“Have a good chat with them, gain their trust, make ’em feel secure ... words, the way you talk to them means a lot ... especially young ones, that’s what they’re looking for.” (Older Aboriginal woman from remote community, Central Australia as quoted in Wilson 2009)
The fundamentals of providing woman-centred care discussed in Chapter 2 apply to all women. This section discusses issues specific to providing appropriate antenatal care for Aboriginal and Torres Strait Islander women.
3.2.1 Individual cultural competenceCultural competence among health professionals is an essential component of clinical competence and is essential to effective communication and cultural security for Aboriginal and Torres Strait Islander people seeking health care. The evidence confirms that health professionals working individually or as members of a multidisciplinary team can effectively enhance their communication skills and cultural competence. A commitment to cultural competence requires a willingness to gain the knowledge, understanding and skills to communicate sensitively and effectively with Aboriginal and Torres Strait Islander people and to acknowledge and respect cultural differences.
Gaining an understanding about one’s own cultural competence involves:
- reflecting on one’s assumptions, attitudes, beliefs and notions of privilege; and
- considering one’s cultural knowledge of women attending for antenatal care in the community (eg health-related beliefs, practices and cultural values and disease incidence and prevalence).
3.2.2 Improving women’s experience of antenatal careTaking an individualised approach
Factors that may improve the experience of antenatal care for Aboriginal and Torres Strait Islander women include:
- taking the time to establish rapport and trust with each woman;
- explaining confidentiality and that the woman’s privacy will be respected;
- consulting the woman about whom she would like to be involved in her care;
- having knowledge about the health and social wellbeing of the woman’s community; and
- if necessary, advocating on behalf of the woman so that she receives appropriate care throughout pregnancy.
Involving women in decision-making about their health care during pregnancy has been endorsed as a key feature of good quality maternity care (Chalmers et al 2001)(see Section 2.3). However, there is indirect evidence that, in some settings, Aboriginal and Torres Strait Islander women have fewer opportunities to be involved in decision-making than non-Indigenous women, or than is desirable (Hunt 2003). This may be improved through (Hunt 2003):
- taking steps to improve communication;
- increasing available time;
- improving continuity of carer; and
- having protocols that explicitly endorse shared decision-making.