Dr Kiarna Brown is an obstetrician working in the Northern Territory. She is also a proud Aboriginal woman.
Easily one of the proudest moments of my life was walking out of hospital with my first-born baby in my arms. I remember it so vividly. I’d had a smooth pregnancy and a great birth. My bouncing baby boy was three days old when we left the hospital. He was healthy and I genuinely left like the cat that got the cream as I walked the hospital corridors to my car. There are few times in my life when I have felt that happy. Sadly this is not the case for everyone. As an obstetrician working in the Northern Territory (NT), I see the devastating effects of babies born too early far too often.
Preterm birth in Aboriginal babies
Preterm birth remains the leading cause of death in children up to 5 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.
For many Aboriginal babies, the news gets worse. In the Northern Territory, the preterm birth rate for our Aboriginal and Torres Strait Islander babies is almost DOUBLE that of the non-Aboriginal population at over 14%.
The biggest discrepancy is in the extremely preterm gestational age. Aboriginal women in the NT are 4 times more likely to lose a baby between 20 and 23 weeks gestational age. That is before the baby even gets a chance to survive. This equates to too many mothers walking out of hospital without their babies in their arms.
Social determinants of health contributes to preterm birth
So why is this the case and what can we do about it? There is no doubt that women who experience poorer health overall are also at higher risk of preterm birth. Globally there is wide variation of preterm birth between countries. The highest rates in the world occur in low-income countries. Not surprisingly, the lowest rates tend to occur in high-income countries.
The social determinants of health are the conditions in which people are born, grow, live, work and age. These conditions directly affect people’s health. They are shaped by the distribution of money, power and resources. The social determinants of health are mostly responsible for health inequities—the unfair and avoidable differences in health status seen within and between countries.
The risk factors associated with preterm birth are also more prevalent in families with poorer health status, influenced by social determinants. Risk factors include young maternal age, low body mass index, chronic disease and infections. These factors are influenced by social issues such as adequate housing, food security, education and employment status. Other influencing factors include access to health services and poor health literacy.
Overall, people who are more vulnerable to poorer health because of the conditions in which they are born, grow and live are also more vulnerable to problems such as preterm birth. The result is a vicious cycle of very challenging health conditions.
The way forward
So then what hope do we have of closing the gap in health discrepancy for Aboriginal and Torres Strait Islander families? Well first we must start to address health status holistically. We cannot solve specific health problems without taking into account a person’s living conditions and life circumstances.
We need to better understand risk factors of preterm birth and think more broadly at addressing these factors.
And we need to do much research. We need to carefully consider the elements of causative factors and how to appropriately treat them. For example, what elements of nutrition could we improve for better outcomes for babies? What infections are we potentially missing that could reduce preterm birth rates? What chronic diseases are our mothers enduring that could be better optimised for pregnancy?
It’s a long road ahead, but every mother deserves to walk out of hospital with a healthy baby in their arms and so it is well worth the investment.
Dr Kiarna Brown
Obstetrician and Gynaecologist, Darwin Public and Private Hospital, and co-lead of the Top End chapter of the Australian Preterm Birth Prevention Initiative