A review of literature, 2006 ( pdf - 438 KB) - ARCHI

Influences on the health and wellbeing
of women from a Macedonian background
who live in south eastern Sydney
A review of literature
Women’s Health Unit
SESIAHS

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Acknowledgments
The Macedonian Women’s Health Project team would like to thank Nada Tizzone,
Valentina Angelovska, Gorjana Milosevski, Dushan Ristevski and Dr Lillijana
Stojanovska-Petrovska for taking time to discuss the project as it was being
developed and providing resources and suggestions for the literature review.
Thanks to Mindy Xie (Clinical Services Policy and Planning Unit) and Seema Shariff
(Multicultural Health Unit) for their contributions to the collection of data on the
Macedonian community.
Thanks must also be extended to Reverend Father Blaze Poposki for giving his
permission for photographs to be taken of women’s offerings for the health of loved
ones at the front of Saints Kiril and Metodij Macedonian Orthodox church at
Rosebery.
Literature review prepared by Mara Tanevska, Claire Ferguson and Wilma Espinoza
© Women’s Health Unit
South Eastern Sydney and Illawarra Area Health Service

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Contents
Overview 1
Introduction 2
Purpose 3
Method 3
Background 4
Macedonia 4
History 4
Identity 5
Migration 5
Religion 6
Family 6
Demographic profile 7
Macedonian population in south eastern Sydney and NSW 8
Macedonian women in south eastern Sydney 9
Cause of death and hospitalisation 13
Use of other health services 14
Factors influencing the health of women 16
Historical influences 16
Cultural influences 17
Social influences 19
Behavioural influences 22
Conclusion 25
References

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Overview
This literature review is the first phase of Macedonian Women’s Health Project
initiated by the Women’s Health Unit (WHU) in late 2004. Macedonian women were
selected as the focal point of this project as they have been identified as a group who
may be disadvantaged in accessing mainstream health services.
The review of literature is the first step in gaining an understanding of some of the
many influences (both positive and negative) on the health and wellbeing of
Macedonian women in south eastern Sydney. Its contents will be combined with
information gained from interviews and discussion groups with Macedonian women
and consultations with those who work with the community to inform the priorities and
strategies employed in the Macedonian Women’s Health Project in the future.
The first section of the review provides some information on Macedonia, its history
and culture to serve as a background and context for the influences on the health of
Macedonian women outlined later in the document. In the next section, a
demographic profile of Macedonian women in south eastern Sydney presents
information on social factors such as English proficiency, education and occupation
as well as data on causes of death and reasons for hospitalisation. The body of the
review collates the limited published information available on historical, cultural,
social and behavioural factors that may influence the health of Macedonian women in
south eastern Sydney.
Although it is difficult to measure or document the precise impact, it is clear that
Macedonia’s turbulent history and the experience of migrating to Australia are potent
influences on the lives of women in the Macedonian community in south eastern
Sydney. A background of conflict, oppression and persecution has damaged and
continues to influence their identity as Macedonians. The many roles of Macedonian
women in the family and community and their beliefs and practices relating to their
health and well being are also clearly influenced by a blend of the traditional
Macedonian culture – especially its religion – with the modern Australian (or more
specifically south eastern Sydney) culture in which they live.
The review of literature provides an overview of some of factors that may affect the
health of Macedonian women but is limited to summarising what has been published.
It also raises several important questions relating to the complex interaction of
influences on women’s health that may be explored in more detail in the next phase
of the Macedonian Women’s Health Project in consultations with women and
community workers.
- 1 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Introduction
Late in 2004, the Women’s Health Unit appointed a part-time project officer to work
with the Macedonian community to enhance their capacity to identify and address
heath issues for women. Local breast screening data, some published studies and
anecdotal evidence indicated that Macedonian women were less likely to access
mainstream health services such as screening and primary prevention activities and
may therefore miss out on the benefits of health promoting and early detection
programs. Meetings with community workers and representatives of the Macedonian
Australian Welfare Association confirmed an interest in working in partnership with
health and other local agencies to run the Macedonian Women’s Health Project.
Data provided by BreastScreen NSW on screening rates for Macedonian women in
the St George area of south eastern Sydney indicate they have consistently low
participation rates in breast screening compared to state averages for all women and
to other culturally and linguistically diverse (CALD) groups in the area (South East
Health 2002 – 2004). In 2002 and 2003, BreastScreen NSW, Women’s Health
Nurses from the Women’s Health Unit and other members of the Breast and Cervical
Cancer Screening Recruitment Working Party in South East Health collaborated to
improve participation rates among Macedonian women in both breast and cervical
screening by running a number strategies including radio discussions, clinics and
information sessions for women at the Rockdale ‘St Petka’ Macedonian church.
Screening rates for breast cancer, however, continue to be low. BreastScreen
NSW’s figures in 2003 indicated only 40.3% of Macedonian women in the St George
area were screened compared with around 50% for most other CALD communities.
Participation rates in breast screening among all Macedonian women in New South
Wales in 2004 indicate that 47.7% of women were screened compared with around
56% for other CALD communities.
Although Macedonian women in south eastern Sydney have been consulted about
their service needs by the local Division of General Practice (St George Division of
General Practice 1997) and the St George Hospital and Community Health Service
(St George Hospital and Community Health Service 2001) and young women
included in a report on the issues affecting young people (Macedonian Welfare
Association of Sydney 1998), it does not appear that a comprehensive review of
literature with a focus on the factors influencing the health and wellbeing of
Macedonian women in south eastern Sydney has been done to date.
In addition to the overview of available literature on social, cultural, behavioural and
other factors that may influence the health and wellbeing of Macedonian women in
south eastern Sydney, this review includes some background information on
Macedonia, its turbulent history and reasons for emigration to Australia to provide a
broader understanding of the wide range of influences on the health of the
Macedonian community.
When ‘Macedonian women’ in south eastern Sydney are discussed in this document
the phrase refers to both women born in Macedonia and women born in Australia
who have Macedonian ancestry. It is also acknowledged that all Macedonian women
may not possess the same or similar views, attitudes or behaviours as those featured
in this review of literature. These differences may relate to where women where born
(country of birth and region within Macedonia), when they settled in Australia and a
range of other factors unique to each individual.
- 2 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Purpose
The purpose of this review is to summarise available literature to provide a profile of
the Macedonian community and factors that may influence the health and wellbeing
of women from a Macedonian background who live in south eastern Sydney. The
literature review is the initial focus of an information gathering process of the
Macedonian Women’s Health Project to provide a better understanding of influences
on Macedonian women’s health and attempt to identify opportunities for communitybased
initiatives in the future.
