Indigenous Australians are receiving substandard medical care that sees them dying during childbirth at a rate comparable to women in developing countries, the regional manager of maternal and child health at the Institute of Urban Indigenous Health, Prof Sue Kruske, says.
Kruske was commenting on a report on maternal deaths released by the Australian Institute of Health and Welfare on Wednesday, which found Indigenous women died during pregnancy and childbirth at more than twice the rate of other women.
The incidence of maternal death in Aboriginal and Torres Strait Islander women who gave birth between 2008 and 2012 was 13.8 per 100,000, compared with 6.6 per 100,000 for non-Indigenous women, the statistics show.
While this was an improvement when compared with the previous five-year period, Kruske said the Indigenous death rate remained unacceptably high.
“It’s as high for Indigenous women as it is in some developing countries, and I think that is a stark reminder that all governments and health departments have a responsibility to address this issue,” Kruske said.
“I think we have good evidence that Aboriginal women are coming into our health services, so it’s a myth to say it’s because they’re not accessing care. What we do know is the quality of care we provide to them is substandard.”
Research Kruske was involved with in the Northern Territory found women were not being adequately treated and followed up for conditions during pregnancy such as urinary tract infections, diabetes and anaemia. Indigenous women also experienced high rates of postnatal depression, sometimes leading to suicide, she said.
Indigenous women were prone to stress in the final weeks of pregnancy because they had to travel long distances to give birth, Kruske said.
“Aboriginal and Torres Strait Islander women have been asking for decades to give birth closer to their homes,” she said. “Those in remote locations are sent from their homes between two and four weeks before giving birth, to regional towns where the hospitals are, and they are expected to sit there alone in B-grade hostels, where they are surrounded by alcohol and humbugs, and have a baby by themselves,” Kruske said.
Their partners remained at home to work, or to care for children, Kruske said.
“It happens to white women as well, but they don’t sit in a hostel for four weeks by themselves, they’ll fly from Arnhem Land to Melbourne to give birth because they have the resources and family support to do that,” she said.
“There’s good evidence internationally that birthing services can be provided in remote areas to women with low risk of complications and with very good health outcomes, but there is a lack of political and medical will to implement it.
“We need a conversation in mainstream media about this very small but very disadvantaged proportion of our population who continues to miss out on the same care, and it’s disgusting when the solutions are clear.”
Altogether, there were 105 deaths from complications of pregnancy and childbirth during the period, the report found.
The leading causes of direct maternal death identified included obstetric haemorrhage (11 deaths), blood clots (10), and hypertension (nine). The leading cause of indirect maternal death was cardiac disease and mental health and substance abuse issues.
The women who died were between 17 and 50 years old, with women over 35 at higher risk of maternal death, the report found, while a higher number of previous pregnancies and obesity were also associated with increased risk of death.
The lead author of the report, Prof Michael Humphrey, said there needed to be more effort made to provide culturally appropriate medical care to Indigenous Australians.
“When I set up the first specialist outreach program in Cape York [in remote far north Queensland], the issues around working with Aboriginal women were magnified in that I was the only specialist available, and I was a white male,” he said.
“That’s as culturally inappropriate as you can get.”
While Indigenous outreach programs now exist across a range of medical specialities, there are still very few Aboriginal midwives and doctors, Kuske said.
“While there is no magic bullet, we need more culturally appropriate care to ensure good access to peri- and ante-natal services,” Humphrey said.
“It’s just so, so sad, every time another woman dies. We need to do better.”
