Australian Aboriginal Women Research Articles

Educating Rita at the cultural interface: exploring intersections between race and gender in the experiences of Australian Aboriginal women at university

ABSTRACT While a significant minority cohort, Australian Aboriginal women are increasingly attending university. However, their experiences remain largely undocumented in the literature. This study focused on the experience of eight female Aboriginal students who completed an Indigenous-only bridging course where they watched the film, Educating Rita, about a working-class woman attending university. The protagonist was a catalyst for a yarning circle which captured participants’ free-flowing conversation about barriers and motivators at university. Thematic analysis of yarning data suggested that the participants faced class and gender-based struggles, which intersected with struggles faced by Indigenous students more broadly. Motivation to persist with university was expressed through paradox; family, community, and caregiving were key motivators and key obstacles. Findings from this study have theoretical and practical application: they illustrate a gendered experience of the Cultural Interface and offer catalysts for tailored support strategies to enable Australian Aboriginal women to undertake and achieve university degrees.

Gender Differences in the Clinical and Polysomnographic Characteristics Among Australian Aboriginal Patients with Obstructive Sleep Apnea.

BackgroundIn this study, we assessed the clinical and polysomnographic (PSG) characteristics according to gender among Australian Aboriginal men and woman diagnosed to have obstructive sleep apnea (OSA).MethodsIn this retrospective study, all adult Aboriginal patients over 18 years of age diagnosed to have OSA with an apnea hypopnea index (AHI) > 5/hour over a 5 year period were included.ResultsOf the 337 patients (168 females and 169 males), who underwent a diagnostic PSG, 297 (88%) were diagnosed to have OSA (AHI) >5/hour), 154/297 males (52%) and 143/297 females (48%). Amongst male and female patients with OSA, 63% and 37% were in the severe spectrum (AHI>30/hour). The male cohort had higher stage N1 NREM sleep (P<0.001), reduced N3 NREM sleep (P<0.001), higher AHI severity (P<0.001), higher NREM AHI (P<0.001), and high arousal index (P<0.005). REM sleep-related AHI was higher among female patients with all severity of OSA, along with severe oxygen desaturation during REM sleep. Among patients with severe OSA, the female cohort were younger (age 46 years vs 49 years, P=0.030) and had higher BMI with all severity of OSA, while males had larger neck circumference compared to females. Hypertension increased the odds of severe OSA versus the combined odds of mild and moderate OSA for both genders.ConclusionThis study highlights some important differences in the way sleep apnea manifests in Australian Aboriginal males and females and further studies are warranted to explore avenues to look for a physiological basis for these observations and targeted interventions.

Racism, stress, and sense of personal control among Aboriginal Australian pregnant women

ObjectivesTo characterise racism experiences in the past year and to investigate a causal association between racism, stress, and sense of personal control in a sample of pregnant South Australian Aboriginal women.MethodsData was from the baseline sample of 369 Aboriginal women participating in a randomised controlled trial to prevent early caries in children. Data on demographics, racism experiences, stress, sense of personal control, and health behaviours were collected through interview‐guided questionnaires. Linear regression modelling was used to test the association between racism and stress and sense of personal control in separate models. The final models presented were adjusted for confounding.ResultsParticipant mean age was 24.7-years (SD ±0.30; Min–Max: 14–43-years). Almost two‐thirds (64.7%) resided in rural and regional areas and the highest educational attainment for almost three‐quarters (73.7%) was high school or less. Nearly half (48.3%) reported at least one experience of racism in the previous year and almost one third (31.8%) reported racism occurring in a public setting. The adjusted regression coefficients for the effect of racism on stress and sense of personal control were respectively 0.61 (95% confidence interval [CI] 0.28, 0.93) and −0.36 (95% CI −0.68, −0.04).ConclusionsOur findings contribute with evidence that racism is one of the psychosocial causes of poor mental health among Aboriginal Australians. Culturally sensitive and safe mental health interventions may be beneficial in buffering racism effects during pregnancy. Societal‐level policies aimed at both naming and reducing institutionalised racism against Aboriginal Australian Aboriginals are necessary.

