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

• Main Authors: Steenkamp Malinda (Author), Rumbold Alice (Author), Barclay Lesley (Author), Kildea Sue (Author)
• Format: Book
• Published: BMC, 2012-06-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

<p><b>Abstract</b></p> <p><b>Background</b></p> <p>Comparisons 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.</p> <p><b>Methods</b></p> <p>Our 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 <it>Indigenous</it> status; region (<it>Top End</it> (<it>TE</it>)<it>/Central Australia</it> (<it>CA</it>)); <it>Remote/Urban</it> residence; and across two large <it>TE</it> communities.</p> <p><b>Results</b></p> <p>Of the sample, 34.1% were Indigenous women, of whom 65.6% were remote-dwelling versus 6.7% of non-Indigenous women. In comparison to <it>CA Urban</it> mothers: <it>TE Remote</it> (adjusted odds ratio [aOR] 1.47, 95%CI: 1.13, 1.90) and <it>TE Urban</it> mothers (aOR 1.36 (95% CI: 1.02, 1.80) were more likely, but <it>CA Remote</it> mothers (aOR 0.43; 95% CI: 0.31, 0.58) less likely to smoke during pregnancy; <it>CA Remote</it> 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); <it>TE Remote</it> (aOR 0.71; 95%CI: 0.53, 0.95) and <it>CA Remote</it> women (aOR 0.68; 95%CI: 0.49, 0.95) who experienced labour had lower odds of epidural/spinal/narcotic pain relief; and <it>TE Remote</it> (aOR 0.47; 95%CI: 0.34, 0.66), <it>TE Urban</it> (aOR 0.67; 95%CI: 0.46, 0.96) and <it>CA Remote</it> 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 <it>TE Remote</it> newborns was 2.09 (95%CI: 1.20, 3.64) and they weighed 137 g (95%CI: -216 g, -59 g) less than <it>CA Urban</it> babies. There were few significant differences for communities, except for smoking prevalence.</p> <p><b>Conclusions</b></p> <p>This 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 <it>TE</it>. Smoking prevention and high-quality antenatal care is fundamental to addressing many of the adverse outcomes identified in this paper. </p>

Item Description

10.1186/1471-2393-12-44
1471-2393