Review Of Maternal Mortality And Child Health Programs For Aboriginal People Of Australia
Background
The aboriginal health has become one of the main concern for the Australian health department and many studies have considered the health condition of the aboriginal as the part of their research. High prevalence of communicable and non-communicable disease and increase in the mortality rate has influenced the researchers to investigate the health issue of the population and identify effective strategies in order to improve the health status of the aboriginal people (Souza et al., 2013). In this regards studies have identified a significant issue in this population such as maternal and child health (Eades et al., 2010). As defined by WHO, maternal mortality is considered as the death of a woman during the period of pregnancy or death within 42 days of termination of pregnancy, associated with the site or duration of pregnancy or death caused by any factor associated with pregnancy (except incidental or accidental causes) (World Health Organization, 2011). On the other hand WHO has defined that, child health is considered as a state of physical, emotional and social well-being of a child, instead of considering the absence of disease only (Souza et al., 2010).
The incident of maternal mortality is not only limited to the developing or underdeveloped countries, however, the risk and prevalence of maternal mortality has been figured in developed nations as well. The incident of maternal death and associated complications are poorly investigated and miscalculated for the aboriginal people of Australia (Eades et al., 2010). Studies have considered the fact of maternal mortality and it has been proven that the incident of maternal mortality is common in the aboriginal population. Various contributing factors of such poor health condition of aboriginal women and children have been identified by research (Ahmed et al., 2010). According to the report of Australian Institute of Health and Welfare, life expectancy is lower in the indigenous population as compare to the general Australian population, hence, the aboriginal children have a few older and experienced people to guide them or inform them about the maternal health (Tamrat & Kachnowski, 2012). Such disadvantage contributes to the incident of childhood pregnancy which is risky for the health of both the mother and the foetus.
The retrospective cohort study conducted by Fairthorne et al., (2016) has reported that there are several external causes of high mortality rate in aboriginal population. Accident has been identified as one of the major risk factor during pregnancy and accidental cause has been found to contribute to the high maternal death in this population. On the other hand substance abuse has been identified as another risk factor. Many cases of prolonged substance abuse such as smoking tobacco drugs and excessive alcohol intake during pregnancy in aboriginal population have been reported. Such behavioural factors affect both the health of the pregnant mother and the foetus as well (Jongen et al., 2014).Tamrat and Kachnowski (2012), have indicated that, babies of the women who involved in substance abuse during pregnancy show alter response to the visual stimuli, increase in the tremulousness is also identified and they have high-pitched cry. This is a factor of concern as it indicates problem with neurological development of the babies (Rumbold et al., 2011). On the other hand the babies of the pregnant women that are associated with high alcohol intake have been found to born with foetal alcohol syndrome as well. In addition, high rate of substance abuse also affected the health of pregnant women as it could lead to the consequence of suffering from chronic disease and increase the risk of gaining weight during pregnancy (Rumbold et al., 2011). Research has identified 2 types of illegal substances, such as substance that are illegitimate to possess like heroine and ecstasy and another include substance that are legally available like petrol used as inhalant and some pain killers that are used non-medically(Pinto et al., 2010). Behnke Smith and Committee on Substance Abuse (2013), has reported that addiction to such drugs may lead to delirious effect which affect the health of the pregnant women and their social and economic aspects as well. Hence, it has been demonstrated that substance abuse is directly or indirectly associated with maternal and child health.
Maternal Mortality in Aboriginal Population
Studies have been included the factors influencing high rate of substance abuse in this population as a topic of research. It is important to investigate and identify the contributing factor in order to introduce effective strategy to create awareness about substance abuse and achieve positive health outcomes (Ludlow, 2010). It has been found that, substance abuse is an oppressive social and economic impact such as, domestic violence, unemployment, antisocial activities and lack of education, especially for the rural resident such as aboriginal people in Australia (Schmied et al., 2011). In addition the impact of colonization cannot be ignored. During the settlement the aboriginal people have faced dramatic changes in their life, for example, they have been removed from their own land forcefully and their children have been suffered from the incident of loss of children, the situation was a threat for the existence of their cultural and traditional aspects, suffering from various disease and economic loss was also experienced by the aboriginal people (Ludlow, 2010). Such experience has played a significant role in the consequence of substance abuse, which has led to the development of various health issues.
