Within the diversity of women that make up the Australian population, some face greater disadvantage in terms of access to health services and may experience poorer perinatal outcomes AWHN 2008. These include adolescent women and women living in rural and remote areas. This chapter discusses considerations in providing optimal antenatal care for these groups of women.
6.1 Adolescent women
While a higher risk of poor birth outcomes such as low birth weight is seen for births to teenage women, this is likely to be related more to the social circumstances of these young women, rather than their age.
The number of births to women aged younger than 20 years in Australia accounted for around 2% of non- Indigenous births and 17% of Aboriginal and Torres Strait Islander births AIHW 2016a. Women younger than 20 years experience higher rates of stillbirth and neonatal deaths than Australian women in general (14.2 vs 9.6 per 1,000 births) AIHW 2016a.
Adolescent women are likely to seek antenatal care later in pregnancy. In 2014, 47% of women aged younger than 20 attended antenatal care before 14 weeks of pregnancy, compared with 66% of women aged between 30 and 34 years AIHW 2016b.
The high levels of social disadvantage, higher incidence of domestic violence, higher rates of smoking in pregnancy, lack of social supports and lower socioeconomic and education status of these women contribute to poorer outcomes. Young women still have their own developmental needs that should be addressed in addition to the needs related to the pregnancy. Whether the pregnancy is planned, unplanned or unwanted, and the need for reporting of sexual activity in a minor at risk, are also considerations.
6.1.1 Improving perinatal outcomes for adolescent women and their babies
In the context of growing recognition of young people’s need for services that are sensitive to their unique stage of biological, cognitive and psychosocial transition into adulthood, the World Health Organization identified that youth-friendly services need to be equitable, accessible, acceptable, appropriate, comprehensive, effective and efficient WHO 2002. Key features of youth-friendly care include WHO 2002, Tylee et al 2007:
- health professionals and support staff who are non-judgemental and considerate, treat each young person with equal care and respect, are competent, motivated and well supported
- health services that have an appealing ambience, convenient working hours, offer privacy and avoid stigma, and aim for short waiting times and (when needed) swift referral.
6.2 Women in rural and remote areas
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. DoH 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.
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.
6.2.1 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 (23% in 2014) are Aboriginal and Torres Strait Islander women AIHW 2016a.
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.
- AIHW (2016a) Australia’s mothers and babies 2014—in brief. Canberra: Australian Institute of Health and Welfare.
- AIHW (2016b)Perinatal data. Accessed: 25 August 2016.
- AIHW (2005)Rural, Regional and Remote Health Indicators of Health. Canberra: Australian Institute of Health and Welfare.
- AWHN (2008) Women’s Health: The New National Agenda: AWHN Position Paper March 2008. Melbourne: Australian Women’s Health Network.
- DoHA (2008)Improving Maternity Services in Australia.A Discussion Paper from The Australian Government. Canberra: Commonwealth of Australia.
- Middleton PF, for the Strategic Health Research Program Team (2009)Preventing Infant Deaths among Aboriginal and Teenage Women in South Australia.Adelaide: The University of Adelaide.
- Perinatal Mental Health Consortium (2008)National Action Plan for Perinatal Mental Health 2008–2010 Full Report.Melbourne:beyondblue: the national depression initiative.
- Sullivan EA, Hall B, King JF (2008)Maternal Deaths in Australia 2003–2005. Maternal deaths series no 3, Cat PER 42. Sydney: AIHW Perinatal Statistics Unit.
- Tylee A, Haller DM, Graham T et al (2007) Youth-friendly primary-care services: how are we doing and what more needs to be done?Lancet369: 1565–73.
- WHO (2002)Adolescent Friendly Health Services — An Agenda for Change. Geneva: Department of Child and Adolescent Health and Development, World Health Organization.