Abstract
In this call to action, a coalition of Indigenous and non-Indigenous researchers from Australia, Aotearoa New Zealand, United States and Canada argue for the urgent need for adequately funded Indigenous-led solutions to perinatal health inequities for Indigenous families in well-resourced settler-colonial countries. Authors describe examples of successful community-driven programs making a difference and call on all peoples to support and resource Indigenous-led perinatal health services by providing practical actions for individuals and different groups.
Keywords
1. Too many dead and harmed brown and black mothers and babies [[1]]
As an international coalition of Indigenous and non-Indigenous researchers, we are gravely concerned by the lack of meaningful action to calls on Indigenous [
[2]
] and perinatal health [[3]
,[4]
]; as are others [[5]
,[6]
]. Many Indigenous families in well-resourced settler-colonial countries remain unable to access clinically and culturally safe services. Families must birth in a health system that contributes to unacceptable and harmful healthcare experiences, resulting in higher rates of adverse outcomes, including death, in the perinatal period [7
, 8
, 9
, 10
]. Pregnancy and birth are critical periods for the best start to life, with cultural significance for Indigenous families:“[Birth] is about cultural interconnectedness… we revitalise and renew our traditional practices for mother and babies… it is a connection to country…it’s the start of our first ceremony.” Jody Currie, Mununjahli Yugambeh woman [[11]]
We call out leaders, researchers, educators and service providers to uphold the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) [
[12]
]: the right to quality, culturally safe healthcare; be self-determining and participate in the design of health services; and include/revitalise cultural practices, languages and medicines [[12]
,[13]
]. This commitment should drive changes to healthcare delivery; calls to action can no longer go to voicemail.2. Research activism
In the absence of meaningful government action, we use research to support Indigenous peoples to determine their own transformative change. We affirm Indigenous knowledges as foundational and relational to health research and service delivery [
13
, 14
, - Ireland S.
- Maypilama E.L.
- Roe Y.
- Lowell A.
- Kildea S.
Caring for mum on country: exploring the transferability of the birthing on country RISE framework in a remote multilingual Northern Australian context.
Women Birth. 2020; (in press)https://doi.org/10.1016/j.wombi.2020.09.017
15
, 16
, 17
]. For Indigenous Yolŋu in Northern Australia, this is ‘both ways’ working, integrating knowledges at every level of the system [[18]
]. Across countries, we respect the role of ancestors in knowledge production and guard our privileged position as temporary custodians of shared knowledge. We test innovative ways to decolonise institutions and redesign services to embrace what is sacred for Indigenous wellbeing.3. This approach works
Our Australian colleagues in Lancet Global Health demonstrate profound life-changing impacts of a Birthing on Country service for Indigenous families [
[19]
].- Kildea S.
- Gao Y.
- Hickey S.
- et al.
Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians: a prospective, non-randomised, interventional trial.
Lancet Glob. Health. 2021; (S2214-109X(21)00061-9. Epub ahead of print. PMID: 33743199)https://doi.org/10.1016/S2214-109X(21)00061-9
A partnership between local Indigenous organisations and a hospital redesigned a service and improved health outcomes (e.g. preterm birth, breastfeeding, antenatal care attendance), reduced medical interventions [
[19]
], improving healthy life trajectories [- Kildea S.
- Gao Y.
- Hickey S.
- et al.
Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians: a prospective, non-randomised, interventional trial.
Lancet Glob. Health. 2021; (S2214-109X(21)00061-9. Epub ahead of print. PMID: 33743199)https://doi.org/10.1016/S2214-109X(21)00061-9
20
, 21
, 22
].Birthing on Country services respond to families’ needs by: privileging Indigenous knowledges and solutions, embedding Indigenous governance, ensuring continuity of midwifery carer, increasing the Indigenous workforce, focusing on family wellbeing, strength-based approaches and improving cultural capabilities of non-Indigenous staff [
[15]
].With customised services like these making a difference in Australia, Canada [
[23]
] and Aotearoa-New Zealand [[24]
,[25]
], we have strong evidence that Indigenous leadership in health service planning and provision improves outcomes for Indigenous peoples [[16]
,[26]
,[27]
].4. This urgent work needs immediate resourcing
We call on all peoples to support and resource Indigenous-led health services.
Communities and families: You have the right to access quality safe care that meets your needs.
Service providers: Create opportunities for community and families to participate in all care provision and planning. Partner with local Indigenous communities and inquire how you might support them with their healthcare aspirations. Show commitment to providing quality safe and culturally responsive care, and be accountable to service users. Nurture and facilitate positive family and community relationships.
Policy makers: Seek leadership from Indigenous peoples in policy development, implementation and evaluation. Consider unintended and/or disproportionately negative consequences that might adversely affect Indigenous peoples (e.g. visitor restrictions, closing rural/remote facilities).
Health service funders: Ensure Indigenous community-controlled health organisations have sustainable funding and insurance cover.