Intersecting paths of the local and the international: Joyce Clague's activist journeys

ABSTRACT Recent histories have drawn attention to indigenous peoples’ mobilities, trans-indigenous activist networks and the participation of indigenous people in international forums, such as the United Nations. However, many of these histories have overlooked indigenous women as key players on the international stage and the ways their presence in the international arena was transformative for indigenous rights back home. One example of the contribution Aboriginal Australian women made to both local Aboriginal and Torres Strait Islander rights and global anti-colonial movements is Joyce Clague, a woman of Yaegl, Bundjalung and Gumbainggirr heritage. Joyce’s activism was defined by collaboration with international organisations, especially the World Council of Churches where she was promoted as a national delegate to the Programme to Combat Racism. This article, which combines oral history with archival sources, considers how Joyce’s early life and international travels shaped her advocacy for Aboriginal and Torres Strait Islander rights.

Psychosocial disadvantage and residential remoteness is associated with Aboriginal women's mental health prior to childbirth.

IntroductionOptimal mental health in the pre-conception, pregnancy and postpartum periods is important for both maternal and infant wellbeing. Few studies, however, have focused on Indigenous women and the specific risk and protective factors that may prompt vulnerability to perinatal mental disorders in this culturally diverse population.ObjectivesTo assess mental health contacts in the period before childbirth among Australian Aboriginal and Torres Strait Islander women, the association with socioeconomic factors and whether it differs by geographic remoteness.MethodsThis is a retrospective cohort study of 19,165 Aboriginal mothers and includes all Aboriginal mothers and their children born in Western Australia from January 1990 to March 2015. It draws on population-level, linked administrative data from hospitals and mental health services, with a primary focus on the mental health contacts of Aboriginal women in the 5 years leading up to childbirth.ResultsThe prevalence of maternal mental health contacts in the five years prior to birth was 27.6% (93.6% having a single mental health disorder), with a greater likelihood of contact in metropolitan areas compared with regional and remote settings. There was a positive relationship between socioeconomic advantage and the likelihood of a mental health contact for women in Metropolitan (β = 0.044, p=0.003) and Inner regional areas (β = 0.033, p=0.018), and a negative association in Outer regional (β = -0.038, p=0.022), Remote (β = -0.019, p=0.241) and Very remote regions (β = -0.053, p<0.001).ConclusionsThe findings from this study provide new insights on the dynamic relationship between SES, geographic location and mental health issues among Aboriginal women in the 5 years leading up to childbirth. The results underscore the need to apply location-specific approaches to addressing the material and psychosocial pathways that lead to mental health problems and the provision of culturally safe, appropriate and accessible services for Aboriginal women

Abstract P2-10-09: Aggressive tumour biology contributes to poor breast cancer outcomes for indigenous Australians

