How equitable is Australia’s maternal healthcare?
Disparities in health service use exist in many sectors of Australia's health system, and they particularly affect the most vulnerable people in the population, who are typically those with the greatest healthcare needs. Understanding patterns of health service coverage is critical for acknowledging the underlying systemic drivers that inhibit engagement with health services for affected population groups.
Associate Professor Emily Callander recently undertook a study investigating such disparities within the maternal healthcare sector, focussing on health service access by mothers with high blood pressure, diabetes and mental health conditions. Her findings were recently published in the International Journal of Health Planning and Management.
She says, “We’re fortunate that Australia is a high-income country with a universal healthcare system that has yielded one of the highest levels of maternal and child health globally. However, research has shown that there are striking disparities between pregnancy and birth outcomes in some groups, particularly between First Nations and non-First Nations mothers and babies.
“First Nations mothers and babies are at far greater risk of death or illness in the time surrounding birth, and for miscarriage and pre-term birth. Many of the risk factors for these are modifiable, such as smoking, nutrition, mental health support.
“Fully understanding the barriers to healthcare access for pregnant women and new mothers in these priority groups is vital to designing and implementing health services that deliver on their potential, by saving lives and improving health.”
Emily’s team used a Queensland based administrative dataset called Maternity1000 to gather health and outcomes information on 186,789 mothers who gave birth in the State between 2012-2015.
They stratified the mothers across socio-economic, geographic and Indigenous status, and examined their health service use, focusing on attendance at antenatal care appointments, chronic disease clinics and mental health services.
Emily says, “Perhaps unsurprisingly, we found a broad trend of inequitable health service utilisation, where those with the greatest healthcare needs – First Nations women, rural and remote women and those at socio-economic disadvantage – engaged with health services less frequently than other women, and when they did engage, they accessed a narrower range of services.
“The data showed that almost half of the First Nations mothers smoked during pregnancy, and they were twice as likely to be underweight during pregnancy than non-First Nations mothers. Women experiencing socio-economic disadvantage were more likely to be obese during pregnancy than women from the highest socio-economic quartile.
“The poor health outcomes of our First Nations people in particular is a national tragedy, because so much of the burden they bear is avoidable. It is upon our governments and health planners to understand the structural discrimination inherent in our health services, and respond by designing health services that are culturally appropriate, geographically accessible, and affordable to all.”