ethnicity. Indigenous adolescents (819/10.2%) were compared with Nonindigenous adolescents (813/10.1%), Indigenous adult women (3324/41.3%), and Nonindigenous adult women (3092/38.4%). Bivariate analysis and multiple logistic regression were applied.ResultsWe found that Indigenous adolescents who gave birth in the public hospital had fewer years of schooling than Nonindigenous adolescents (p < 0.001), Indigenous adults (p < 0.001), and Nonindigenous adults (p < 0.001). Indigenous adolescents were more likely to have an unplanned pregnancy than Nonindigenous adolescents (p = 0.038) and Nonindigenous adults (p < 0.001) and were more likely to be single (p < 0.001) and use less previous contraception than Indigenous and Nonindigenous adult women (p = 0.007 and p = 0.013, respectively). More than one-third of Indigenous adolescents and adults did not attend antenatal care; Indigenous adolescents had fewer antenatal care visits than Nonindigenous adults (p < 0.001), and the results were borderline in comparison to Nonindigenous adolescents (p = 0.051). Indigenous and Nonindigenous adult women underwent episiotomy less often than Indigenous adolescents (OR: 0.60 [95% CI 0.49–0.74] and OR: 0.56 [95% CI 0.45–0.70], respectively) and received less local anesthesia than Indigenous adolescents (OR: 0.59 [95% CI 0.46–0.76] and OR: 0.77 [95% CI 0.60–0.99], respectively). Nonindigenous adults received more analgesia than Indigenous adolescents (OR: 1.36 [95% CI 1.07–1.73]). Nonindigenous adolescents had more newborns with low birth weight than Indigenous adolescents (OR: 1.44 [95% CI 1.10–1.87]).ConclusionIndigenous adolescents who gave birth in a public hospital in Guatemala were more likely to be single during pregnancy and attend fewer years of school than Nonindigenous adolescents. Unplanned pregnancies were more common among Indigenous adolescents, and some of them underwent not recommended obstetric practices during childbirth, such as episiotomy. Police should be enforced ensuring equal opportunities for different ethnic and age groups regarding pregnancy.

From Childhood System Contact to Adult Criminal Conviction: Investigating Intersectional Inequalities using Queensland Administrative Data

It is well known that youth justice contact is associated with criminal conviction in adulthood. What is less well understood is whether ‘cross-over’ children, who have contact with both child welfare and youth justice systems, experience relatively worse outcomes and, if so, whether these outcomes vary by important demographic factors, such as sex and race. Criminal careers scholars have examined patterns of adult convictions for different groups, but attempts to understand intersectional variation in these outcomes have been constrained by limitations of standard statistical analysis. Using administrative data from the Queensland Cross-sector Research Collaboration, we adopt a flexible regression model specification to explore the cumulative effects of both child welfare and youth justice contact on adult conviction trajectories, and how these associations vary by sex and Indigenous status. We find clear evidence across all demographic groups that contact with both justice and welfare systems in childhood is associated with increased likelihood and severity of conviction trajectories in adulthood. The cumulative effect of cross-over status results in greater equity of negative outcomes across groups, although the conviction profile is worst for Indigenous men. Evidence of an additional inequality is present only for non-Indigenous women, who have the lowest likelihood of conviction overall. We conclude that while cross-over children are at elevated risk of conviction in adulthood, the nature and seriousness of their conviction pathways is conditional on pre-existing intersectional inequalities. The model specification used is a promising method by which to explore the existence of such inequalities.

Breast Cancer Among Indigenous and Non-Indigenous Women at the Mexican Teachers' Cohort