In addition to the poor health condition of the pregnant women, poor health status of the children is a significant issue in the aboriginal population. Beside the presence of physical health problem, mental health issue has contributed to the poor health status of the children in this population (Rumbold et al., 2011). One significant cause of high prevalence of mental health issue among children is the poor health behaviour such as substance abuse of their mothers during their pregnancy (Ludlow, 2010). As mentioned before, high addiction to abusive substance leads to the consequence of poor neurological development of the children which may lead to the development of various neurological issue and psychological problems as well (Souza et al., 2013). In addition, the incident of colonization is also responsible for the poor mental health of the aboriginal children due to its contribution to the development of racism and overcrowding living condition (Souza et al., 2010). The poor socio-economic condition is another potential contributing factor to the poor psychological condition of the aboriginal children. Another significant cause of poor maternal and child health in this population is lack of access and availability of effective health service (Eades et al., 2010).
Hence, it is clear that poor maternal health has contributed to the consequence of poor child health in the aboriginal population and there are various factors that have led to the development of poor maternal and child health as well. Therefore, it is important to investigate the health issues and different social determinants that have contributed to the development of such health issues in order to introduce effective strategies to mitigate the health issues and improve the maternal and child health in this population, as improvement of child and maternal health would ensure improve health status of the future generation (Souza et al., 2013). There is lack of policies regarding the maternal and child health of aboriginal population, however, several programs have been introduced by the Australian government focusing on the maternal and child health, such as Australian Nurse Family Partnership Program, in order to facilitate the aboriginal population to access adequate health service and improve their health status (Eades et al., 2010). Evaluation of these programs is needed in order to understand their effectiveness. In this regards this report aims to review the available policies and programs for the aboriginal maternal and child health. In addition the report will focus on the consequence of high maternal death and investigate the association of substance abuse with poor maternal and child health outcomes.
Substance Abuse and Maternal and Child Health
The objectives of this literature review are-
- To give an overview of the current situation of indigenous maternal health and child health and the substance abuse, tobacco and smoking in indigenous people.
- To find out the effects of substance abuse on pregnancy in indigenous people.
- To review the government policies or programs that are introduced in order to address the various substance abuse in indigenous people
As described earlier, the aboriginal population is suffering from various health issues including communicable and non-communicable disease. Beside such poor health condition, maternal and child health has become one of the major concern in this population due to increase in maternal and infant mortality rate. Previous studies have identified various factors that have contributed to the poor maternal and child health status in the aboriginal population (Eades et al., 2010). It has been found that impact of colonization is one of the major contributor in the poor health status of this population. Due to loss of land, consequence of stolen generation, settlement in new place and adjusting in new environment, economic disaster and threat to the existence of their culture and tradition, the people in aboriginal population has suffered from drastic changes which affected their mental health due to excessive stress. Such condition has led to the dependence on various abusive substance which has been considered as the major risk factor of poor health condition of aboriginal women and children (Behnke, Smith & Committee on Substance Abuse, 2013). On the other hand, increased racism and social disadvantage has limited the access to effective health service as well. The overall condition has impacted on the health of the aboriginal women during pregnancy, which has contributed to the poor neurological and physical development of their children (Souza et al., 2013).
Hence, it is important to investigate the health issue of the aboriginal people in order to understand and identify the contributing social determinants and introduce effective strategies to address them in an effective manner. There are many studies including, report, articles and journals that have included general health, health issues and current trends of maternal and child health and its relation with substance abuse in the aboriginal population. However, there are few studies that have included all aspects of maternal health such as health issues, association with substance abuse and review of the policies and programs available for them. Therefore, the previous studies lack the connection between all aspects of maternal and child health of aboriginal population. In addition, the previous studies have provided interventions to improve the health condition of aboriginal mothers however, they did not focus on improving the existing policies and programs. Hence, this study aims to investigate the health status of aboriginal women and children along with the evaluation of existing policies and programs in order to understand the gap in the practice and improve the existing measures to help the population to overcome the high prevalence of maternal and child mortality rate.
Factors Contributing to Substance Abuse in Aboriginal Population
Selecting appropriate methodology is an important part of any study. Methodology is the systematic and theoretical analysis that allows individual to conduct the study in a logical manner (Kaplan, 2017). This study aims to review the previous literature based on indigenous maternal and child health and association of substance abuse with poor maternal and child health. In addition, the study focuses on the evaluation of currently available policies and programs for indigenous maternal and child health, hence method of systematic review has been utilised in order to address the objectives of the study. In order to use appropriate method this study has used the guidelines of JBI scoping reviews as described in 2015 JBI Reviewers Manual (Peters et al., 2015). The study has utilised the method of systematic review in order to investigate the aboriginal maternal and child health and impact of substance abuse on maternal and child health and review the existing policies and programs related to the maternal and child health in this population. Hence, this systematic review is different from the other literature review that aims to address any research question, as it aims to evaluate or interpret the previous research available on maternal and child health of aboriginal people. In this regards, the guidelines of JBI scoping reviews has helped in an effective manner and has supported the methods used in this review.