Abstract Breast cancer (BrCa) incidence is lower in Aboriginal Australian women but carries more than double the risk of death. However, rates of Aboriginal BrCa diagnosis are increasing, hypothesized to be due to lifestyle changes. Thus, with rising incidence and higher mortality, deaths due to BrCa are rising in absolute terms in Aboriginal women. Studies of this higher death rate thus far have been epidemiological, exploring factors such as higher stage at diagnosis, younger age, increased co-morbidities, remoteness, socioeconomic disadvantage, and access to culturally sensitive health services. Collectively, these factors do not fully explain this higher rate of death. However, no study has explored any aspect of tumour or host biology in Aboriginal BrCa. We have studied a cohort of 262 Aboriginal women identified from the WA Cancer Registry comprising all cases diagnosed with BrCa in Western Australia for the period 2001-2016. Remoteness, in the form of an Accessibility/Remoteness Index of Australia (ARIA) score, was calculated from address at the time of diagnosis for each patient. All participants were then matched 2:3 by remoteness of residence and age with non-Aboriginal patients. Mortality data including cause was collected through state Death Registry linkage. Basic tumour parameters as well as receptor expressions were extracted from routine pathology assessment data with extra sections scored for missing values when tissue was available. A BrCa sub-type was assigned to each participant based on a modified IHC4 method using tumour grade, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2) status. A significant detriment was found for Indigenous BrCa mortality, univariate hazard ratio (HR)=4.19 (95% confidence interval (CI) 2.42 - 7.25, p&amp;lt;0.001) after matching for remoteness and age, multivariate HR=2.55 (95% CI 1.39 - 4.67, p=0.003) after further adjustment for lymph involvement and size.Supporting the hypothesis that Indigenous BrCa is more likely to be aggressive, substantially more tumours in Aboriginal women were greater than 2cm (51 v 23%, p&amp;lt;0.0001), grade 3 (45 v 26%, p&amp;lt;0.0001) and lymph node positive (56 v 33%, p=0.011). Considering individual receptors, HER2 positivity was substantially more common (21 v 12%, p=0.009) although ER and PR did not differ. Combining grade and receptor status revealed substantially higher proportions of the higher risk sub-types luminal B (29 v 16%) and HER2-enriched (11 v 5%), but no difference in triple negative cancers (15 v 15%), overall p=0.001 for sub-type differences. These biological differences explained part but not all of the survival detriment observed for Aboriginal women with attenuated survival detriment seen within each biological sub-type. Further studies on more detailed aspects of tumour biology are ongoing. Citation Format: Andrew David Redfern, Lisa J Spalding, Edward YC Lee, Connor F Redfern, Leanne Pilkington, Max Bulsara, Richard Trevithick, Katie Meehan. Aggressive tumour biology contributes to poor breast cancer outcomes for indigenous Australians [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-10-09.

Abstract P5-04-18: Unfavourable tumour stromal immune cell infiltrates but not circulating immune cell profiles in Aboriginal women with breast cancer

