8046NRS Assessment 2: Aboriginal Maternity Care Review Report

This report provides an integrative literature review on maternity care for Aboriginal and Torres Strait Islander women in Australia. It begins with an introduction highlighting the importance of maternity care and the unique challenges faced by these communities. The report then identifies and evaluates relevant literature, examining the policy framework, including the multiagency system and clinical guidelines, and cultural education programs designed to improve awareness and access to care. It details various maternity care models available across Australian territories, comparing public and private options, as well as specialized services like midwife clinics and birth centers. The analysis section emphasizes the critical need for maternity care for these women, addressing disparities in health outcomes and the impact of historical factors. The report also assesses the current state of maternity care facilities, including the National Maternity Services Plan and key priority areas for improvement. Recommendations are provided to enhance maternity care, focusing on increasing the indigenous workforce and developing culturally sensitive programs. The report concludes by summarizing the key findings and emphasizing the need for continued efforts to improve maternity care access and outcomes for Aboriginal and Torres Strait Islander women.

Running head: 8046NRS Assessment item 2
8046NRS Assessment item 2

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Table of contents
Introduction......................................................................................................................................3
Literature identification and evaluation...........................................................................................3
Policy framework.........................................................................................................................3
Cultural education programs........................................................................................................4
Maternity care models across Australian territories....................................................................5
Analysis...........................................................................................................................................6
Importance of maternity care needs for an aboriginal/Torres strait islander women..................6
Current condition of maternity care facilities for Aboriginal /Torres Strait islander woman......7
Conclusion.......................................................................................................................................9
Recommendations..........................................................................................................................10
References:....................................................................................................................................12
Appendix:......................................................................................................................................15
Summary table...........................................................................................................................15

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Introduction
Maternity care is something which is crucial for each and every women on this planet. It is
associated with one of the most critical health situation which any women undergoes at least
once in their entire lifetime. This sector of healthcare has been evident to be very sensitive and
thus there are supportive measures which are put in to place for idealizing these operations and
managing significances all along the defined possibilities. There are large scale complications
and requirement for huge transformational changes across the traditional healthcare services
available for the aboriginal communities of Australia. Since, the available set of regulations and
policies for this community is limited and scare the knowledge base among these communities
are also less. Especially, in the case of aspects related to women health and wellness. Thus, the
maternity operations and facilities need to be explained in a more organized manner to make
them aware of their body and avail better opportunities through governmental schemes and
programs (Health.gov.au, 2019).
This review report explains the current maternity provisions and facilities which are associated
with the aboriginal/Torres straits islander women of Australia. As the amount of information and
connectivity to the outer world for these communities are limited, it is much complicated to
facilitate better results in terms of healthcare services for these communities. Especially, in
segments such as maternity care and pregnancy factors, the operational framework which is put
at these places are quite scarce and complicated. This report identifies and analyses different
piece of literatures which are based on maternity facilities for aboriginal women (Homer, 2016).
A series of competent resources linked to these segments have been assessed to create a value
based review of systems, principles, regulations and policies which are available for dealing with
this healthcare segment inside Australian territories.
Literature identification and evaluation

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Policy framework
The Australian policy framework is based on multiagency system which links the aboriginal
community based health organizations with the mainstream hospitals. Under this policy
framework, initiatives for improving the current state of maternity healthcare support provided to
the indigenous women are discussed and implemented. It helps in guiding the operational
accountabilities and justified responsibilities for inclusion of high level maternity care for the
related women. The main ideology which groups together both of these possibilities relate with
the availability of significant approaches which are associated with the availability of better
performing and resulting operations. The cross cultural context and differences in their basic
operational factors are neglected to perform as a single team which is ideal in gaining a more
comprehensive form of advantages across its defined segments. The operational possibilities and
inclusions for this system is largely helpful in guiding most of the aboriginal community
development opportunities (Health.gov.au, 2019). The aboriginal -mainstream cooperation based
partnership with a common goal to establish a better approach for enhancement in maternity
factors across the institution.
The Australian clinical practice guidelines on antenatal care, which was released in 2012
includes important provisions for maternal healthcare support for Australian women population.
It optimizes the available regulatory provisions and provides additional support to the available
beneficiaries. The operations conducted under this segment are developed through a partnership
between territory and state governments and are funded by the maternity services inter-
jurisdictional committee (Foley & Schubert, 2016). In addition to this, another significant policy
making body named community care population health principal committee has the liability to
frame significant measures which can be used to idealize imprecisions in policy management.
Australian Government Department of Health, National Maternity Services and Australian
Health Ministers’ Advisory Council are some of the other responsible authorities which are
liable to undertake important decisions for justifying the development process of maternity care
among the indigenous women. These government and independent sections of healthcare society
have a major role to play in identifying and resolving issues related to maternity health among
the indigenous population. These act as stakeholders in the process of improving maternity care
across the Australian women population (Mja.com.au, 2019).