Research funders: Prioritise funding for studies that use Indigenous knowledges and are led by/partnered with Indigenous communities and organisations. Provide grants for meaningful relationship building and for the co-designing of studies with community. Ensure funded researchers evidence their accountability to Indigenous peoples.
Government and political leaders: Mandate, resource and monitor implementation of UNDRIP [
[12]
]. Address systemic racism. You are responsible for driving evidence-based change through policy and practice to equitability improve health and wellbeing of your constituents.Everyone else: We urge you to support widespread scale-up of Indigenous-led health services such as #BirthingOnCountry services to protect #OurFirstCeremony. Donate money to Indigenous-led perinatal programs, create scholarships or directly support Indigenous midwifery students; have zero tolerance for racism. Reflect on how you contribute to and can challenge a colonial system that does not serve Indigenous peoples, and on what is required to safeguard futures where Indigenous families flourish.
Authors’ statement
SH drafted the original manuscript based on group discussion in which all authors made intellectual and strategic contributions to the conceptualisation of the manuscript. YR, SI, SKi, BL, AA contributed to the drafting. All authors critically reviewed, edited and approved the final version.
Conflict of interest
None declared.
Ethical statement
None declared.
References
- Indigenous and tribal peoples’ health (The Lancet-Lowitja Institute Global Collaboration): a population study.Lancet. 2016; 388: 131-157
- Indigenous peoples: time to act now for equity and health.Lancet. 2006; 367: 1705-1707
- Healthy motherhood: an urgent call to action.Lancet. 2006; 368: 1129
- Quality maternity care for every woman, everywhere: a call to action.Lancet. 2016; 388: 2307-2320
- A unified call to action from Australian nursing and midwifery leaders: ensuring that Black lives matter.Contemp. Nurse. 2020; : 1-12
- Indigenous Maternal Health—A Crisis Demanding Attention.JAMA Health Forum; 2020: American Medical Association, 2020 (p. e200517-e)
- Barriers to equitable maternal health in Aotearoa new Zealand: an integrative review.Int. J. Equity Health. 2019; 18: 168
- Improving maternity services for Indigenous women in Australia: moving from policy to practice.Med. J. Aust. 2016; 205: 374-379
- Indigenous birth outcomes in Australia, Canada, New Zealand and the United States — an overview.Open Womens Health J. 2010; : 7-17
- Te Ha o Whanau: a culturally responsive framework of maternity care.N. Z. Med. J. 2020; 133: 66-72
- Jody Currie and Professor Sue Kildea.Let’s Talk, Australia2016
- Assembly G UN Declaration on the Rights of Indigenous Peoples (A/RES/61/295). United Nations General Assembly, 2007
- Traditional medicine and restoration of wellness strategies.J. Aborig. Health. 2009; : 26-42
- Caring for mum on country: exploring the transferability of the birthing on country RISE framework in a remote multilingual Northern Australian context.Women Birth. 2020; (in press)https://doi.org/10.1016/j.wombi.2020.09.017
- Implementing birthing on country services for Aboriginal and Torres Strait Islander families: RISE framework.Women Birth. 2019; 32: 466-475
- Truth, respect and recognition: addressing barriers to Indigenous maternity care.Can. Med. Assoc. J. 2019; 191: E207-E208
- He Korowai Manaaki (Pregnancy wraparound care): study protocol for a cluster randomised clinical trial.JMIR Res. Protoc. 2021; 10: e18154https://doi.org/10.2196/18154
- “We are sacred”: an intercultural and multilingual approach to understanding reproductive health literacy for Yolŋu girls and women in remote Northern Australia.Health Promot. J. Austr. 2021; 32: 192-202https://doi.org/10.1002/hpja.439
- Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians: a prospective, non-randomised, interventional trial.Lancet Glob. Health. 2021; (S2214-109X(21)00061-9. Epub ahead of print. PMID: 33743199)https://doi.org/10.1016/S2214-109X(21)00061-9
- Born Too Soon: the Global Action Report on Preterm Birth.World Health Organization, 2012
- Statement: Exclusive Breastfeeding for Six Months Best for Babies Everywhere.World Health Organization, 2011
- WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience.World Health Organization, 2016
- Reclaiming birth, health, and community: midwifery in the Inuit villages of Nunavik, Canada.J. Midwifery Womens Health. 2007; 52: 384-391
- He Korowai Manaaki: mapping assets to inform a strengths-based, Indigenous-led wrap-around maternity pathway.Aust. J. Prim. Health. 2019; 25: 509-514
- Covid-19: an urgent threat and an opportunity for Indigenous and minority groups in high-income countries.BMJ Opin. 2020;
- Understanding the role of Indigenous community participation in Indigenous prenatal and infant-toddler health promotion programs in Canada: a realist review.Soc. Sci. Med. 2016; 150: 128-143
- Innovation to prevent sudden infant death: the wahakura as an Indigenous vision for a safe sleep environment.Aust. J. Prim. Health. 2019; 25: 406-409
Article info
Publication history
Published online: April 29, 2021
Received:
March 23,
2021
Identification
Copyright
© 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
