Aboriginal women in rural Australia; a small study of infant feeding behaviour

BackgroundAboriginal women in rural areas have lower rates of breastfeeding than Australian averages. The reasons for this are poorly understood. Aboriginal people experience higher morbidity and increased rates of chronic disease throughout the life cycle. The protective effects of sustained breastfeeding could benefit rural Aboriginal communities.ObjectiveTo explore the factors impacting upon infant feeding choices in a rural Aboriginal Community.MethodsSemi-structured interviews were conducted with eight Aboriginal rural dwelling first time mothers. These women received a continuity of midwife and Aboriginal Health Worker model of care. Interviews were also undertaken with five Aboriginal Health Workers and two Aboriginal community breastfeeding champions. The analysis was integrated with a conventional literature review and was further developed and illustrated with historical literature. Indigenist methodology guided the study design, analysis and the dissemination of results.ResultsThree key themes were identified. These were “I’m doing the best thing for…” which encompasses the motivations underpinning infant feeding decisions; “this is what I know…” which explores individual and community knowledge regarding infant feeding; and “a safe place to feed” identifying the barriers that negative societal messages pose for women as they make infant feeding decisions. It appears loss of family and community breastfeeding knowledge resulting from colonisation still influences the Aboriginal women of today.DiscussionAboriginal women value and trust knowledge which is passed to them from extended family members and women within their Community. Cultural, historical and socioeconomic factors all strongly influence the infant feeding decisions of individuals in this study.ConclusionsEfforts to normalise breastfeeding in the culture of rural dwelling Aboriginal women and their supporting community appear to be necessary and may promote breastfeeding more effectively than optimal professional care of individuals can do.     

Paperbark and pinard: A historical account of maternity care in one remote Australian Aboriginal town

Background and aimMaternity care in remote areas of the Australian Northern Territory is restricted to antenatal and postnatal care only, with women routinely evacuated to give birth in hospital. Using one remote Aboriginal community as a case study, our aim with this research was to document and explore the major changes to the provision of remote maternity care over the period spanning pre-European colonisation to 1996.MethodsOur research methods included historical ethnographic fieldwork (2007–2013); interviews with Aboriginal women, Aboriginal health workers, religious and non-religious non-Aboriginal health workers and past residents; and archival review of historical documents.FindingsWe identified four distinct eras of maternity care. Maternity care staffed by nuns who were trained in nursing and midwifery serviced childbirth in the local community. Support for community childbirth was incrementally withdrawn over a period, until the government eventually assumed responsibility for all health care.ConclusionsThe introduction of Western maternity care colonised Aboriginal birth practices and midwifery practice. Historical population statistics suggest that access to local Western maternity care may have contributed to a significant population increase. Despite population growth and higher demand for maternity services, local maternity services declined significantly. The rationale for removing childbirth services from the community was never explicitly addressed in any known written policy directive. Declining maternity services led to the de-skilling of many Aboriginal health workers and the significant community loss of future career pathways for Aboriginal midwives. This has contributed to the current status quo, with very few female Aboriginal health workers actively providing remote maternity care.     

Security and Belonging: Reconceptualising Aboriginal Spatial Mobilities in Yamatji Country,Western Australia

Abstract

Since British colonisation of Australia began, Aboriginal mobility practices have been poorly understood within the Anglo‐Australian consciousnesses. This paper examines current discourses and conceptualisations of Aboriginal mobilities in Yamatji country, Western Australia. Finding none of these explanations and interpretations singularly sufficient to encompass the diverse spatial practices of Aboriginal people in the region, the paper proposes an alternative framework for interpreting and understanding these population dynamics. The central tenet of this reconceptualisation is that contemporary Aboriginal spatialities – including spatial distribution, movements, and immobility – are iteratively shaped by the processes of procuring, contesting, and cultivating security and belonging. In a conscious shift away from generalised and pejorative interpretations of Aboriginal mobility, this more holistic framework considers historical and geographical context, cultural identity, and individual aspirations.     

Massive drive to reenergize the family planning programme

A massive drive has been launched throughout India in an effort to reenergize the family planning program. The Prime Minister has made a special appeal to the nation from radio and television networks and through the press to adopt the small family norm as a way of life. The Chief Ministers and the Health Ministers in the States have made similar appeals to the people and the doctors. The current drive was preceded by 18 months of concentrated efforts to vitalize the family planning program. The change in nomenclature from "family planning" to "family welfare" created some misunderstanding regarding the government's own commitment to the program, but it is now widely understood that while family welfare aims at the total welfare of the family, family planning is an essential part of it. The government has tried to involve all sectors of society in program efforts. The mass media is now focusing attention on "family welfare" almost continuously. In villages, a large-scale program of organizing education camps of opinion leaders is now underway. The rural health scheme, initiated in October 1977, promises to bring about increased participation of the people in village programs. 54,000 community health workers have already started serving the rural population in their areas. In 2-3 years there will be 1 trained community health worker in every Indian village.     

