Improving antenatal engagement for Aboriginal women in Australia: A scoping review

BACKGROUND

Aboriginal women have an increased risk of poor antenatal engagement in pregnancy in comparison with Caucasian women, due to inequalities in health care provision. The Pregnancy Outcome in South Australia reports Aboriginal women having 10 times the risk of non-attendance of antenatal care throughout their pregnancy, 3 times the risk of attending the initial booking appointment later than recommended in their pregnancy, and Aboriginal women have an increased risk of attending significantly less antenatal appointments than Caucasian women.

OBJECTIVE

The primary purpose of the scoping review is to map the body of literature known about Aboriginal women engaging with antenatal care in Australia, and the factors that facilitate or cause barriers to this engagement. Secondary to this, the review will describe how culturally safe care influences antenatal engagement.

METHODS

Scoping reviews utilise a broad range of literature, encompassing all types of studies. An online search of 6 databases was conducted to identify and critically analyse sources discussing antenatal engagement for Aboriginal women in Australia. Using the JBI framework for Scoping Reviews, the researcher was able to strengthen the rigour of the methodology.

FINDINGS

The search produced 9 articles, relating to 6 studies addressing antenatal engagement for Aboriginal women in Australia. Several themes were prevalent in the research that impact antenatal engagement including: Smoking, Relocation, Continuity of Care, Aboriginal maternity infant care workers, home visits, birthing on country, age, family and culturally safe care.

CONCLUSION

Aboriginal women have identified continuity of care, Aboriginal workforce, home visits, family involvement, birthing on country and cultural safety as factors that improve antenatal engagement. Aboriginal women have reported smoking, rural and remote location, cultural incompetence and young age as factors that deter them from engaging with antenatal care. In order to improve antenatal engagement for Aboriginal women in South Australia, culturally safe care is essential. In order to determine the factors that facilitate and/or deter Aboriginal women from antenatal engagement, further research is required.

Improving Access to Antenatal Care for Aboriginal Women in South Australia: Evidence from a Population-Based Study

INTRODUCTION

Aboriginal and Torres Strait Islander women are two to three times more likely to experience adverse maternal and perinatal outcomes than non-Aboriginal women in Australia. Persisting health inequalities are at least in part explained by late and/or inadequate access to antenatal care.

METHODS

This study draws on data collected in a population-based study of 344 women giving birth to an Aboriginal infant between July 2011 and June 2013 in South Australia to investigate factors associated with engagement in antenatal care.

RESULTS

About 79.8 percent of mothers accessed antenatal care in the first trimester of pregnancy, and 90 percent attended five or more antenatal visits. Compared with women attending mainstream regional services, women attending regional Aboriginal Family Birthing Program services were more likely to access antenatal care in the first trimester (Adj OR 2.5 [1.0-6.3]) and markedly more likely to attend a minimum of five visits (Adj OR 4.3 [1.2-15.1]). Women attending metropolitan Aboriginal Family Birthing Program services were also more likely to attend a minimum of five visits (Adj OR 12.2 [1.8-80.8]) compared with women attending mainstream regional services. Women who smoked during pregnancy were less likely to attend a visit in the first trimester and had fewer visits.

CONCLUSIONS

Scaling up of Aboriginal Family Birthing Program Services in urban and regional areas of South Australia has increased access to antenatal care for Aboriginal families. The involvement of Aboriginal Maternal Infant Care workers, provision of transport for women to get to services, and outreach have been critical to the success of this program.

Identification and evaluation of models of antenatal care in Australia--a review of the evidence

BACKGROUND

Antenatal care has been routine practice throughout the world since early in the 20th century, and in most developed countries, antenatal care consists of a scheduled program of individual consultations with a healthcare practitioner, using a doctor or midwife. Women seek antenatal care that provides a physical review of the health and development of their unborn baby, the reassurance and ability to be listened to and the opportunity for their partner to be involved in their care.

AIMS

To identify the types of antenatal care services that are available to Australian women and investigate the views and opinions of Australian women related to these services.

MATERIALS AND METHODS

A systematic literature review using Scopus and Medline databases was used to find appropriate journal articles in January 2013. Articles were restricted to those in the Australian setting from the past 10 years with a focus on different models of antenatal care and the views and experiences of women during their antenatal care.

RESULTS

Eighteen relevant peer-reviewed journal articles were included. Emerging forms of antenatal care that are showing increasing levels of satisfaction from Australian women include continuity of carer, the midwifery-led care and group- or community-led care. These approaches are proving to be safe and successful.

CONCLUSION

Newer models of antenatal care in Australia may offer benefits over standard practice.

Factors associated with the timing of antenatal care seeking in Bangladesh

This study investigates the factors affecting the timing of antenatal care (ANC) seeking among Bangladeshi women using the 2007 Bangladesh Demographic and Health Survey data. Overall, 52% of the most recently pregnant women sought skilled ANC. The most pronounced reason for not receiving the services was that it was "not needed." Of the women who sought ANC, 57% entered for ANC at the fourth month or later. The multivariate regression analysis revealed that maternal age, women's education, residence, wealth index, pregnancy intention status, child's birth order, and wanting more children were the important determinants of ANC services utilization. Wanting more children and contraception use were no longer independent contributors to late ANC entry. These barriers should also be addressed as part of health interventions through information education and communication programs to early entry to ANC. The need to reduce financial barriers to care is a major implication of this study.