Health professionals may also find this resource useful as an aid to gaining a better
understanding of the Macedonian-Australian community and, in particular, factors
that may influence the health of Macedonian women. Given that south eastern
Sydney is so culturally and linguistically diverse, this document may assist health
professionals in taking into account the cultural uniqueness of the Macedonian
community and in tailoring health interventions which may be appropriate and
effective for them.
It is acknowledged that the information contained in this literature review is limited to
a summary of the contents of available published documents and therefore does not
include knowledge of influences on the health and wellbeing of Macedonian women
held by people who work in or with the community or women themselves. Hopefully,
much of this knowledge will be captured through interviews and discussion groups
with representatives from various sectors of the community and with women in the
next phase of the Macedonian Women’s Health Project.
Method
Several electronic databases were searched to identify articles particularly relating to
research on Macedonian women (CIAP, Medline, PsychINFO, Science Direct, Health
and Society, Australian Public Affairs Information Service (APAIS) and APAIS-
Health, Meditext, DRUG, HIV/ AIDS Database). Keywords used in this search were
‘Macedonian Australian’, ‘Macedonian’, ‘Macedonia‘, ‘Macedonia and health’ and
‘Macedonia and women’. Searches were kept broad due to the limited amount of
published information on Macedonians in Australia.
Articles on Macedonians in Macedonia were also reviewed to find further relevant
materials for the literature review. Reference lists of retrieved articles were checked
to identify additional articles. Some information for the review was derived from
reports and data that where collated for the Macedonian Women’s Project meetings
(a subcommittee of the South East Health Breast and Cervical Cancer Recruitment
Working Party) held prior to the commencement of the Macedonian Women’s Health
Project.
Also, key community members, generously sharing their time and extensive
experience with the Macedonian-Australian community, provided insight into factors
influencing the health of women in the St George region through meetings and
providing documents that have been included in the review of literature. These
meetings were held with representatives from the Macedonian Australian Welfare
Association of Sydney (MAWA), Rockdale Mental Health, Bexley Migrant Resource
Centre (Home and Community Care services) and St George Youth Network in late
2004 and January 2005.
- 3 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Background
This section includes some information on the country of Macedonia, its history,
patterns of migration to Australia and some aspects of Macedonian culture to provide
a broader understanding of the factors that may influence the health and wellbeing of
Macedonian women in south eastern Sydney.
Macedonia
The Republic of Macedonia is located on the Balkan Peninsula in southern Europe.
Macedonia is landlocked, surrounded by Serbia in the north, Greece in the south,
Bulgaria to the east and Albania in the west. The republic of Macedonia has a
population of just over two million people in an area of 67,741 square kilometres.
The capital city of Macedonia is Skopje which is in the northern part of country on the
Vardar River. Macedonia is a mountainous country with small basins of agricultural
land linked to rivers leading to the Aegean Sea. The interior of Macedonia has a
moderate continental climate with warm summers and cold wet winters (Macedonian
Australian Welfare Association 2004).
The official language spoken in Macedonia is Macedonian. The Macedonian
alphabet is a distinct alphabet called Cyrillic. The Cyrillic alphabet (with some minor
distinctions) is also used in other countries such as Russia, Bulgaria, Serbia, Bosnia,
Montenegro, Ukraine, Mongolia and in other central Asian republics.
History
For much of its history Macedonia has been occupied, divided and dominated at
various times by the Roman, Byzantine, Serbian, Bulgarian and Ottoman empires. In
the 1912–1913 Balkan Wars, Serbia, Greece, and Bulgaria formed alliances which
resulted in Macedonia being discharged from the Turkish rule. Consequentially the
victors each annexed parts of Macedonia.
In 1944 Vardar Macedonia entered the Yugoslav Federation whereas the southern
part (Aegean Macedonia) stayed with Greece. In 1991 when Yugoslav Federation
was dissolved, Vardar Macedonia became known as the Former Yugoslav Republic
of Macedonia (Thomas 2001).
Following the break up of Yugoslavia, however, the Australian Bureau of Statistics
did not provide a separate category for people from Macedonia in the census until
1996; Macedonians were categorised as ‘Yugoslav’ , ‘Greek’ (Macedonian Australian
Welfare Association 2004) and ‘Slav’ (Najdovski 1997) thereby underestimating the
number of Macedonians in Australia. The Australian government still officially uses
the term ‘Former Yugoslav Republic of Macedonia’ in preference to ‘Republic of
Macedonia’ as used by Macedonians themselves.
In the late1990s Macedonia was faced with an escalation of ethnic conflicts between
the Macedonian and the ethnic Albanian population (Copic 2004). The North Atlantic
Treaty Organisation’s (NATO) failure to disarm and disband the Albanian Kosovo
Liberation Army resulted in a major security threat for Macedonia. A full-scale war did
- 4 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
not occur but Macedonia was brought to the brink of catastrophe for six months until
they were forced into negotiations with the Albanians (Hislope 2003).
Apart from a history of continual political crisis Macedonia has been affected by
economic crisis which is to a great extent a consequence of war (Copic 2004). In
January 2001 the unemployment rate stood at 45 percent (Hislope 2003). An influx of
refugees as a result of ethnic conflicts in Kosovo, the 1992 to 1995 United Nationsimposed
sanctions that cut Macedonia from Serbia (its most important trading
partner) and Greece’s severing of economic trade with Macedonia, all took their toll
on the Macedonian economy (Hislope 2003).
Identity
This history of conflict, oppression by groups that have refused to recognise
Macedonian culture as unique and valuable and the labelling of Macedonia as a
‘former Yugoslav Republic’ rather than a republic in its own right has created an
identity crisis for many Macedonians.
In Australia, the Federal government continues use of the acronym FYROM (Former
Yugoslav Republic of Macedonia) when referring to Macedonia – compounding the
damage to cultural identity that has occurred over many centuries in Europe. These
identity issues continue to impact on Macedonians in their new life in Australia,
complicating their settlement and adversely affecting their wellbeing (Macedonian
Australian Welfare Association 2004).
Migration
Early emigration to Australia from Macedonia began in the late nineteenth century
when some young men left their homeland to earn a living in places like Kalgoorlie
and Broken Hill after hearing about the discovery of gold and other minerals in
Australia (Thomas 2001). Working away from home was a common practice in
Macedonia as it was a rurally based and economically impoverished country. This is
known as ‘pechalba’ in Macedonian. Pechalbari usually moved away from home only
for a period of time to raise money that could be invested back into the family at
home.
Pre-Second World War immigration occurred in two waves; the first in 1924 when the
United States of America imposed heavy migration restrictions and the second after
1936 when a Greek fascist regime forced an exodus on many of the Aegean
Macedonians. Consequently many Macedonians became political refugees (Danforth
1993). Some settled permanently in Australia with their families whereas others later
returned to their homeland.
