Strategies for Reduction of Maternal Mortality and Morbidity among Indigenous Women in Rural Areas

Huge gap in health status persists between the indigenous and non-indigenous people of Australia and mothers and infants are not out of this. The present assignment would show the difference in the morbidity and mortality of the native and non-native women and babies and the initiatives that midwives should take to lessen the gap (Gould, Lim & Mattes, 2017). It would also highlight the concept of birth on country and some of my traits that would help in aligning with the criteria for being a culturally competent healthcare service.

The data produced by the Department of Prime minister and Cabinet has shown that the in the year 2016, mortality rate of the indigenous children of the age of 0 to 4 year old is seen to be within the range  of meeting the targets of closing the Gap by 2018. Therefore, it can be considered to be on the correct track for reducing the numbers of the native children death within the years contributing to meet the gap in the health status between the children of the native background and the non-native background. However, in the five-year period of 2011 to 2015, about 610 deaths of the native children of the age 0 to 4 years were found and of these 500 of them were infant deaths (Middleton et al., 2017). The total number of deaths of the infant children of the Aboriginal and Torres Strait Islander children aged 0–4 years was found to be two times of the non-indigenous rate. This accounted for about 164.9 over 100,000 to that of 80.1 per 100,000. In case of the indigenous infants in the period of 2011 to 2015, the mortality rate was found to be 1.9 times than that of the non-native infants. The most common causes that contributed to the death of the infants of the native people were mainly because of the poor perinatal conditions and this accounted for about 51% of the deaths (Kildea et al., 2016).  These mainly would be due to certain reasons like fetal growth disorders, birth trauma, complications of the pregnancy as well as cardiovascular and respiratory disorders specific to the peri-natal periods. The second leading cause of the deaths was signs, symptoms as well as ill defined conditions that accounted for about 21%. This category is mainly seen to include the SIDS that had accounted for about 85 of the infant deaths. The third most common cause of indigenous death can be attributed to the congenital malformations accounting for about  13% of the infant deaths. Among the older individuals for like around 1 to 4 years old, injury was seen to be the main reason for deaths of half the number of children and this rate was 4 times than that of the non0indiginous children (Josif et al., 2014). Many perinatal conditions like issues during the pregnancy, fetal growth disorders, and labor and delivery issues are mainly resulting in sufferings of the mother leading to poor quality lives.

A number of social determinants of health have been identified which are considered to be the main factors that results in ill health of both the mothers and the babies. Researchers are of the opinion improper nutrition during the time of pregnancy results in poor health of not only the mother but also affects the fetal development. Exposure to nutritious and organic foods is limited as well as costly. Hence, the native people suffering from financial instability cannot afford to spend on such foods and hence nutritional requirements of both the children and the mothers remain incomplete (Ashman et al., 2016). These expose them to various disorders and ailments. Besides, food availability becoming one determinant, other social determinant is lack of education and health literacy. The mothers and the people taking caring of her are not aware of the diet they need to take and the different behaviors that they need to withdraw for the betterment of the child. This can be well associated with other social determinists like smoking and alcohol uptake. Although their culture supports smoking and drinking alcohol, but these prove to have negative effect on the fetal growth. It was seen that indigenous mothers were 4 times more likely to smoke during the times of pregnancy in comparison to that of the other mothers of the non-indigenous backgrounds. Many of the researchers are of the opinion that smoking during pregnancy  can be attributed to low socio-economic status as well as stress and even due to social norms (Hafekost et al., 2017). Lack of knowledge of the consequences during the times of the pregnancy is mainly another contributor to ill health of both mothers and their infants. Smoking is also seen to increase the risks of complications in the mothers resulting in miscarriage, placental abruption, ectopic pregnancy as well as gestational diabetes. These are in turn associated with the low birth weight, fetal growth restriction, perinatal death, pre-term birth as well as congenital anomalies. Poor access to healthcare services due to remoteness and due to cultural differences, they tend to avoid western healthcare system service. This also affects their health condition as well as their babies.

Role of Midwife in Reducing Maternal Mortality and Morbidity among Indigenous Women in Rural Areas

New directions: Mothers and Babies service called the NDMBS has been proposed too be exposed from the 85 to 124 sites and further expansion are planned by the government to additional 12 sites. NDMBS would continue to support the native children as well as their mothers for getting access to the different types of antennal as well as postnatal care. Standard information should be provided by them about the baby care as well as provide practical advice as well as assistance with the different important topics like the breast feeding, monitoring f the developmental milestones as well as nutrition and parenting. It also involves immunization as well as infection along with health checkups (Kildea et al., 2016). It would also involve health checkups along with referrals for the treatment for the indigenous children before they start school. The midwives have the responsibility of describing the importance of home environment for the development of children to the mothers, fathers as well as family members living with the children. The midwives have the responsibility of ensuring that every family and community take extra initiatives for helping the children to grow up in the safe, healthy as well as in the nurturing environment.

One of the most important responsibility of the nursing midwives in such a situation would be to provide primary healthcare services which would be comprising of the  important information. This information would help the mother as well as the family members develop ideas of the wrong practices and inappropriate behaviors that might harm the health of babies and their mothers. For this, the midwives would be educating and at the same time arranging for health promotion campaigns that would help the native people to develop awareness about the actions the would take for keeping the mother and the health of the children fit and healthy. This should mainly include the provision of the standardized as well as consistent information about the child as well as infant care to the mother in addition to the practical advice along with assistance for breastfeeding, nutrition and parenting (Josif et al., 2017). The midwives should be also develop programs or advocate to the government for the development of programs which would help in the monitoring of the developmental milestones of the children as well as their immunization status. This would help in ensuring to the midwives that any deviations from the norm are present or not and accordingly, they would be addressed early to prevent any complications. Proper healthcare services should be arranged in the remote areas where the expecting mothers can come from screening as well as regular checkups to get reviews about their conditions and whether any form of interventions are important or not (Lee et al., 2018).

