Abstract
BackgroundAustralia's Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities.MethodsWe undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4) were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems.ResultsThe proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician.ConclusionParticipating services had both strengths and weaknesses in the delivery of maternal health care. Increasing access to evidence-based screening and health information (most notably around smoking cessation) were consistently identified as opportunities for improvement across services.
Highlights
Australia’s Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians
There is no complete national data for Indigenous women, the available data suggests that antenatal care is underutilised, as Indigenous women are more likely to present for care later in pregnancy and have fewer antenatal visits [6,7,8]
Government funded/operated Managed by local or regional Indigenous committee or board Accreditation status Accredited Not accredited Population sizes of communities served ≤ 500 501-999 ≥1000 No of women participating in maternal health audits Median age of women Indigenous status Indigenous Non-Indigenous Not stated Mean estimated gestational age at the first antenatal visit Proportion of women with estimated gestational age at first antenatal visit < 12 weeks Mean number of antenatal visits First antenatal assessments by: Aboriginal health workers Nurses Midwives Doctors Unknown Proportion of women with folic acid prescribed before 20 weeks Proportion of women with folic acid prescribed prior to conception Proportion of women with iron prescribed Proportion of women with a general antenatal care plan present in the file
Summary
Australia’s Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities. High rates of poor pregnancy outcomes including maternal and perinatal mortality, preterm birth and low birth weight have. Providing access to appropriate and quality care in the antenatal and postnatal period is a key part of closing the gap in Indigenous perinatal outcomes. Almost all pregnant Australian women have some antenatal care, which can be delivered by a diverse range of providers (e.g. midwives, obstetricians, Aboriginal health workers, general practitioners etc.) working across hospital and community settings. There is no complete national data for Indigenous women, the available data suggests that antenatal care is underutilised, as Indigenous women are more likely to present for care later in pregnancy and have fewer antenatal visits [6,7,8]
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