The largest wave of Macedonian migration to Australia occurred in the late 1960s
and early 1970s. Many settled in suburbs like Rockdale in Sydney. Much of the
migration in this period was due to rising unemployment at that time and a disastrous
earthquake that effected Skopje in 1963. Many of the emigrants were from the Biltola
and Ohrid regions and were from peasant and working class backgrounds.
- 5 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Immigration in the 1970s waned and then increased again in the 1990s after the
disintegration of Yugoslavia. These migrants were different from the earlier post-war
migrants in that they were mostly educated and professional people (Thomas 2001).
Religion
Most Macedonian people identify themselves as being of Macedonian Orthodox
religion. The first Macedonian church was founded in Macedonia in the tenth century.
The Macedonian Orthodox faith is a very significant force on Macedonian culture,
beliefs and social and family lives. Many daily and seasonal activities are tied to a
religious calendar that community members follow. For example, the calendar will
show when to celebrate occasions such as saints’ days and when to harvest crops.
The Macedonian Orthodox Church in Australia continues to play an important role in
the lives of Macedonian people today as most Macedonians still choose the church
to marry, have their children baptised and perform the funeral service for their loved
ones (Macedonian Australian Welfare Association 2000). A priest is sometimes also
called upon to bless a home or to intervene when there is a health crisis. A mental
health crisis, for example, is seen by spiritual leaders to be the domain of the church
(St George Division of Mental Health 2003).
The church in Australia has also been responsible for bringing the Macedonian
community together in Sydney. It has organised various activities over the years such
as community dances and picnics and initiated organisations for folk dancing, sport
and other social activities.
Family
Family is considered very important in Macedonian culture. Regular contact with the
family is therefore maintained and usually takes priority over maintaining contact with
friends. Visiting both family and friends is, however, an important socialising activity
to Macedonians (Macedonian Australian Welfare Association 2004).
The extended family structure is still common among Macedonian families today.
Older people are generally respected in the family and are therefore usually
incorporated in decision-making and are often expected to mediate disagreements.
The elderly also often manage the household; carrying out tasks for the family such
as the cooking cleaning, shopping and minding grandchildren (St George Division of
Mental Health 2003).
Traditionally Macedonian families have a patriarchal social structure (St George
Division of Mental Health 2003). Some authors suggest that the Macedonian woman
is not usually aware of this patriarchy and performs ’her role’ in the family according
to social mores because she believes it is natural for her to do so (Stankovska 1991).
This may be partly due to the political and socio-economic turmoil of the past 500
years in Macedonia which has not created an ideal environment for the development
of feminism, given the struggle for national survival, oppression and partition by many
other powers (Sapurma-Petkovska 1990). In more recent times in Australia, however,
women play a greater role in the decision-making processes in the family (St George
Division of Mental Health 2003).
- 6 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Outside the family unit, many Macedonian women do not involve themselves in
community activities. This may be due to difficulty in communicating in English and
strict traditional Macedonian cultural values and beliefs which dictate that the married
Macedonian woman be the centre of domestic family life and leave community
involvement to her husband (Tkalcevic 1980).
Demographic profile
This section provides an overview of some of the demographic information available
on the Macedonian community in New South Wales and in the areas of Sydney
formerly included in the South Eastern Sydney Area Health Service (SESAHS). T
his Area Health Service amalgamated with Illawarra from 1 January 2005 to form the
South Eastern Sydney and Illawarra Area Health Service (SESIAHS).
South Eastern Sydney Area Health Service included ten local government areas
(LGAs) in south eastern Sydney: Botany, Hurstville, Kogarah, Randwick, Rockdale,
South Sydney (part), Sutherland, Sydney (part), Waverley and Woollahra. The
estimated residential population in the 2001 Australian census was 781,287 with
approximately one third (31%) born overseas.
As noted previously, confusion regarding the naming of Macedonia and the way data
has been collected by the Australian government means that figures documenting
country of birth and ancestry for Macedonians may underestimate their true numbers.
The raw data collated in this report was made available by the SESAHS Clinical
Services Policy Unit and Planning and SESAHS Multicultural Health Unit.
- 7 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Macedonian population in south eastern Sydney and NSW
In the last census undertaken by the Australian Bureau of Statistics (ABS) in 2001,
5,924 people in the areas of Sydney served by SESAHS indicated they had been
born in Macedonia. There were slightly more males (3,065) than females (2,859).
This represented nearly one third (31.1%) of the total Macedonian-born population in
New South Wales (19,062).
A much larger number of people in NSW (approximately 34,000) indicated they had
Macedonian ancestry. A large proportion of those with Macedonian ancestry reside in
the LGA of Rockdale in SESAHS with 5,708 (16.8%); second only to Wollongong
LGA with 18.9%. Kogarah and Hurtsville LGAs are also areas where a relatively
large proportion of those in NSW with Macedonian ancestry live (Figure 1).
25.0%
Percentage of people in NSW
with Macedonian ancestry
20.0%
15.0%
10.0%
5.0%
0.0%
Wollongong
Rockdale
Bankstown
Fairfield
Hurstville
Liverpool
Newcastle
Shellharbour
Kogarah
Queanbeyan
Other
Local Government Area
Figure 1: Proportion of people with Macedonian ancestry in NSW
in selected LGAs 2001 (Source: Australian Bureau of Statistics 2001)
In 2001, in the areas of Sydney served by SESAHS, there were 9,543 people who
indicated that Macedonian was the language they spoke at home. The vast majority
of those who speak Macedonian at home live in the St George area of SESAHS in
the local government areas of Rockdale (57.6%), Hurstville (19.2%) and Kogarah
(12.1%). When asked about their ancestry, a similar number (10, 306) indicated they
had a Macedonian background.
- 8 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Macedonian women in south eastern Sydney
Data collected by the Australian Bureau of Statistics in 2001 has been used to
describe some of the characteristics of women from south eastern Sydney who
indicated they were born in Macedonia. Macedonian-born women are compared with
all women in south eastern Sydney in terms of their reported level of education and
occupation.
Data collected by the South Eastern Sydney Area Health Service and from other
sources is used to outline cause of death, reasons for hospitalisation and use of
some other services among Macedonian women. Because the numbers of
Macedonian women involved in these records are small, there are limited
conclusions to be drawn from this information.
Age distribution
Of the 2,859 females born in Macedonia that resided in the area served by SESAHS
in 2001, those aged 45 to 54 years made up the largest group (27.7%), followed by
females aged 35 to 44 years (22.8%) and women 55 to 64 years (15.9%) (Figure 2).
