Aboriginal and non‐Aboriginal perinatal deaths in Darwin: a comparative view

Abstract

Objective To compare perinatal deaths in Aborigines and non‐Aborigines, and to identify the differences between the two groups in order to plan better prevention and bring about a reduction in perinatal deaths. Design A retrospective review of the records of 198 consecutive perinatal deaths (96 Aboriginal and 102 non‐Aboriginal) in infants delivered in the maternity unit between 1984 and 1989. Setting Royal Darwin Hospital Maternity Unit. Main outcome measures Stillbirth rate, neonatal death rate, perinatal mortality rate; classifying perinatal deaths by cause and birthweight. Main results The Aboriginal perinatal mortality rate was 40.9 per 1000, three times that of the non‐Aboriginal rate (13.4 per 1000). The stillbirth rate in Aborigines was 18.7 per 1000, 2.5 times that in non‐Aborigines (7.2 per 1000). The Aboriginal neonatal mortality rate was 22.5 per 1000, 3.5 times the non‐Aboriginal rate (6.2 per 1000). There was no significant difference in the distribution of Aboriginal and non‐Aboriginal perinatal deaths when classified by cause, with the exception of pre‐eclampsia. Aboriginal women appeared to be 2.5 times more likely than non‐Aboriginal women (P = 0.002) to have pre‐eclampsia causing perinatal death. Prematurity and the unexplained categories were the major causes of perinatal death in both Aboriginal and non‐Aboriginal infants. Main conclusion The suboptimal perinatal outcome in Aborigines highlights the importance of antenatal care for Aboriginal mothers, and indirectly reflects the need for improving their standard of living.

Is being Aboriginal or Torres Strait Islander a risk factor for poor neonatal outcome in a tertiary referral unit in north Queensland?

“…Neonatal mortality rates in the neonatal intensive care unit were expected to be higher in the Indigenous group, as has been reported in other studies 3,4,7 …”

“…Perinatal outcomes for the Aboriginal group at the KWH were slightly better than the overall Queensland Aboriginal figures (12.9% preterm, 12.4% low‐birthweight births, PMR 24.8 deaths per 1000 births) 3 and were not dissimilar to those of the non‐Indigenous group at the KWH. While there was a trend to a higher PMR and a higher prevalence of preterm births for Aboriginal infants, compared to non‐Indigenous infants, the relative risk was nearer 1 than the 2 that has often been reported 1–5,7,11 . These findings may reflect both the lower socioeconomic status of non‐Indigenous women attending KWH and the higher‐risk pregnancies associated with tertiary referral centres.…”

“…Aboriginal and Torres Strait Islander people, while having much in common, do have differing cultural backgrounds, which may well have an impact on perinatal health. The present study adds to the few reports on obstetric and neonatal outcomes in major urban centres, 4,5,7 examining the outcomes separately for the Aboriginal and TSI populations 8 …”

Obstetric Outcomes in an Aboriginal Community: A Comparison With the Surrounding Rural Area

“…There are two separate and largely contradictory currents in obstetric services to Aboriginal communities. The first is concern about the continuing poor outcomes for Aboriginal mothers 1 –4 and their infants compared with the general Australian population. The second is the desire of some Aboriginal mothers to give birth to their infants in their own communities, which means domiciliary obstetrics 5 …”

On the Path to Decolonizing Health Care Services: The Role of Marketing

“…Such colonial solutions were rooted in the discriminatory assumptions that depicted First Nations people as unclean and uncivilized (Kidd 1997). The institutionalization of birthing for First Nations women is thus consistent with a colonized perception of medicine that dismisses more than 60,000 years of traditional practice (such as older women teaching young women about the Grandmother’s Law and bonding during their first labor) (Matthias and Morgan 1992). Such institutional solutions aimed at ensuring compliance were legitimized by health experts through the practice of marketing.…”