First Nations health professionals are working to close the gap in preterm (premature) birth rates.
Rates of early birth continue to disproportionately impact Aboriginal and Torres Strait Island women and their newborns.
Recent Closing the Gap data showed that the official target for healthy birthweights for babies has gone from being "on track" to "not on track".
Now, an innovative preterm birth prevention program led out of the Northern Territory is taking aim at this unacceptable disparity and the hope is that it will provide "a roadmap for improved outcomes" for all First Nations women and their children.
Indigenous health professionals Dr Kiarna Brown and Marisa Smiler-Cairns and their colleague Jess Murray are a team based in Garramilla (Darwin), on Larrakia Country, that make up the Top End chapter of the Australian Preterm Birth Prevention Alliance.
They note that preterm birth remains the leading cause of death in children up to five years of age.
"The national average rate of preterm birth in Australia has remained relatively constant over the last 10 years (between 8.1 and 8.7%). Many of these babies lose their fight for life," the Australian Preterm Birth Prevention Alliance noted in a statement.
"In 2018, there were twice as many preterm live born babies born to First Nations mothers (17%) than to non-Aboriginal mothers (8%)."
The biggest discrepancy is in the extremely preterm gestational age. First Nations women in the Northern Territory are four times more likely to lose a baby between 20 and 23 weeks gestational age: before the baby even gets a chance to survive.
Pregnancy can be a particularly vulnerable time for First Nations women, especially for those with pre-existing medical conditions such as diabetes and cardiac conditions like Rheumatic Heart Disease.
Dr Kiarna Brown said there have been some key improvements in outcomes for First Nations women over the past decade.
"There has been a notable increase in the proportion of First Nations mothers attending an antenatal visit in the first trimester (from 49% in 2012 to 70% in 2020)," she said.
"There has also been an increase in the proportion of First Nations mothers attending five or more antenatal visits and we have also observed a decrease in the proportion of First Nations who reported smoking in the first 20 weeks of pregnancy (48% in 2011 to 43% in 2020)."
A First Nations obstetrician and gynaecologist, Dr Brown said despite these improvements, First Nations mothers and babies continue to experience poorer health outcomes, and there are complex interactions between maternal and perinatal health outcomes and the determinants of health.
"One such determinant is remote living. Remoteness can influence several key statistics for First Nations women including smoking rates (First Nations mothers who live very remote are more likely to smoke), antenatal visit in the first trimester, low birth weights and of course, preterm birth," Dr Brown said.
"A workforce and health system that is capable of addressing social determinants of health, including education, social support, cultural pride, housing, transport and financial support leads to health improvements."
The Top End Alliance is developing a "community-driven, strengths based" public health campaign that encourages not only First Nations women, but all women to "take control of their pregnancy care", to understand important milestones in their pregnancies, and to better engage with their health care providers.
Key areas of focus of the Top End Alliance will include:
· Developing strong partnerships with community health centres, and remote community councils and governing bodies
· Engaging with the community, to construct a health campaign that is co-designed with the community
· The production of an educational pregnancy health resource that is again co-designed but also relevant and desirable to the community
· Women (especially First Nations women) being well informed about risk factors for and treatments and preventions for preterm birth and taking and active interest in their pregnancy care to achieve a birth at term
· Better understanding from health care providers and services of risk factors, treatments and preventions for preterm birth and advocating for improved care for pregnant women across the Top End.
Recent evidence has shown that First Nations women have better pregnancy outcomes when health care services are constructed to specifically meet the needs of First Nations families; a concept well documented by the team of dedicated researchers at the Molly Wardaguga Research Centre, who have been driving this change in key regions across the country.
The key factors to deliver better services include: First Nations leadership and governance, continuity of care models that are community based, a First Nations workforce and non-First Nations staff who are trained within a culturally safe framework, a holistic approach to care, and meaningful partnerships between multiple stakeholders.
"We want women to be the drivers of their pregnancy care and to better understand an approach to reaching term, rather than preventing preterm birth. By doing this we will have the opportunity to positively impact the health of future generations," Dr Brown said.
The Top End Alliance is working with chapters in each Australian state and territory as part of the Every Week Counts National Preterm Birth Prevention Collaborative which has brought together more than 50 Australian maternity hospitals in the hope to reduce the rate of preterm birth by 20% by July 2024.