Inclusion criteria of a systematic review is set before conducting the search in order to include most relevant and acceptable literatures for the study which could address the objective of the study in an effective manner (Kaplan, 2017). In this regards 5 inclusion criteria have been selected for this particular study. Such inclusion criteria have been selected for the previous literatures based on aboriginal maternal and child health. The first criteria is the choice of language. In order to review a paper it is important to understand the language of the paper, hence, report, articles and journals that have been published in English language have been chosen for the purpose of this review (Kaplan, 2017). The second criteria includes the date and year of the previous papers. In order to understand the maternal and child health condition in aboriginal population it is required to understand the current trend in health system and current health status as well. Therefore, studies published during 2010-2018 have been chosen for this particular review. Third, only relevant papers that have considered indigenous maternal and child health as the research topic have been selected for this study. Fourth, all the papers have been screened and author information have been evaluated in order to select the peer reviewed papers only in order to strengthen the findings of this review. The fifth inclusion criteria includes selecting the full text articles, report or journal only. Papers for which only abstract is available have been excluded as they lack in-depth information about the study which is required for the purpose of this review. Previous papers that have met all of this inclusion criteria have been selected in order to derive the result of this study. In addition currently available health policies and programs have been selected in order to evaluate them and inclusion criteria has not been set for these policies and programs.
Poor Mental Health Status of Children in Aboriginal Population
In order to complete a literature review it is important to select effective sources to gather information and represent them in an effective manner to derive the result of the review. In this regards, effective electronic data bases has been used as the prime source of information that are required for the purpose of literature review. The selected previous papers such as article, journal and various policies and programs related with maternal and child health of Australian aboriginal population have been considered and represented with simple language that is easily understandable. All of the articles are downloaded into Endnote X8 version in order to keep record of the literature sources. Such sources has helped to poceed the literature review in an efective manner while maintaining adequate research, data collection and data storing process.
As the study aims to review the current studies, therefore both the published and unpublished studies have been considered for this study. In order to find out both the unpublished and published studies an initial search strategy has been developed. Relevant key words have been used to search the relevant literatures. For example, Indigenous people, maternal mortality, substance abuse in indigenous people, child health, tobacco use in pregnancy and programs on maternal and child health in Australia. Databases such as Ebook Central, Emerald, Medline,ProQuest, PsycInfo, ScienceDirect, SciFinder, Web of Science, Wiley Online Library, PubMed and Google Scholar have been used to find out the relevant literatures, policies and programs. An initial search has been conducted followed by the analysis of text words and subject words contained in the titles and abstract of the initially searched papers. Using all of the key words and index terms from the extracted studies in initial research a second search has been done. In order to collect additional data, the reference lists of selected studies have been analysed. Date limit has not been provided, hence, all the relevant studies published from beginning date to present date have been evaluated.
Using the above specified criteria and methodological features datasets have been selected in order to address the objectives of this review. As the study aims to investigate the maternal and child health condition in aboriginal population of Australia and understand the impact of substance abuse on the maternal and child health, only relevant studies that have considered these topics as the research topic. As mentioned above using key terms an initial search has been conducted. In this initial search total 126 previous literatures including report, article and journal have been identified. All the references, index items and key terms from these literatures have been collected and secondary search have been done to collect additional data. After the secondary research total 135 literatures on maternal and child health of aboriginal people and impact of substance abuse on maternal and child health have been identified. After analysing the studies only 33 studies have been found to meet the all inclusion criteria. Among the 33 studies 12 studies have been found to inform about maternal and child health of aboriginal population. 5 has informed about only maternal health condition of indigenous people and 8 have informed about child health in aboriginal population. 5 studies have been selected that are associated with substance abuse and its impact on maternal and child health. 3 studies have been identified to describe about health programs for maternal and child health of indigenous people. In addition six programs have been chosen including both the government and non-government service providers that are currently available for aboriginal people to improve the maternal and child health status. The findings of these papers has been described in the following discussion section.
