What risks do herbal products pose to the Australian community?

The letter by Morton draws timely attention to another group of patients who are sometimes overlooked in health initiatives, that is, migrant and refugee women. Although our review of herbal use in Australia noted a higher usage among younger women with tertiary education,1 there is no doubt that other groups within the community may have specific culturally determined practices involving complementary medicines. A Belgian study in 2014, which revealed that a large number of African medicinal plants were being sold in Brussels, proposed that part of the reason for this trade for migrant groups was that it assisted in treating culturally defined illnesses, and helped to maintain cultural identity.2 Morton also pointed out that up to 84% of pregnant women in African countries ingest soils, chalk or clay. It is significant that such geophagia has been reported in 57% of Afro-American women in one county in Mississippi, United States. This shows that “deeply embedded cultural conditions and attitudes” may remain in displaced communities for a number of generations.3 Usage of herbal products by pregnant women is found in many cultures that may then have migrated elsewhere. For example, a study of Palestinian women found that 40% of them used herbal preparations during pregnancy, sometimes without telling their treating doctors.4 The rationale for the use of herbs in contemporary Western societies is clearly far from homogeneous. Thus, in evaluating the role of herbal medicines in a particular population, it is important to consider cultural imperatives and traditions of specific ethnic or migrant groups that may have a strong influence on how they are used and over what time.