Abstract Breast cancer (BrCa) in Aboriginal Australian women carries more than double the risk of death relative to non-Aboriginal Patients. This higher death is partially explained by factors such as higher stage at diagnosis, younger age, increased co-morbidities, remoteness, socioeconomic disadvantage, and access to culturally sensitive health services. Aboriginal women in a Western Australian cohort also more frequently had tumours with adverse biological features including high grade and luminal B or HER2-enriched phenotype. However, an unexplained detriment remained relative to non-Aboriginal women after accounting for these factors. The immune environment of a tumour as well as of the patient in general can impact on native tumour behaviour as well as response to treatment. Studies in many tumour types including meta-analyses in breast cancer correlate higher circulating neutrophil: lymphocyte ratios (NLR) and neutrophil:platelet ratios (NPR) with poorer outcome. Further to this, tumour infiltrating lymphocyte (TIL) levels also have prognostic significance, associating with improved outcome in triple negative and HER2 positive cancers receiving chemotherapy but with adverse outcomes in estrogen receptor positive (ER+) cancers, potentially through to links to anti-estrogen resistance. To further explore drivers of poor outcome in Aboriginal women we studied circulating NLRs and NPRs in a cohort of Indigenous women matched by remoteness of residence and age to non-Indigenous women in Western Australia. Considering the impact of incidental inflammatory conditions over time only levels from counts taken within 90 days either side of diagnosis were considered. Tissue sections where available were assessed for TILs by standard published methods. NLR was available on 214 patients. The median ratio for Indigenous patients (2.46) was not different to non-Indigenous patients (2.13). Considering patients with NLR &amp;gt; 3.0, a cut-off noted to have poorer prognosis in meta-analysis (ref), there was a stronger trend to higher relapse in non-Indigenous (HR 2.14, p=0.07) than Indigenous patients (HR =1.38, p=0.43) for higher NLR. High NLR was not more common in Indigenous relative to non-Indigenous patients (32% v 25%, p=0.37). Considering very high NLR, significantly more Indigenous women had NLRs &amp;gt;5.0 (4.8 v 6.3%, p=0.04). PLR was available on 225 patients. The median for Indigenous patients (126) was not different to non-Indigenous patients (130). Considering patients with PLR &amp;gt; 185, a cut-off noted to have poorer prognosis in meta-analysis (ref), there were non-significant trends to higher relapse in both Indigenous (HR 1.94, p=0.1) and non-Indigenous patients (HR =1.67, p=0.26) for higher PLR. However, high PLR was not more common in Indigenous relative to non-Indigenous patients (15.4 v 21.6%, p=0.24). Stromal TILs were available on 86 patients. Mean % TIL count was significantly higher in Indigenous women (10.7 v 6.6%, p=0.003). This difference was significant for ER+ (9.6 v 3.5%, p=0.004) but not ER- tumours (20.0 v 21.6%, p=0.79). Significantly more Aboriginal patients with ER positive tumours had &amp;gt;=10% TIL infiltrates (41.7 v 9.8%, p=0.0025) but not those with ER- cancers (70 v 40%, p=0.18). In summary, measured circulating immune or inflammatory profiles did not substantially differ between Aboriginal and non-Aboriginal breast cancer patients. In contrast, although numbers are small, ER+ tumours in Aboriginal women had a higher incidence of significant TIL infiltrates which may both contribute to poorer prognosis and predict for higher utility from immunotherapy. An expansion of the cohort is underway along with immune cell sub-typing and immune checkpoint molecule assessments. Citation Format: Andrew David Redfern, Jacinta J Fong, Lisa J Spalding, Sherene Loi, Benjamin Dessauvagie, Jennet Harvey, Katie Meehan. Unfavourable tumour stromal immune cell infiltrates but not circulating immune cell profiles in Aboriginal women with breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-04-18.

Yarning about oral health: perceptions of urban Australian Aboriginal and Torres Strait Islander women

BackgroundMany factors influence how a person experiences oral health and how such experiences may facilitate supportive oral health behaviours. Women in particular face different challenges due to their environment, responsibilities and physiological differences to men. Within Australia, Aboriginal and Torres Strait Islander women are reported to have poorer oral health and are faced with additional barriers to supporting their oral health compared with non-Indigenous women. The objective of this paper is to report the experiences and perceptions of oral health from the perspective of urban, Aboriginal and Torres Strait Islander women.MethodsThe present data derive from a descriptive study that used yarning circles and face-to-face interviews with women who were mothers/carers of urban, Aboriginal and/or Torres Strait Islander children. This was a qualitative study to investigate the impact of child oral health on families. Participants used the opportunity to share their own personal experiences of oral health as women, thus providing data for the present analyses. Information collected was transcribed and analysed thematically.ResultsTwenty women shared their personal narratives on the topic of oral health which were reflective of different time points in their life: growing up, as an adult and as a mother/carer. Although women are trying to support their oral health across their life-course, they face a number of barriers, including a lack of information and the costs of accessing dental care. The teenage years and pregnancy were reported as important time periods for oral health support.ConclusionsTo improve the oral health of Indigenous Australian women, policymakers must consider the barriers reported by women and critically review current oral health information and services. Current oral health services are financially out of reach for Indigenous Australian women and there is not sufficient or appropriate, oral information across the life-course.

Primary Health Care for Aboriginal Australian Women in Remote Communities after a Pregnancy with Hyperglycaemia.

