Abstract
BackgroundPrematurity and low birthweight are more prevalent among Indigenous and Culturally and Linguistically Diverse infants.MethodsTo conduct a systematic review that used the social-ecological model to identify interventions for reducing low birthweight and prematurity among Indigenous or CALD infants. Scopus, PubMed, CINAHL, and Medline electronic databases were searched. Studies included those published in English between 2010 and 2021, conducted in high-income countries, and reported quantitative results from clinical trials, randomized controlled trials, case-control studies or cohort studies targeting a reduction in preterm birth or low birthweight among Indigenous or CALD infants. Studies were categorized according to the level of the social-ecological model they addressed.FindingsNine studies were identified that met the inclusion criteria. Six of these studies reported interventions targeting the organizational level of the social-ecological model. Three studies targeted the policy, community, and interpersonal levels, respectively. Seven studies presented statistically significant reductions in preterm birth or low birthweight among Indigenous or CALD infants. These interventions targeted the policy (n = 1), community (n = 1), interpersonal (n = 1) and organizational (n = 4) levels of the social-ecological model.InterpretationFew interventions across high-income countries target the improvement of low birthweight and prematurity birth outcomes among Indigenous or CALD infants. No level of the social-ecological model was found to be more effective than another for improving these outcomes.
Highlights
Marginalised individuals in Australia, including Aboriginal, Torres-Strait Islander, First Nations and Culturally and Linguistically Diverse (CALD) women and infants have long had different experiences of health and healthcare in Australia compared to their nonmarginalised counterparts
The results identified a limited number of interventions that targeted reducing preterm birth and low birthweight in infants of Indigenous and CALD women, though over half produced statistically significant improvements in these outcomes [15, 16, 25,26,27,28,29]
Greater research and evaluation of interventions targeting Indigenous and CALD women will be essential for actioning policies aimed at closing inequality gaps
Summary
Marginalised individuals in Australia, including Aboriginal, Torres-Strait Islander, First Nations (respectfully referred to as Indigenous Australians hereafter) and Culturally and Linguistically Diverse (CALD) women and infants have long had different experiences of health and healthcare in Australia compared to their nonmarginalised counterparts. Social determinants of health that differ for Indigenous Australians, including cultural identity, family support, participation in cultural activities and access to traditional lands, can contribute to differences in health outcomes such as low birthweight and prematurity, as well as quality of life within the Indigenous population [4]. Disadvantages and social determinants to CALD women that act as barriers to accessing care, and in turn contribute to poor birth outcomes include cultural differences, language barriers, limited health literacy, insufficient support, transport issues and limited financial capacity [3]. Marginalised women in Australia are at an increased risk of low birthweight and premature births secondary to factors that include intergenerational trauma, colonisation, and stigma and racism [5]. Prematurity and low birthweight are more prevalent among Indigenous and Culturally and Linguistically Diverse infants
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