Midwifery Research Unit, Mater Medical Research Institute, Brisbane, QLD
Midwifery and Women's Health Research Unit, The University of Sydney, Sydney, NSW.
Med J Aust. 2016 Oct 17;205(8):374-379. doi: 10.5694/mja16.00854.
The well established disparities in health outcomes between Indigenous and non-Indigenous Australians include a significant and concerning higher incidence of preterm birth, low birth weight and newborn mortality. Chronic diseases (eg, diabetes, hypertension, cardiovascular and renal disease) that are prevalent in Indigenous Australian adults have their genesis in utero and in early life. Applying interventions during pregnancy and early life that aim to improve maternal and infant health is likely to have long lasting consequences, as recognised by Australia's National Maternity Services Plan (NMSP), which set out a 5-year vision for 2010-2015 that was endorsed by all governments (federal and state and territory). We report on the actions targeting Indigenous women, and the progress that has been achieved in three priority areas: The Indigenous maternity workforce; Culturally competent maternity care; and; Developing dedicated programs for "Birthing on Country". The timeframe for the NMSP has expired without notable results in these priority areas. More urgent leadership is required from the Australian government. Funding needs to be allocated to the priority areas, including for scholarships and support to train and retain Indigenous midwives, greater commitment to culturally competent maternity care and the development and evaluation of Birthing on Country sites in urban, rural and particularly in remote and very remote communities. Tools such as the Australian Rural Birth Index and the National Maternity Services Capability Framework can help guide this work.
澳大利亚原住民和非原住民在健康结果方面存在明显且令人担忧的差异，包括早产、低出生体重和新生儿死亡率的显著增加。在澳大利亚原住民成年人中普遍存在的慢性疾病（如糖尿病、高血压、心血管和肾脏疾病）起源于子宫内和生命早期。在怀孕期间和生命早期实施旨在改善母婴健康的干预措施，可能会产生持久的影响，正如澳大利亚国家孕产妇服务计划（NMSP）所认识到的那样，该计划为 2010-2015 年设定了一个为期 5 年的愿景，得到了所有政府（联邦、州和地区）的认可。我们报告了针对原住民妇女的行动，以及在三个优先领域取得的进展：原住民产妇劳动力；文化上胜任的孕产妇保健；以及为“在本土生育”制定专门计划。NMSP 的时间框架已经过期，但在这些优先领域没有取得显著成果。澳大利亚政府需要更紧急的领导。需要为优先领域分配资金，包括为奖学金提供资金，以培训和留住原住民助产士，更加致力于文化上胜任的孕产妇保健，以及在城市、农村，特别是在偏远和极偏远社区开发和评估“在本土生育”场所。澳大利亚农村分娩指数和国家孕产妇服务能力框架等工具可以帮助指导这项工作。