Policies and Programs for Maternal and Child Health of Aboriginal People
The state of pregnancy and the resultant motherhood associated with it is more often than not, a positively enriching experience for the concerned mother as well as her developing child and the associated family member in her vicinity. In accordance to the statistical data outlined by the World Health Organization in 2018, a total of over 140 million women throughout the world are engaged in pregnancy and childbirth (Fleischer et al., 2014). Hence, it is of utmost importance to ensure adequate health, nutrition, treatment and care for the concerned mother, through the deliverance of appropriate and optimum pregnancy, maternal and neonatal health services. The overall status and health of the mother exhibits direct association with the health of the future population and proves to be a major determinant as well as an essential predictor of the major shortcomings, requirements and future strides required for public and global health serves to overcome, fulfill and undertake (Graham et al., 2016).
Despite the relevant information associated with maintenance of optimum maternal health, mothers experiencing pregnancy across the worldwide are still compelled to live a life of misery and burden, due to the lack of sufficient maternal health services, along with the prevalence of harmful life conditions (Kassebaum et al., 2014). As stated by outlined by the Global Health Advisory Data presented by the World Health Organization in the year 2015, a total of 830 pregnant women succumb to death due to the occurrence of avoidable disease and health conditions. The major causes of death include conditions such as hypertension, hemorrhage, infections or obstructions during labour and complications during abortion (Alkema et al., 2016). According to the United Nations International Children’s Emergency Fund, the maternal mortality rate displayed considerable decline from the years 1990 to 2015, resulting in a shift from 385 to 216 deaths for 100, 000 live births (Liu et al., 2015). The incidences of maternal mortality has been reported to be the highest in women inhabiting remote, rural or economically underprivileged areas, with over 99% of deaths prevalent across developing nations worldwide. The rate mortality is also observed to be prevalent across teenagers or young adults overcome with pregnancy (Say et al., 2014). As outlined in the Sustainable Development Goals, the need of the hour is to work actively for the reduction of the global maternal mortality rate to 70 deaths per 100, 000 live births undertaken, between the years 2016 and 2030. This can be possible only through the implementation and execution of appropriate and timely treatment care policies and programs during the stages of pregnancy as well the time commencing from it, for the concerned young mothers (Norheim et al., 2015).
Evaluation of the Effectiveness of Programs for Aboriginal Maternal and Child Health
In the country of Australia, the maintenance of the optimum health status of pregnant women, are one of the salient principles adhered to the Department of Health and the Australian Institute of Health and Welfare in the Government of Australia. Such dedicated and collaborative governmental efforts can be observed in the significantly low maternal mortality rate in Australia as compared to international statistics, exhibiting 6.8 deaths from 100, 000 childbirths, between the years 2012 and 2014 (Sullivan et al., 2015). However, women below the age of 20 and beyond the age of 35 are still at risk of succumbing to death, due to primary reasons outlining abdominal and cerebral hemorrhages. Additional causes of maternal mortality was the prevalence of clots in the lungs or disruption in the cardiovascular system. However, the incidence of maternal deaths continue to remain high across women residing in aboriginal and indigenous group of Australia, due to the lack of prevalence of equitable distribution of optimum treatment and healthcare services (Diouf et al., 2016).
Despite the appreciable global healthcare strides undertaken resulting reduction in the improvement of global child health, the incidences of child mortality continue to plague the global community. As stated by the World Health Organization, the majority of child deaths occur due to the presence of causative factors which could have been prevented through the implementation of appropriate and timely healthcare strategies (Tate et al., 2017). During the year of 2017, a total of 6.3 million deaths were observed amongst children under the age of 15, with an additional alarming statistics reporting 2.5 million deaths during the primary year of life and death of 5.4 million children below the age of 5 years. While the mortality rate amongst elder children have shown considerable reductions, the rate of mortality amongst children who are newborn are expected to further increase. Some of the major causative factors outlining the deaths of children under the age of 5 years include malaria, pneumonia, diarrhea, asphyxia and preterm complications (You et al., 2015).
Is presented in the statistical data prepared by the Australian Institute of Health and Welfare, of the Government of Australia, the child mortality rate has displayed considerable reductions by 41% between the years of 2001 and 2016, resulting in a decrease of 312 from 531 for every 100, 000 live births. However, the rate of mortality amongst children residing in indigenous communities continue to remain significantly high, with over 602 deaths for every 100, 000 live births, which is almost twice that of the data associated with the general population of Australian children (Schlapbach et al., 2015).
