Dr Kiarna Brown - Close the Gap Day 2024

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Dr Kiarna Brown is proud First Nations Obstetrician and Gynaecologist and co-lead of the Top End chapter of the Australian Preterm Birth Prevention Alliance. This Op Ed has been written by Dr Brown as part of National Close the Gap Day 2024 (Thursday, 21 March).
Why is the early birth of Aboriginal and Torres Strait Islander babies still such a burden?
 
In my antenatal clinics I have the great privilege of looking after women from remote Aboriginal communities.

Usually, it’s a fairly short and brief friendship. Women come into town for “sit down”. That is, wait for their babies to arrive so as to avoid unplanned birth in their communities where resources can be limited. I get to know them at this time.

But sometimes my relationships are lengthy.

Sometimes expectant mothers are in town and away from their families for longer, especially if they have medical conditions that can impact their pregnancies.

I recall one of my patients who was stuck in town for many weeks. She was having her first baby. Unfortunately, she has Rheumatic Heart Disease (RHD) and at the tender age of 15 she had an operation to repair her heart valve.

Because of this she needed extra care throughout her pregnancy. She was quite sad about being away from home for so long, but our local midwives were able to give her excellent care and support away from home.

Sadly, medical disorders affecting pregnancy outcomes are a real issue for First Nations women. Pregnancy can sometimes be a vulnerable time for these women, especially for those with pre-existing medical conditions such as diabetes and cardiac conditions like RHD.

Being born too early also remains a huge issue for Aboriginal and Torres Strait Islander mothers and babies and one of significant disproportion.

Australia’s preterm birth landscape

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. Many of these babies lose their fight for life.

For many First Nations babies, the news gets worse. In 2021, there were almost twice as many preterm live born babies born to First Nations mothers (14%) than to non-Aboriginal mothers (8%).

The biggest discrepancy is in the extremely preterm gestational age. First Nations 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.

Alarmingly, First nations women living in pockets of the Top End experience some of the highest rates of premature birth in the world, on par with disadvantaged groups in low-income countries. 

The importance of social determinants of health

The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances 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.

Some such determinants that lead to poor health for my patients include living in overcrowded houses because of a lack of safe and affordable housing.

It can include chronic poor health because of difficulty accessing quality, multidisciplinary health care and resources.

There is little to gain unless we address the root cause of the problem. Babies will continue to be born preterm if we do not address the basic health needs of the mothers growing them.

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.

A way forward for our mothers and babies

Central to achieving effective change rests in recognising that Aboriginal and Torres Strait Islander health status needs to be a high priority.

It is important for all of us to remain aware and to be always learning and striving for better.

The key ingredients to better constructed services include: services designed with 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. 

This is something we can all contribute to. It will take a collaborated effort of Close the Gap. And I look forward to working with the Australian Preterm Birth Prevention Alliance and the Every Week Counts National Preterm Birth Prevention Collaborative on doing just this

And as for my patient...she eventually went home, with a healthy baby who was born at term. This was achieved through good-quality and respectful care.

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Dr Kiarna Brown is an obstetrician and gynaecologist and co-lead of the Top End chapter of the Australian Preterm Birth Prevention Alliance.

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 63 Australian maternity hospitals to reduce rates of preterm birth across the country. The Commonwealth- funded National Program is a collaboration between the Australian Preterm Birth Prevention Alliance, Women’s Healthcare Australasia, Institute for Healthcare Improvement - IHI, Safer Care Victoria, and the Women and Infants Research Foundation.


 
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