How colonisation determines social justice and Indigenous health—a review of the literature

Disparities in health status persist for Indigenous people in Australia. In the bid to reduce the disparity gap, the concept of achieving social justice is central to advancing the services and systems that can challenge inequitable circumstances within a nation. Colonisation is well known as the underlying factor influencing the social injustices that result in inequitable health for Indigenous people. A literature review was conducted identifying how the colonial impact on social justice is described in the relationships with the health of Indigenous Australians. A comprehensive search strategy was developed, including four broad search terms of ‘Indigenous people’ and ‘health status’ and ‘colonisation’ or ‘social justice’, and applied within five databases. Publications were limited to Australia, dated from 1 January 2000 to 31 December 2014. The literature acknowledging the effect that colonisation has on Indigenous Australians includes evidence from oral and political histories, and social determinants frameworks. There was a general consensus that the impact of colonisation on the health of Indigenous people is highly complex and that the legacies are experienced intra-generationally and inter-generationally. There is paucity in the evidence that examines the associations of colonisation and its impact on social injustice. Because social justice is considered central to equitable practices across all sectors in society (health, education, legal etc.), questions are raised about the magnitude of the effect that colonisation has on health disparities and importantly how the desideratum to tackle disparities that have stemmed from colonisation are adequately addressed.     

Challenging the colonisation of birth: Koori women’s birthing knowledge and practice

Background

The 2007 United Nations Declaration on the Rights of Indigenous Peoples states that Indigenous peoples have the right to self-determination for social and cultural development. This fundamental right has been impeded worldwide through colonisation where many Indigenous peoples have had to adapt to ensure continuation of cultural knowledge and practice. In South East Australia colonisation was particularly brutal interrupting a 65,000 year-old oral culture and archives have increasing importance for cultural revival.

Colonisation,racism and indigenous health

In settler-colonies such as Canada, Australia, New Zealand and the United States, the historical impacts of colonisation on the health, social, economic and cultural experiences of Indigenous peoples are well documented. However, despite being a commonly deployed trope, there has been scant attention paid to precisely how colonial processes contribute to contemporary disparities in health between indigenous and non-indigenous peoples in these nation-states. After considering pertinent issues in defining indigeneity, this paper focuses on operationalising colonisation as a driver of indigenous health, with reference to emerging concepts such as historical trauma. Conceptualisations of coloniality vis-à-vis health and their critiques are then examined alongside the role of racism as an intersecting and overlapping phenomenon. To conclude, approaches to understanding and explaining Indigenous disadvantage are considered alongside the potential of decolonisation, before exploring ramifications for the future of settler-indigenous relations.     

Breastfeeding initiation for Aboriginal and Torres Strait Islander women in Victoria: analysis of routinely collected population-based data

Background

Increasing breastfeeding rates is one way of improving the short and long term health of Aboriginal and Torres Strait Islander children (hereafter referred to as Aboriginal). Despite the benefits of breastfeeding and recommendations for strategies to increase breastfeeding among Aboriginal people, there is a lack of available population data.

Elements of cultural competence in an Australian Aboriginal maternity program

Background

Pregnancy, labour and neonatal health outcomes for Australian Aboriginal women and their infants are frequently worse than those of the general population. Provision of culturally competent services may reduce these differences by improving access to timely and regular antenatal care. In an effort to address these issues, the Aboriginal Maternity Group Practice Program commenced in south metropolitan Perth, Western Australia, in 2011. The program employed Aboriginal Grandmothers, Aboriginal Health Officers and midwives working in a partnership model with pre-existing maternity services in the area.

Sustainability of family planning and health projects

USAID has assisted the Ghanian Ministry of Health since 1991 to boost family planning services under the Ghana Family Planning and Health Project by providing supplies and information and increasing the effectiveness of HIV/AIDS prevention and control. The sustainability of the health system is endangered by favoring capital expenditures in lieu of continuous expenditures; the lack of linkage between project activities and regular activities; the centralization of resource flow; and too ambitious targeting. Capital outlays provided by USAID featured in the construction of four public health laboratories, but their operation also requires continuous financing amounting to about 10% of the whole investment. The latter is the responsibility of the government, although the details of these recurrent costs were not detailed at the outset and providing these funds for continuous operation may impair the operation of other systems. The resource constraints could be alleviated by an effective cost-recovery system or by the general improvement of the economy. The lack of linkage between project and regular activities is serious at regional and district levels. The centralization of resource flow means that most resources are kept for headquarter level activities, thus other activities suffer and the health sector becomes excessively reliant on donor support. Too ambitious planning stems from pressure on donors and hastily implemented projects result in duplication and waste. Closer consultation with the parties involved would improve the situation. The rivalry of technical and policy groups has contributed to past deficiencies. Double funding for the same activity has also occurred further increasing the dependence on donor funding. By concentration on people and systems sustainability would be enhanced, while cost recovery would help the operation of the laboratories. The Health Education Unit (HEU) recognized the importance of IEC and obtained financing for such activities.     

