Closing the gap on infant mortality

Birthing on Country programs aim to engage Aboriginal and Torres Strait Islander women in effective antenatal care.

Infant mortality rates among Indigenous Australians are almost double those of other Australian children.

Indigenous babies also have higher rates of low birth weight, with maternal smoking a major contributing factor.

The Birthing on Country (BoC) movement has arisen over recent years with the aim of reducing these and other health disparities. BoC services aim to be community-based and governed, and are developed by, or with, Indigenous Australians. They aim to incorporate traditional practice, value Indigenous and nonIndigenous knowledge and practice, be culturally competent and adopt a holistic definition of health.

Southern Cross University (SCU) has secured a $3.6 million federal government grant to design a BoC program in collaboration with three Aboriginal community-controlled health organisations.

Dr Marilyn Clarke, who graduated as Australia’s first Aboriginal obstetrician and gynaecologist in 1997, is jointly leading the SCU project.

She grew up in Port Stephens near Newcastle and credits her mother, Grace Kinsella, a Worimi woman and passionate community nurse, for inspiring her to become a doctor.

“Also, the hospital system is very focused on acute management. Hospital settings are not designed to connect with Aboriginal people in their communities and there’s often no continuity of midwifery care.

“Having a known and trusted carer is important to all women and Indigenous women in particular, because it provides a sense of safety.”

Dr Clarke said there is still a disparity in rates of perinatal mortality, maternal mortality, and medical conditions such as preeclampsia and gestational diabetes.

BoC programs aim to reduce these inequities by engaging Aboriginal

Culturally Safe Care

Dr Clarke said the essence of BoC is “providing culturally safe care where the woman is feeling safe and empowered in her pregnancy journey. It is also about providing holistic care that incorporates social supports and meets the woman’s cultural needs as well.

“Historical and inter-generational trauma has often led Aboriginal women to have a negative view of hospitals,” she said.

A Voice at the table

Aboriginal obstetrician and gynaecologist Dr Marilyn Clarke is a supporter of the proposed Aboriginal and Torres Strait Islander Voice to parliament and government.

“As an Aboriginal person who has worked in Aboriginal health for my entire career and been a consumer of Aboriginal health services for myself and my family, I’m a witness to the importance of having an Aboriginal voice at the table when things are being designed and implemented,” she said.

“If the referendum is successful, the Voice will give us an input at the national level into programs and policies that are going to directly affect us.

“Without such an input, programs and services for Indigenous people will not be as effective. That’s been proven in Australia time and time again.” n and Torres Strait Islander women in effective antenatal care, and ensuring mums and their pregnancies are as healthy as possible.

Dr Clarke added that a Birthing in Our Community service implemented at Mater Mothers Public Hospital in Brisbane achieved a significant reduction in preterm births.

The service also cost less than standard care due to fewer interventions and procedures in birth and fewer neonatal admissions.

Quit Smoking Scheme

Maternal smoking has a strong association with low birth weights and the SCU BoC project will tailor a quit-smoking program to the needs of partner communities.

Dr Clarke said smoking rates among Indigenous women are slowly coming down, but at 44 per cent it is still almost quadruple the nonIndigenous rate of 12 per cent.

SCU has a midwifery program at its Coffs Harbour and Gold Coast campuses, with the provision of culturally appropriate care part of the curriculum.

Scholarships For Midwives

The SCU BoC project aims to boost the number of graduating Aboriginal midwives through an increase in scholarships and opportunities.

“Having an Aboriginal midwife can make a massive difference to Indigenous mothers, yet they are a tiny part of the overall midwifery workforce,” Dr Clarke said.

“The federal government grant includes scholarships for Aboriginal people to do the midwifery course and have placements out in the communities we are going to partner with.”

She believes the involvement of Aboriginal communities in the design of maternity programs is vital to their success.

“In designing our project, we will go out to our partner communities and involve them from the ground up.

“We want them to be co-designers of how BoC would look for their communities, how smoking cessation training can be adapted to their needs, and how Aboriginal midwives can be incorporated into the model of care.” n