Critically analyse access to a health services for a cultural group other than your own within our community. -- Aboriginal and/or Torres Strait Islanders (ATSI)

Table Of Contents

Title	1
1.  Introduction	3
2.   Aboriginal And Torres Strait Islander (ATSI) And Health Services	3
3.   Maternity Related Problems to Aboriginal And Torres Strait Islanders	4
4.   Difficulties In Offering Proper Maternity Care	6
5.   Recommendations: How maternity services and care can be improved for women of ATSI?	6
6.   Conclusion	8
7.   References	9

Introduction

A theory of social determinants identifies that health and inequality in population is established by several interrelated social factors. Similarly, it is a fundamental principle of human rights decree that all rights are integrated and that influencing on the pleasure of one right will influence the enjoyment of others. Due to this synergy, human rights discussion offers a framework for evaluating the likely health impacts of government programs and policies on Indigenous peoples. The social determinants affect the health status of the population indirectly and directly through lifestyle risk factors and access to, or/and utilisation of the health care system. In Australia, providing improvement and easy access to the health of the indigenous people is still a big challenge for the government of Australia. 

Aboriginal And Torres Strait Islander (ATSI) And Health Services

Aboriginal and Torres Strait Islander (ATSI) are the indigenous people of Australia with distinct histories, identities, and cultural practices.  The national statistics for them may mask significant geographic disparities in their health and social wellbeing. The health construct of ATSI is not merely regarding the physical wellbeing of the person. It is the cultural, emotional and social wellbeing of the whole community, a notion that is generally overlooked by conventional health services. It is thus expected that conventional health services suffer from added challenges in an attempt to gain the trust of Torres Strait Islander and Aboriginal people. The most prominent area suffering in this regard is the maternity.  Aboriginal and Torres Strait Islander females and children persist to experience greater rates of morbidity and mortality in comparison to non-Indigenous females and children (Kildea & Wardaguga, 2009). About delivery of such maternal care, ATSI health services put emphasis on the value of a holistic approach towards their health care, where mental, ethical and social wellbeing is associated with its cultural and historical context. Nevertheless, there is an uneven burden of unfavourable perinatal effects for mothers and their children of Aboriginal and Torres Strait Islander, including high maternal mortality rate.  And this rate is four fold high compared to Australian females. In ATSI there is wide difference in pre-term birth percentage (13.5% against 8.0%), perinatal deaths rates (17.1 percent against 8.8 percent per one thousands births) and low birth weight percentage (12.0 percent against 6.0 percent) ( Jongen,  McCalman , Bainbridge  & Tsey, 2014; Australian Bureau of Statistics, 2015).

The causes behind the sobering inequality are diverse and multifaceted.  This paper will critical analysis the maternity issue among ATSI women, difficulty to use maternity services for them owing to their culture and social determinant and will also present the recommendation to improve the current situation.

Maternity Related Problems to Aboriginal And Torres Strait Islanders

The maternity period is a unique stage of life for women since it may bring lots of challenges as well as opportunities with it. Since the reproductive health outcomes for mothers and infants of Aboriginal and Torres Strait Islander are considerably poorer; they even deteriorate with growing distance where the provision of such services becomes more difficult (Murphey & Best, 2012).  In fact, a lot of Aboriginal and Torres Strait Islander women at present do not have access to quality primary maternity care. Even in rural and distant areas such women in particular are being deprived of access to first-class care from the complete variety of health expertise. They can only receive such a care that is inconsistent and does not meet their social and cultural requirements.

At present the provision of maternity services to women of Aboriginal and Torres Strait Islander is greatly inadequate.  The pregnant women of ATSI often face seclusion from a partner, friends, family, and culture and society for the birth of their babies and this may cause a great impact on their wellbeing.  Too much stress, separation from familiar and fostering people, environment and cultural ways, brings about apprehension, sorrow and loneliness at a vital phase. While several urban promotes the values of family-friendly birth settings and offer choices for community midwifery services, a lot of female in remote areas and of Aboriginal and Torres Strait Islander face dislocation from the families (Hancock, 2009) and this serves as risk factors for causing high stress levels .  The use of alcohol tobacco and other drugs pregnancy in the women of this community is also found to be high which lack their proper health education and awareness.  Due to cultural difference women of ATSI feel uncomfortable for regular medical checkups and suffer from such unhealthy activities.

Difficulties In Offering Proper Maternity Care

The magnitude and lasting nature of disparity in provision of maternity care to Aboriginal and Torres Strait Islander women is partially due to cultural and traditional values of these people. The notion of gender specific scaffolds among ATSI people conveys that women and men have dissimilar needs, life experiences, degrees of authority, access to information from diverse sources to help decision making and approaches of expressing sickness(Kildea, Kruske, Barclay, & Tracy, 2010). Those dissimilarities impact on the manner that women and men of ATSI interact with the health services.  Furthermore, culturally, it is not easy for women of Aboriginal and Torres Strait Islander to seek medical help early in their pregnancy. For a large number of Indigenous women, their primary visit to a medical centre or hospital is on the day of labour.  As a result it becomes difficult to recognise antenatal complications in such women as early as possible and likewise, premature birth rates and mortality rates rise in them.

