Indigenous fertility in the Northern Territory of Australia: what do we know? (and what can we know?)

In the Northern Territory of Australia, Indigenous people make up 30% of the population. Demographic features of the Indigenous population are thus important for understanding Northern Territory population dynamics, but our understanding of what is happening within the Indigenous population is limited by poor data and limited research attention. This paper exploits birth registration and census data to explore Northern Territory Indigenous fertility trends over a 20-year period. It investigates whether fertility decline identified for the 1960 and 1970s is a contemporary feature of Indigenous fertility in the Northern Territory. Results show that our understanding of Northern Territory Indigenous fertility is heavily constrained by data and that trend analysis is essential for avoiding erroneous conclusions because of annual fluctuations. The outstanding feature of Indigenous fertility in the Northern Territory is women becoming mothers at extremely early ages, particularly in rural and remote parts of the Territory. Age patterns appear to have changed little since the middle of last century despite modest declines in age-specific fertility at the youngest ages. While these declines may continue, any trends will be slow to emerge. Continued close scrutiny of data sources and monitoring of trends is needed to ensure that Northern Territory population dynamics are properly understood, and care must be taken in interpreting results to make certain policy interventions aimed at population outcomes are appropriate and achievable.     

Independent Correlates of Reported Gambling Problems Amongst Indigenous Australians

To identify independent correlates of reported gambling problems amongst the Indigenous population of Australia. A cross-sectional design was applied to a nationally representative sample of the Indigenous population. Estimates of reported gambling problems are presented by remoteness and jurisdiction. Multivariable logistic regression was used to identify independent correlates of reported gambling problems amongst individuals and their social and family networks. The analysis was stratified by remoteness. Indigenous people living in remote locations reported significantly more gambling problems than those living in non-remote locations. In non-remote areas, being female, having high personal income, being more socially connected (i.e. involved in an Indigenous organisation or living in a household where all members were Indigenous) and reporting community problems were associated with higher levels of reported gambling problems. In remote areas, multifamily households, participation in sports and cultural events, and reporting of community problems were associated with higher reported gambling problems, while having a relative removed from their natural family was associated with lower reported problems. Problematic gambling is clearly related to the social and environmental contexts in which it occurs. Harm minimisation policies that focus on a reduction in crowding (especially in remote locations), increased public awareness of the negative consequences of gambling, improving access to support services, and lifting the socioeconomic status of Indigenous people may reduce gambling related harm in the medium to long term.     

Measuring and Analysing the Wellbeing of Australia’s Indigenous Population

According to most standard socioeconomic indicators (for example employment, income and education), Indigenous Australians tend to have worse outcomes than their non-Indigenous counterparts. Most objective health indicators including life expectancy also tend to be worse. Traditionally, these two domains and associated objective indicators have been the focus of research, government policy and evaluation. There has been less research, however, on differences between Indigenous and non-Indigenous Australians in subjective measures of wellbeing. In this paper, I attempt to answer three related research questions on Indigenous wellbeing—What is the average level of emotional wellbeing and satisfaction with life for the Indigenous and non-Indigenous population of Australia? How do the differences between the two populations change once other characteristics have been controlled for? What are the factors associated with emotional wellbeing within the Indigenous population? With regards to the first two questions, Indigenous Australians are less likely to report frequent periods of happiness and more likely to report periods of extreme sadness than the non-Indigenous population. Surprisingly, given these results for emotional wellbeing, a major finding from the analysis was that Indigenous Australians were significantly more likely to report above-average satisfaction with their life. The main finding with regards to the third question is that using retrospective measures, those in remote areas report higher levels of happiness than those in non-remote areas. This is different to the results for socioeconomic status and objective measures of health found elsewhere and has important implications for government policy in Australia.     

