The Link Between Primary Health Care and Health Outcomes for Aboriginal and Torres Strait Islander Australians

Aboriginal Maternal and Infant health Strategy, New South Wales

This review explores the evidence both domestically and internationally as to whether access to high quality primary health care is essential to enhancing Indigenous health status.

Page last updated: June 2008

The New South Wales Aboriginal Maternal and Infant Health Strategy began in 2001 with an overall goal of improving the health of Aboriginal women during pregnancy and decreasing perinatal morbidity and mortality.128 The strategy included targeted antenatal / postnatal programs for Aboriginal women and infants; a state-wide training and support program for midwives and Aboriginal health workers who provided these services; and an evaluation of the pilot program.

In five of the six former Area Health Services where the strategy was implemented, a community midwife and Aboriginal health worker team were established to provide community based services for Aboriginal women in conjunction with existing medical, midwifery, paediatric and child and family health staff. The sixth region commenced their program later in response to identified community need.

The evaluation showed that services across the program were provided to 321 women in 2003 and 368 women in 2004. A number of results were documented, including slight decreases in the proportion of births to women aged less than 20 years and to the proportion of women who reported smoking in the second half of their pregnancy. Access improved, with the proportion of women attending for their first antenatal care visit before 20 weeks gestation increasing from 65% in 1996-2000 to 76% in 2003. The perinatal mortality rate decreased from 20.4 per 1000 live births in 1996-2000 down to 14.2 per 1000 live births in 2003, although this was not statistically significant. The proportion of women who gave birth to preterm or low birth weight babies was unchanged over this period.

It must be noted that the methodology for the evaluation has not been well-explained and there was no attempt to determine the extent to which the program itself can be held responsible for improvements, nor to investigate in more than a cursory way the elements of the program that may have been responsible.

Measures

  • births to women aged less than 20 years decreased
  • proportion of women attending for their first antenatal care visit before 20 weeks gestation increased significantly
  • proportion of women who reported smoking in the second half of their pregnancy decreased
  • perinatal mortality rate decreased (not statistically significant)

Contributing factors
  • multidisciplinary team approach (Aboriginal Health Worker / Aboriginal Health Education Officer plus midwife)
  • primary health care model:
- continuity of care
  • Indigenous care givers
  • training and support provided
  • community development approach:
- partnerships with other organisations
- art programs, peer education

128 New South Wales Health (2005). NSW Aboriginal Maternal and Infant Health Strategy Evaluation. N. Health, University of Technology Sydney (2006). NSW Aboriginal Maternal and Infant Health Strategy Evaluation: Final Report. Centre for Midwifery Child and Family Health. Sydney, NSW Health.