Aboriginal and Torres Strait Islander Health Performance Framework - 2010

3.01 Antenatal care

Page last updated: 26 May 2011

Why is it important?:

Antenatal care involves “recording medical history, assessment of individual needs, advice and guidance on pregnancy and delivery, screening tests, education on self-care during pregnancy, identification of conditions detrimental to health during pregnancy, first-line management and referral if necessary” (WHO 2007). Antenatal care for pregnant women commenced in the early 1900s with the aim of detecting, and thereby preventing, both maternal and neonatal adverse events (Dodd et al. 2002). “Good access to primary health care can make a difference to the health of women of childbearing ages and women during pregnancy, as well as the fetus during growth and development and the infant and young child” (Eades 2004). Antenatal care may be especially important for Aboriginal and Torres Strait Islander women, as they are at higher risk of giving birth to low birthweight babies and other factors such as anaemia, poor nutritional status, hypertension, diabetes or glucose intolerance, genital and urinary tract infections and smoking (de Costa & Wenitong 2009). Two studies of women attending tertiary referral hospitals for obstetric care found poorer birth outcomes associated with late antenatal bookings for pregnant Indigenous women (Eades 2004).

National Evidence-Based Antenatal Care Guidelines are currently under development. Existing guidelines for antenatal care vary and are not always consistent with national policies or research evidence (Hunt & Lumley 2002). Most guidelines recommend that antenatal care should commence during the first trimester, as it is at this early stage that risk factors can best be assessed (Mercy Hospital for Women et al. 2001). The schedule of antenatal visits most commonly followed in Australia is monthly visits up until 28 weeks of pregnancy, fortnightly visits until 36 weeks and weekly visits thereafter. Research has found that the frequency of visits could safely be reduced to between 7 and 10 visits for low risk women (Mercy Hospital for Women et al. 2001; Wallace & Oats 2002).

The closure of rural obstetric services due to safety and workforce issues has created issues for some women requiring antenatal care in that they lose local supports and need to transfer to regional centres for parts of their pregnancy (Arnold et al. 2009). Other factors apart from geography preventing Indigenous women presenting early for antenatal care include socioeconomic, educational and family factors, transport, the frequency (or absence) of local clinics, and cultural accessibility of the services (de Costa & Wenitong 2009).

Findings:

In the four jurisdictions that recorded information on antenatal care in 2007 (NSW, Qld, SA and the NT), 97% of Aboriginal and Torres Strait Islander mothers accessed antenatal care services at least once during their pregnancy. This compares with 98% for non-Indigenous mothers. There have been significant increases in access to antenatal care in South Australia and New South Wales between 1998 and 2007 for Indigenous mothers. Despite this, access to antenatal care appears to be lower in South Australia (91%) compared with other states.

In 2007 in the four jurisdictions for which data was available, there was little difference in the proportion of Indigenous mothers who attended at least one antenatal care session by remoteness (around 96% in major cities, 97% in regional areas and 96%–97% in remote areas). However, there were pronounced differences in those accessing antenatal care in the first trimester of the pregnancy (45% in remote areas compared with 58% in non remote areas).

In 2007, Aboriginal and Torres Strait Islander mothers accessed services later in the pregnancy and had significantly fewer antenatal care sessions. In the four jurisdictions, 54% of mothers had their first antenatal session in the first trimester of the pregnancy, compared with 72% for other mothers. On average, 75% of Indigenous mothers had 5 or more antenatal sessions compared with 93% of non-Indigenous mothers.

As the number of antenatal visits increase, there is a decreased likelihood of low birthweight babies. Indigenous mothers attending 5 or more sessions have much lower rates of low birthweight babies (9%), compared with those have 2–4 sessions (23%), 1 session (27%) or no antenatal care (36%). Similar patterns are evident with pre-term births and perinatal mortality. These relationships are also evident for non-Indigenous mothers, although the rates of low birthweight pre-term births and perinatal mortality are generally lower for non-Indigenous mothers.

In 2008–09, 54 Indigenous primary health care services participating in the Healthy for Life Program provided data on antenatal care. Of the 1,704 Indigenous mothers who gave birth to an Indigenous baby who were regular clients of these services, 48% attended their first antenatal visit in the first trimester of pregnancy.

Implications:

Around 97% of Aboriginal and Torres Strait Islander mothers access antenatal services at least once during their pregnancy. However, Indigenous mothers are accessing these services later in their pregnancy and less frequently than other mothers. Little is known about the factors contributing to lower levels of access, how the pregnancies for Indigenous women with higher risks are managed and whether they have adequate access to specialist obstetric care.

Targeted programs suggest improved antenatal visiting can be achieved and these can translate into improvements in health outcomes such as increased birthweight and reduced premature birth (Eades 2004; Herceg 2005; Panaretto et al. 2007). Studies have demonstrated how sustained access to community-based, integrated, shared antenatal services improve perinatal outcomes for Indigenous women (NSW Health 2006; Panaretto et al. 2007). Programs that have been reviewed are mostly based in Aboriginal and Torres Strait Islander health services or tertiary maternity services. Little is known about the factors likely to impact on antenatal care for mothers seeking care through private GPs.

There are a number of policies and programs that seek to increase access to antenatal care. In October 2008, COAG signed the Indigenous Early Childhood Development National Partnership Agreement with joint funding of around $564 million over 6 years to address the needs of Indigenous children in their early years. One of the key objectives of this Partnership is to increase access to antenatal care. The New Directions: Mothers and Babies Services provide Aboriginal and Torres Strait Islander children and their mothers with access to antenatal care; standard information about baby care; practical advice and assistance with parenting; monitoring of developmental milestones by a primary health care service; and health checks for children. In addition, the Healthy for Life program also aims to improve access to antenatal, postnatal and child health care. This program aims to improve pregnancy, birth and child health outcomes and reduce the incidence of illness for Indigenous babies and children. The Australian Nurse Family Partnership Program provides sustained home visiting to selected Indigenous communities across Australia and aims to improve pregnancy outcomes and childhood development including improving birthweights, and effect positive life course decisions.

Figure 136 – Proportion of mothers who attended at least one antenatal care session, by Indigenous status NSW, Qld, SA, 1998–2007


Figure 136 – Proportion of mothers who attended at least one antenatal care session, by Indigenous status NSW, Qld, SA, 1998–2007[
Source: AIHW analyses state/territory Perinatal Collections
Text description of figure 136 (TXT 1KB)

Figure 137 – Proportion of mothers whose first antenatal care session occurred in the first trimester, by Indigenous status and remoteness, NSW and NT, 2007


Figure 137 – Proportion of mothers whose first antenatal care session occurred in the first trimester, by Indigenous status and remoteness, NSW and NT, 2007[
Source: AIHW analyses state/territory Perinatal Collections
Text description of figure 137 (TXT 1KB)

Figure 138 – Proportion of mothers who attended at least one antenatal care session, by Indigenous status, by jurisdiction, NSW, Qld, SA and NT, 2007


Figure 138 – Proportion of mothers who attended at least one antenatal care session, by Indigenous status, by jurisdiction, NSW, Qld, SA and NT, 2007
Source: AIHW analyses state/territory Perinatal Collections
Text description of figure 138 (TXT 1KB)

Figure 139 – Relationship between antenatal care sessions attended and proportion of low birthweight babies , by Indigenous status, Qld, SA and NT, 2007


Figure 139 – Relationship between antenatal care sessions attended and proportion of low birthweight babies , by Indigenous status, Qld, SA and NT, 2007
Source: AIHW analyses state/territory Perinatal Collections
Text description of figure 139 (TXT 1KB)

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