Aim and Objectives of the Report
Hence, it is evident that maternal and child health amongst indigenous communities continue to remain a significant shortcoming at the public health platform and requires immediate and elaborate mitigation through the usage of appropriate governmental strategies, policies, programs and intervention frameworks (Mitrou et al., 2014).
As highlighted by the data mentioned above, there lies a need to implement and execute appropriate governmental strategies and interventions for the purpose of improvement of indigenous health. The salient features of ‘Indigenous Health’, refer to the improvement and enhancement of the health status of individuals residing in indigenous communities, at the psychological, physiological, social, emotional and cultural levels. At present, due to prevalence of inequitable distribution of health resources, the health of aboriginal and indigenous communities continue to be at stake, with the occurrences of frequent and untimely deaths as compared to individuals belonging to non-indigenous communities (Delany, 2018). Further, indigenous population groups of Australia continue to be susceptible to diabetes, pulmonary diseases, renal as well as health disorders. Hence, as a response to the prevalence of such health status disparities between non-indigenous and indigenous populations, the various governments all over Australia have undertaken active participation in the intervention program titled ‘Closing the Gap’, which will aim to reduce the prevalent cultural and ethnical disparities in terms of occupations, health, housing and health (Paradies, 2016).
According to the Australian Institute of International Affairs, the reasons for such detrimental health outcomes amongst the families residing in Indigenous communities are the result of an interplay of a number of factors including lack of governmental investment, lack of culturally appropriate health facilities to such women, and the mismanaged possession of healthcare resources amongst the indigenous and non-indigenous population groups (Schuch et al., 2017).
The status of health and wellbeing amongst mother and children continue to remain significantly poor, due to the prevalence of a number of social, cultural and physiological factors as outlined above. Ashman et al., (2016) attempted to highlight the present state of maternal and child health in indigenous populations of Australia through the usage of a cohort study. The authors utilized the Gomeroi gaayngaal study, which is a well known research initiative with the idea to uncover the intrauterine causative factors behind the occurrences of growth, diabetes and renal disorders as a pre-requisite information for the purpose of developing health promotion frameworks for women and children belonging to indigenous populations. The data collection was performed at the Gomeroi gaayngaal center, present at the University of Newcastle in Tamworth, New South Wales Australia – a region accommodating the largest population of indigenous individuals in the nation, and included a sample size of 236 mother and child diads. The authors collected the various biochemical samples for evaluation, namely, urine, cord blood, saliva, maternal blood and child urine, which were utilized to uncover full blood cell count, serum cystatin, plasma, urea, electrolytes, protein in urine, immunoglobulin, Vitamin B12, cortisol, folate, cotinine and specific immunoglobulin for Helicobacter pylori. The results revealed a prevalence of hypertension as well as increased proteinuria amongst the indigenous women. One of the key research findings were the indication that almost half of the sample population of selected indigenous women, engaged in smoking during the stages of pregnancy. Some of the key strength of this research, included the active recruitment of workforce belonging to indigenous populations, along with the initiation of trust, supply of adequate transport services as well as increased accessibility to the health services prevalent at the local level. Time and financial constraints due to the lack of funding, along with large rates of absence amongst the participants proved to be key limitations of this study. However, this research indicated effective results which will pave the way for future knowledge concerning the prevalence as well as underlying factors resulting in detrimental health, nutrition and lifestyle status of children and pregnant women residing in indigenous communities (Ashman et al., 2016).
The prevalence of detrimental maternal conditions burdened further with the high rates of mortality amongst indigenous women and children in Australia, is majorly due to factors outlining inequity and social disadvantage considering possession of health resources. The following research by Lindquist et al., (2014), aimed to assess the effect of social disadvantage and inequality on the occurrence of high maternal mortality rate in indigenous Australia pregnant women. The research included a case control study, with the inclusion of indigenous maternal mortality cases acquired from the database of the Australian Maternal Outcomes Surveillance System (AMOSS), which resulted in a total of 820 controls and 623 cases. The researchers investigated the differences in outcomes with the help of a statistic tool outlined by the Socio-Economic Indexes for Areas (SEIFA) quintile, namely logistic regression analysis. The results suggested the several factors associated with maternal mortality, namely, the presence of complications during pregnancy, a high maternal age beyond 35 years, usage of caesarean delivery and most importantly social disadvantage as evident in the presence of the highest number of maternal mortality cases amongst indigenous women residing in underprivileged areas. Despite being the lack of a randomized trial as a major limitation, this research highlights the effect of social status – which is a key determinant resulting in detrimental health impacts of Australian indigenous women. The authors also highlighted the prevalence of key health issues resulting in indigenous maternal mortality, namely, eclampsia, placenta accrete, amniotic fluid embolism, pulmonary embolism and peripartum hysterectomy (Lindquist et al., 2014).
