Feature

Antenatal care for Aboriginal and Torres Strait Islander women


Morgan Liotta


9/03/2018 1:55:13 PM

In the fourth part of a series focusing on the coming third edition of the ‘National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people, newsGP looks at health for Aboriginal and Torres Strait Islander women during pregnancy.

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The National Guide supports comprehensive care during routine antenatal visits for Aboriginal and Torres Strait Islander women.

Providing good antenatal care for Aboriginal and Torres Strait Islander women in pregnancy is one of the best opportunities available to improve Aboriginal and Torres Strait Islander health. It is a time when people are most motivated to make changes to their life that protect and enhance health and wellbeing.
 
The National Aboriginal Community Controlled Health Organisation (NACCHO) and the RACGP’s National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people (National Guide) highlights recent evidence of an increase in the number of Aboriginal and Torres Strait Islander women receiving antenatal care.
 
According to the Australian Institute of Health and Welfare (AIHW) 2016 report, Australia’s mothers and babies 2015 – In brief, although they remain less likely to receive antenatal care early in pregnancy than non-Indigenous women, there has been an increase in Aboriginal and Torres Strait Islander women attending antenatal visits during the first trimester.
 
The fact fewer Aboriginal and Torres Strait Islander women attend antenatal visits is partly due to a lack of access to maternal health services for those living in remote areas. More than 25,000 Aboriginal and Torres Strait Islander women of child-bearing age live more than one hour’s drive from a public birthing unit, according to the AIHW 2017 report, Spatial variation in Aboriginal and Torres Strait Islander women's access to 4 types of maternal health services.
 
What are often seen as medical lifestyle risk factors for Aboriginal and Torres Strait Islander women frequently arise as a result of living in disadvantaged areas, with the multiple associated stressors. Pregnancy care that is welcoming and non-judgemental can make a difference to women and their families. Strengths in Aboriginal and Torres Strait Islander communities that can provide a positive influence, such as a supportive extended family network and kinship, connection to country, and active cultural practices in language, art and music can be encouraged by healthcare professionals providing antenatal care. This allows interventions to improve mental health and give opportunities to reduce smoking and alcohol consumption, and enable healthy eating.  
 
Smoking
It is estimated that almost half of Aboriginal and Torres Strait Islander women smoked during pregnancy in 2015, compared to 12% of non-Indigenous women. However, these rates are decreasing as a result of healthcare professionals providing advice and tools on smoking cessation, and initiatives such as the SISTAQUIT research project. Pregnancy is often a time where women are very highly motivated to quit smoking.
 
Alcohol
Up to date figures on Aboriginal and Torres Strait Islander women’s alcohol consumption in pregnancy are difficult to find, but it has been found that 40% of Australian women drink alcohol during pregnancy, and identifying this is important in reducing the risk to a mother and her baby.
 
Aside from clear risk factors for the health of the woman and unborn child, fetal alcohol spectrum disorder (FASD) presents major health issues from prenatal exposure to alcohol. The Alcohol Use Disorders Identification Test – Consumption (AUDIT–C) tool is an effective brief screening test for harmful use of alcohol which can be used in a primary care setting, and can be used with pregnant women.
 
Diet
The same issues exist for good diet in pregnancy as do throughout Aboriginal and Torres Strait Islander communities. The cost of healthy food can be prohibitive, especially in rural and remote areas; the quality, after delivery of food over long distances, can be poor; and a quality diet is dependent on having adequate cooking and refrigeration facilities.
 
The Federal Government recently funded a Western Australian research project focusing on the diet of pregnant women and the impact on their babies, including food allergies, which could be effective in Aboriginal and Torres Strait Islander populations. There are other examples of provision of subsidised fruit and vegetables, which have good health outcomes in communities.
 
Gestational diabetes
Aboriginal and Torres Strait Islander women have high rates of gestational diabetes; in 2014, an estimated 4% of pregnant Aboriginal and Torres Strait Islander women had pre-existing diabetes and 13% developed gestational diabetes. Each of these rates was higher than those of non-Indigenous women.
 
Mental health
The Edinburgh Post Natal Depression scale can be used to screen pregnant Aboriginal and Torres Strait Islander women for issues of mental health. There are also examples of culturally appropriate screening tools that may be used in some communities, such as the Kimberly Mum’s Mood Scale.
 
Family, domestic and sexual violence may also be a factor in the mental health of pregnant women, with the AIHW report, Family, domestic and sexual violence in Australia, 2018, presenting statistics related to the fact that Aboriginal and Torres Strait Islander women and pregnant women are particularly at risk.


The National Guide supports comprehensive care during routine antenatal visits for Aboriginal and Torres Strait Islander women in order to provide relevant information and advice, ensure optimum health outcomes for mother and child, and prevent future health issues.
 
The Federal Government released new antenatal care guidelines in March, including support for Aboriginal and Torres Strait Islander health workers referring to maternity services. The principle of Birthing on Country can be used to develop maternity services that can make a difference to pregnancy outcomes for Aboriginal and Torres Strait Islander women.
 
The National Guide covers further information on antenatal care in the following chapters:

  • Antenatal care
  • Fetal alcohol spectrum disorder
  • Alcohol
  • Smoking
  • The health of young people
  • Child health
  • Overweight and obesity
  • Family abuse and violence
  • Sexual health and blood-borne viruses



Aboriginal-and-Torres-Strait-Islander-health antenatal-care national-guide





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