Background: Hyperglycaemia in pregnancy contributes to adverse outcomes for women and their children. The postpartum period is an opportune time to support women to reduce cardiometabolic and diabetes risk in subsequent pregnancies. Aims: To identify strengths and gaps in current care for Aboriginal women after a pregnancy complicated by hyperglycaemia. Methods: A retrospective review of the 12 month postpartum care provided by primary health centres in remote Australia in 2013–2014 identified 195 women who experienced hyperglycaemia in pregnancy (gestational diabetes (GDM) (n = 147), type 2 diabetes (T2D) (n = 39), and unclear diabetes status (n = 9)). Results: Only 80 women (54%) with GDM had postpartum glycaemic checks. Of these, 32 women were diagnosed with prediabetes (n = 24) or diabetes (n = 8). Compared to women with GDM, women with T2D were more likely to have their weight measured (75% vs. 52%, p <0.01), and smoking status documented as “discussed” (65% vs. 34%, p < 0.01). Most women (97%) accessed the health centre at least once in the 12 month postpartum period but, during these visits, only 52% of women had service provision, either structured or opportunistic, related to diabetes. Conclusion: High rates of dysglycaemia among women screened for T2D after GDM in the 12 month postpartum period highlight the need for increased screening and early intervention to prevent the development of T2D and its complications. Whilst a clear strength was high postpartum attendance, many women did not attend health services for diabetes screening or management.

Benefits of not smoking during pregnancy for Australian Aboriginal and Torres Strait Islander women and their babies: a retrospective cohort study using linked data

ObjectivesTo provide evidence for targeted smoking cessation policy, the aim of this study was to compare pregnancy outcomes of Aboriginal mothers who reported not smoking during pregnancy with Aboriginal mothers...

Midwife – The Keeper of the Spring – a personal midwifery philosophy

The 2007 United Nations Declaration on the Rights of Indigenous Peoples states that Indigenous peoples have the right to self-determination for social and cultural development. This fundamental right has been impeded worldwide through colonisation where many Indigenous peoples have had to adapt to ensure continuation of cultural knowledge and practice. In South East Australia colonisation was particularly brutal interrupting a 65,000 year-old oral culture and archives have increasing importance for cultural revival.The aim of this research was to collate archival material on South East Australian Aboriginal women’s birthing knowledge and practice.Archivist research methods were employed involving a search for artefacts and compiling materials from these into a new collection. This process involved understanding the context of the artefact creation. Collaborative yarning methods were used to reflect on materials and their meaning.Artefacts found included materials written by non-Aboriginal men and women, materials written by Aboriginal women, oral histories, media reports and culturally significant sites. Material described practices that connected birth to country and the community of the women and their babies. Practices included active labour techniques, pain management, labour supports, songs for labour, ceremony and the role of Aboriginal midwives. Case studies of continuing cultural practice and revival were identified.Inclusion of Aboriginal women’s birthing practices and knowledge is crucial for reconciliation and self-determination. Challenging the colonisation of birthing, through the inclusion of Aboriginal knowledge and practice is imperative, as health practices inclusive of cultural knowledge are known to be more effective.

Tiddaism: Negotiating Aboriginality and the Experiences of the Australian Aboriginal Woman in a Cross-Cultural Context

Tiddaism: Negotiating Aboriginality and the Experiences of the Australian Aboriginal Woman in a Cross-Cultural Context

Birth outcomes in Aboriginal mother-infant pairs from the Northern Territory, Australia, who received 23-valent polysaccharide pneumococcal vaccination during pregnancy, 2006-2011: The PneuMum randomised controlled trial.

