Monash Rural Health, Monash University, Australia.
Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University.
Women Birth. 2023 Feb;36(1):136-140. doi: 10.1016/j.wombi.2022.04.007. Epub 2022 Apr 27.
The perinatal period is a time when provision of responsive care offers a life course opportunity for positive change to improve health outcomes for mothers, infants and families. Australian perinatal systems carry the legacy of settler-colonialism, manifesting in racist events and interactions that First Nations parents encounter daily.
The dominance of a western risk lens, and conscious and unconscious bias in the child protection workforce, sustains disproportionately high numbers of First Nations infants being removed from their parents' care. Cascading medical interventions compound existing stressors and magnify health inequities for First Nations women.
Critical discourse was informed by Indigenous ways of knowing, being and doing via targeted dialogue with a group of First Nations and non-Indigenous experts in Australian perinatal care who are co-authors on this paper. Dynamic discussion evolved from a series of yarning circles, supplemented by written exchanges and individual yarns as themes were consolidated.
First Nations maternity services prioritise self-determination, partnership, strengths and communication and have demonstrated positive outcomes with, and high satisfaction from First Nations women. Mainstream perinatal settings could be significantly enhanced by embracing similar principles and models of care.
The Australian Anti-racism in Perinatal Practice (AAPP) Alliance calls for urgent transformations to Australian perinatal models of care whereby non-Indigenous health policy makers, managers and clinicians take a proactive role in identifying and redressing ethnocentrism, judgemental and culturally blind practices, reframing the risk narrative, embedding strength-based approaches and intentionally prioritising engagement and connectedness within service delivery.
围产期是一个提供响应性护理的时期，为母亲、婴儿和家庭提供了积极改变的机会，从而改善健康结果。澳大利亚围产期系统带有殖民主义的遗产，表现在种族主义事件和第一民族父母每天遇到的互动中。
西方风险视角的主导地位，以及儿童保护工作者的有意识和无意识偏见，导致不成比例地大量第一民族婴儿被从父母的照顾中带走。医疗干预的连锁反应加剧了现有的压力源，并扩大了第一民族妇女的健康不平等。
通过与一群参与本文的澳大利亚围产期护理的第一民族和非原住民专家进行有针对性的对话，批判性话语受到了原住民的认知、存在和行为方式的启发。通过一系列的对话圈，动态讨论得以发展，辅以书面交流和个人对话，以整合主题。
第一民族产妇服务优先考虑自主、合作、优势和沟通，并已通过与第一民族妇女的合作取得了积极的成果，并获得了她们的高度满意。主流围产期环境可以通过采用类似的护理原则和模式得到显著加强。
澳大利亚反种族主义围产期实践（AAPP）联盟呼吁澳大利亚围产期护理模式进行紧急转型，要求非原住民卫生政策制定者、管理者和临床医生在识别和纠正种族中心主义、评判性和文化盲目性实践、重新构建风险叙述、嵌入基于优势的方法以及在服务提供中有意优先考虑参与和联系方面发挥积极作用。
