A population-based investigation into inequalities amongst Indigenous mothers and newborns by place of residence in the Northern territory, Australia

Abstract

Background Comparisons of birth outcomes between Australian Indigenous and non-Indigenous populations show marked inequalities. These comparisons obscure Indigenous disparities. There is much variation in terms of culture, language, residence, and access to services amongst Australian Indigenous peoples. We examined outcomes by region and remoteness for Indigenous subgroups and explored data for communities to inform health service delivery and interventions. Methods Our population-based study examined maternal and neonatal outcomes for 7,560 mothers with singleton pregnancies from Australia’s Northern Territory Midwives’ Data Collection (2003–2005) using uni- and multivariate analyses. Groupings were by Indigenous status; region ( Top End ( TE ) /Central Australia ( CA )); Remote/Urban residence; and across two large TE communities. Results Of the sample, 34.1% were Indigenous women, of whom 65.6% were remote-dwelling versus 6.7% of non-Indigenous women. In comparison to CA Urban mothers: TE Remote (adjusted odds ratio [aOR] 1.47, 95%CI: 1.13, 1.90) and TE Urban mothers (aOR 1.36 (95% CI: 1.02, 1.80) were more likely, but CA Remote mothers (aOR 0.43; 95% CI: 0.31, 0.58) less likely to smoke during pregnancy; CA Remote mothers giving birth at >32 weeks gestation were less likely to have attended ≥ five antenatal visits (aOR 0.55; 95%CI: 0.36, 0.86); TE Remote (aOR 0.71; 95%CI: 0.53, 0.95) and CA Remote women (aOR 0.68; 95%CI: 0.49, 0.95) who experienced labour had lower odds of epidural/spinal/narcotic pain relief; and TE Remote (aOR 0.47; 95%CI: 0.34, 0.66), TE Urban (aOR 0.67; 95%CI: 0.46, 0.96) and CA Remote mothers (aOR 0.52; 95%CI: 0.35, 0.76) all had lower odds of having a ‘normal’ birth. The aOR for preterm birth for TE Remote newborns was 2.09 (95%CI: 1.20, 3.64) and they weighed 137 g (95%CI: -216 g, -59 g) less than CA Urban babies. There were few significant differences for communities, except for smoking prevalence. Conclusions This paper is one of few quantifying inequalities between groups of Australian Indigenous women and newborns at a regional level. Indigenous mothers and newborns do worse on some outcomes if they live remotely, especially if they live in the TE . Smoking prevention and high-quality antenatal care is fundamental to addressing many of the adverse outcomes identified in this paper.

Risk factors for preterm, low birthweight and small for gestational age births among Aboriginal women from remote communities in Northern Australia

“…The rates are possibly the highest rates in Australia, 11 are also high by international standards, 1 and were higher than those reported in the general Darwin region (their sample had 76.7% of Aboriginal babies which included women from these communities) more than 20 years ago (liveborn singletons had PTB: 7.4% and LBW 13.9%). 31 Even though remoteness is a known independent risk factor for poorer outcomes in the NT and regional differences have been identified 12 this study highlights the importance of community/regional specific reporting to enable targeted strategies where they are needed most. When looking at socioeconomic disadvantage these communities are in the lowest 2% of all communities in Australia, thus it was not surprising that we found high rates of teenage mothers (28.3%).…”

“…1,6,7,10 There is significant disparity between Aboriginal and nonAboriginal Australians for these outcomes: PTB (14.3% vs. 8.3%) and LBW (11.8% vs. 6.0%) 11 ; and the risk factors for example: teenage pregnancy (18.6% vs 3.0%), smoking in pregnancy (48.1% vs 10.7%) and living in remote areas (24.1% vs. 1.8%). 11,12 Aboriginal mothers are also more likely to attend antenatal care later in pregnancy and receive less antenatal visit than non-Aboriginal mothers. 4 A few Australian studies have reported risk factors for PTB and LBW among Aboriginal women from regional and urban areas.…”

“…13,14 However, about a third of Aboriginal births are to women who live in remote/very remote areas. 12 Pregnancy and birth characteristics and outcomes differ from those occurring in urban, rural and remote areas. 12,15 In 2007, the authors were awarded an Australian National Health and Medical Research Council (NHMRC) grant aiming to improve outcomes for Aboriginal women and infants living in two remote communities in Northern Territory (NT), Australia.…”

“…12 Pregnancy and birth characteristics and outcomes differ from those occurring in urban, rural and remote areas. 12,15 In 2007, the authors were awarded an Australian National Health and Medical Research Council (NHMRC) grant aiming to improve outcomes for Aboriginal women and infants living in two remote communities in Northern Territory (NT), Australia. Key results are reported elsewhere 16,17 however, we found that PTB and LBW rates were some of the highest in Australia, which urged us to investigate the risk factors for PTB, LBW and small for gestational age (SGA) births for women in our study.…”

Letter to the Editor

“…12 In Australia, remoteness was found to be an independent factor in birth outcomes. 13 In France, greater distance was associated with worse outcomes. 14 In Wales, greater distance to hospital was associated with higher risk of neonatal mortality.…”