900
800
Number of Macedonian women
700
600
500
400
300
200
100
0
0-5
4-14
15-24
25-34
35-44
45-54
55-64
65-74
75 & over
Age of women
(years)
Figure 2: Age distribution of Macedonian-born women (SESAHS 2001)
(Source: Australian Bureau of Statistics 2001)
- 9 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
English proficiency
When asked about their level of English proficiency most Macedonian-born women
indicated they spoke English ‘Well’ or ‘Very Well’ (64%). Just over one quarter of
Macedonian-born women (27%) responded they did not speak English well. Only
four percent stated they did not speak English at all (Figure 3).
Not at all
Not stated
Speaks
English only
Not Well
Very Well
Well
Figure 3: Proficiency of English among Macedonian-born women (SESAHS 2001)
(Source: Australian Bureau of Statistics 2001)
- 10 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Level of education
When asked about their level of education, the most common response among
Macedonian-born women (24%) was that their highest level of education was year
eight or lower (compared with six percent for all women in SESAHS).
Macedonian-born women were also much less likely to be tertiary educated with six
percent possessing a university degree or higher compared with 19 percent for all
women in SESAHS (Figure 4).
30%
Percentage of population
25%
20%
15%
10%
5%
0%
Degree or higher
Diploma/certificate
Year 12
Year 9-11
Year 8 or lower
Level of education
Still at school
Macedonian
w omen in
SESAHS
All w omen in
SESAHS
Did not go to school
Not stated
Figure 4: Highest level of education for Macedonian-born women and all women
(SESAHS 2001) (Source: Australian Bureau of Statistics 2001)
- 11 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Occupation
Among the Macedonian-born women in employment, the most common category of
occupation was ‘Labourers and Related Workers’ (36%). The corresponding rates for
all women residing in the region served by SESAHS were substantially lower in this
category (4%).
Seven percent of Macedonian-born women classified their occupation as
‘Professional’ compared to 25 percent for all women in the area. Many Macedonianborn
women indicated they were employed in the clerical, sales and service
categories (Figure 5).
40%
35%
Percentage of women
30%
25%
20%
15%
10%
Macedonian w omen in
SESAHS
All w omen in SESAHS
5%
0%
Managers and Administrators
Profesionals
Associate Professionals
Tradespersons and Related Workers
Advanced Clerical and Service Workers
Intermediate Clerical, Sales and Service
Labourers and Related Workers
Intermediate Production and Transport
Elementary Clerical, Sales and Service
Occupation
Not stated
Figure 5: Occupations of Macedonian-born women (SESAHS 2001)
(Source: Australian Bureau of Statistics 2001)
- 12 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Cause of death and hospitalisation
According to data collected by SESAHS in the period 1997 to 2001, there were 55
deaths recorded among Macedonian-born women. It is likely that these figures
underestimate the number of women of Macedonian background because, at the
time of their birth, a separate Republic of Macedonia would not have existed and
their country of birth may have been recorded as Yugoslavia, Serbia, Greece or
Bulgaria.
Although these numbers are too small to provide an accurate profile of mortality in
this group, the leading causes of death among Macedonian-born women were similar
to those in the general community with cancer (20 women) and diseases of the
circulatory system (18 women) being the most common causes of death.
In SESAHS data on hospitalisation in the same period, the largest proportion of
inpatient episodes among Macedonian-speaking females related to diseases of the
digestive system (18.9%) and childbirth and pregnancy (18.0%). Other common
reasons for hospitalisation included illness related to neoplasm and the genitourinary,
circulatory and nervous systems (See Figure 6).
70
Number of Macedonian women
60
50
40
30
20
10
0
Digestive System Total
Pregnancy/Childbirth/Puerperium Total
Reason for hospitalisation
Neoplasm Total
Genitourinary System Total
Circulatory System Total
Nervous System and Sense Organs Total
Figure 6: Main reasons for hospitalisation among Macedonian-speaking
women SESAHS 1997–2001 (Source: Australian Bureau of Statistics 2001)
- 13 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Use of other health services
Figures from BreastScreen NSW for 2003 in the local government areas (LGAs) of
Rockdale, Hurstville and Kogarah illustrate Macedonian women's low participation
rates in mainstream health services. Macedonian women have the lowest
participation rate for screening (40.3%) apart from Serbian women who are the least
likely to attend breast screening (Figure 7).
When compared with 2004 figures for all women in NSW (51.0%) and the combined
South Eastern Sydney and Illawarra screening rates for all women (56.2%), breast
screening rates among Macedonian women are quite low. Many Macedonian women
may not be accessing breast and cervical screening services in Australia due to the
fact that these services do not exist in Macedonia (Macedonian Australian Welfare
Association 2004).
Percentage of women screened
for breast cancer
70%
65%
60%
55%
50%
45%
40%
35%
30%
Arabic
Chinese
Croatian
English
Greek
Italian
Maltese
Macedonian
Portuguese
Serbian
Spanish
Language spoken
Figure 7: Breast screening participation rate of women aged 50-69 in the LGAs of
Hurstville, Kogarah, and Rockdale (Source: BreastScreen NSW 2003)
Although ethnicity is not documented in NSW cervical screening rates, a Victorian
study has explored the factors associated with high cervical cancer rates among
women from the former Federation of Yugoslavia (Fernbach 2000). Although the
majority of women in the study were familiar with cervical screening, Macedonian
women reported a much lower two yearly screening rate (56%) compared with that of
other cultural groups (67%) and the general population (69%). This was coupled with
a perception that most of their peers (75%) were well-screened. Compared to other
women in the study, Macedonian women were more likely to believe that it is difficult
to have Pap tests every two years.
- 14 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
In the 2004 Annual Report from the St George Migrant Resource Centre, the
Macedonian Welfare Association (MAWA) reported that health (both general and
mental) was one of the main issues with which their clients required assistance. The
Association has experienced double the number of health-related enquiries since the
Macedonian Health Worker position based in St George was de-funded.
Although demand for the services of the Macedonian Australian Welfare Association
has increased, the Macedonian community remain significantly under-resourced.
They also have low participation rates in accessing mainstream services due to a
lack of awareness of the services that exist. Other factors that contribute to low
participation rates of the Macedonian community are culturally inappropriate
services, language barriers, client attitude to disabilities and stigma, negative past
experience of services, lack of trust and cultural expectations that family members
are responsible for the wellbeing of their significant others (Macedonian Australian
Welfare Association n.d.)
