Aboriginal and Torres Strait Islander mothers have almost double the risk of experiencing premature delivery and low birth weight as compared to non-Indigenous women in Australia, a fact which is indicative of disparities in healthcare services provided to these women during pregnancy. Furthermore, these outcomes increase the child’s risk of developing non-communicable diseases (slow progressing diseases that cannot be passed from person to person) later in life. Studies have shown that non-communicable diseases are more common among the Aboriginal and Torres Strait Islander people than non-indigenous people: indigenous adults are 3.3 times more likely to have diabetes, 10 times as likely to be hospitalized for chronic kidney disease, and twice as likely to commit suicide. This is starkly reflected in the fact that life expectancy is 10 years lower in this population than it is for the average Australian.
Melanie Gibson-Helm and colleagues’ recent research, ‘Identifying evidence-practice gaps and strategies for improvement in Aboriginal and Torres Strait Islander maternal health care’, forms part of the fifth Maternal Health Task Force collection, published in PLOS ONE. With its focus on ‘Non-Communicable Diseases and Maternal Health Around the Globe’, the collection features vital new research on a range of conditions such as cancer, diabetes, obesity and mental illness affecting pregnant women and mothers.
This paper addresses the disparity in outcomes for Indigenous mothers and babies in Australia, which is both attributable to, and contributes to, the elevated risk of non-communicable diseases (NCDs) in this group. It highlights the pressing need for health services and systems to provide high quality, specialized care for the 4% of women giving birth in Australia who are Aboriginal and Torres Strait Islanders. The paper takes into account feedback and suggestions for change from key stakeholders in healthcare services, thus drawing on the expertise and lived experiences of the doctors, nurses, midwives and healthcare assistants on the front line.
The research conducted by Gibson-Helm and colleagues shows that the Aboriginal and Torres Strait Islander community must be placed at the centre of healthcare services in order to provide appropriate and effective healthcare. When healthcare service teams are representative of the diverse communities, they can demonstrate that these services are meant for, and safe for, Aboriginal people. As a preliminary step, the authors found that recruiting and retaining doctors, nurses, midwives and health care workers from this community could be vital. In addition to this, services should consult and collaborate with the Aboriginal and Torres Strait Islander communities in order to improve the care they offer these groups. This has several components. First, the communities themselves should be involved in the design of any healthcare campaigns and initiatives aimed at them. Second, they should be involved in the development and implementation of cultural awareness training programs for healthcare staff. Third, they should be consulted as to the ways in which health services can become more accessible, sensitive and effective in dealing with the needs and preferences of Aboriginal and Torres Strait Islander patients and community members.
Gibson-Helm and colleagues show that health services are failing in several areas to provide the care that could address the increased risks faced by Aboriginal mothers. Not only will effective interventions improve the health of Aboriginal and Torres Strait Islander mothers and their babies, but supporting these women to understand the risks associated with certain behaviours (smoking, risky drinking, poor diet, drugs), and alter their lifestyles accordingly, is likely to have a long-lasting positive impact on their children later in life.
It could be that the contact these women have with health workers during pregnancy offers a unique experience for community liaison and for developing a relationship of trust between Aboriginal and Torres Strait Islander people and health services. A positive relationship with health services at this point in a woman’s life has the potential to extend beyond the postnatal period into later life, and beyond her as an individual to her families and friends. If this is true, the strategies laid out by Gibson-Helm and colleagues could contribute to breaking the cycle of elevated risk for non-communicable disease that has plagued Aboriginal communities for several generations.
The lessons to be learned from this research are not limited to services treating Aboriginal and Torres Strait Islander women, but can be applied to health systems wherever there are marginalised or minority groups. These results should be taken into account by governments and health services worldwide in order to work towards a future of parity in healthcare for all.
References and links
- Australian Institute of Health and Welfare. Australia’s mothers and babies 2014—in brief. Canberra: AIHW, 2016. https://www.aihw.gov.au/getmedia/68429bae-ebcd-4edb-9861-73d5fbdc258c/20210.pdf.aspx?inline=true
- Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet. 2008;371(9608):261–9. http://dx.doi.org/10.1016/S0140-6736(08)60136-1. pmid:18207020 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60136-1/fulltext
- Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander people Canberra, Australia: Australian Institute of Health and Welfare, 2011. https://www.aihw.gov.au/getmedia/584073f7-041e-4818-9419-39f5a060b1aa/18175.pdf.aspx?inline=true
- Australian Institute of Health and Welfare. Contribution of chronic disease to the gap in adult mortality between Aboriginal and Torres Strait Islander and other Australians. Canberra, Australia: Australian Institute of Health and Welfare, 2010. https://www.aihw.gov.au/getmedia/79b73a27-c970-47f0-931b-32d7badade40/12304.pdf.aspx?inline=true
- Korff J. Aboriginal health. Creativespirits.info, 2017, accessed February 2018. https://www.creativespirits.info/aboriginalculture/health/
- Gibson-Helm ME, Bailie J, Matthews V, Laycock AF, Boyle JA, Bailie RS (2018) Identifying evidence-practice gaps and strategies for improvement in Aboriginal and Torres Strait Islander maternal health care. PLoS ONE 13(2): e0192262. https://doi.org/10.1371/journal.pone.0192262
- Maternal Health Task Force https://www.mhtf.org/
- Non-Communicable Diseases and Maternal Health Around the Globe: MHTF/PLOS ONE collection https://collections.plos.org//maternal-ncds