Remote links: Redesigning maternity care for Aboriginal women from remote communities in Northern Australia – A comparative cohort study (original) (raw)
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Midwifery, 2014
Objective: there is a significant gap in pregnancy and birth outcomes for Australian Aboriginal and Torres Strait Islander women compared with other Australian women. The provision of appropriate and high quality antenatal care is one way of reducing these disparities. The aim of this study was to assess adherence to antenatal guidelines by clinicians and identify factors affecting the quality of antenatal care delivery to remote dwelling Aboriginal women. Setting and design: a mixed method study drew data from 27 semi-structured interviews with clinicians and a retrospective cohort study of Aboriginal women from two remote communities in Northern Australia, who gave birth from 2004-2006 (n ¼412). Medical records from remote health centres and the regional hospital were audited. Measurements and findings: the majority of women attended antenatal care and adherence to some routine antenatal screening guidelines was high. There was poor adherence to local guidelines for followup of highly prevalent problems including anaemia, smoking, urinary tract infections and sexually transmitted infections. Multiple factors influenced the quality of antenatal care. Key conclusions and implications for practice: the resourcing and organisation of health services and the beliefs, attitudes and practices of clinicians were the major factors affecting the quality of care. There is an urgent need to address the identified issues in order to achieve equity in women's access to high quality antenatal care with the aim of closing the gap in maternal and neonatal health outcomes.
Australian and New Zealand journal of public health, 2016
To investigate the extent to which Aboriginal women access primary care for themselves and their infant in the year after childbirth. Cross sectional population-based survey of women giving birth to Aboriginal babies in South Australia between July 2011 and June 2013. A total of 344 women took part in the study 4-9 months after giving birth. The majority had seen a primary health care practitioner since the birth: 86% had seen a Child and Family Health Service (CaFHS) nurse, 81% a general practitioner (GP), and 61% an Aboriginal health worker (AHW). Women living in remote areas were more likely to have seen primary care practitioners than women living in Adelaide (GP: OR 2.3, 95% CI 1.0-5.2; CaFHS: OR 2.4, 95% CI 1.0-5.8; AHW: OR 5.2, 95% CI 2.8-9.8). Around 16% of women with gestational diabetes and 10% with hypertension had not seen a GP since the birth, and 24% of women who had a low birthweight infant had not seen a CaFHS nurse. Despite high prevalence of maternal and infant mor...
Remote dwelling Aboriginal Australian women and birthing: A critical review of literature
Women and Birth, 2019
Australian Aboriginal women's aspirations for birthing on country (having our babies born on our traditional land) are increasingly being reported in Australian scholarly and policy literature. However given the paucity of publications authored by Aboriginal Australians from remote areas of Australia, how well can the current knowledge base in Australia inform the development of culturally appropriate maternity services for our communities? Objective: The aim of this literature review is to critically analyse the policy documents informing maternity services policy and scholarly literature on the birthing experiences (including the provision of maternity services) of Aboriginal Australian women from remote communities from an Indigenous standpoint. Method: Policy documents and scholarly literature were critically analysed to identify who the authors were, their background, approaches and perspectives; and emergent themes. A further analysis of the literature drew on Fairclough's ideas on discourse, power and hegemony. Findings: A critical discourse analysis of this literature exposed how these texts are ideologically shaped to give voice (and power) to the medical fraternity, maternity care services practitioners and policy makers (whose knowledge is valued) while simultaneously silencing the voices of Aboriginal Australians that pose a challenge to that power. Conclusion: This critical review of current literature highlights the importance of ongoing critique of maternity services policy and practice discourse necessary to combat western medical hegemony that maintains the disenfranchisement of Aboriginal Australians.
Birth, 2016
IntroductionAboriginal and Torres Strait Islander women are two to three times more likely to experience adverse maternal and perinatal outcomes than non‐Aboriginal women in Australia. Persisting health inequalities are at least in part explained by late and/or inadequate access to antenatal care.MethodsThis study draws on data collected in a population‐based study of 344 women giving birth to an Aboriginal infant between July 2011 and June 2013 in South Australia to investigate factors associated with engagement in antenatal care.ResultsAbout 79.8 percent of mothers accessed antenatal care in the first trimester of pregnancy, and 90 percent attended five or more antenatal visits. Compared with women attending mainstream regional services, women attending regional Aboriginal Family Birthing Program services were more likely to access antenatal care in the first trimester (Adj OR 2.5 [1.0–6.3]) and markedly more likely to attend a minimum of five visits (Adj OR 4.3 [1.2–15.1]). Women...