Pregnant women and infants <6months old have a high baseline risk for pneumococcal disease compared to the general population, particularly among Indigenous populations living in poverty and low-resource settings. Efficacy trials of pneumococcal vaccination in pregnancy examining adverse birth outcomes are lacking. We report adverse birth events as secondary outcomes from the 'PneuMum' randomised controlled trial of 23-valent pneumococcal polysaccharide vaccination (23vPPV) in pregnancy (August 2006-January 2011). Australian Aboriginal women aged 17-39years with singleton uncomplicated pregnancies were randomised (1:2 ratio) to receive 23vPPV or no 23vPPV in pregnancy at 30-36weeks gestation. We compared risks of stillbirth, preterm birth, low birthweight (LBW), and small for gestational age (SGA) between vaccinated and unvaccinated pregnant women. Cox proportional hazard ratios (HRs) were calculated on an intention-to-treat basis. Among 227 enrolled participants, 75 (33%) received 23vPPV in pregnancy. Risk differences in adverse birth outcomes between 23vPPV vaccinated and unvaccinated pregnant women were; preterm birth 9% vs 4% (HR 2.79; 95% CI 0.94-8.32) P=0.07; LBW 9% vs 5% (HR 2.09; 95% CI 0.76-5.78) P=0.15; and SGA 15% vs 17% (HR 1.02; 95% CI 0.50-2.06) P=0.96. There were no stillbirths. We found a numerically higher rate of preterm births among women who received 23vPPV in pregnancy compared to unvaccinated pregnant women. Although further investigation with larger participant numbers is needed to better evaluate this safety signal, the contribution of safety results from smaller studies using appropriate data analysis methodologies is critical, particularly as more clinical trials in pneumococcal vaccination in pregnancy are progressing.

Tobacco and Pituri Use in Pregnancy: A Protocol for Measuring Maternal and Perinatal Exposure and Outcomes in Central Australian Aboriginal Women.

Maternal tobacco smoking is a recognized risk behavior that has adverse impacts on maternal and fetal health. However, in some populations, the use of smokeless tobacco exceeds the use of smoked tobacco. In central Australia, Aboriginal populations utilize wild tobacco plants (Nicotiana spp.) as a smokeless product. These plants are known by a variety of names, one of which is pituri. The plants are masticated and retained in the oral cavity for extended periods of time and their use continues throughout pregnancy, birth, and lactation. In contrast to the evidence related to combusted tobacco use, there is no evidence as to the effects of pituri use in pregnancy. Central Australian Aboriginal women who were at least 28 weeks pregnant were stratified into three tobacco exposure groups: (a) Pituri chewers, (b) smokers, and (c) non-tobacco users. Routine antenatal and birth information, pre-existing and pregnancy-related maternal characteristics, fetal characteristics, and biological samples were collected and compared. The biological samples were analysed for tobacco and nicotine metabolite concentrations. Samples from the mother included venous blood, urine, hair and colostrum and/or breast milk. From the neonate, this included Day 1 and Day 3 urine and meconium, and from the placenta, arterial and venous cord blood following delivery. This is the first study to correlate the pregnancy outcomes of central Australian Aboriginal women with different tobacco exposures. The findings will provide the foundation for epidemiological data collection in related studies. Note to readers: In this article, the term “Aboriginal” was chosen by central Australian women to refer to both themselves and the Aboriginal people in their communities. “Indigenous” was chosen to refer to the wider Australian Aboriginal and Torres Strait Islander people.

Pregnancy intentions in a group of remote-dwelling Australian Aboriginal women: a qualitative exploration of formation, expression and implications for clinical practice

BackgroundUnintended pregnancies are associated with poorer obstetric outcomes and are sometimes measured at a population level as a surrogate marker for reproductive autonomy and access to health services, including contraception. Aboriginal Australians face many disparities in health outcomes, including in reproductive health and antenatal care. We aimed to explore the formation and expression of pregnancy intentions in an Aboriginal population to inform health service improvements.MethodsSemi-structured interviews were conducted with 27 remote-dwelling Aboriginal women, aged 18–49 years. Content analysis was conducted; key themes were discussed with groups of women from participating communities to refine interpretation.ResultsMost (19/27) participants expressed pregnancy intentions congruent with reported contraceptive behaviour while eight expressed ambivalent or uncertain intentions. Intentions were shaped by traditional kinship practices, reproductive autonomy and desired family formation. Younger women tended to aspire to smaller family sizes than older women and support was expressed for the postponement of first pregnancy to achieve other life goals. Women in these communities hold strong traditional beliefs, including regarding conception, but did not use traditional methods of contraception in place of modern methods. Reproductive coercion, in the form of pressure to fall pregnant, was recognised as an important issue by women in the community.ConclusionConsultation strategies that promote rapport, allow space for uncertainty and are inclusive of important personal and cultural contexts are likely to improve shared understanding of pregnancy intention. Universal screening for reproductive coercion and broad counselling on contraceptive options (including discrete methods) may reduce unmet need for contraception. Community approaches supporting reproductive autonomy that is inclusive of men, and enhanced educational and occupational opportunities for young women are needed.

