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

Malinda Steenkamp,Lesley Barclay,Alice Rumbold,Sue Kildea

doi:10.1186/1471-2393-12-44

Abstract

BackgroundComparisons 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.MethodsOur 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.ResultsOf 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.ConclusionsThis 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.

Highlights

Comparisons of birth outcomes between Australian Indigenous and non-Indigenous populations show marked inequalities
Comparing Indigenous and non-Indigenous mothers and newborns living in remote areas Indigenous mothers living in remote areas more often had worse outcomes for important antenatal risk factors in comparison to remote-dwelling non-Indigenous mothers (Table 2)
Both Top End (TE) Remote and TE Urban mothers were more likely to report smoking tobacco in pregnancy after the model was adjusted for age of mother, multiparity and reported alcohol use, while Central Australia (CA) Remote women were less likely to smoke during pregnancy than CA Urban women

Summary

Introduction

Comparisons of birth outcomes between Australian Indigenous and non-Indigenous populations show marked inequalities Australia’s Aboriginal and Torres Strait Islander (Indigenous) peoples were its original inhabitants They currently comprise 2.5% of the Australian population [1] and experience substantial disadvantage evident on a range of health and socio-economic indicators [2]. Most Australian literature compares outcomes between Indigenous and non-Indigenous women and infants [7] This is important to direct policy measures to reduce health inequalities, such as the Australian Government’s Close the Gap campaign [8], but it obscures the recognised heterogeneity of Indigenous populations in terms of culture, language, residence, socio-economic circumstances and access to services [2,9,10]. A greater proportion of Indigenous births occur in areas considered remote/very remote (26.2% versus 1.9% amongst non-Indigenous mothers) [4]

Objectives

Methods

Results

Discussion

Conclusion