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Health care experiences and birth outcomes: Results of an Aboriginal birth cohort

  • Stephanie J. Brown
    Correspondence
    Corresponding author at: Murdoch Children’s Research Institute, Royal Children’s Hospital, 50 Flemington Road, Parkville, Vic 3052, Australia.
    Affiliations
    Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia

    Department of Paediatrics and Department of General Practice, University of Melbourne, Parkville, Victoria, Australia

    South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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  • Deirdre Gartland
    Affiliations
    Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia

    Department of Paediatrics and Department of General Practice, University of Melbourne, Parkville, Victoria, Australia
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  • Donna Weetra
    Affiliations
    Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
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  • Cathy Leane
    Affiliations
    Women’s and Children’s Health Network, SA Health, Adelaide, South Australia, Australia
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  • Theresa Francis
    Affiliations
    Southern Health Network, SA Health, Adelaide, South Australia, Australia
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  • Amanda Mitchell
    Affiliations
    Aboriginal Health Council of South Australia Ltd., Adelaide, South Australia, Australia
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  • Karen Glover
    Affiliations
    Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia

    South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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      Abstract

      Objective

      The aim of this study was to investigate the relationship between perceived discrimination in perinatal care and birth outcomes of women giving birth to an Aboriginal baby in South Australia using methods designed to respect Aboriginal culture and communities.

      Design and setting

      Population-based study of women giving birth to Aboriginal infants in South Australia, July 2011–June 2013. Women completed a structured questionnaire with an Aboriginal researcher. Study measures include: standardised measure of perceived discrimination in perinatal care; maternal smoking, cannabis use and exposure to stressful events and social health issues; infant birthweight and gestation.

      Participants

      344 women (mean age 25, range 15–43 years) living in urban, regional and remote areas of South Australia.

      Results

      Half of women (51%) perceived that they had experienced discrimination or unfair treatment by hospitals or health services providing care during pregnancy and soon after childbirth. Women experiencing three or more stressful events or social health issues were more likely to perceive that care was discriminatory or unfair. Aboriginal women who perceived that they had experienced discrimination in perinatal care were more likely to have a baby with a low birthweight (Adj Odds Ratio 1.9, 95% CI 1.0–3.8) or small for gestational age (Adj Odds Ratio 1.9, 95% CI 1.0–3.5), adjusting for parity, smoking and cannabis use.

      Conclusions

      The study provides evidence of the ‘inverse care law’. Aboriginal women most at risk of poor infant health outcomes were the least likely to perceive that they received care well matched to their needs. Building stronger evidence about what works to create cultural safety in perinatal health care is an urgent priority.

      Keywords

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