The association between mammographic density and breast cancer risk in Western Australian Aboriginal women.

Mammographic density is an established breast cancer risk factor within many ethnically different populations. The distribution of mammographic density has been shown to be significantly lower in Western Australian Aboriginal women compared to age- and screening location-matched non-Aboriginal women. Whether mammographic density is a predictor of breast cancer risk in Aboriginal women is unknown. We measured mammographic density from 103 Aboriginal breast cancer cases and 327 Aboriginal controls, 341 non-Aboriginal cases, and 333 non-Aboriginal controls selected from the BreastScreen Western Australia database using the Cumulus software program. Logistic regression was used to examine the associations of percentage dense area and absolute dense area with breast cancer risk for Aboriginal and non-Aboriginal women separately, adjusting for covariates. Both percentage density and absolute dense area were strongly predictive of risk in Aboriginal women with odds per adjusted standard deviation (OPERAS) of 1.36 (95% CI 1.09, 1.69) and 1.36 (95% CI 1.08, 1.71), respectively. For non-Aboriginal women, the OPERAS were 1.22 (95% CI 1.03, 1.46) and 1.26 (95% CI 1.05, 1.50), respectively. Whilst mean mammographic density for Aboriginal women is lower than non-Aboriginal women, density measures are still higher in Aboriginal women with breast cancer compared to Aboriginal women without breast cancer. Thus, mammographic density strongly predicts breast cancer risk in Aboriginal women. Future efforts to predict breast cancer risk using mammographic density or standardize risk-associated mammographic density measures should take into account Aboriginal status when applicable.

The distribution and determinants of mammographic density measures in Western Australian aboriginal women

BackgroundMammographic density (MD) is an established risk factor for breast cancer. There are significant ethnic differences in MD measures which are consistent with those for corresponding breast cancer risk. This is the first study investigating the distribution and determinants of MD measures within Aboriginal women of Western Australia (WA).MethodsEpidemiological data and mammographic images were obtained from 628 Aboriginal women and 624 age-, year of screen-, and screening location-matched non-Aboriginal women randomly selected from the BreastScreen Western Australia database. Women were cancer free at the time of their mammogram between 1989 and 2014. MD was measured using the Cumulus software. Kolmogorov-Smirnov tests were used to compare distributions of absolute dense area (DA), precent dense area (PDA), non-dense area (NDA) and total breast area between Aboriginal and non-Aboriginal women. General linear regression was used to estimate the determinants of MD, adjusting for age, NDA, hormone therapy use, family history, measures of socio-economic status and remoteness of residence for Aboriginal and non-Aboriginal women separately.ResultsAboriginal women were found to have lower DA and PDA and higher NDA than non-Aboriginal women. Age (p < 0.001) was negatively associated and several socio-economic indices (p < 0.001) were positively associated with DA and PDA in Aboriginal and non-Aboriginal women. Remoteness of residence was associated with both mammographic measures but for non-Aboriginal women only.ConclusionsAboriginal women have, on average, less MD than non-Aboriginal women but the factors associated with MD are similar for both sample populations. Since reduced MD is associated with improved sensitivity of mammography, this study suggests that mammographic screening is a particularly good test for Australian Indigenous women, a population that suffers from high breast cancer mortality.

Diabetes screening in pregnancy failing women in rural Western Australia: An audit of oral glucose tolerance test completion rates.