Maternal and Child Health Journal, 2012
This paper aims to describe delivery and birth outcomes of Aboriginal infants and their mothers in an urban setting on the east coast of Australia. The paper uses a causal pathway approach to consider the role of risk and protective factors for low birthweight. All mothers who delivered at Campbelltown Hospital between October 2005 and May 2007 were eligible. The study included 1,869 non-Aboriginal infants and 178 Aboriginal infants and their mothers. Information on delivery and birthweight was extracted from electronic medical records. Risk factors for poor outcomes were explored using regression and causal pathway analysis. Mothers of Aboriginal infants were younger than mothers of non-Aboriginal infants, and were more likely to be single, less educated, unemployed prior to pregnancy, and live in a disadvantaged neighbourhood. Health and service use was similar. They were significantly more likely to have a vaginal delivery than mothers of non-Aboriginal infants (77% cf 62.5%; v 1 2 = 14.6, P \ 0.001) and less likely to receive intervention during delivery. Aboriginal infants (3,281.1 g) weighed 137.5 g (95%CI: 54-221 g; P = 0.001) less then non-Aboriginal infants (3,418.7 g). Gestational age, and single mother with incomplete education, prior unemployment, smoking, and living in a disadvantaged neighbourhood were associated with lower birthweight. Maternal vulnerability had a cumulative impact on birthweight. A causal pathway analysis demonstrated the associations between risk factors.
Antenatal care for Aboriginal and Torres Strait Islander women
Australian family physician
About 6% of Australian births are to an Aboriginal or Torres Strait Islander parent and there is a clear disparity in birth outcomes between Aboriginal and Torres Strait Islander and non-Indigenous Australians. Some issues affecting birth outcomes are similar nationally whilst others will be more particular to certain areas. This paper will highlight important areas that may facilitate improved care for Aboriginal and Torres Strait Islander women. A key component of improving pregnancy outcomes is early and ongoing engagement in antenatal care, which is facilitated by the provision of culturally appropriate and evidence based care relevant to the local community. The majority of Aboriginal and Torres Strait Islander peoples live in urban or inner regional areas and receive healthcare through mainstream services and it is important therefore for all practitioners to be aware of how to optimise care to Aboriginal and Torres Strait Islander women.
Birth, 2015
Background: Aboriginal and Torres Strait Islander families experience markedly worse maternal and child health outcomes than non-Aboriginal families. The objective of this study was to investigate the experiences of women attending Aboriginal Family Birthing Program services in South Australia compared with women attending mainstream public antenatal care. Method: Population-based survey of mothers of Aboriginal babies giving birth in urban, regional, and remote areas of South Australia between July 2011 and June 2013. Results: A total of 344 women took part in the study around 4-9 months after giving birth; 93 percent were Aboriginal and/or Torres Strait Islanders, and 7 percent were non-Aboriginal mothers of Aboriginal babies. Of these, 39 percent of women lived in a major city, 36 percent in inner or outer regional areas, and 25 percent in remote areas of South Australia. Compared with women attending mainstream public antenatal care, women attending metropolitan and regional Aboriginal Family Birthing Program services had a higher likelihood of reporting positive experiences of pregnancy care (adjOR 3.4 [95% CI 1.6-7.0] and adjOR 2.4 [95% CI 1.4-4.3], respectively). Women attending Aboriginal Health Services were also more likely to report positive experiences of care (adjOR 3.5 [95% CI 1.3-9.4]). Conclusions: In the urban, regional, and remote areas where the Aboriginal Family Birthing Program has been implemented, the program has expanded access to culturally responsive antenatal care for Aboriginal women and families. The positive experiences reported by many women using the program have the potential to translate into improved outcomes for Aboriginal families. (BIRTH 2015
Obstetrical outcomes of Aboriginal pregnancies at a major urban hospital
Australian Journal of Public Health, 1994
While a number of previous papers have documented the poor general health of Australia's Aboriginal population, relatively few have considered the health of Aborigines living in Australia's urban centres. In this latter instance, Aborigines have access to conventional medical services and they live in a physical environment that does not differ greatly from that experienced by the lower-class white population. Of course, racial, familial and economic differences may continue to influence differentially the perceived accessibility of services to Aborigines and their non-Aboriginal neighbours. This paper compares the pregnancy outcomes of Aboriginal women and non-Aboriginal women living in a major urban centre in Australia. The data indicate that urban Aboriginal women have adverse pregnancy outcomes at one and a half o two times the rate experienced by the non-Aboriginal population. Much of the difference can be attributed to Lifestyle variations in the groups being compared.