PURPOSE Hispanics and Indigenous women are underrepresented in cancer research. We aimed to estimate the incidence of breast cancer (BC) among indigenous and non-indigenous women and describe reproductive and lifestyle risk factors. METHODS The baseline questionnaire was completed by 115,307 women (2006-2008). Indigenous ancestry was defined by self-adscription and/or speaking an indigenous language. Incident BC-cases were confirmed using self-reports, administrative and clinical databases, cancer registries, and death certificates. We calculated person-years from the baseline questionnaire to the date of diagnosis, death, or the end of follow-up (December 31, 2019). We age-standardized reproductive and lifestyle information. RESULTS After a median follow-up of 10.8 years, we confirmed 1,212 BC-cases. The crude incidence rate per 100,000 person-years was 55 for indigenous and 95 for non-indigenous women; the mean age at diagnosis was 48.2 and 50.8, respectively. In indigenous BC-cases, early menarche (11.9 v 26.7%), first pregnancy &gt; 25 years (36.8% v 51.7%), and nulliparity (11.7% v 14.1%) were less frequent compared to non-indigenous. The number of children (3.0 v 2.6) and breastfeeding &gt; 12 months (71.6% v 45.2%) were higher among indigenous. Indigenous had earlier menopause (44.8 v 47.5 years) and more premenopausal-BC (27.8% v 25.1%). Oral contraceptives use (42.6% v 48.0%), hormone-replacement therapy (12.4% v 24.6%), family history of BC (11.9% v 15.1%) and benign breast-disease (17.8% v 23.0%) were less frequent in indigenous cases. Physical activity (&gt; 150 min/week) was higher in indigenous women (34.3% v 27.8%). Smoking (6.6% v 11.2%) and alcohol consumption (47.9% v 61.3%) were lower in indigenous women; however, they had more diabetes (14.6% v 6.0%) and were at the highest tertile of the dietary glycemic index (40.2% v 35.0%). CONCLUSION In the MTC, BC-incidence in indigenous women is lower than in non-indigenous; this might be explained by a lower prevalence of hormonal and reproductive risk factors and higher physical activity among indigenous women.

Inequities in maternal stressful life events between Indigenous and non-Indigenous women – evidence from a prospective cohort study in New Zealand

ABSTRACT Experiences of major, stressful life events (SLE) prior to and during pregnancy, and in early childhood, are associated with a range of adverse outcomes that disproportionately impact Indigenous women and their families. However, little is known about Indigenous women's experiences of SLE . The aim of this study was to investigate: (1) inequities in the prevalence and patterning of SLE between Indigenous and non-Indigenous mothers over time, and; (2) associations between maternal SLE and ethnicity, age, socioeconomic deprivation and time. Data were from the Moe Kura prospective cohort study of 418 Indigenous Māori and 768 non-Māori women in New Zealand. Questionnaires were completed at 35–37 weeks gestation, 12-weeks postpartum, and when their child was 3–4 years of age. The prevalence of five SLE domains was estimated by ethnicity. Generalised linear mixed effects models examined associations between SLE domains and ethnicity, age, socioeconomic deprivation, and time. The prevalence of SLE was greater for Māori than non-Māori at each time point. The probability of reporting SLE increased as neighbourhood deprivation worsened. The probability of reporting SLE reduced with older age, although changes in the estimates were greater for non-Māori than Māori women. Findings show that Indigenous women experience persistent and significant inequities in SLE. Younger maternal age and greater socioeconomic deprivation explain some but not all of the inequities observed. Policies and interventions to address how colonialism and racism structure experiences of SLE for Indigenous women, including via socioeconomic deprivation, are required.

Modos imaginativos e colaborativos de fazer pesquisa: dispositivos e disposições com cuidado

Abstract This article is focused on methodological aspects impplied in a research on the responses of indigenous peoples to COVID-19 conducted by a network of indigenous and non-indigenous women researchers in different Brazilian states. We seek to share experiences and reflections on the limits and potentialities of a research carried out in the pandemic and with the pandemic, since the sickeness felt in the bodies and collective life of the researchers was an unavoidable agent in the methodological and analytical parcourses, in dialogue with feminist debates on the theme of care.

Caring for Pregnant Women with Rheumatic Heart Disease: A Qualitative Study of Health Service Provider Perspectives.