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Cultural education programs
Culture has been an important factor for establishment of better social development scenarios for
the indigenous population of Australia. The indigenous people are more attached to their cultural
beliefs and practices and thus operate according to the culturally recognized aspects. According
to the views of Reilly & Rees (2018), development of cultural competencies across individual,
organizational and systematic ways are crucial for establishing better approaches all along the
defined perspectives. This helps in building a more ideal ways to communicate and developing
flourishing relationships with the related people and make them aware about the possible
advantages. In majority of the cases, indigenous women are not at all aware about their
individual rights and obligations for maternity care and this leads to the development of a high
end lacking across the available sections. The overall operability factor which is linked to any
cultural education program is to spread awareness among the common population about their
obligations for better living and healthcare services. These educational programs are also
advantageous in order to maintain a more comprehensive form of operational perspective for
each of the related structures and avail better services for the lacking communities (Kildea et al.
2016). An educated and culturally sensitive population is less prone to the negative implications
of maternity crisis as they are aware of the government programs and plans.
Maternity care models across Australian territories
Australia is considered as one of the safest place to be born or to give birth in the world. This
factor is justified by the diverse range of maternity care models available across the country.
These models are distinguished in terms of their operational limitations and availability factors.
Each of the models specified under this section has a major role to play in the overall process of
maternity care and maintenance. However, majority of these models are exclusively used by the
non-indigenous Australians, but a large number of indigenous women are also benefited by some
of these models. These are the publically funded and maintained maternity control models across
Australian territories (Homer et al. 2018). These include medical staffs and midwives for
monitoring and maternity care possibilities. This facility is capable of undertaking both complex
and simple pregnancy issues and provide required treatment and care. These healthcare models
are privately controlled and operated service providers and are generally used by the non-
indigenous communities in Australia. A constant monitoring and evaluation for maternity care is

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provided under this model and it is comparatively costing as these are privately. These facilities
are based on the public hospital clinic care but are smaller in terms of operational dimensions.
Medical staffs and midwives are the main service providers across this model. Indigenous
women have access to this healthcare model. This segment of providing maternal care is carried
out in a separate section within the hospital. The team of midwives are associated to perform
facilities such as antenatal, postpartum and intrapartum care (Health.gov.au, 2019).
Following are the various models related to heath and maternity care operations across Australia:
 Public hospital clinic care
 Private maternity care
 Public hospital midwives clinic
 Birth centre care
 Shared maternity care
 Combined maternity care
 Team midwifery care
 Caseload midwifery care
 Midwife public care
 Outreach midwifery care
 Planned homebirths
Analysis
Importance of maternity care needs for an aboriginal/Torres strait islander women
The importance of maternity care needs for an aboriginal/Torres strait islander women can be
analyzed from the fact that there are huge disparities between aboriginal communities and
indigenous Australians. Apart from the issues for women, the aboriginal community as whole
has been suffering from basic health issues. The cases of hypertension, diabetes, renal and
cardiovascular diseases are significant in numbers. According to the views of Longman et al.
(2017), a major reason for the availability of high prone healthcare issues among these
communities is the unavailability of proper maternity care and lack in basic healthcare facilities
for newly born children across this community. The unavailability of significant care and