In the St George Division of General Practice’s consultations with the local
Macedonian community in 1997, young people, new migrants and older people in the
community were identified by participants as being most disadvantaged or having the
greatest health needs. Although there was general satisfaction with local health
services expressed, it was also apparent that participants had limited knowledge of
the range of services available. Language was seen as a major barrier in accessing
services and appropriate health and service information. Mental health, alcohol and
other drugs, family and women’s health were identified as areas of concern and the
need for more bilingual workers, educators and counsellors and adequate numbers
of interpreters was documented.
In focus groups conducted among Macedonian men and women by the St George
Hospital and Community Health Service (2001), participants talked of long waiting
times, the availability of parking and interpreters and a lack of information as issues
when asked about accessing services.
Although these local consultations have been informative, issues and barriers to
using health services among Macedonian women have not yet been identified. Also,
misclassification of Macedonians in data collection procedures for both census
collections and health service records may well have contributed to an inequitable
allocation of resources for the Macedonian community in south eastern Sydney.
- 15 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Factors influencing the health of women
‘Women’s health is seen to depend upon complex interactions between individual
biology, health behaviour and the historical, economic and socio-political context of
women’s lives.’ (Cohen 1998 p188)
This section of the review will summarise the available literature relating to the
historical, cultural, social and behavioural factors that may influence the health and
well being of Macedonian women. A broader and deeper understanding of the
influences on the health of Macedonian women will hopefully be achieved through
the next phase of information gathering when Macedonian women and those working
in the Macedonian community will be asked to share their perspectives on women’s
health.
Historical influences
Given Macedonia’s long history of war, oppression and political violence, it is likely
that most, if not all, Macedonian women in south eastern Sydney would have been
touched by these experiences in some way. Case studies involving women (between
50 and 70 years of age) from Macedonian villages reveal lives scarred by war,
poverty, hunger, deaths of loved ones and family separation (Sapurma-Petovska
1990).
In addition to surviving war, Macedonians have been subjected to long periods of
repression and subjugation. The dividing of Macedonian territory in the 1912–1913
Balkan Wars resulted in the renaming of Macedonian cities and villages, unfair Greek
government assimilation policies (Vidanovski 2003) and severe persecution of
Macedonians during the Greek civil war (Danforth 1993) in Aegean parts of
Macedonia. Many Macedonians became political refugees at this time (Danforth
1993) and again in the late 1990s after experiencing ‘harassment, threats, damage of
properties and dispossession by Albanian extremists’ (Karoski 2004).
Unfortunately it is difficult to know the impact that such events as those described
above have had on the health of Macedonian women. Assessments of the short or
long term effects on civilian populations who have experienced war are scarce and
changes to lifestyle resulting from war are also difficult to measure and attribute
significance in terms of life expectancy or resulting morbidity and burden of illness
(Pederson 2002).
It is likely that these events have challenged some Macedonians’ confidence with
their Macedonian identity. This issue dominated informal interviews with Macedonian
women in Melbourne, Victoria, where some women explained how their feelings
about their identity had become more positive when they gained a better
understanding of the history of the Macedonian people (Stanovska 1995). Erosion of
cultural identity may result from prolonged racial oppression.
- 16 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Cultural influences
The Australian Institute of Health and Welfare (2004) acknowledges the influence of
cultural factors on health through traditions, attitudes, beliefs and customs. Culture
also ‘…plays an important role in whether people seek early diagnosis, how they
understand their disease, the kind of support they are willing to accept, decisions
about treatment and how they experience the process of getting well or dying’
(Gifford 1991 p171). This section outlines some aspects of Macedonian culture that
may positively or negatively affect women’s health and wellbeing.
Fatalistic views on health
Macedonians often express a fatalistic approach to health (St George Division of
Mental Health 2003). Fatalistic attitudes to health – based on the belief that one has
no control over health – may be a factor leading to unhealthy behaviours (Australian
Institute of Health and Welfare 2004).
A Melbourne study examining cultural beliefs about breast cancer among
Macedonian women found that the women believed cancer to be caused by God.
With this view came the belief that if one were to have cancer then it would be one’s
destiny and little could therefore be done to treat the disease (Gifford 1991). Such
beliefs may have implications for early detection of breast cancer and the willingness
of Macedonian women to participate in other prevention and early detection
programs. The low breast screening rates among Macedonian women in south
eastern Sydney documented in the demographic profile on page 14 of this review are
consistent with such beliefs.
Herbal and traditional healing methods
Despite a somewhat fatalistic attitude to health, Macedonians also have strong
cultural practices and traditional methods of maintaining health and wellness. They
use a variety of home remedies such as teas, herbs, grasses and ointments to treat,
maintain and prevent illness.
Remedies such as chamomile tea, rakija (plum brandy), and St Johns Wart and
sugar water are often used to reduce stress. Stress is seen to be the major cause of
illness and therefore traditional remedies to reduce stress are commonly used (St
George Division of Mental Health 2003).
Rakija is also used to cure colds and sore throats. Rakija and vinegar are both used
to reduce high temperatures by using a soaked cloth on the forehead and feet (St
George Division of Mental Health 2003).
Food is also considered to be important to health and is often given to those in
hospital by visitors. This is an expression of support for the ill person (St George
Division of Mental Health 2003).
- 17 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Traditional healers
Some Macedonians also seek the help of traditional healers called a bajach/
bajachka (male and female healers) or gledach/gledachka in times of illness and
hardship. Practitioners are usually women who have had no special training other
than being of an appropriate age and willing to receive the collective wisdom
(Kerewsky-Halpern 1985). Traditional healers are usually sought out of the belief that
one’s sickness or hardship is brought on by a magic spell or the evil eye. In some
cases, the primary task of the folk healer is to remove the curse or spell (St George
Division of Mental Health 2003).
Folk healers may use a number of techniques such as talk and touch to dispel the
illness and other situations of disorder. Talk involves the use of narratives, repetitious
patterns of alliteration, assonance and inflection to induce the patient into a hypnotic
state. The induction of a trance may produce calm in the patient, or alleviate pain;
methods that modern medicine has also started using for treatment of cancers and
other health issues. Therapeutic touch is also used to heal the patient. Homemade
treatments may also be used for this, including rakija to disinfect an area and herbs,
beeswax and incense to produce an aromatic ointment. (Kerewsky-Halpern 1985)
It is difficult (though important) to know how common it is for Macedonian women in
south eastern Sydney to seek out traditional healing for their health. According to the
literature available it appears to be quite common in both Australia and in Macedonia,
sometimes in preference to qualified doctors (Tkalcevic 1980) and prior to seeking
treatment from health professionals particularly in earlier stages of mental illness (St
George Division of Mental Health 2003). Anthropological studies including people
from villages in Macedonia also show a common use of traditional healers, even with
relatively easy access to medical facilities (Kerewsky-Halpern 1985).