The psychological and physiological health status of children residing in aboriginal and indigenous communities have always shown detriment and compromise as compared to their non-indigenous counterparts. The following research included an aboriginal cohort profile by Sayers, Mackerras and Singh (2017), which included a sample size of 686 indigenous babies, who were followed at 5, 11, 18 and 25 years of age. With the aid of the growth curves presented by the Centers of Disease Control, it was found that the children displayed low birth weight and lower than normal head circumferences along with a prevalence of under-nutrition. Significant trends associating towards obesity were also recorded. The long duration along with the extensive rates of follow up were the key strengths of this study, with the primary limitation being the small sample size. Hence, this study clearly indicates a lack of optimum health status amongst indigenous and aboriginal children, further requiring immediate mitigation by the Australian government (Sayers, Mackerras and Singh, 2017).
As opined by the Australian Institute of Health and Welfare, despite the considerable reduction in the adherence to smoking and alcohol oriented behaviors, there still lies considerable prevalence of substance abuse amongst the individuals belonging to Aboriginal and Torres Strait Islander groups. During the years 2014 and 2015, a total of 45% of indigenous populations was found to engage in smoking, while 15% are involved in the adherence to alcohol usage. The usage of cannabis amongst 16.7% of the population along with the compliance to use drugs for non-pharmaceutical purposes in 11% of the population continue to be prevalent (Lee at al., 2018).
Despite the prevalence as well as the significant reduction of such behaviors, there still lies a lack of appropriate treatment intervention strategies for the mitigation of the same, as outlined by Clifford et al. (2011), in their research published in the Australian and New Zealand Journal of Public Health. The authors included a review of over twenty case studies focusing in the usage of intervention strategies concerning smoking and alcohol prevention as well as adherence to adequate nutrition. The authors reported the lack of mentioning important details, along with omitting of validated measure usage and avoidance of reporting necessary outcomes in the selected case studies, hence leading to the need to incorporate effective intervention strategies coupled with efficient evaluation for the purpose of mitigation of this problem amongst indigenous groups in Australia. While this study elaborately focused on the topic of substance abuse by aboriginals which is generally untouched, the lack of a randomized trial and lack of relevance due to avoidance of adhering to the MESH terms were key limitations of this study (Clifford et al., 2011).
The extensive adherence to smoking coupled with substance abuse has been positively associated with the occurrences of stillbirths in pregnant women. A case control study conducted by Varner et al. (2014), highlighted the above association through the assessment of 663 case studies characterized by stillbirths, with the aid of the Stillbirth Collaborative Research Network. For the purpose of future research, samples of umbilical cord along with maternal serum were collected. For all the case studies outlining stillbirth, assays were conducted to evaluate the presence of maternal cotinine and homogenate, of which a positive test for the latter is associated with drug usage as a causative factor for stillbirth delivery. Over 95% of the case studies were tested positive (CI 1.16, 3.27) where the remaining tested positive for maternal cotinine which has also been associated with stillbirths (CI 1.24, 3.41). Cannabis was reflected to the most prevalent drug (95%, CI 1.13, 4.81). The research possessed several strengths in the form of ethnical diversity along with usage of standardized protocols. The absence of information concerning the time of drug usage was a major limitation of this study (Vamer et al., 2014).
Despite the potential health effects there lies significant prevalence of the usage of alcohol, substance abuse and tobacco smoking amongst pregnant Australian women, residing in aboriginal and Torres Strait Islander populations. The following research by Passey et al. (2013), examined the prevalence of the above through the conductance of a cross-sectional survey consisting of a sample size of 257 pregnant women belonging to indigenous and aboriginal populations who have received services of antenatal care in two Australian states. About 119 women adhered to tobacco smoking, 53 of them engaged in alcohol consumption and 38 of them reported to engage in usage of cannabis. Amongst the total sample size, a total of 148 women admitted to smoking tobacco, 80 for alcohol consumption and 25 women engaging in cannabis while being pregnant. Hence, considering the large numbers, governmental policies and programs must aim to intervene strategically in order to eradicate such behaviors considering the serious health implications. Despite the presence of extensive data as a strength, the small sample size and possible discrepancies due to participant self reporting are key limitations of this research (Passey et al., 2013).
