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Birthing on Country results prove the gap can be closed. Now such services need to expand

Introduction by Croakey: A study of the Birthing in Our Community service in Queensland has shown that an urban Birthing on Country service can significantly improve clinical outcomes for Aboriginal and Torres Strait Islander mothers and infants compared with standard care services, including a reduction of preterm birth.

Kristie Watego, a Bundjalung woman and Birthing and Early Childhood Service manager at the Institute for Urban Indigenous Health, writes about her own experience birthing with the service and the need to provide the program to all Indigenous women across South East Queensland.


Kristie Watego writes:

Author Kristie Watego, with Luke. Photo supplied

When I gave birth to my third son, Luke, in 2018 my experience was vastly different to that of my previous pregnancy.

Throughout my second pregnancy I had felt categorised and disempowered. Every antenatal appointment felt like a checklist ticking exercise with someone who viewed me as ‘high risk’.

For my third pregnancy I chose to receive my care through the Birthing in Our Community (BiOC) program, offered to women pregnant with an Aboriginal or Torres Strait Islander bub booked to birth at Mater Mothers Hospital in Brisbane.

I was surrounded by a team who took the time to hear me and to listen. Who weren’t judging me. Who were walking alongside me and supporting me to make healthy choices for me and my family.

When it was time for Luke to be born my extended family were there and were able to be involved in this magical and sacred time. And back at the hub the team were just so excited to add Luke’s photo to their BiOC baby photo wall.

The difference for me as an Aboriginal woman birthing my baby surrounded by support from a program that has been designed by Aboriginal and Torres Strait Islander people was astounding.

Proven benefits

My experience is backed up by research. A paper published this year in Lancet Global Health has confirmed that babies born through the BiOC program are 50 per cent less likely to be born premature and more likely to be breastfed – and their mothers are more likely to access antenatal care.

The study, led by Professors Sue Kildea and Yvette Roe, Associate Professor Yu Gao, and Dr Sophie Hickey from the Molly Wardaguga Research Centre, Charles Darwin University, compared women who birthed through the BiOC service to women receiving standard maternity care at the same hospital during January 2013 to June 2019.

In addition to being 50 per cent less likely to give birth prematurely, women birthing through BiOC are:

  • more likely to attend 5 or more antenatal appointments
  • less likely to need a planned caesarean or an epidural in labour
  • less likely to have bub admitted to the neonatal care nursery
  • more likely to be able to exclusively breastfeed on discharge.

These are all factors that are clearly leading the way towards achieving Target 2 of the new National Agreement on Closing the Gap: ‘Aboriginal and Torres Strait Islander Children are born healthy and strong – by 2031 increase the proportion of Aboriginal and Torres Strait Islander babies with a healthy birthweight to 91 percent.’

These results are extraordinary. If we are reducing the risk of a baby being born premature, we are reducing the risk of that baby dying in childhood, of experiencing disability and developing chronic disease such as diabetes, cardiovascular disease or kidney disease later in life.

BiOC was established by the Institute for Urban Indigenous Health (IUIH) and the Aboriginal and Torres Strait Islander Community Health Service (ATSICHS) Brisbane in 2013 in partnership with Mater Mothers’ Hospital.

It is a unique example of what can be achieved through genuine partnership in an Indigenous-led setting. The program was designed by Elders, mums and dads and community.

It works by providing wrap-around care addressing factors that impact on preterm birth – early engagement with the health service, attending antenatal appointments, smoking rates, transport to and from appointments, and education around nutrition, breastfeeding and secure attachment.

Women are given their own midwife who looks after them throughout their pregnancy, at birth and for 6 weeks following (continuity of care), as well as a dedicated family support worker who coordinates the wrap-around care needed by mum and her family.

By mob, for mob

I now work as the Manager of Birthing and Early Childhood services at IUIH – and I am one of many women who have birthed through the program, as well as working with it.

What we know as Aboriginal and Torres Strait Islander people is there are so many aspects of our lives that are just as important as our physical wellbeing.

At the hub we walk alongside our mums and dads and aunties and uncles to support and develop strong, black deadly families.

This type of program works because it provides clinical care alongside social care and advocacy – by mob, for mob. If we get these things right – and we are – we are closing the gap. This is what it looks like.

While the results just published are those of a 5-year study, we’ve known the effectiveness of this model all along. We know that we’ve turned things around for Indigenous families using a program designed by community, that empowers community.

But BiOC is only available to a small number of mums booked to birth at a single hospital in Brisbane. At the very least, we need to see this program funded so it is available for women across South East Queensland, to access it whether they are booked to birth at Logan, Royal Brisbane or Caboolture hospital.

This is the world’s best evidence on a model that is actually closing the gap. Yet calls for funding to expand this service across South East Queensland to date have been ignored.

We acknowledge the commitment and the investment required to do this. But it’s not necessarily about new funding – we are asking both Federal and State governments to look at where money is being put into programs that are not working and re-direct those funds towards programs that are.

We are hopeful that next week’s Queensland budget announcement might include a funding announcement, with our call for funding to expand BiOC backed by the Australian Medical Association’s Queensland branch in its Budget submission.

It’s time to step back and support community controlled organisations to get the results.

Kildea S, Gao Y, Hickey S, Nelson C, Kruske S, Carson A, Currie J, Reynolds M, Wilson K, Watego-Ivory K, Costello J, Roe Y (2021) Effect of a Birthing on Country service redesign on preterm birth and key maternal and infant health outcomes for First Nations Australians: A prospective, non-randomised, interventional trial; Indigenous Birthing in an Urban Setting study. Lancet Global Health


See Croakey’s archive of stories about Birthing on Country.

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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
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