Background:Rheumatic heart disease (RHD) persists in low-middle-income countries and in high-income countries where there are health inequities. RHD in pregnancy (RHD-P) is associated with poorer maternal and perinatal outcomes. Our study examines models of care for women with RHD-P from the perspectives of health care providers.Methods:A descriptive qualitative study exploring Australian health professionals’ perspectives of care pathways for women with RHD-P. Thematic analysis of semi-structured interviews with nineteen participants from maternal health and other clinical and non-clinical domains related to RHD-P.Results:A constellation of factors challenged the provision of integrated women-centred care, related to health systems, workforces and culture. Themes that impacted on the provision of quality woman-centred care included conduits of care – helping to break down silos of information, processes and access; ‘layers on layers’ – reflecting the complexity of care issues; and shared understandings – factors that contributed to improved understandings of disease and informed decision-making.Conclusions:Pregnancy for women with RHD provides an opportunity to strengthen health system responses, improve care pathways and address whole-of-life health. To respond effectively, structural and cultural changes are required including enhanced investment in education and capacity building – particularly in maternal health – to support a better informed and skilled workforce. Aboriginal Mothers and Babies programs provide useful exemplars to guide respectful effective models of care for women with RHD, with relevance for non-Indigenous women in high-risk RHD communities.For key goals to be met in the context of RHD, maternal health must be better integrated into RHD strategies and RHD better addressed in maternal health.

Ethnic inequalities in health intervention coverage among Mexican women at the individual and municipality levels.

BackgroundUsing data from Mexico, the country with the largest indigenous population in Latin America, we describe ethnic inequalities in coverage with women's health interventions at individual and municipal levels.MethodsCross-sectional study using data from the National Health and Nutrition Survey 2018 and the Mexican Intercensal Survey 2015. We selected five outcomes: modern contraceptive use, content-qualified antenatal care (ANCq), and skilled birth attendant (SBA) for women aged 15–49 years; Pap smear test and mammogram among women aged 25-64 and 40-69 years respectively. Municipalities were classified into three groups by the percentage of indigenous population: <10%, 10% – 39%, and ≥40%. We calculated crude and adjusted coverage ratios (CR) and 95% confidence intervals (CI) using Poisson regression.FindingsWomen living in municipalities with indigenous population ≥40% were poorer, less educated, and more rural. Coverage was lower for indigenous than non-indigenous for modern contraceptive use (CR: 0·73; CI 0·65-0·83), ANCq (CR: 0·72; CI 0·62-0·83), SBA (CR: 0·83; CI 0·77-0·90) and undergoing a mammogram (CR: 0·54; CI 0·41-0·71), but not for Pap smears (CR: 0·94; CI 0·83-1·07). Coverage with the five interventions increased as the municipal proportions of indigenous population decreased, both for indigenous and non-indigenous women. Coverage gaps at municipal level tended to be wider than at individual level.InterpretationBoth indigenous and non-indigenous women living in municipalities with high proportions of indigenous people were systematically excluded from reproductive and maternal interventions. Our findings suggest that social and health interventions targeted at the individual level should be complemented by structural interventions in municipalities with high proportions of indigenous people, including strengthening health and social services.

“Parir no es un asunto de etnia, es un asunto de humanidad”: experiencias frente a la violencia obstétrica durante la atención al parto en mujeres indígenas

This study aims to understand the experiences of obstetric violence experienced by Embera women during childbirth at healthcare facilities in the city of Medellin, Colombia. Employing a qualitative, ethnographic approach, semi-structured interviews were conducted with nine indigenous Embera women between February and March of 2020. The data indicate these women, members of the largest indigenous community in Medellín, experience similar forms of obstetric violence to non-indigenous women, which might be explained by the authoritarian medical habitus and a health system that prioritizes market forces. However, the data also reveal that indigenous women experience a specific form of this phenomenon: a lack of respect or cultural sensitivity, stemming from the process of colonialism to which indigenous peoples have been subjected. This dynamic continues to be expressed during delivery in healthcare childbirth settings via ignorance and disregard for indigenous ancestral knowledge, which can be understood as microaggressions that occur frequently but are difficult to identify.