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medical facilities lead to some of the major issues in newly born babies such as preterm birth and
low birth weight. The inequalities and backwardness of these communities have significantly led
to the development of a much critical situation across these regions of Australia. Factors such as
colonization, institutionalized racism, inequalities and social exclusions have led to the
development of a less operational healthcare services across these regions. The differences in
operational strategies across these communities have also contributed majorly as there is a
significant lacking in the educational structure across these communities (Williams et al. 2018).
Current condition of maternity care facilities for Aboriginal /Torres Strait islander
woman
The Australian government has been largely involved in providing respective solutions to this
community specific issue prevalent across the maternity issues in the country. The country has
put in place a reliable and competent planning system named National maternity services plan,
which is aligned to provide suggestions and improvising ideologies for development of maternity
issues (Gould, Bittoun & Clarke, 2015). This planning commission is contained to perform
different programs and services through inclusion of investments and improvements across the
selected set of operations. The four key areas which are included across this planning process
relates with access, workforce, service delivery and infrastructure. Initiatives such as the
National evidence based antenatal care guidelines are put in to place for managing the maternity
and child birth issues across these communities in Australia. A thorough analysis of different
regions and segments related to improvising the maternal health and care factors across
indigenous women population in Australia depicts certain priorities which need to be addressed.
These priority factors are integrated to impact the overall maternity and pregnancy process
across the available populations (Health.gov.au, 2019). An illustrative analysis of these priority
factors which can be used to identify the needs related to maternity among indigenous women
population in Australia have been provided in the below mentioned sections:
 Increment in indigenous women workforce
Women workforce is an important section of any economy. It has large scaled socioeconomic
advantages across the countries of practice. In context of the indigenous population, the scale at
which women workforce is incorporated across the systems reflect their current social and

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economic states. In the year 2015, a national involvement of 230 indigenous midwives were
recorded across Australia, which comprises of 1% of the total midwives population in the
country. Since the indigenous population resembles 3% of the total population and holds
accountability for around 6% of the total Australian birth the limited availability of its midwives
population reflects the lacking services (Larkins & Page, 2015). However, there are several
provisions for increasing the development and recognition of various maturity models across the
indigenous population. These models are significantly helping the workforce from these
population to integrate them across different jobs and titles. The significantly less number of
indigenous workforce across maternity operations in the country relate with the availability of
less vibrant and dynamic range of healthcare services for these communities.
 Development of culturally compatible and related maternity care possibilities
Culturally compatible maternity care services and programs are eventually considered as one of
the best practice for making transformational development across the related regions of
backwardness. Presently, the Australian government has been evident in providing a more secure
and determined form of treatment to the healthcare objectives for the related indigenous
population and especially women. These programs themselves revel the consistent need and
support which the indigenous women population needs across Australia (McHugh et al. 2019).
Culturally competent maternity care has been evident in unveiling the actual conditions which
are available across the specified sections of women healthcare as whole. Since, the indigenous
communities relate with their own people and are largely cut off from the common population,
the need based inclusion is identified and secured through application of cultural belongingness.
A boarder audience group is being benefited by the availability of these possibilities and thus
provides explanation for the present maternity conditions. The face to face health based training
related to cultural safety program by the congress of Aboriginal Torres Strait Islander Nurses and
Midwives are a major example of a culturally compatible maternity care structure
(Womenandbirth.org, 2019).
 Inclusion of dedicated programs for births in the country
Accessibility to efficient maternity care is an important issue for the indigenous women as they
are generally associated to remote and very remote regions of the country. This provides them
with an ability to initiate a much required form of operation for each of the individual

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community members. According to the views of Bar-Zeev et al. (2017), the 24% of indigenous
women in Australia give birth at remote and very remote regions of the country. Thus, the
accessibility to basic maternity care is not available and this results in different issues for the
mother as well as newly born child. This information depicts the extent of issues which are
available for indigenous women in concern to their maternity health and wellness. These areas
also lack midwifery and suboptimal care quality due to high end accessibility issues. In order to
deal with this factor, initiatives like birthing on country plan have been largely supportive. These
programs are associated with providing medical and health related care for indigenous women at
their own locations and communities. However, there are several communities which have come
out to avail these facilities at the places where it is available. But there are certain sections of
women who cannot avail these services and thus need maternal healthcare support at their remote
households.
Following are some of the most important elements which relate with the need of programs and
plans like Birthing on country for the indigenous women:
 Based and governed by the community and its regulations
 Incorporating of traditional practices
 Land and country based connection recognition
 Incorporation of a holistic health definition
 Value system based on knowing and learning of both indigenous as well as non-
indigenous ways and cultures (Brown et al. 2016).
 Availability of cultural competency and relativeness with the indigenous people.
These elements relate with the need of a country based system which can facilitate primary
maternity care closer to home. However, the need and demand for these facilities have been
consistent for a significant amount of time but there have been no any prominent solutions made
by the authorities in this particular field. The overall operations have been carried out in a
selective manner and thus, the requirement in remote and very remote regions remain intact. The
areas which are closer have been capable of availing these services but the far flung regions have
been demanding solutions since the past 25 years in context of maternity care possibilities for the
indigenous women (Thewomens.org.au, 2019).