CONSTRUCTING A HEALTH AND SOCIAL INDICATOR FRAMEWORK FOR INDIGENOUS COMMUNITY HEALTH RESEARCH

Health and social indicators that capture the distinct historical, social, and cultural contexts of Indigenous communities can play an important role in informing the planning and delivery of community interventions. There is currently considerable interest in cataloguing and vetting meaningful community-level health and social indicators that could be applied to research and health promotion activities in Indigenous communities in Australia, Canada, and New Zealand, inclusive of conventional indicators as well as measures developed specifically for use in or with Indigenous communities. To avoid haphazard selection of indicators, and to assure the comprehensiveness and relevance of any given set of indicators, a framework that can accommodate and conceptually classify indicators representing a full range of domains is required. We report here on the development of a conceptual framework, by which Indigenous community indicators, and more general community-level social indicators, can be sorted, catalogued, and systematically classified within four hierarchical levels. The indicator framework was developed across Canada, Australia and New Zealand in consultation with academic researchers and Indigenous community stakeholders, building from established health and social indicator systems. The Indigenous indicator framework permits Indigenous communities, public health researchers, and funding agencies to compare and select the most appropriate indicators for application in specific contexts from the multitude of existing indicators.     

The future of Australia’s Indigenous Population, 2011–61

Existing projections of Australia’s Indigenous Population suffer from a number of limitations: problematic input data, unsatisfactory projection model design, and poor forecast performance. The aim of this study was to create a new model for projecting that population that better represents the demographic processes at work, and that makes use of a newly available data source on identification change. A new projection model is presented that explicitly incorporates ethnic-identification change, and mixed (Indigenous/Non-Indigenous) partnering and childbearing. It is a composite static–dynamic model which takes a multi-state form where data allow. The model was used to produce projections for the 2011–61 period. Rapid growth of the Indigenous Population is expected, with population momentum, identification change, and mixed partnering and childbearing shown to contribute more to growth than above-replacement fertility and increasing life expectancy. The future growth of Australia’s Indigenous Population is thus intimately connected to its interaction with the Non-Indigenous Population.     

Childbirth evacuation among rural and remote Indigenous communities in Canada: A scoping review

ProblemRoutine evacuation of pregnant Indigenous women from remote regions to urban centres for childbirth is a central strategy for addressing maternal health disparities in Canada. Maternal evacuation continues despite mounting evidence of its negative impacts on Indigenous women and families.BackgroundSince the 1960s, pregnant Indigenous women living in remote regions in Canada have been transferred to urban hospitals for childbirth. In the following decades, evidence emerged linking maternal evacuation with negative impacts on Indigenous women, their families, and communities. In some communities, resistance to evacuation and the creation of local birthing facilities has resulted in highly diverse experiences of childbirth and evacuation.AimA scoping review mapped the evidence on maternal evacuation of Indigenous women in Canada and its associated factors and outcomes from 1978 to 2019.MethodsWe searched MEDLINE, Embase, and CINAHL, and grey literature from governmental and Indigenous organizations. We collated the evidence on maternal evacuation into 12 themes.ResultsFactors related to evacuation include (a) evacuation policies (b) institutional coercion (c) remoteness and (d) maternal-fetal health status. Evacuation-related outcomes include (e) maternal-child health impacts (f) women’s experience of evacuation (g) financial hardships (h) family disruption (i) cultural continuity and community wellness (ij) engagement with health services (k) self-determination, and (l) quality of health services.DiscussionNumerous emotional, social and cultural harms are associated with evacuation of Indigenous women in Canada. Little is known about the long-term impacts of evacuation on Indigenous maternal-infant health. Evidence on evacuation from remote Métis communities remains a critical knowledge gap.     

The labour supply of Indigenous Australian females: the effects of fertility and interactions with the justice system

Indigenous females are among the most disadvantaged groups in Australia; Furthermore outcomes for Indigenous Australians compare unfavourably with those for similar First Nations around the world. There appears to be a demographic transition under way in Indigenous Australia whereby declines in fertility and mortality are likely to lead to an increase in the number of Indigenous people supplying their labour in the near future. This paper examines the determinants of Indigenous female labour force participation with a particular focus on the role of fertility and interaction with the justice system. The analysis controls for the standard determinants of labour supply, but its main contribution is in taking into account the endogeneity of these potential interruptions to labour market participation. These findings are also important because Indigenous Australian females are 22 times more likely to be in prison than other Australian females and hence the analysis has crucial implications for the ability of policy makers to ‘close the gaps’ between Indigenous and other Australians. Once endogeneity of fertility with labour supply is taken into account, there is no significant independent effect on labour force participation and hence policy should focus on the other factors including education and training.     

