Clinical Practice Guidelines Antenatal care - Module I

4.3 Women in rural and remote areas

Page last updated: 02 April 2013

“While it is generally accepted that women should have access to safe maternity care, consistent with their assessed level of risk, as close as possible to where they live, the options available to women differ according to where they live.” (DoHA 2008)

Women living in outer regional, remote or very remote areas may have difficulties accessing appropriate antenatal health care due to distance and limited availability of services. They may be required to give birth away from their communities, which can lead to extra financial costs, lack of practical and emotional support, isolation, lack of integrated care between systems, inappropriate or culturally unsafe health care, and temporary separation from older children (Perinatal Mental Health Consortium 2008).

Rates of neonatal death are significantly higher among women living in rural areas and rates of fetal death are higher among women living in remote areas (AIHW 2005). Rural and remote families also experience higher rates of maternal death. For example, the rate of direct maternal deaths is high in rural and remote areas (8% of direct maternal deaths in locations inhabited by 3% of the population) and proportionately high in outer regional areas (Sullivan et al 2008).

Providing integrated care in rural and remote areas

Care pathways in rural, remote and very remote Australia are different to those in urban settings and options can be limited. This has a particular impact on women and families living in these areas, a significant proportion of whom are Aboriginal and Torres Strait Islander women (see Chapter 3).

In rural and remote settings, care is largely provided by the local primary care health professionals — midwives, nurses, Aboriginal and Torres Strait Islander health workers, GPs, or a combination of these. It is important that these health professionals have access to specialist advice and support. Contemporary approaches including telemedicine, support lines and online services are becoming increasingly available and will be extremely valuable in rural and remote areas. Innovative models of care (eg specialist outreach services and caseload midwifery care) may also expand women’s possibilities to have care as close to home as possible. It is also important for health professionals in these areas to use family and community networks where possible and explore community initiatives and existing programs to improve pathways to care for women in their region.