As with the Indigenous Australian population, family violence is an unseen concern. A study demonstrated that family violence causes major influence on the health of Indigenous women compared to women of other Australian groups.  Due to the family fear, they avoid consulting a health service and therefore escape those issues which can be prevented if detected earlier. Early and ongoing maternity care facilitates a plan of care to be made in the first trimester. Lack of care and late visiting to get the antenatal care increases the rates of perinatal morbidity and mortality (Rumbold et al, 2012). This also affects their reproductive health outcomes and presents challenges to healthcare provider to identify them and offer them with pertinent treatment accordingly. The ATSI women have least awareness regarding how to be cautious in pregnancy because they lack a proper health education due to less exposure to it. Women with comorbidities need to be conscious of the effect of their diseases on pregnancy, in addition to, the effect of pregnancy on their existing health comorbidity.  

Additionally, social, financial and psychological problems which generate stress, a lack of control over situations and unproductive self-management are believed to be the greater determinants (Whiteside, Tsey & Cadet, 2009).  Their financial resources are less which also prevent them for undergoing proper medical advice and help.

Recommendations: How maternity services and care can be improved for women of ATSI?

In spite of cultural and social resistance, it is the duty of the health care provider to provide culturally safe maternity health care. A policy should be developed which tackle such issues and endorses education of not only indigenous women but also of practitioners regarding delivery of maternity services to challenging patients.  Since cultural, spiritual, and social wellbeing is very important to the people of Aboriginal and Torres Strait Islander it is imperative that their health needs be considered in this background. Cultural safety offers a practical framework to improve the provision of maternity services to ATSI women and their families (Reibel & Walker, 2010).  This can be offered by developing a multi-agency move towards service delivery in line with the fact that maternity services for indigenous people cannot address health inequalities singly.

“The Council of Australian Governments (COAG) recognises that strategies aimed at achieving improvements in any particular area will not work in isolation – the building blocks must fit together through the integration of policy ideas and an agreed approach to their implementation” (Aboriginal Health Council of Western Australia, 2011)

It is the duty of the government as well as health practitioner to make sure that Aboriginal and Torres Strait Islander women should have access to first-rate maternity services. And, these services must be culturally safe, offer continuous care and access to the greatest expertise (Australian Government, 2009). Nurses can help filled the gap by enhancing communication, by addressing social, cultural and emotional health needs of and Aboriginal and Torres Strait Islander women.  Considering the disparity in health services to indigenous community, the nurses can play a role in improving the care of Aboriginal and Torres Strait Islander pregnant women by removing those disparities and giving equal treatment opportunities.  They can encourage women living in rural or remote areas to get an early maternal care and can work to get them access to such services. Early access to maternity service is a sign of the victory of this approach (Bar-Zeev, Barclay, Farrington & Kildea, 2012).

Conclusion

In conclusion, there are growing rather than declining challenges to the provision of safe maternity services to Aboriginal and Torres Strait Islander women. Transforming the approach care is delivered could endorse significant improvements. The cultural aspect should be considered because it is from within the community and culture that actual optimistic changes in the people’s health commence.

References

AHMAC (2012). Aboriginal and Torres Strait Islander Health Performance Framework 2012 report. Canberra: AHMAC.

Australian Bureau of Statistics (2015). 'Births, Australia, 2014', ABS, Canberra, Retrieved from: <www.abs.gov.au>.

Australian Government (2009). Steering Committee for the Review of Government Service Provision, Overcoming Indigenous Disadvantage Report. Canberra, ACT: Commonwealth of Australia: Retrieved from: http://www.pc.gov.au/research/ongoing/overcoming-indigenous-disadvantage/key-indicators-2014

Bar-Zeev SJ, Barclay L, Farrington C, Kildea S. (2012). From hospital to home: the quality and safety of a postnatal discharge system used for remote dwelling Aboriginal mothers and infants in the top end of Australia. Midwifery 28, 366–373.

Hancock, H. (2009). Low birth weight in Aboriginal babies: A need for rethinking Aboriginal women’s pregnancies and birthing. Women and Birth 20, 77–80.

Heffernan, B., Iskandar, D. & Freemantle, J. (2012), The History of Indigenous Identification in Victorian Health Datasets, 1980-2011: Initiatives and Policies Reported by Key Informants. Lowitja Institute, Melbourne.

Jongen C,  McCalman J , Bainbridge R and Tsey K. (2014). Aboriginal and Torres Strait Islander maternal and child health and wellbeing: a systematic search of programs and services in Australian primary health care settings. BMC Pregnancy and Childbirth, 14, 251.

Kildea S, Kruske S, Barclay L, Tracy S (2010) ‘Closing the Gap’: How maternity services can contribute to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait Islander women Rural and Remote Health 10, 1383. 

Kildea S, Wardaguga M. (2009). Childbirth in Australia: Aboriginal and Torres Strait Islander Women. In: H Selin, P Stone (Eds). Childbirth across cultures, ideas of pregnancy, childbirth and the postpartum period in many of the worlds cultures. Amherst: Springer, 275-287.

Murphey E, Best E. (2012).  The Aboriginal Maternal and Infant Health Service: a decade of achievement in the health of women and babies in NSW. N S W Pub Health Bull 23, 68–72.

Reibel, T & Walker, R. (2010). Antenatal services for Aboriginal women: the relevance of cultural competence. Quality in Primary Care 18, 65–74.

Rumbold, A, Bailie, R, Si, D, Dowden, M, Kennedy, C, Cox, R, O’Donoghue, L, Liddle, H, Kwedza, R & Thompson, S. (2011).Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative’, BMC pregnancy and childbirth 11, 1, 16.

Whiteside M, Tsey K, Cadet-James Y. (2009). Empowerment as a social determinant of Indigenous Australian health - the case of the Family Wellbeing Programme. In Social Work and Global Health Inequalities. Edited by Bywaters P, McLeod E, Napier L. Bristol, UK: Policy Press; 165–171.