3.1 Background to culturally safe antenatal care

“Cultural respect is achieved when the health system is a safe environment for Aboriginal and Torres Strait Islander peoples and where cultural differences are respected.” (AHMAC 2004)

History and politics have shaped and continue to shape the lives and health of Aboriginal and Torres Strait Islander people. Social disadvantage and family disruption are continuing effects of government policies that have contributed to Aboriginal and Torres Strait Islander peoples having by far the worst health status of any identifiable group in Australia and the poorest access to services (Couzos & Murray 2008). This is reflected in the overall health of Aboriginal and Torres Strait Islander women and their babies (see Table 3.1).

Table 3.1: Snapshot of perinatal health among Aboriginal and Torres Strait Islander women

Overall poorer perinatal outcomes than non- Indigenous women	At least four times the rate of maternal mortality (Sullivan et al 2008) Higher rates of preterm birth (13.3% vs 8.0%), low birth weight (12.3% vs 5.9%) and perinatal deaths (17.3 vs 9.7 per 1,000 births) (Laws et al 2010)
Risk factors for complications of pregnancy experienced in some communities	High levels of life stressors Limited access to affordable nutritious food High prevalence of urinary tract infections, sexually transmitted infections and anaemia High prevalence of chronic illness — diabetes, kidney disease and rheumatic heart disease High prevalence of smoking Harmful levels of alcohol consumption in pregnancy Lack of family or social support Pregnancy in adolescence High rates of incarceration
Access to health services	Limited availability of culturally appropriate services may affect attendance (eg average number of antenatal visits ranges from 5.5 in mainstream health care settings to 10.5 in community-controlled settings [Jan et al 2004; Rumbold & Cunningham 2008]) While most Aboriginal women live in urban settings, and many live in rural towns, Aboriginal and Torres Strait Islander women are more likely to live in remote areas where there are fewer health services Financial issues may restrict access

A holistic view of Aboriginal health includes the physical, social, emotional, spiritual and cultural wellbeing of both an individual and his or her community (NAHSWP 1989). Traditional practices around pregnancy and birth are also important to many Aboriginal and Torres Strait Islander women, particularly in remote areas (Carter et al 1987; Myles 1992; Danila Dilba Medical Service 1999). However, the cultural beliefs, practices and needs of Aboriginal and Torres Strait Islander women vary, both between and within culturally defined groups, and respect for the views and beliefs of individual women and of local communities is needed (Hunt 2008).

The development of a health service that is culturally equipped to provide holistic antenatal care is one of many important requirements to improve general health and wellbeing in Aboriginal and Torres Strait Islander communities.