- 18 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Social influences
Social factors related to women’s roles and responsibilities such as socio-economic
status, social support and networks, adequate housing and exposure to violence and
discrimination strongly influence their health and wellbeing (South East Health 2003).
Attitudes towards people with health problems
Many Macedonians do not readily seek assistance for their problems out of fear that
the wider Macedonian community may find out about the problem. The community’s
knowledge of a health problem in a family sometimes results in the family being
shamed and in some cases ostracised (Macedonian Australian Welfare Association
1994).
This generally seems to be the case when there is a disability in the family
(Milosevski 2004) and often with mental illness (St George Division of Mental Health
2003). Fear that others will find out about a mental illness in the family arises out of
the community’s own view of itself as being cruel and discriminatory (St George
Division of Mental Health 2003).
As a result problems tend to be kept and dealt with within the confines of the family
(Macedonian Australian Welfare Association 1994) and benefits and services
available to them will then tend not to be fully utilised (Milosevski 2004).
Roles, responsibilities and expectations associated with being female
Traditional Macedonian cultural values and expectations emphasize that the married
Macedonian woman should essentially be the centre of domestic family life.
Generally, even though the Macedonian woman works hard to contribute to the
family income she is still expected to perform all of the household duties (Tkalcevic
1980).
The unfair burden in the total workload of women has also been highlighted through
analysis of time use surveys which indicate women’s increased time spent in the paid
labour force has not led to a decrease in the time spent in unpaid work such as
domestic labour and the role of the carer (NSW Health 2002). Managing multiple
roles and responsibilities disproportionately affects women compared with men and
is therefore an important determinant of the health of Women (South East Health
2003).
It should also be acknowledged that it is common in Macedonian culture for
grandmothers to assist their family with providing childcare for children. A Melbourne
study which examined the motivations of Macedonian grandmothers in providing
childcare and its impacts on their health and wellbeing discovered that these women
provided free childcare for an average of 10 hours a day, even though fifty percent of
them had chronic illnesses such as diabetes, hypertension, angina, arthritis and
migraine (Drysdale and Yarman 2000).
In this study, grandmothers also seemed to undertake much of the household
responsibilities including cleaning, washing, cooking and taking children to school,
immunisation, libraries, school events and sporting activities. Quite often they would
- 19 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
also prepare an evening meal for the whole family to share when parents arrive to
pick the children up. Although some of the Macedonian grandmothers interviewed
reported having less time for themselves, all of the grandmothers also reported a
range of positive health gains such as increased physical fitness and improved
mental and emotional well being.
Socio-economic disadvantage
The demographic profile of Macedonian women provided earlier in this review
indicated that, compared with the general population, Macedonian women are more
likely to have lower levels of education and work in occupations attracting much
lower pay rates.
Women who are newly arrived from Macedonia are particularly disadvantaged. Their
lack of English skills may hinder them in obtaining employment, housing and medical
care. Unfortunately many of these women with children may not be able to attend
English classes if childcare is not provided. These factors may contribute to financial
problems, especially when new arrivals must wait two years before they are eligible
for income support (Macedonian Australian Welfare Association 2005).
Like other women from culturally and linguistically diverse backgrounds, most
Macedonian women also work in the occupations and industries which have the
highest rates of occupational injury and diseases (Multicultural Health Unit WSAHS
n.d.).
There is strong and consistent evidence, that those in the community who experience
social and/or economic disadvantage are more likely to have poor health than those
with more advantages (Marmot 2001).
- 20 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Exposure to violence
Violence and abuse has profound effects on both physical and emotional health of
women (Lee 2001). There does not appear to be any previous research specifically
in the area of domestic violence and Macedonian women in south eastern Sydney.
A study in 2001 involving 850 women in Macedonia found that 61.5% of women had
been exposed to psychological violence, 23.9% to physical violence and 5% to
sexual violence (Copic 2004). A combination of stress and frustration resulting from
war, and the strong impact of patriarchy and traditional gender role socialisation
provide fertile ground for violence against women in Macedonia. War and violence
may also become a model of conflict resolution in the family (Copic 2004).
In consultations with various workers in the Macedonian community in the St George
region, the issue of violence against women was raised as an important issue
concerning Macedonian women. The Macedonian Australian Welfare Association
documented an increased load of complex casework associated with domestic
violence in the recent Annual Report of the St George Migrant Resource Centre (St
George Migrant Resource Centre 2004).
The situation for women who are newly arrived from Macedonia on the spouse visa
and who experience domestic violence issues is very complicated. These women are
often very isolated because they may have limited family and few friends in Australia.
Many of these women may not be permitted by their partners to attend English
classes. This adversely effects their employment prospects and adds to their
isolation.
Due to the two year waiting period for residency these women are also ineligible for
some services. Consequently they may have to rely on their partner for income and
financial abuse may also occur (Macedonian Australian Welfare Association 2004).
- 21 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Behavioural influences
Lifestyle factors such as nutrition, physical activity and use of alcohol and other drugs
have a strong influence on the risk of disease, particularly cardiovascular disease
and cancer. Some of these behaviours are also linked to social and economic factors
discussed in the previous section.
Nutrition
A healthy diet is increasingly considered to make an important contribution to health
and wellbeing. Over the last few decades, a growing body of evidence has linked
food consumption patterns with the risk of a number of lifestyle diseases (Australian
Institute of Health and Welfare 2004). Although no information was located on the
nutritional status of Macedonian women in Australia, it could be expected that their
diet would combine some elements of traditional Macedonian cuisine with
contemporary Australian eating patterns.
A report on the nutritional intakes in Macedonia over the last 30 years (World Health
Organisation 2002) documented consumption of fruit, vegetables and dairy products
below recommended levels. There were also some micronutrient deficiencies
observed including anaemia and vitamin A and iodine deficiencies.
Over the period monitored, rates of nutritionally related diseases in Macedonia such
as cardiovascular disease, diabetes and some cancers have increased substantially
– increasingly mirroring the morbidity and mortality patterns in other developed
countries around the world.
Physical activity
Physical activity is an important factor in maintaining good health (Australian Institute
of Health and Welfare 2004) and a particularly important aspect of cardiovascular
disease prevention (Eyler et al 2003). Maintaining regular physical activity assists in
improvement of cardiovascular risk factors such as high blood pressure, Type 2
diabetes, being overweight, low levels of HDL (the ‘good’ cholesterol) and can help
reduce the risk of some types of cancer. Other benefits are a reduction of
osteoporosis, reduction of stress, anxiety and depression (Australian Institute of
Health and Welfare 2004).