As highlighted in the previous paragraphs, the respective governments present across Australia, are aiming to reduce the prevalent health disparities between the indigenous and non-indigenous groups. One of the key campaigns undertaken actively is ‘Close the Gap’, with the aim to reduce the mortality rates amongst the indigenous groups, along with increasing the life expectancy rates and improvement of health conditions. Despite the reductions in child and maternal mortality rates amongst the indigenous maternal and child groups, the present rates are still twice that of their non-indigenous counterparts (Jaravani et al., 2016).
A number of governmental as well as non-governmental policies and programs have been implemented for the purpose of enhancement of the health of pregnant women and children residing in aboriginal and Torres Strait Islander communities. One of the key programs formulated by the department of health in the Australian Government is the Indigenous Australians’ Health Program. The program was established in the year 2014, with the aim to improve and provide indigenous financial health in the fields of maternal and child health programs, primary health care services, disease eradication programs covered by the Aboriginal and Torres Strait Islander Chronic Disease Fund and the health programs of ‘Stronger Futures in the Northern Territory. The program aims to increase the accessibility and equity for individuals of Torres Strait Islander groups through funding of targeted as well as primary health activities, capital works and improvement of efficiency of governance systems for the ethical diverse groups (Waterworth et al., 2016).
An additional program for the purpose of improvement of maternal and child health services is the Aboriginal Maternal and Infant Health Strategy, implemented in New South Wales, in the year 2001. The program aimed at the improving the antenatal and obstetric services provided to the pregnant indigenous Australian population through conductance of extensive training programs of the associated health workers engaged in the same such as midwives and Aboriginal care workers. With the aid of standardized primary care model accompanied with a multidisciplinary approach, the program has resulted in reductions in mortality rate of perinatals, reductions of pregnancies amongst young women under the age of 20 years as well as an increase in the number of pregnant women adhering to antenatal service and treatment care programs. This program was unique in its kinds, since it also reported the reduction of smoking in pregnant indigenous women during pregnancy (Jongen et al., 2014).
The Australian Nurse Family Partnership Program aims to provide in home nursing services to aboriginal pregnant women for the purpose of management and improvement of the maternal as well as health of the concerned child. The program also engages actively in the development of the indigenous child, through various early child care and education intervention strategies. The program has been reported to yield beneficial outcomes through enhancement of the perinatal health of the mother, improvement of the psychological and physiological health of the aboriginal child through imparting skilled parenting strategies to the respective parents and enhancement of the aboriginal women lives through imparting education on the requirement for planned conception, completion of academic education and engagement in employment (Zarnowiecki et al., 2018).
The New Directions Program which was implemented between the years of 2012 and 2013 aimed to improve the existing treatment and care procedures of aboriginal maternal and child health through the provision of primary health services. It was observed that the clinical organizations which were receiving financial aid from the New Directions Program reported reductions in the occurrences of maternal and mortality along with further improvement in provision of seven maternal health services, out of a total of 8, whereas organizations devoid of such funding reported improvement in only four of the health measures undertaken by them. Despite the prevalence of improvements, there seemed to be no enhancements in the incidences of low birth weight amongst aboriginal and indigenous babies (Yelland et al., 2015).
Waminda is a non-governmental organization aiming to provide aid and support to indigenous women inhabiting the Shoalhaven region. The organization aims to improve the health and well-being of pregnant as well as non-pregnant population of indigenous women, through the establishment of their Aboriginal Women’s Health and Well-being Program: Dead or Deadly. The program aims to provide holistic health improvement program through imparting information on importance of adhering the optimum dietary and exercise guidelines, mitigation and prevention of harmful chronic diseases and reduction in the activities associated with smoking. The program follows a social model of health improvement and health promotion through provision of supporting community platforms and serving as a collective voice for the needs and interests of indigenous women (Nicholson et al., 2015).
