“Aboriginal peoples and Torres Strait Islanders should access services and health care not just at a level enjoyed by other Australians (principle of equality) but at one that reflects their much greater level of health care need (principle of equity).” (Couzos & Murray 2008)
In many regions of Australia, there are specific services and programs to respond to the expressed preferences of Aboriginal and Torres Strait Islander women (Hunt 2008) and several evaluations have shown their success in improving uptake of antenatal care services. However, these programs are not available for all Aboriginal and Torres Strait Islander women and many women seek antenatal care through mainstream primary health services, such as general practice, community health services, public hospitals and other settings.
Mainstream health services frequently prioritise managing physical illness over addressing a woman’s social and cultural needs during pregnancy. Reasons for Aboriginal and Torres Strait Islander people not attending health services include a lack of Aboriginal and Torres Strait Islander staff, perceptions of staff as unfriendly and uncaring (including talking down and using body language suggesting Aboriginal and Torres Strait Islander people are not welcome) and long waits to see the doctor (Hayman et al 2009). Communication issues, mistrust of the system, racism and poor cultural understanding have also been identified as factors affecting uptake of services (AHMAC 2004). As well, many women have described negative experiences of hospital care (Carter et al 1987; Sutherland 1998; Daruk AMS & Western Sector Public
Health Unit 1998; Ireland et al 2010) and there may be poor communication between primary and secondary care and duplication of care.
Evidence confirms that embedding cultural competence within an organisation’s continuous quality improvement processes enhances Aboriginal health outcomes as well as building organisational capacity (Walker 2010). Tools for evaluating an organisation’s cultural competence have been developed (see Section 3.4) and provide a useful aid in reviewing the concepts, principles and processes that underpin cultural competence (Walker 2010).
Table 3.2: Key components in providing culturally responsive antenatal care services
|There is evidence that Aboriginal and Torres Strait Islander people are welcome at the health service, such as local artwork in the waiting room and Aboriginal staff at reception, and waiting areas are family friendly|
|Aboriginal and Torres Strait Islander health professionals and/or Aboriginal health workers are involved in the maternal health care team|
|Aboriginal and Torres Strait Islander women have the option of consulting female health staff|
|Non-Indigenous health professionals are supported in gaining an understanding of Aboriginal ‘women’s business’|
|Women have the opportunity to involve extended family and kin (community) in decision-making|
|Interpreters are available|
|Internal roles and kinship systems within the community are not compromised (eg family members may not be appropriate interpreters)|
|Where possible, services are provided in a location intended for health care for women and children|
|There are effective partnerships between obstetricians, general practitioners, midwives and Aboriginal health workers and between primary and hospital care|
|In consultation with the woman, engagement of fathers and partners is encouraged and supported|
|Home visits and outreach activities are offered|
|Transport and child care or playgroups are available|
|Culturally appropriate education about health in pregnancy is provided (this may include local adaptation of written materials [booklets, posters] or using other media [such as video])|
|Feedback is invited from women and used for continuous quality improvement purposes|
|Attention is given to accurate reporting of Indigenous status|
|A community approach is taken to program development and Aboriginal and Torres Strait Islander women are involved in planning|