title: Improving maternity services for Indigenous women in Australia: moving from policy to practice.
abstract: 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). We report on the actions targeting Indigenous women, and the progress that has been achieved in three priority areas: The Indigenous maternity workforce; Culturally competent maternity care; and; Developing dedicated programs for "Birthing on Country". The timeframe for the NMSP has expired without notable results in these priority areas. 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.
authors.affiliation: Midwifery Research Unit, Mater Medical Research Institute, Brisbane, QLD sue.kildea@mater.uq.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Kildea
authors.affiliation: Midwifery and Women's Health Research Unit, The University of Sydney, Sydney, NSW.
authors.forename: Sally
authors.initials: S
authors.lastname: Tracy
authors.affiliation: National Centre for Cultural Competence, The University of Sydney, Sydney, NSW.
authors.forename: Juanita
authors.initials: J
authors.lastname: Sherwood
authors.affiliation: Aboriginal Culture Birthing and Parenting Organisation, Coonamble, NSW.
authors.forename: Fleur
authors.initials: F
authors.lastname: Magick-Dennis
authors.affiliation: Centre for Rural Health, The University of Sydney, Lismore, NSW.
authors.forename: Lesley
authors.initials: L
authors.lastname: Barclay
mesh_terms: D001315:Australia; D065246:Culturally Competent Care / Q000331:legislation & jurisprudence*; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility; D006303:Health Services, Indigenous / Q000331:legislation & jurisprudence*; D006801:Humans; D008427:Maternal Health Services / Q000331:legislation & jurisprudence*; D011247:Pregnancy; D019035:Rural Health Services / Q000331:legislation & jurisprudence; D012424:Rural Population; D000095283:Australian Aboriginal and Torres Strait Islander Peoples