The different services should be providing important group programs as well as clinic support and home visits that would help the nursing midwives for providing the flexible services to meet the needs of the clients. The different antenatal as well as the postnatal services that would be provided should be prepared in consultation with the Aboriginal health workers or the AHW. This would be helping to maintain the cultural preferences and traditions of the patients as well as their children and this would be helping to maintain their autonomy as well as dignity. The health promotion programs that would be developed should be mainly concerning on the important topics. These would include importance of breastfeeding and educating them about child health as well as development. Specialized screening for the maternal health would include antenatum, postnatal, interpartum care that would also include home visit support. Preventive measurements for disorders like proper immunization programs should be developed along with child accident and injury prevention (Spangaro et al., 2016). Development of health literacy regarding nutrition, family planning as well as regular health check-op significances should be ensured. Smoking and alcohol cessation programs can be also advised for mothers who are screened to be addicted to smoking and alcohol consumptions.

Strategies Linked to PHC Principles

Traditionally, every Aboriginal and Torres Strait Islander mothers expects to give birth to the children on the land of their ancestors. This concept is called the birthing on country. In the present generations, often when mothers face complicacy they have to travel to the western healthcare centers away from their native regions and have to give birth under the western healthcare professionals that might make them feel disconnected to their cultural roots and traditions.  Therefore, non-indigenous midwives are often seen to work together not only with the community elders bit also with the traditional midwives (Short et al., 2017). This would help in ensuring that the mother can maintain a spiritual connection to their own country that is they can choose where they can give birth. The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) as well as the Australian College of Midwives and the Council of Remote Area Nurses of Australia (CRANA) have described it as “an appropriate transition to motherhood and parenting, and an integrative holistic and culturally appropriate model of care for all”. The main element associated with the concept of birthing on country is that services, which are providing antenatal care or care during the birthing process, should be according to the cultural norms and tradition that the native women follow during their birthing procedures. Researchers therefore believe that although giving birth is a physiological procedure, there is also a need to value the culture that can be supported and maintained. When the mothers feel pleased to give birth following their cultural protocols and experiencing the essence of their traditions, the baby would also be having a fresh start in their lives (Bar-Zeev et al., 2014).  Therefore, in order to give birth to children within the won community, midwives of the western healthcare system along with traditional midwives should support the native mothers so that complication that might arise in child birth can be handled and more number of mother and children can be saved from untimely deaths.

A partnership had been developed between the  Australian College of Midwives (ACM), the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), the University of Queensland (UQ) and the University of Sydney (USyd). They had established a groundbreaking ‘Birthing on Country’ maternity services program. The Ms Ann Kinnear and Ms Karel Williams had developed them on Monday 7 in November in the year 2016 at the CATSINaM International Indigenous Health Workforce Meeting (Brwon et al., 2016). It ensured that while  midwives will be supporting the Aboriginal and Torres Strait Islander’s mothers’ ways of following the ritual of giving birth, inclusion of different types of traditional programs as well as maintain the connection if the mothers and babies with their land and culture (Ireland et al., 2015). It also focuses on the improvement on the empowering of the voice of the mothers of the indigenous background in the development as well as delivery of the services making them the centre to the concept. This would be done in association with the midwives of western healthcare centers who would be supporting the mothers in every of the attributes mentioned above and at the same time would be preventing the complication and trying best to develop the health of the mother and the children. These would help in reducing the gap on the health status between the native and non native mothers helping the mothers and children to overcome barriers and ensure safety lives free of complications. Better Start to Life approach, New Directions: Mothers and Babies services, Aboriginal Family Birthing Program are some of the programs helping mothers and children to live safe lives ensuring maintaining the goals of Closing the gap policy (Gibberd, Simpson & Eades, 2016).

Concept of Birthing on Country and Its Impact on Health Outcomes of Indigenous Women and Newborns

From the very childhood, I had been taught with very good principles, values and beliefs about my culture and it e to follow them in every aspect of my life. The guidance of my parents regarding development of the cultural virtues had helped me to understand the importance of developing an open outlook and to maintain transparency towards other cultures. I have always tried to respect every tradition of other cultures and have tried to find out the rationales behind the following of such traditions. This had helped me in being more creative in my personal life. I never tend to be judgmental about the attributes of other cultures that prevent any form of cultural biasness within me. I always harbored high level of cultural sensitivity and this would be helping me in working with the aboriginal and Torres Islander people as well. I have researched a lot and have developed cultural knowledge and cultural awareness about them that would be contributing to my provision for best intervention to them.

From the above discussion, it becomes clear that mortality and morbidity rate between the indigenous mothers and babies to that of the non-indigenous individuals are quite high. Smoking, alcohol, improper nutrient, lack of proper access and absence of healthcare literacy are some of the social determinants of health that contribute to this besides their poor socio-economic status. Therefore, midwives need to engage in proper primary healthcare services helping in arranging for health promotion sessions, advocating for program and funds, screening sessions preparation and many others. Midwives should also ensure birthing on country for the native mothers at the same time of ensuring closing the Gap goals. Cultural sensitivity and cultural awareness in me would help me to participate effectively in all of them and ensure best health for mothers and babies.

References:

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