Improving maternity services for Indigenous women in Australia: moving from policy to practice

Abstract

The well established disparities in health outcomes between Indigenous and non-Indigenous Australians include a significant and concerning higher incidence of preterm birth, low birth weight and newborn mortality. Chronic diseases (eg, diabetes, hypertension, cardiovascular and renal disease) that are prevalent in Indigenous Australian adults have their genesis in utero and in early life. Applying interventions during pregnancy and early life that aim to improve maternal and infant health is likely to have long lasting consequences, as recognised by Australia's National Maternity Services Plan (NMSP), which set out a 5-year vision for 2010-2015 that was endorsed by all governments (federal and state and territory). We report on the actions targeting Indigenous women, and the progress that has been achieved in three priority areas: The Indigenous maternity workforce; Culturally competent maternity care; and; Developing dedicated programs for "Birthing on Country". The timeframe for the NMSP has expired without notable results in these priority areas. More urgent leadership is required from the Australian government. Funding needs to be allocated to the priority areas, including for scholarships and support to train and retain Indigenous midwives, greater commitment to culturally competent maternity care and the development and evaluation of Birthing on Country sites in urban, rural and particularly in remote and very remote communities. Tools such as the Australian Rural Birth Index and the National Maternity Services Capability Framework can help guide this work.

Disparities between Aboriginal and non‐Aboriginal perinatal mortality rates in Western Australia from 1980 to 2015

“…Sub‐optimal access to, and use of, responsive and appropriate antenatal care services has long been considered a critical issue in achieving equitable outcomes for Aboriginal women and their babies . Aboriginal women are typically confronted with a number of barriers to quality antenatal care services which extend beyond the individual constraints of socio‐economic circumstances and location, to the cultural safety, security and competence of mainstream care providers and health practitioners .…”

Aboriginal and Torres Strait Islander health‐care delivery: The views of health‐care professionals in Sydney's tertiary paediatric hospitals

“…Access to Aboriginal health‐care professionals within hospitals is known to be a core component to improving health‐care delivery and outcomes for Aboriginal patients . In different parts of Australia and other countries, like Canada, the Indigenous workforce has been shown to improve health‐care delivery by assisting with bridging the cultural gap . Unfortunately, Aboriginal people are significantly under‐represented in the health workforce …”

“…12 In different parts of Australia and other countries, like Canada, the Indigenous workforce has been shown to improve health-care delivery by assisting with bridging the cultural gap. 13 Unfortunately, Aboriginal people are significantly under-represented in the health workforce. 12 Pathways to improving health outcomes for Aboriginal patients should include improved identification of gaps in current delivery practices.…”

Indigenous mothers' experiences of using acute care health services for their infants

“…While most participants did not expect their infants’ ACP to offer natural therapies or traditional medicine in an acute care encounter, they wanted their infants’ ACP to link them with Indigenous Elders, on‐site spiritual care rooms and other cultural resources in the community. International research has similarly reported that meeting spiritual and cultural needs is essential to the provision of culturally safe care for Indigenous mothers and infants (Adcock, Cram, & Lawton, ; Kildea, Tracy, Sherwood, Magick‐Dennis, & Barclay, ; Stevenson, Filoche, Cram, & Lawton, ).…”