To quantify screening rate for gestational diabetes mellitus and completion of oral glucose tolerance test in rural and remote Western Australia. Retrospective audit of 551 antenatal records from women of 16 years and older without pre-existing diabetes and with singleton pregnancies delivered in 2013. Number of women recorded screened for gestational diabetes mellitus in second or third trimester using oral glucose tolerance test or other tests; gestational diabetes mellitus rate. Only 278 (50.5%) women were screened with oral glucose tolerance test; 113 (20.5%) had no record of any screening related to gestational diabetes mellitus. In a nested mixed-effects logistic regression model, women with a previous gestational diabetes mellitus diagnosis, two or more risk factors (excluding ethnicity) or high-risk gestational diabetes mellitus ethnicity other than Australian Aboriginal were more likely to be screened, while Australian Aboriginal women were less likely to be screened with oral glucose tolerance test. Clinicians reported patient and clinician factors and logistical difficulties as reasons for the oral glucose tolerance test not being completed at their site. Of those screened with oral glucose tolerance test, a high rate of gestational diabetes mellitus was diagnosed (14.7% versus Western Australia state-wide average of 7.4%). Adherence to oral glucose tolerance test screening in rural Western Australia is inadequate for effective screening for gestational diabetes mellitus. Screening was not acceptable or available for a significant proportion of women at risk. Efforts to improve oral glucose tolerance test adherence and exploration of alternative gestational diabetes mellitus screening strategies are required.

‘Yarn about it’: Aboriginal Australian women’s perceptions of the impact of routine enquiry for intimate partner violence

Aboriginal women globally are disproportionately affected by intimate partner violence (IPV) and face additional barriers to help-seeking. It is crucial that interventions for IPV are made safe for Indigenous women, given inflated rates of statutory intervention and widespread institutional racism. As part of a larger study of antenatal IPV screening, we interviewed 12 Aboriginal Australian women about the perceived impact of an antenatal IPV routine enquiry intervention. Seven women reported positive impact, and five women reported the absence of positive impact. Qualitative comparative analysis was used to map pathways to perceived impact. Cultural safety – the practice of countering tendencies in health care that undermine safety – was a key condition for positive impact. Others included: (i) continuity of care; (ii) asking about abuse without judgement and with care; and (iii) support and validation. Absence of these factors also typified pathways for nil positive impact. Naming the abuse, a sense of connection, unburdening, taking steps to safety and enabling informed care were all reported benefits. Two women reported explicitly negative impacts: one noted a sense of intrusion, and the other, disengagement from the health service. Interventions for IPV have the potential to benefit Indigenous women where cultural safety is prioritised.

Australian Aboriginal women prisoners' experiences of being a mother: a review.

The rise in the incarceration of Aboriginal and Torres Strait Islander mothers is a major public health issue with multiple sequelae for Aboriginal children and the cohesiveness of Aboriginal communities. The purpose of this paper is to review the available literature relating to Australian Aboriginal women prisoners' experiences of being a mother. The literature search covered bibliographic databases from criminology, sociology and anthropology, and Australian history. The authors review the literature on: traditional and contemporary Aboriginal mothering roles, values and practices; historical accounts of the impacts of white settlement of Australia and subsequent Aboriginal affairs policies and practices; and women's and mothers' experiences of imprisonment. The review found that the cultural experiences of mothering are unique to Aboriginal mothers and contrasted to non-Aboriginal concepts. The ways that incarceration of Aboriginal mothers disrupts child rearing practices within the cultural kinship system are identified. Aboriginal women have unique circumstances relevant to the concept of motherhood that need to be understood to develop culturally relevant policy and programs. The burden of disease and cycle of incarceration within Aboriginal families can be addressed by improving health outcomes for incarcerated Aboriginal mothers and female carers. To the authors' knowledge, this is the first literature review on Australian Aboriginal women prisoners' experiences of being a mother.