As outlined in the research prepared by Ring et al. (2016), which extensively analysed statistical data through evaluation of the 2014 report of Aboriginal and Torres Strait Islander Health Performance Framework, the rates of mortality have displayed considerable reductions. The mortality of children has declined considerably resulting in the occurrence of 5.1 deaths for every live 100, 000 live births encountered as compared to the mortality rate of children belonging to non-indigenous populations being 2.2. Mortality rates of aboriginal children during the first year of their life has also decreased to 0.7. Hence, this is indicative of the effectiveness of the governmental and non-governmental policies and programs implemented for improvement of child health (Ring et al., 2016). However, the rates are significantly higher than that of non-indigenous groups, signifying the need for greater effectiveness in maternal and early childhood programs. Despite possessing one of the lowest rates of maternal mortality on a global scale, aboriginal pregnant women are still susceptible to not just substance abuse but also increased morbidity and mortality due to belonging to socially underprivileged groups, and the prevalence of inequity in health resource possession (Renzaho & Oldroyd, 2014).
Hence, the need of the hour is to improve and implemented more robust services of the existing programs. This can be done by increments in cultural competence through recruitment of an ethnically diverse workforce along with increased funding and public health awareness which will aim to improve the accessibility of such services to the indigenous maternal and child population (Raman et al., 2017). Further as noted above, very few programs aimed to highlight the prevalence of substance abuse amongst pregnant women, and hence greater governmental intervention is required in order to impart awareness concerning its harmful implications on child health, along with information of effective prevention and treatment strategies (Hafekost, 2017).
Conclusion:
In conclusion, it can be demonstrated that, the Australian aboriginal population face various health issues which has led to the poor health status of the population, high mortality rate and low life expectancy as well. Due to such poor health status maternal health has been found to be in threat which in turn is a threat for the health status of the children. Studies have investigated the health issues and different social determinants that have contributed to the poor maternal and child health status in this population. It has been found that, there are various social determinants that affected the maternal and child health status of the aboriginal people for example, the consequence of colonization is one of the major contributor in the poor health status of this population. During the period of colonization, the aboriginal people have faced social, economic, cultural problems which has a strong effect on their health. On the other hand, colonization has led to the increase in racism and social disadvantage which has limited the access of aboriginal people to various health services. Due to lack of access and availability of health service the aboriginal people do not get adequate support during the time of need. Lack of education is another factor which contributed to poor maternal and child health. In addition substance abuse has been identified as one of the major contributor in the health issues of pregnant women and children as well. Consequence of colonization, poor education system, social disadvantages, racism and antisocial activities have been found to influence substance abuse in this population.
The poor maternal and child health in aboriginal population has affected the overall health status of Australian population, hence various interventions have been implemented to resolve this issue. Various programs have been found to focus on the maternal and child health of aboriginal population, for example, closing the gap, Australian nurse family partnership program, The Indigenous Australians’ Health Programme, Aboriginal Maternal and Infant health Strategy and others. All of these programs and policies have focused on the overall indigenous health, only few programs have been identified that aims to improve women or maternal health, for example, New Directions: Mothers and Babies Services and The Aboriginal Women’s Health and Wellbeing Program. On the other hand, lack of program have been identified focusing on preventing substance abuse in pregnant woman. The existing policies are effective to provide adequate service and support the indigenous people to meet their health needs including the maternal and child health, however, the gap in the maternal mortality rate and child health status of indigenous and non-indigenous people still exists which has indicated the gap in the practice. It has been found that, the existing programs has provided poor concentration on the cultural aspects. The indigenous people are considered as culturally backward and their culture is different from the culture of general Australian population. Hence, it is important to introduce programs focusing on the cultural aspects of the aboriginal people as it would increase the acceptance of the program and providing respect to the culture of this population would encourage them to participate in this program and follow the guidelines and health behaviours taught by these programs, thus, would increase the effectiveness of these programs and help to achieve positive health outcomes.
This research has identified the maternal and child health issues of Australian aboriginal population and contributing factor as well. In addition association of substance abuse and poor maternal and child health has been discussed. However, all discussion is based on the available previous literatures and programs. Hence, risk of bias may be present. Therefore, it is important to conduct further research using primary research methods such as interview and surveys within the people of aboriginal population in order to understand their concern and collect response of the people regarding the effectiveness of existing programs and policies on maternal and child health.
As described earlier, it is important to focus on cultural aspects of the aboriginal people while implementing health program for this population. This would help to introduce culturally safe practice in the health system. Such cultural consideration would help to introduce health programs that are acceptable for the people of this population. In addition, it is required to increase the availability of this program. Furthermore, it has been found that there are very programs focusing on the prevention of substance abuse of pregnant woman. Hence, specific prevention program for substance abuse focusing on the pregnant woman need to be implemented. Such effort would help to reduce the gap in the practice and improve the health status of the aboriginal women and children, thus could ensure improved health status of the future generation as well.
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