One report examining the inequalities in risk factors and cardiovascular mortality
among Australia’s immigrants found that women from southern European countries
(ie the former Yugoslavia, Italy, Malta and Greece) had higher than average body
mass index and extremely high levels of sedentariness (Bennett 1993).
A study documenting levels of physical activity among Macedonian women in
Newcastle in 1997 found their activity levels well below the national
recommendations of thirty minutes a day of moderate level activity. Of the 33 women
who volunteered to participate in a heart health program, 76 percent reported having
done no vigorous exercise and 40 per cent reported that they had not exercised at all
during the previous six months (Brown et al 1997). In comparison, in the National
Physical Activity Survey in 2000, 13 percent of Australian women reported doing no
physical activity during the previous week (Australian Institute of Health and Welfare
- 22 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
2004). There is evidence that physically active women tend to have more support
from partners, family, friends and paid assistance with child care and domestic work
(NSW Health 2002).
Levels of physical activity among Macedonian women who reside in south eastern
Sydney are unknown. Given the well documented health benefits of being physically
active and the high rates of sedentariness among Macedonian women in a
neighbouring city (Newcastle), however, makes such knowledge important.
Alcohol and other drug use
Alcohol plays an important role in Macedonian culture. It is inevitably part of all
celebrations, from weddings to small social gatherings and even funerals. Many
children are permitted by adults to consume alcohol from a very early age. Alcohol is
even supplied at 16 th birthday parties to anyone who requests a drink (Macedonian
Australian Welfare Association 1994).
There does not appear to be any previous study on alcohol use among Macedonian
women in south eastern Sydney. The only available information relates to a sample
of 103 Macedonian young people (14 to 22 years) from the St George area. Twentyone
percent of the female respondents in this study indicated they drank alcohol on a
weekly basis. Of these, 40% of females said they consumed more than five drinks in
a row (Macedonian Australian Welfare Association 1994).
According to the 2001 National Health and Medical Research Council (NHMRC)
guidelines five or more standard drinks for females puts them at high risk of alcoholrelated
harm. In this local study, of the young women who said they consumed
alcohol, a higher percentage of females (24%) than males (16%) said they consumed
alcohol as a means of escaping their problems (Macedonian Australian Welfare
Association 1994).
Risks associated with excessive drinking include coronary heart disease, liver and
pancreatic disease, stroke, high blood pressure, cancers of the digestive system,
accidents, mental illness and violence. In contrast there are some longer term
benefits for low to moderate alcohol consumption, such as reduced risk of stroke and
coronary heart disease (Australian Institute of Health and Welfare 2004).
Smoking
Tobacco smoking contributes to more deaths and drug-related hospitalisations than
alcohol and illicit drug use combined. It is a major risk factor for coronary heart
disease, stroke, peripheral vascular disease, cancer and a variety of other diseases
and conditions (Australian Institute of Health and Welfare 2004).
A Victorian study examining factors leading to high cervical cancer rates among
women of the former Yugoslavia found women had high rates of tobacco use. Fiftynine
per cent of women participating in the study said they smoked daily in the past
or at present. These smoking rates were substantially higher than those of the
general Victorian population (Trotter et al 1998) and national rates (18%) estimated
- 23 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
by the 2001 National Drug Strategy Household Survey (Australian Institute of Health
and Welfare 2004).
Because of the multitude of harmful effects of tobacco use on health, gaining an
understanding of attitudes to the use of tobacco among Macedonian women,
especially young women, may be valuable in identifying factors that influence their
health and wellbeing.
Sexual health and HIV risk factors
The use of drugs, sexual intercourse for women before marriage, extramarital sex
and homosexuality are not accepted lifestyles in the Macedonian community (Watson
et el 1995). Consultations with young people and key informants in the St George
area undertaken by Watson and colleagues highlighted that although Macedonian
youth had HIV risk factors similar to those of the general population; they were
unlikely to talk openly about sex with their family. They were unsure about whom to
consult regarding sexuality issues for fear that parents may discover that they were
sexually active.
It was also revealed that Macedonian culture was not accepting of condom use. This
was particularly the case with young Macedonian men. Other stakeholders believed
that young Macedonian men were more informed about protecting themselves
compared with young Macedonian women (Watson et el 1995).
When young people themselves were asked about their condom use only 11%
answered they always used condoms with their boyfriend/ girlfriend and 12% said
they always used condoms with a casual partner.
- 24 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Conclusion
The first phase of the Macedonian Women’s Project, the literature review, reveals a
complex combination of factors and their interactions may be influencing the health of
and wellbeing of Macedonian women. Some of these factors are health enhancing
whilst others may have a detrimental effect on their wellbeing.
The literature review indicates that Macedonian women have a number of ways of
maintaining their health and wellness available to them. There are strong cultural and
traditional methods of treating and preventing illness including using a variety of
home remedies such as teas, herbs, grasses and ointments and seeking the
assistance of traditional healers. In terms of social support for health, the community
seems to have strong family values and women usually have the assistance of their
extended family in caring for children.
However, nearly a third of Macedonian women in south eastern Sydney do not speak
English well or do not speak English at all. While these women may have support
within their own community they may have difficulties in accessing mainstream health
information and services. The traditional patriarchal social structure in the community
means that some women may also be isolated by a heavy workload of family and
household responsibilities in addition to paid employment.
It seems likely that a turbulent history of war, persecution and oppression of
Macedonian people and its effect on their identity may have an adverse effect on the
health of Macedonian women. The issue of violence against women has also been
identified by community workers.
Social stigma associated with some illnesses and fatalistic attitudes to health also
have implications for women’s health in relation to their participation in prevention
programs and the early detection of illnesses like breast and cervical cancer.
Some women may be experiencing poor health associated with socio-economic
disadvantage. Macedonian women have lower levels education compared with the
general population in south eastern Sydney and are more likely to work in
occupations attracting lower pay and higher rates of injury and occupational disease.
Little is known of behavioural influences on the health of Macedonian women.
Tobacco and alcohol use, physical activity, nutrition and sexual health may all be
factors influencing the health of Macedonian women in this area but more research
would need to be undertaken to give a more accurate assessment of the situation.
Information specifically relating to the health of Macedonian women in south eastern
Sydney area was generally scarce. The vast majority of literature extracted for this
review related either to the Macedonian community as a whole or to Macedonian
women in other parts of Australia and Macedonia. This lack of information specifically
relating to women, coupled with the evident disadvantage of some Macedonian
women, reinforces the importance of a project such as this one.
In the next phase of the project, Macedonian women and those who have experience
working with the community will be asked to discuss the things that affect the health
and wellbeing of Macedonian women. These consultations will include a broad range
of questions (including exploration of some of the themes brought out in the literature
- 25 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
review) in order to provide a better understanding of factors specifically influencing
the health and wellbeing of Macedonian women in south eastern Sydney.