Echocardiography indices in urbanized representatives of the Shor ethnic group with the presence of arterial hypertension

Abstract In patients with arterial hypertension, the detection of left ventricular hypertrophy has important clinical and prognostic significance. The use of published regulatory “control limits” remains limited and cannot be extended to other racial and ethnic groups. The aim of this study was to compare echocardiography indicators in patients with arterial hypertension from two ethnic groups living in the Gornaya Shoria region. Methods The study included patients with arterial hypertension: 58 indigenous and 50 non-indigenous urbanized residents, comparable in age, and divided by ethnicity and gender into 4 groups: men of indigenous nationality (n=20), women of indigenous nationality (n=38), men of non-indigenous nationality (n=15) and women of non-indigenous nationality (n=35). All of them underwent echocardiographic examination. Results The body weight and BSA were lower in men and women of Shor ethnicity than in men and women of non-indigenous ethnicity (p=0.0014 and p=0.004). LAi was significantly larger in men of Shor nationality (p=0.049), at the same time, the size of their RA was the smallest (p=0.04). The data of the longitudinal LV systolic function in the form of a systolic excursion of the septum (s'sept) were the highest in Shor men (p=0.004), and the LV performance index was the lowest in them (p=0.012). Also in this group, the minimum isovolumic relaxation time (p=0.03) and the highest rate of early diastolic filling of the LV (p=0.04) were noted. When assessing correlations independent factors associated with pronounced LVH were glucose, DBP, and urea in Shor patients. Non-indigenous nationality independent factors associated with pronounced LVH were waist circumference and DBP. Conclusion Echocardiographic examination of patients with hypertension revealed the features of structural and functional indicators in the representatives of the indigenous urbanized population of the Mountain Shoria in comparison with the representatives of the non-indigenous population. This study can be useful in assessing the impact of the development of arterial hypertension, as well as the impact of changing the lifestyle of the Shors when moving to the city from rural areas on ethnic differences in echocardiography. Funding Acknowledgement Type of funding sources: None.

Inequitable use of health services for Indigenous mothers who experience stillbirth in Australia.

The purpose of this study was to identify differences in health service expenditure on Indigenous and non-Indigenous women who experience a stillbirth, women's out-of-pocket costs, and health service use. The project used a whole-of-population linked data set called "Maternity1000," which includes all women who gave birth in Queensland, Australia, between July 1, 2012, and June 30, 2018 (n=396158). Multivariable analysis was undertaken to assess differences in mean health service expenditure; and number of health care services accessed between Indigenous and non-Indigenous women who had a stillbirth from birth to twelve months postpartum. Costs are presented in 2019/20 Australian dollars. There was a total of 1864 babies stillborn to women in Queensland between July 1, 2012, and June 30, 2018, with 135 being born to Indigenous women and 1729 born to non-Indigenous women. There was significantly lower total expenditure per woman for Indigenous women compared with non-Indigenous women ($16083 and $18811, respectively). This was consistent across public hospital inpatient ($12564 compared with $14075), outpatient ($1127 compared with $1470), community-based services ($198 compared with $313), pharmaceuticals ($8 compared with $22), private hospital ($434 compared with $1265), and for individual out-of-pocket fees ($21 compared with $86). Mean expenditure on emergency department services per woman was higher for Indigenous women compared with non-Indigenous women ($947 compared with $643). Indigenous women who experienced a stillbirth accessed fewer general practitioners, allied health, specialist, obstetrics, and outpatient services, and fewer pathology and diagnostic test than their non-Indigenous counterparts. Inequities in access to health services exist between Indigenous and non-Indigenous women who experience a stillbirth.

Neonatal death is a major concern for Indigenous women with asthma during pregnancy and could be prevented with better models of care.

Asthma is the most common respiratory illness in Aboriginal and Torres Strait Islander Australians. From the Mater Mothers routinely collected perinatal data in Brisbane we have identified that 24% of Indigenous and 17% of non-Indigenous women have pregnancies complicated by asthma. Indigenous women with asthma are more likely to have poorer birth outcomes when compared to non-Indigenous women with asthma, with neonatal death being doubled in asthmatic Indigenous women. These data indicate that asthma management during pregnancy is an unmet need for Indigenous women and essential if we are to avoid these devastating outcomes for Indigenous families.

Public health insurance and ethnic disparities in maternal health care: the case of vulnerable Mexican women over the last 25 years.

