The Medical journal of Australia
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Review
Improving maternity services for Indigenous women in Australia: moving from policy to practice.
The well established disparities in health outcomes between Indigenous and non-Indigenous Australians include a significant and concerning higher incidence of preterm birth, low birth weight and newborn mortality. Chronic diseases (eg, diabetes, hypertension, cardiovascular and renal disease) that are prevalent in Indigenous Australian adults have their genesis in utero and in early life. Applying interventions during pregnancy and early life that aim to improve maternal and infant health is likely to have long lasting consequences, as recognised by Australia's National Maternity Services Plan (NMSP), which set out a 5-year vision for 2010-2015 that was endorsed by all governments (federal and state and territory). ⋯ More urgent leadership is required from the Australian government. Funding needs to be allocated to the priority areas, including for scholarships and support to train and retain Indigenous midwives, greater commitment to culturally competent maternity care and the development and evaluation of Birthing on Country sites in urban, rural and particularly in remote and very remote communities. Tools such as the Australian Rural Birth Index and the National Maternity Services Capability Framework can help guide this work.
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There has been substantial reform in the past decade in the provision of maternal and child health services, and specifically regarding models of maternity care. Increasingly, midwives are working together in small groups to provide midwife-led continuity of care. This article reviews the current evidence for models of maternity care that provide midwifery continuity of care, in terms of their impact on clinical outcomes, the views of midwives and childbearing women, and health service costs. ⋯ A reorganisation of the way maternity services are provided in Australia is required to ensure that women across the country can access this model of care. Critical to such reform is collaboration with obstetricians, general practitioners, paediatricians and other medical professionals involved in the care of pregnant women, as well as professional respect for the central role of midwives in the provision of maternity care. More research is needed into ways to ensure that all childbearing women can access midwifery continuity of care.
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The Australian National Cervical Screening Program (NCSP) will transition in 2017 from cytology-based screening every two years, starting from age 18-20 years, to HPV-based screening every 5 years, starting from age 25. To examine the impact of the program before this transition we analysed trends in the incidence of cervical cancer, by age and histological subtype. ⋯ Although women aged 20-24 years have been included in the NCSP since its inception, no significant impact on cervical cancer incidence was observed in this age group. The NCSP has had a substantial impact on SCC and overall cervical cancer incidence in women aged 25 years and over. Its impact on the incidence of adenocarcinoma, in contrast, has been limited.