Comparing Self-Rated Health, Satisfaction and Quality of Life Scores Between Diabetics and Others Living in The Bella Coola Valley

Objective: To investigate the relative effect that diabetes has on self-rated health, satisfaction with various specific domains of life, and satisfaction with quality of life operationalized as happiness, satisfaction with life as a whole, and satisfaction with overall quality of life. Design: Mixed methods – mailed survey and chart review. Study Population: All people aged 17 years or older, residing in the Bella Coola Valley in September 2001 and having a chart at the Bella Coola Medical Clinic. Main outcome measures: Self-rated health, self-rated stress, rating of self-care received, global life satisfaction (Life as whole; Overall standard of living; Overall quality of life; and Overall happiness); and satisfaction with various domains of life. Results: A total of 968 useable surveys were returned for a response rate of 56 (968/1734). Age was negatively related to General Health, but positively related to Life Satisfaction. Not being of Aboriginal descent was positively related to all of the four global health indicators and to Subjective Well-Being. After accounting for age, race, and weight, we found that diabetics report significantly poorer self-rated health, and lower satisfaction with health scores compared to people without diabetes. Participants with diabetes who were the least compliant with their treatment regimens rated their current health significantly lower than those who were the most compliant. People with diabetes were, however, no more likely to be unhappy or dissatisfied with their lives as a whole or with the overall quality of their lives compared to people without diabetes. Among people with diabetes, however, those who used insulin did report significantly less satisfaction with the overall quality of their lives than those who didn’t use insulin. Conclusion: Diabetics understand they have poorer health than others, but they do not have poorer global life satisfaction scores. This may explain why it is difficult to get diabetics to adopt behaviours which may lower their quality of life – e.g., diet plans, lose weight, engage in exercise programs, or take medications.     

Aboriginal migration to the cities

Aboriginal migration to the cities is frequently assumed to be adding to the population of urban Aborigines. An analysis of actual patterns of Aboriginal migration to the large Australian cities (major urban areas), using data from the 1981 and 1986 Australian Censuses, shows that the major urban areas of New South Wales and Victoria were actually losing Aboriginal population through net migration throughout the period 1976 to 1986. At both inter-State level and country-to-city lev/el, any Aboriginal migration flow in one direction tends to be almost cancelled out by a flow of similar size in the opposite direction. However, there are definite age-specific patterns. In particular, there is movement of young single adults to the cities, often counterbalanced by migration of somewhat older adults with their children to the country. Aboriginal migrants have higher levels of labour-force participation than equivalent categories of non-migrants.     

The effects of child health on marital status and family structure

The purpose of this paper is to provide evidence on the effect of child health on marital stability and family structure in an economic framework. We use the 1988 National Health Interview Survey's Child Health Supplement, with a sample of about 9,000 families, to test whether having an unhealthy child decreases the mother's chance of being married and whether it increases her chance of living in an extended family. Using two different measures of child health, we find that having an unhealthy child decreases the mother's likelihood of being married. Our results imply that children in poor health are more likely to face obstacles beyond their illness because they also are more likely to suffer the consequences of poverty and the poor schooling outcomes that result from being raised in a female-headed household. The only mitigating factor is that unhealthy white children are more likely than their healthy counterparts to be living in an extended family.     

The Study on the Satisfaction of the Elderly People Living with Their Children

In today’s society, with the aging population, the satisfaction of the elderly people is highly connected with the social sustainability. This article used the data of the Chinese Health and the Pension Follow-up Survey from CHARLS in 2013 to analyze the relation between the elderly people’s satisfaction and their living arrangement. Based on the control of the influential factors on the individual, family and the regional level, this article used ordinary least square regression method to find out that the elderly people’s satisfaction will be deceased because of living with their children. However, the elderly people’s dissatisfaction will be vanished along with the growth of the age of the elderly. Therefore, the elderly people’s living arrangements have been changed, to maintain the satisfaction of the elderly in China, the appropriate health care and other activities should be redesigned and developed for the elderly who live by themselves.     

Workshop on promotion of reproductive health and family planning held

Two reproductive health advocacy networks have been established in two districts in eastern Africa to help promote family planning and reproductive health among the people in this area. The districts are the Suhum-Kraboa-Coaltar and the New Juaben Municipality. To enhance the performance of the network, a 4-day workshop was held at Koforidua for the members to prepare an action plan for their advocacy and map out areas of collaboration between the public and the private sector group. The workshop, organized by the Futures Group International based in the US with support from the USAID, was attended by 30 participants from nongovernmental organizations and public offices. In an address, Ms. Patience Adow, the Regional Minister observed that through the idea of family planning has been promoted in the country over the past two decades, the country continues to experience a population growth rate of about 2.8%. She expressed the hope that the workshop will equip the participants with the relevant skills to develop and implement their advocacy strategy effectively. Dr. J. E. Taylor, Medical Administrator of the Koforidua Central Hospital, who chaired the function in a bid to improve the health of women and the quality of life of the people. The Ministry of Health as part of its medium term strategic plan has developed the national reproductive health and service policy.