This article examines the coverage in the continuum of antenatal-postnatal care for vulnerable women in Mexico according to indigenous status and assesses the influence of public health insurance strategies on the evolution of coverage over the last 25 years. We studied a total of 19 613 567 Mexican women, aged 12-54 years at last birth, based on a pooled cross-sectional analysis of data from the 1997, 2009, 2014 and 2018 waves of the National Survey of Demographic Dynamics. After describing sociodemographic characteristics and maternal-health coverage by indigenous status, we constructed a pooled fixed-effects and interaction multivariable regression model to assess the influence of the Seguro Popular programme on continuum of care. We estimated adjusted continuum of care coverage between 1994 and 2018 according to Seguro Popular affiliation and indigenous status. Prior to the Seguro Popular programme, crude coverage in the continuum of care for non-indigenous women stood at 14.5% [95% confidence interval (CI): 13.2-15.8%] or 11 percentage points higher than for indigenous women. During the last period of the programme, it rose to 46.5% [95% CI: 45.6-47.5%] and 34.1% [95% CI: 30.7-37.4%], respectively. Our regression analysis corroborated findings that, on average, indigenous women faced lower odds of benefiting from continuum of care [adjusted odds ratio (aOR) = 0.48, 95% CI: 0.40-0.57] than did their non-indigenous counterparts. It also revealed that coverage for indigenous women without Seguro Popular affiliation was 26.7% [95% CI: 23.3-30.1%] or 12 percentage points lower than for those with Seguro Popular affiliation (38.6%, 95% CI: 35.7-41.4%). Our regression results confirmed that the latter benefited from higher odds of continuum of care (aOR = 1.67, 95% CI: 1.36-2.26). Gaps between those of indigenous and non-indigenous status have persisted, but the Seguro Popular clearly contributed to reducing the coverage gaps between these two groups of women. Strategies yielding better outcomes are required to improve the structural conditions of indigenous populations.

Diertary Intake of Micronutrients in Non-Indigenous Womens in the Cities of Khanty-Mansiysk and Salekhard

Introduction: Healthy nutrition is an important determinant of physical and mental wellbeing. A significant amount of evidence has been accumulated on the effect of nutrition on health promotion, disease prevention, resiliance to unfavorable climatic factors, longevity and life quality. Insufficient intake of micronutrients is often combined with an excess intake of macronutrients, particularly fats and simple carbohydrates increasling the risk of developing chronic diseases. Nutrition of women is of particular importantce not only for the present, but also for future generations. Aim: To assess dietary intake of vitamins A, C, E, D and trace elements, such asFe, Mn, Ca, Mg, Cu, Zn and Se in women of fertile age in Khanty-Mansiysk and Salekhard, North-Eastern Siberia. Methods: A cross-sectional study. A total of 137 non-indigenous women aged 18-44 years living in Khanty-Mansiysk (n = 75) and Salekhard (n = 62) participated in a cross-sectional dietary survey. A 3-day diet was assessed by a questionnaire and the ASPON-nutrition software. Dietary intake of the abovementioned vitamins and nutrients were compared with the naitonal recommended daily amounts (RDA). Results: No statistically significant differences in the intake of vitamines and nutrients were observed between the two settings. Women from the Northen city of Salekhard had insufficient intake of Ca, Mg, Cu, Zn (70-89 % RDA) and Se in partlicular (49 % RDA). They also consumed insufficient amounts ofvitamins E (82-87 % RDA), C (62-73 % RDA) D ( 54-55 % RDA). We also oserved excess intake of vitamin A (111-115 % RDA). Conclusion: A substantial proportion of fertile-age women in North-Eastern Siberia have insufficient intake of vitamines C, E and D as well as Ca, Mg, Cu, Zn and Se warranting development of public health programms including activities to promote dietary supplements and food fortification to improve nutrition of residents in general and women in particular in North-Eastern Siberia.

Gestational diabetes is associated with postpartum hemorrhage in Indigenous Australian women in the PANDORA study: A prospective cohort.

