Dear Minister Butler,

Dear Minister Butler,

I am writing to advocate for the widespread implementation of "Birthing on Country" (BoC) models of care in Australia. These models are essential to improving the birthing outcomes and experiences of Aboriginal and Torres Strait Islander families. As a vital aspect of culturally safe healthcare, BoC models provide an opportunity to address systemic inequities and enhance the health and well-being of First Nations women and their babies. This submission will present the importance of BoC, its effectiveness, and the need for resource allocation and policy reform to support its national implementation..

Aboriginal and Torres Strait Islander women experience substantial disparities in birthing outcomes compared to non-Indigenous women. Research highlights that these women face higher rates of preterm births, low birth weights, and perinatal mortality (Brown et al., 2015). The mainstream maternity care system often fails to meet their cultural and holistic needs, leading to disempowerment and disengagement. Many report experiences of racism, culturally inappropriate care, and limited access to services, particularly in rural and remote areas (Jongen et al., 2014). Despite recognising these health disparities for years, progress in improving outcomes has been slow (Kildea et al., 2016). The Australian maternity systems inability to adequately address these needs has impeded advancements in national health strategies aimed at improving outcomes for Aboriginal and Torres Strait Islander families (Kildea et al., 2016).

"Birthing on Country" refers to maternity services developed and implemented in collaboration with Aboriginal and Torres Strait Islander women and their communities (Kildea et al., 2016). The aim is to enhance maternal and infant outcomes by fostering a strong connection to culture and Country during childbirth, regardless of location, and addressing the cultural risks associated with not birthing on Country (Kildea et al., 2016). BoC programs adhere to guiding principles that include integrating traditional knowledge, respecting family roles, fostering partnerships, ensuring continuity of care, connecting with Country, building capacity through training, adopting a holistic view of health, employing evidence-based practices, and embracing a social model of health and well-being (Kildea et al., 2016). Despite the frequent use of health services for pregnancy and childbirth, the uptake of specialised programs by Aboriginal and Torres Strait Islander families remains low (Brown et al., 2015), underscoring the need for widespread BoC models.

Need for 'Birthing on Country' Models

Evidence supporting BoC models demonstrates their effectiveness in improving maternal and infant health outcomes. Studies show that BoC is associated with reduced preterm births, higher breastfeeding rates, and greater maternal satisfaction (Brown et al., 2015). However, barriers such as funding constraints, a lack of culturally trained staff, and policy limitations have hindered broader implementation (Jongen et al., 2014). The persistent health disparities faced by Aboriginal and Torres Strait Islander families highlight the need for a reform in health systems, with BoC models offering a culturally safe and effective solution (Kildea et al., 2016). Current research predominantly focuses on small-scale interventions, providing limited insights into the potential of broader initiatives (Herceg).

Successful Examples of Implementation

In South Australia, the Aboriginal Family Birthing Program (AFBP) has been successfully implemented in several regions, including Adelaide, Port Augusta, and Whyalla. This program builds on previous regional initiatives, providing culturally sensitive care and involving community consultation, specialized training, and continuity of care (Brown et al., 2015). Other states, such as New South Wales and Victoria, have also adopted similar models with varying approaches (Murphy).

Expected Outcomes and Adaptations

Widespread implementation of BoC models is expected to lead to improved birthing outcomes, increased engagement with maternity services, and strengthened cultural identity among First Nations communities. While core principles should remain consistent, the implementation of these models may need to be adapted to meet specific community needs. For instance, local Elders' involvement, traditional birthing practices, and the design of birthing spaces may vary based on regional cultural practices and community preferences. This flexibility ensures that BoC models remain culturally relevant and effective.

Strategies for Effective Development

To develop effective BoC models, a collaborative approach involving co-design, consultation, and ongoing engagement with First Nations communities is essential. Co-design ensures that the models are culturally appropriate and tailored to the specific needs of each community. Ongoing consultation with community leaders, health workers, and families will help refine and adapt the models to changing needs and circumstances. These models would need to be different across different parts of the country. Statistics show that

Stats/ need to word into my own Aboriginal and Torres Strait Islander women living in remote areas can experience poorer health outcomes, which are compounded by factors related to geographic isolation, such as poorer access to appropriate housing, essential services and employment opportunities (AIHW 2020).

Previous reports have shown that Aboriginal and Torres Strait Islander mothers who lived in remote areas were more likely to face socioeconomic disadvantage, have poorer access to maternity care, have higher rates of behavioural risk factors and pre-existing maternal health conditions, and have babies who experienced poorer outcomes than Aboriginal and Torres Strait Islander mothers who lived in non-remote areas (AIHW 2022). Aboriginal and Torres Strait Islander mothers may have to travel away from their community to give birth due to a lack of acceptable or appropriate maternal health or acute services. In these instances, Birthing on Country models of care ensure mothers receive culturally safe care despite being away from their community (AIHW 2017; Barclay 2016; Kildea et al 2016).

The widespread implementation of Birthing on Country models of care is crucial to addressing the disparities in maternity care experienced by First Nations women in Australia. These models offer a culturally safe, empowering, and effective approach to maternity care that respects the traditions and values of Aboriginal and Torres Strait Islander communities. By prioritising the implementation of BoC models, the Australian government can significantly improve maternal and infant health outcomes, strengthen cultural identity, and ensure that First Nations women receive the respectful and holistic care they deserve. I urge you to allocate resources and enact policy reforms to support this important initiative.

Thank you for considering this important matter.

Sincerely,

Keeley Madigan