A population-based investigation into inequalities amongst Indigenous mothers and newborns by place of residence in the Northern territory, Australia

BMC Pregnancy and Childbirth

Research Article

Sue Kildea¹  Alice Rumbold²  Lesley Barclay³  Malinda Steenkamp³ 

[1] Australian Catholic University and Mater Medical Research Institute, Women's Health and Newborn Services (Maternity), Mater Health Services, Brisbane, Australia;Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide and Services Systems and Society Division, Menzies School of Health Research, Darwin, Australia;University Centre for Rural Health North Coast, School of Public Health, University of Sydney, Lismore, Australia;

关键词: Indigenous;    Remote;    Maternal;    Neonatal;    Inequalities;   

DOI  :  10.1186/1471-2393-12-44

 received in 2011-08-25, accepted in 2012-05-23,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundComparisons of birth outcomes between Australian Indigenous and non-Indigenous populations show marked inequalities. These comparisons obscure Indigenous disparities. There is much variation in terms of culture, language, residence, and access to services amongst Australian Indigenous peoples. We examined outcomes by region and remoteness for Indigenous subgroups and explored data for communities to inform health service delivery and interventions.MethodsOur population-based study examined maternal and neonatal outcomes for 7,560 mothers with singleton pregnancies from Australia’s Northern Territory Midwives’ Data Collection (2003–2005) using uni- and multivariate analyses. Groupings were by Indigenous status; region (Top End (TE)/Central Australia (CA)); Remote/Urban residence; and across two large TE communities.ResultsOf the sample, 34.1% were Indigenous women, of whom 65.6% were remote-dwelling versus 6.7% of non-Indigenous women. In comparison to CA Urban mothers: TE Remote (adjusted odds ratio [aOR] 1.47, 95%CI: 1.13, 1.90) and TE Urban mothers (aOR 1.36 (95% CI: 1.02, 1.80) were more likely, but CA Remote mothers (aOR 0.43; 95% CI: 0.31, 0.58) less likely to smoke during pregnancy; CA Remote mothers giving birth at >32 weeks gestation were less likely to have attended ≥ five antenatal visits (aOR 0.55; 95%CI: 0.36, 0.86); TE Remote (aOR 0.71; 95%CI: 0.53, 0.95) and CA Remote women (aOR 0.68; 95%CI: 0.49, 0.95) who experienced labour had lower odds of epidural/spinal/narcotic pain relief; and TE Remote (aOR 0.47; 95%CI: 0.34, 0.66), TE Urban (aOR 0.67; 95%CI: 0.46, 0.96) and CA Remote mothers (aOR 0.52; 95%CI: 0.35, 0.76) all had lower odds of having a ‘normal’ birth. The aOR for preterm birth for TE Remote newborns was 2.09 (95%CI: 1.20, 3.64) and they weighed 137 g (95%CI: -216 g, -59 g) less than CA Urban babies. There were few significant differences for communities, except for smoking prevalence.ConclusionsThis paper is one of few quantifying inequalities between groups of Australian Indigenous women and newborns at a regional level. Indigenous mothers and newborns do worse on some outcomes if they live remotely, especially if they live in the TE. Smoking prevention and high-quality antenatal care is fundamental to addressing many of the adverse outcomes identified in this paper.

【 授权许可】

CC BY   
© Steenkamp et al.; licensee Biomed Central. 2012