To assess associations of hyperglycemia in pregnancy with the risk of postpartum hemorrhage (PPH) in a prospective cohort of Indigenous and non-Indigenous women, compared with normoglycemia. Data were from 1102 (48% Indigenous) women of the Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study. Age-adjusted associations of gestational diabetes mellitus (GDM) or pre-existing type 2 diabetes mellitus (T2DM), obstetric and demographic covariables with PPH (blood loss ≥500ml) were assessed using logistic regression. Multivariable-adjusted models included Indigenous ethnicity, diabetes type and their interaction. A higher proportion of Indigenous women developed PPH than non-Indigenous women (32% versus 22%; P<0.001). Compared with non-Indigenous women with normoglycemia, risks of PPH for Indigenous women with GDM or T2DM were higher (odds ratio [OR] 1.83, 95% confidence intervals [CI] 1.11-3.02, and OR 1.72, 95% CI 0.99-3.00 after age adjustment, OR 1.84, 95% CI 1.06-3.19, and OR 1.33, 95% CI 0.70-2.54 after adjustment for school education and delivery mode, and OR 1.62, 95% CI 0.95-2.77, and OR 0.99, 95% CI 0.53-1.86 after adjustment for birth weight). Importantly, Indigenous women without hyperglycemia in pregnancy were not at increased risk of PPH. The significantly higher rates of PPH experienced by Indigenous women compared with non-Indigenous women may be explained by a greater effect of GDM among Indigenous women that was only partly accounted for by birth weight.

Knowledge, attitudes, beliefs, intentions and behaviours of Australian Indigenous women from NSW in response to the National Cervical Screening Program changes: a qualitative study

Background: Indigenous women in New South Wales Australia are nearly four times more likely to die from cervical cancer than non-Indigenous women due to lower screening rates. We aimed to understand Indigenous women's cervical screening awareness, behaviours, knowledge, perceptions, motivators and barriers since the December 2017 National Cervical Screening Program changed to HPV testing, new screening age and screening interval, and introduced the new self-collection test.Methods: A qualitative study was conducted with 94 Indigenous women 25 to 74 years of age across metropolitan, regional and remote New South Wales. A team of six specialist researchers conducted the fieldwork, analysis and reporting. All data were coded thematically.Findings: Participants showed limited awareness of the renewed cervical screening program and the role of cervical screening in cervical cancer prevention, with most having a strong negative attitude towards cervical screening. Several motivators and behavioural barriers to screening were identified into four audience segments based on key characteristics. Most participants eligible to self-collect were unwilling to, due to concerns they would administer it incorrectly, injure themselves or have to return for a more invasive test.Interpretation: This study demonstrates the complex and heterogenous nature of attitudes and behaviours, among Indigenous women and highlights the intrinsic negative attitudes and social norms that are currently shaping community discourse and ultimately limiting screening. Our findings support the need for enhancing positive sentiment and community advocacy.Funding: Cancer Institute NSW Cervical Screening Program

Young breast cancer and the influence of ethnicity in Sandakan: A 3-year retrospective cross-sectional study.

Breast cancer (BC) is the most common cancer in Malaysia, with incidence increasing with age. There have been demonstrated differences in age of presentation and tumour biology when comparing ethnicities. Twenty percent of Caucasian women present before 50 years old, but almost 50% of Southeast Asian (SEA) women present before 50. However, BC in Indigenous sub-groups has not yet been studied. Sandakan is a city in Sabah with a large Indigenous population. Current nationwide screening guidelines are based on the U.S. Preventive Task Force 2009 Guidelines, which may not represent our population. We aim to examine the age of incidence for our local population, for local screening recommendations. Retrospective cross-sectional study, including all consecutive cases of epithelial invasive tumours, from January 2016 to December 2018. Other histological types were excluded. Univariate and multivariate analyses were performed. A total of 115 breast tumours were identified. Ten tumours were excluded (five ductal carcinoma in situ, four phyllodes, and one sarcoma), leaving a study population of 105 patients. Median age of presentation was 53 years (min 30; max 97). A total of 41.9% presented before the age of 50. Patients of Indigenous ethnic origins were 11years younger at presentation than non-Indigenous women. Tumour grade was more likely to be higher among Indigenous women. Median age of presentation of BC in Sandakan matches regional data; however, patients of Indigenous ethnic groups present even earlier. Screening guidelines should consider the growing evidence of young BC in SEA.