The information derived from these interviews and group discussions will be used to
develop and implement strategies in partnership with the community consistent with
the health issues identified by women themselves. The findings will be disseminated
among local service providers to inform them about the Macedonian culture, raise
awareness of health issues for women and to assist them in tailoring their services to
the needs of the community. The future success of this project, however, will depend
on the Macedonian community’s readiness for such a project, their involvement and
the effective use of available resources.
_______________________________________
- 26 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
References
Australian Institute of Health and Welfare 2004 Australia’s Health 2004 AIHW
Canberra
Bennett SA 1993 Inequalities in risk factors and cardiovascular mortality among
Australia’s immigrants Australian Journal of Public Health 17:251-261
Brown WJ Lee C Nasstasia YN 1997 Heart Health for Migrant Women: A Short
Intervention with Macedonian Australian Women Health Promotion Journal of
Australia 7(2):134-137
Cohen M 1998 Towards a framework for women’s health Patient Education and
Counselling 33(3):187-196
Copic S 2004 Wife abuse in the countries of the former Yugoslavia Feminist Review
76:46-64
Danforth LM 1993 Claims to Macedonian Identity: The Macedonian Question and the
Breakup of Yugoslavia Anthropology Today 9(4):3-10
Drysdale P, Yaman N 2000 It’s a Long Day on Your Own: Exploring and Addressing
the Health Impacts of Grandmothering in Culturally and Linguistically Diverse
Communities Women’s Health in the North, Melbourne
Fernbach M 2000 Exploration of factors linked with high cervical cancer rates in
women from the former Yugoslavia in Victoria, Australia PapScreen Victoria
Communications and Recruitment Strategy, Anti-Cancer Council of Victoria
Gifford S 1991 Culture and Breast Cancer: Myth or Mosaic? Cancer Forum 15(3):
171-174
Eyler AA Matson-Koffman D Young DR Wilcox S Wilbur J Thompson JL Sanderson
B Evenson KR 1993 Qualitative study of correlates of physical activity in women from
diverse racial/ethnic groups American Journal of Preventive Medicine 25(3):93-103
Kerewsky-Halpern B 1985 Trust, Talk and Touch in Balkan Folk Healing Social
Science and Medicine 21(3):319-325
Karoski S Bosnian Macedonian Serbian: Migration Refugee Experiences and
Settlement Notes from a presentation in Disability Service Provider Workshops run
by the Multicultural Disability Advocacy Association of NSW 2004
Lee C 2001 Women and Health Australia: Progress on the Australian Longitudinal
Study on Women’s Health 1995–2000 Australian Academic Press Brisbane
Hislope R 2001 Between a bad peace and a good war: insights and lesions from the
almost-war in Macedonia Ethnic and Racial Studies 26(1):129-151
Marmot M 2001 Economic and social determinants of disease Bulletin of the World
Health Organisation 79(10):988-989
- 27 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
Macedonian Australian Welfare Association 2000 Macedonian Community in Sydney
MAWA Sydney
Macedonian Australian Welfare Association 2004 Macedonian 2004 Directory MAWA
Sydney
Macedonian Australian Welfare Association 2004 Issues Paper examining settlement
experiences of newly arrived and special needs entrants from Macedonia MAWA
Sydney
Macedonian Australian Welfare Association no date The Macedonian Community in
NSW Fact Sheet MAWA Sydney
Milosevski G 2004 Disability and Community Linkages Project. Bosnian Macedonian
Serbian: The communities in NSW MAWA Sydney
Multicultural Health Unit WSAHS no date Women’s Health at Work Program:
Reaching women from culturally and linguistically diverse backgrounds in the
workplace. Strategic Direction and Business Plan 2001 – 2003 Western Sydney Area
Health Service
Najdovski C 1997 Contested Identity: Macedonians in Contemporary Australia Vic
NSW Health 2002 Women’s Health Outcomes Framework NSW Health Department
Sydney
Pederson D 2002 Political Violence, ethnic conflict, and contemporary wars: broad
implications for health and social wellbeing Social Science & Medicine 55(2):175-190
Papscreen Victoria 2000 Exploration of factors linked with high cervical cancer rates
in women from the former Yugoslavs in Victoria Australia Anti-Cancer Council of
Victoria Carlton Melbourne
Sapurma-Petkovska P 1990 Macedonian Women and Culture Panorama 1:1-8
South East Health 2002 – 2004 Minutes of the Cervical and Breast Cancer Screening
Recruitment Working Party SESAHS (unpublished documents)
South East Health 2003 Healthier Women: Strategic directions to advance the health
of women in South East Health 2003 – 2008 South Eastern Sydney Area Health
Service
St George Division of General Practice 1997 NESB Health Needs Project Evaluation
Report St George Division of General Practice Sydney
St George Division of Mental Health 2003 Macedonian Mental Health Project Report:
Understanding the attitudes and beliefs of the Macedonian community about mental
illness St George Division of Mental Health Sydney
St George Hospital and Community Health Service 2001 Analysis of Findings of
Focus Groups within Culturally and Linguistically Diverse Communities St George
Hospital & Community Health Service Sydney
- 28 -

Macedonian Women’s Health Project
Review of literature
___________________________________________________________________
St George Migrant Resource Centre 2004 Annual Report St George MRC Rockdale
Sydney NSW
Stankovska M 1995 Barriers to Social Change for Macedonian Women Macedonian
Agenda in Victor Bivell (Ed) 16 Essays on the Development of Macedonian Culture in
Australia Pollitecon Publications Sydney
Thomas M 2001 A Multicultural Landscape: National parks and the Macedonian
experience Pluto Press Australia
Tkalcevic M 1980 Macedonians in the Australian society Government Printers
Melbourne
Trotter L Mullins R Boulter J and Borland R 1998 Key findings of the 1996 and 1997
household surveys in L Totter & R Mullins (eds) Quit Evaluation Studies 9. Centre for
Behavioural Research in Cancer Anti-Cancer of Victoria Carlton Melbourne pp1-25
Vidanovski V 2003 Rebuilding Macedonian National Identity in Australia Canberra
Historical Journal September:20-22
Watson R Eccleston P Elliott A Clews C Fisher J Grunseit A Needs Assessment.
HIV/AIDS & Youth of the St George District, NSW Southern Sydney HIV/AIDS
Program and the Southern Sydney Health Promotion Unit
World Health Organisation 2002 Development of Food and Nutrition Action Plans in
South East Europe: Report on a Second Workshop Sofia 8-11 October 2001 WHO
Geneva
- 29 -