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Conclusion
A major conclusion which can be derived from this review report reflects the overall condition of
indigenous women and their maternity care possibilities in practice across the country.
Identification of current maternity practices and their respective impacts across the operational
framework are assessed all across the reporting. A series of useful literature are also reviewed for
deriving a competent information base for the concerned subject. The maternity care received by
non-indigenous communities in Australia are quite satisfactory but the situation for indigenous
women remain critical. Cultural and locational variations are two basic reasons which can be
held accountable for this major lacking. The Aboriginal/Torres strait islander women are not able
to avail maternity benefits provided by the governments as they are not well connected with the
social structure. In many of the cases, giving birth to any other land except their local land
deprives them from their basic community rights, which holds them for moving to better
facilities and service related to maternal care. The literature analysis carried out depicts a more
organized form of operations across the defined perspectives as it helps in guiding the process
straight in to the intense communities and indigenous regions. The principles and practices which
the government has initiated at both state as well as territory levels are analyzed to provide a
more detailed information about the available situation.
Recommendations
Following are some of the major recommendations which can be used to facilitate an improved
form of maternity care across the indigenous women population in Australia:
 Inclusion of state and territory consultation for collection and monitoring of collected
data on perinatal and maternal morbidity and mortality.
 Development of country wide researches for integration of better maternity care
possibilities across the country.
 Incorporation of evidence based change across the maternity services
 Development of more focussed and expectation based maternity care models across the
less significant regions of the country (Aitken & Stulz, 2018).

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 Providing adequate financial independence to the basic healthcare models and
strengthening of ground level service providers such as midwives and healthcare staffs.
 Development of culturally compatible educational programs for the indigenous
population and especially the women population.
 Establishment of a better regulatory and policy framework for the healthcare sector
dealing with indigenous population.

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References:
Aitken, R., & Stulz, V. (2018). Factor analysis to validate a survey evaluating cultural
competence in maternity care for Indigenous women. Australian Journal of Advanced
Nursing, The, 36(1), 25.
Bar-Zeev, Y., Bovill, M., Bonevski, B., Gruppetta, M., Reath, J., & Gould, G. (2017). Assessing
and validating an educational resource package for health professionals to improve
smoking cessation care in aboriginal and torres strait islander pregnant
women. International journal of environmental research and public health, 14(10), 1148.
Brown, S., Glover, K., Weetra, D., Ah Kit, J., Stuart Butler, D., Leane, C., ... & Yelland, J.‐
(2016). Improving Access to Antenatal Care for Aboriginal Women in South Australia:
Evidence from a Population Based Study.‐ Birth, 43(2), 134-143.
Foley, W., & Schubert, L. (2016). Ethics of care and urban Aboriginal and Torres Strait Islander
Breastfeeding beyond three months. SOJ Nursing and Health Care, 2(1), 1-8.
Gould, G. S., Bittoun, R., & Clarke, M. J. (2015). A pragmatic guide for smoking cessation
counselling and the initiation of nicotine replacement therapy for pregnant Aboriginal
and Torres Strait Islander smokers. Journal of Smoking Cessation, 10(2), 96-105.
Health.gov.au (2019), improving maternity services in Australia, Retrieved on 01 October 2019,
Retrieved from
https://www1.health.gov.au/internet/main/publishing.nsf/Content/624EF4BED503DB5B
CA257BF0001DC83C/$File/Improving%20Maternity%20Services%20in%20Australia
%20-%20The%20Report%20of%20the%20Maternity%20Services%20Review.pdf
health.gov.au (2019), Improving maternity services in Australia: the report of the Maternity
Services Review, Retrieved on 01 October 2019, Retrieved from
https://www1.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesrevie
w-report
Health.gov.au (2019), Pregnancy Care Guidelines, Retrieved on 01 October 2019, Retrieved
from https://www.health.gov.au/resources/pregnancy-care-guidelines/introduction