Morphological and Prognostic Characteristics of Breast Cancer in Women Living in the Sakha Republic (Yakutia)

Background: This article presents the results of the analysis of the clinical and morphological examination of breast cancer (BC) in women of the Republic of Sakha (Yakutia) (RS(Y)). Methods and Results: The object of the study was fragments of breast tissue from 294 women who underwent surgical treatment and/or needle biopsy. By ethnicity, there were 118(40.1%) women of indigenous nationalities and 176(59.9%) women of non–indigenous nationalities. The greatest number of cases of BC was registered in the age group of 50-59 (32.6%). The age group of 40-49 was in second place (20.4%). Among the indigenous population, women in the age groups of 40-49 years (23.7%) and 50-59 years (26.3%) predominated. The age groups of 50-59 years (36.9%) and 60-69 years (22.2%) predominated among the non-indigenous women. Tumors with a size of 2 cm to 5 cm prevailed; they were detected in 185(62.9%) women. Tumors with a spread to the chest wall and skin develop more often in women of non-indigenous nationalities (15.9% of cases), than in women of indigenous nationality (6.8% of cases). Regardless of ethnicity, the most common histological form of BC in women of the RS(Y) was infiltrative ductal cancer (65.3%). Cancer staging according to the TNM staging system showed that n the age group of women under 39 years, Stage IIIB+IIIC (43.2%) was most often registered (p=0.01), while in other age groups, Stage IIA (32.4%) was more often noted. Conclusion: Our findings suggest that further investigation of the peculiarities of the course of BC in the female population of Yakutia would lead to much improved methods of diagnosis and treatment.

Sexual Assault: Indigenous Women's Experiences of Not Being Believed by the Police.

Rates of sexual victimization among Indigenous women are 3 times higher when compared with non-Indigenous women. The purpose of this secondary data analysis was to explore the experiences and recommendations of Indigenous women who reported sexual assault to the police and were not believed. This qualitative study of the experiences of 11 Indigenous women reflects four themes. The women experienced (a) victimization across the lifespan, (b) violent sexual assault, (c) dismissal by police, and (d) survival and resilience. These women were determined to voice their experience and make recommendations for change in the way police respond to sexual assault.

An analysis of lines of treatment and survival analysis in older Indigenous and Nonindigenous women of Western Australia with breast cancer.

e12529 Background: Indigenous women with breast cancer (BrCa) have markedly higher mortality and are more likely to be diagnosed with more advanced disease compared with non-indigenous women. However, it is unknown if Indigenous older adults receive same lines of treatment as non-indigenous older adults with breast cancer. Methods: We retrospectively examined data from WA cancer registry from 2001 to 2016 with BrCa by Indigenous status. Indigenous were considered older adults aged above 55 years and non-indigenous aged above 65 years. Cases with confirmed breast cancer, where chemotherapy was indicated in adjuvant and metastatic setting were included for analysis. Overall survival was compared between treatment arms of indigenous and non-indigenous cohort using log-rank analysis and demonstrated by Kaplan Meier curve. Chi-square was employed as well. Results: At time of writing, results were available for 75 indigenous and non-indigenous older adults identified for analysis from cohort of 315 older adults. 79% Indigenous received treatment in adjuvant setting, 14% was not offered and 7% declined adjuvant treatment compared to 89% non-indigenous patients received adjuvant chemotherapy, 7% were not offered and 4% declined therapy. In first line metastatic setting, only 65% older indigenous group received chemotherapy compared to 76% non-indigenous patients. In second line, only 48% patients received treatment compared to 61% non-indigenous patients. In third line, 23% indigenous women received chemotherapy compared to 51% non-indigenous women with significant p-value 0.012. The rate of decline was higher in indigenous cohort. Kaplan meier curve of 10-year survival analysis favors the Non-Indigenous group. The difference between groups was 55 vs 68%. When comparing groups, the median survival of Indigenous group was 79 months and mean survival of Non-Indigenous cohort was 97 months. Log-rank testing p value 0.0025. Conclusions: In this study, indigenous patients have shown reduced survival outcomes and with drop in lines of treatment in the course of disease, highlighting a potential area to address and improve survival outcomes, along with addressing barriers that lead to treatment disparity in older adults.