Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 3—Effective/appropriate/efficient—3.01 Antenatal care

The HPF was designed to measure the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and will be an important tool for developing the new National Aboriginal and Torres Strait Islander Health Plan (NATSIHP).

Page last updated: 15 November 2012

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 has been found to have a positive effect on the health outcomes for both mother and baby (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 have greater exposure to other risk factors such as anaemia, poor nutritional status, hypertension, diabetes, genital and urinary tract infections and smoking (de Costa et al. 2009).

The Department of Health and Ageing is currently developing new National Evidence-Based Antenatal Care Guidelines on behalf of all Australian Governments. The Guidelines are designed to cover the antenatal care of healthy pregnant women, and to present recommendations based on the clinical evidence for a wide range of care. Module 1 of the Guidelines covers the first trimester of pregnancy and provides advice on over 20 topic areas including tobacco smoking, alcohol and nutritional supplements. Developed with input from the Working Group for Aboriginal and Torres Strait Islander Women's Antenatal Care, the Guidelines will provide culturally appropriate information for the health needs of Aboriginal and Torres Strait Islander pregnant women and their families.

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.

The closure of some rural obstetric services due to safety and workforce issues has impacted upon some women living in these areas. These women may need to transfer to regional centres for parts of their pregnancy and can lose local supports in the process (Arnold et al. 2009). Other factors apart from geography preventing Indigenous women presenting early for antenatal care include socioeconomic, educational factors, transport, the frequency (or absence) of local clinics, and cultural accessibility and appropriateness of the services (de Costa et al. 2009).

Findings:

In the four jurisdictions that recorded information on antenatal care in 2009 (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 99% for non-Indigenous mothers. There have been significant increases in access to antenatal care in SA, Qld and NSW between 1998 and 2009 for Indigenous mothers. Despite this, access to antenatal care appears to be lower in SA (90%) compared with other states.

In 2009, Aboriginal and Torres Strait Islander mothers, on average, accessed services later in the pregnancy and had significantly fewer antenatal care sessions. In NSW, Qld, SA and the NT combined, 56% of Indigenous mothers had their first antenatal session in the first trimester of the pregnancy, compared with 75% for other mothers. On average, 76% of Indigenous mothers had 5 or more antenatal sessions compared with 94% of non-Indigenous mothers.

In 2009, there was little difference in the proportion of Indigenous mothers who had attended at least one antenatal care session by remoteness (97–98% in non-remote areas and 96% in remote areas). However, there were differences in the proportion of women accessing antenatal care in the first trimester of the pregnancy (52% in remote areas compared with 58% in non-remote areas). The 2008 NATSISS found that 11% of Indigenous mothers with children aged 0–3 years gave birth in a hospital or clinic that was 250kms or more from their home. Most mothers (96%) had pregnancy check ups. These check-ups involved doctors (61%), nurses (48%), obstetricians (17%), and/or AHWs (9%).

As the number of antenatal visits increase, there is a decreased likelihood of mothers giving birth to low birthweight babies. Indigenous mothers attending 5 or more sessions have much lower rates of low birthweight babies (8%), compared with those have two to four sessions or one session (20%), or no antenatal care (37%). 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 2009–10, 66 Indigenous primary health care services participating in the Healthy for Life Program provided data on antenatal care. Of the 2,057 Indigenous mothers who were regular clients of these services, 49% attended their first antenatal visit in the first trimester.Top of Page

Implications:

Around 97% of Aboriginal and Torres Strait Islander mothers access antenatal services at least once during their pregnancy. However, Indigenous mothers are currently accessing these services later in their pregnancy and less frequently than other mothers.

The features that have been identified for quality primary maternity services in Australia include high quality care that is enabled by evidence-based practice, coordinated according to the woman's clinical needs, based on collaborative multidisciplinary approaches, continuity of care, woman centred, culturally appropriate and accessible at the local level (Australian Health Ministers' Advisory Council 2011). Reviews of the literature have identified the following key success factors in Aboriginal and Torres Strait Islander maternal health programs to complement the features detailed above: a specific Aboriginal and/or Torres Strait Islander program; a welcoming and safe environment; outreach and home visiting; flexibility in service delivery and appointment times; transport; continuity of care and carer integration with other services—e.g., AMS or hospital; a focus on communication, relationship building and trust; respect for Aboriginal and Torres Strait Islander culture; family involvement and child care; appropriately trained workforce; Indigenous staff and female staff; informed consent and right of refusal; and tools to measure cultural competency (Dudgeon et al. 2010; Reibel et al. 2010; Herceg 2005; Australian Health Ministers' Advisory Council 2011). An audit of antenatal care in WA found that 75% of services failed to provide a model of care consistent with the principals of culturally competent care to Indigenous woman (Reibel et al. 2010). Studies have also demonstrated how sustained access to community based, integrated, shared antenatal services improve perinatal outcomes for Indigenous women (NSW Health 2006; Panaretto et al. 2007).

Australian governments are investing in a range of initiatives aimed to improve child and maternal health. In October 2008, COAG agreed to the National Partnership Agreement on Indigenous Early Childhood Development with joint funding of $564 million over six years. This includes Australian Government funding to state and territory governments for sexual health and young parent programs and support for 85 New Directions: Mothers and Babies Services which provide Aboriginal and Torres Strait Islander families with access to antenatal care; practical advice and assistance with parenting; and health checks for children. 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 Medical Specialist Outreach Assistance Program –Maternity Services is in its second year of operation. The program funds multi-disciplinary teams that may include midwives, medical specialists, GPs, Aboriginal Health Workers and allied health professionals in the delivery of maternity care from pregnancy until the infant is six months of age. Funding for this expansion is $10.6 million over three years.
Figure 144—Proportion of mothers who attended at least one antenatal care session, by Indigenous status, NSW, Qld and SA, 1998–2009
Figure 144—Proportion of mothers who attended at least one antenatal care session, by Indigenous status, NSW, Qld and SA, 1998–2009Top of Page
Source: AIHW analyses state/territory Perinatal Collections
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Figure 145—Proportion of mothers whose first antenatal care session occurred in the first trimester, by Indigenous status and remoteness, NSW, Qld, SA and the NT, 2009
Figure 145—Proportion of mothers whose first antenatal care session occurred in the first trimester, by Indigenous status and remoteness, NSW, Qld, SA and the NT, 2009
Source: AIHW analyses state/territory Perinatal Collections
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Figure 146—Proportion of mothers who attended at least one antenatal care session, by Indigenous status and jurisdiction, NSW, Qld, SA and the NT, 2009
Figure 146—Proportion of mothers who attended at least one antenatal care session, by Indigenous status and jurisdiction, NSW, Qld, SA and the NT, 2009
Source: AIHW analyses state/territory Perinatal Collections
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Figure 147—Relationship between antenatal care sessions attended and proportion of low birthweight babies, by Indigenous status, Qld, SA and the NT, 2009
Figure 147—Relationship between antenatal care sessions attended and proportion of low birthweight babies, by Indigenous status, Qld, SA and the NT, 2009
Source: AIHW analyses state/territory Perinatal Collections
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