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Health.gov.au (2019), The Characteristics of culturally competent maternity care for Aboriginal
and Torres Strait Islander women, Retrieved on 01 October 2019, Retrieved from
https://www1.health.gov.au/internet/main/publishing.nsf/Content/maternity-pubs-cultur
Homer, C. S. (2016). Models of maternity care: evidence for midwifery continuity of
care. Medical Journal of Australia, 205(8), 370-374.
Homer, C. S., Oats, J., Middleton, P., Ramson, J., & Diplock, S. (2018). Updated clinical
practice guidelines on pregnancy care. Medical Journal of Australia, 209(9), 409-412.
Kildea, S., Tracy, S., Sherwood, J., Magick Dennis, F., & Barclay, L. (2016). Improving‐
maternity services for Indigenous women in Australia: moving from policy to
practice. Medical Journal of Australia, 205(8), 374-379.
Larkins, S. L., & Page, P. (2015). Access to contraception for remote Aboriginal and Torres
Strait Islander women: necessary but not sufficient. Sex Health, 12, 231-239.
Longman, J., Kornelsen, J., Pilcher, J., Kildea, S., Kruske, S., Grzybowski, S., ... & Barclay, L.
(2017). Maternity services for rural and remote Australia: barriers to operationalising
national policy. Health Policy, 121(11), 1161-1168.
McHugh, L., Binks, M. J., Gao, Y., Andrews, R. M., Ware, R. S., Snelling, T., & Kildea, S.
(2019). Influenza vaccination in pregnancy among a group of remote dwelling Aboriginal
and Torres Strait Islander mothers in the Northern Territory: The 1+ 1 Healthy Start to
Life study. Communicable diseases intelligence (2018), 43.
Mja.com.au (2019), Improving maternity services for Indigenous women in Australia: moving
from policy to practice, Retrieved on 01 October 2019, Retrieved from:
https://www.mja.com.au/system/files/issues/205_08/10.5694mja16.00854.pdf
Reilly, L., & Rees, S. (2018). Fatherhood in Australian Aboriginal and Torres Strait Islander
communities: An examination of barriers and opportunities to strengthen the male
parenting role. American journal of men's health, 12(2), 420-430.
Thewomens.org.au (2019), Aboriginal and Torres Strait Islander Women – resources, Retrieved
on 01 October 2019, Retrieved from: https://www.thewomens.org.au/health-

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information/pregnancy-and-birth/aboriginal-and-torres-strait-islander-women/atsi-
resources
Williams, H. M., Percival, N. A., Hewlett, N. C., Cassady, R. B., & Silburn, S. R. (2018). Online
scan of FASD prevention and health promotion resources for Aboriginal and Torres Strait
Islander communities. Health Promotion Journal of Australia, 29(1), 31-38.
Womenandbirth.org (2019), Caring for childbearing Aboriginal and Torres Strait Islander
women – The carers perspective, Retrieved on 01 October 2019, Retrieved from:
https://www.womenandbirth.org/article/S1871-5192(17)30355-4/pdf

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Appendix:
Summary table
Resources Areas of influence
Health.gov.au (2019) Details for improvising maternity services in
Australia
Thewomens.org.au (2019) Aboriginal and Torres Strait Islander Women
– resources
Mja.com.au (2019) Improving maternity services for Indigenous
women in Australia: moving from policy to
practice
Homer, C. S. (2016) Models of maternity care: evidence for
midwifery continuity of care
Brown et al. 2016 Improving Access to Antenatal Care for
Aboriginal Women in South Australia:
Evidence from a Population Based Study‐
Williams et al. 2018 Online scan of FASD prevention and health
promotion resources for Aboriginal and
Torres Strait Islander communities
Aitken, R., & Stulz, V. (2018) Factor analysis to validate a survey evaluating
cultural competence in maternity care for
Indigenous women