Culture and Wellbeing: The Case of Indigenous Australians

A recurring theme in Indigenous affairs in Australia is a tension between maintenance of Indigenous culture and achievement of socio-economic ‘equity’: essentially ‘self-determination’ versus ‘assimilation’. Implicit in this tension is the view that attachment to traditional cultures and lifestyles is a hindrance to achieving ‘mainstream’ economic goals. Using data from the National Aboriginal and Torres Strait Islander Social Survey, stronger attachment to traditional culture is found to be associated with enhanced outcomes across a range of socio-economic indicators. This suggests Indigenous culture should be viewed a part of the solution to Indigenous disadvantage in Australia, and not as part of the problem.     

Changing Australia’s Age Pension Qualification Age: Modelling Differential Effects by Race

Increasing the age at which people are eligible for the age pension is one mechanism by which governments of developed nations are attempting to manage increasing costs associated with population ageing. In Australia, there are a number of groups within the population who may be affected in unintended ways by increasing the eligibility age to 70 years by the year 2035, as was proposed in the 2014 Federal Budget. Most notably, Aboriginal and Torres Strait Islander (Indigenous) Australians currently with an average at birth life expectancy of 69.1 years for males and 73.7 years for females, nearly 11 years less than non-Indigenous Australians, may be the most affected. This study explores the consequences of the proposed future amendments to the age pension eligibility age, using projections of the likely age structures of future populations to estimate expected years of life remaining after reaching pension age. Despite projected improvements for Indigenous life expectancies, increasing the pension eligibility age under the schedule proposed in the policy would significantly reduce the expected years in post pension age, thus countering some of the anticipated benefits flowing from expected future life expectancy increases. However, if the eligibility age were to be increased more gradually, Indigenous Australians would be afforded a greater opportunity to access age pension benefits, whilst still reducing the length of time the non-Indigenous population is eligible to access the age pension, thus fulfilling policy objectives to manage increasing costs associated with population ageing.     

The EPDS and Australian Indigenous women: A systematic review of the literature

ProblemThe Edinburgh Postnatal Depression Scale (EPDS) is considered the gold standard in perinatal mental health screening and the Australian Clinical Practice Guidelines recommend universal use. However, screening rates are four times lower with Indigenous Australian women compared to non-Indigenous women. Difficulties have been reported using the EPDS in this context.BackgroundEvidence demonstrates the link between perinatal mental health and maternal and child outcomes. Indigenous Australian maternal and child health and wellbeing outcomes remain unacceptably poor across all measured parameters and reported psychological distress and child removal rates are increasing.MethodsA systematic literature review was conducted to assess the effectiveness, validity, reliability, and cultural safety of the EPDS in the Indigenous Australian context and identify the availability and suitability of any adaptations.FindingsThe EPDS has not been validated for use with Indigenous Australian women.DiscussionThe findings and limitations identified in this review are consistent with concerns in other countries about the cross-cultural use of the EPDS and its sensitivity in predicting risk for postnatal depression amongst Indigenous women. Where adaptations of the EPDS have been used there has been no psychometric and cultural validation beyond the remote communities in which they were developed.ConclusionsThere is no evidence to demonstrate that the EPDS in its current form and application is suitable for screening with Indigenous Australian women. Urgent work is required to evaluate and/or develop culturally meaningful screening tools that are predictive of risk for social and emotional wellbeing and perinatal mental distress in this context.     

Indigenous Wellbeing Frameworks in Australia and the Quest for Quantification

There is an emerging global recognition of the inadequacies of conventional socio-economic and demographic data in being able to reflect the relative wellbeing of Indigenous peoples. This paper emerges out of a recent desktop study commissioned by an Australian Indigenous organization who identified a need to enhance local literacies in data collection and interpretation in order to monitor the wellbeing of the Indigenous people within their region, manage governments in respect of their civic responsibilities to this population, and proactively and imaginatively plan for the future of the Indigenous people in their region. In canvassing available data and the growing Indigenous wellbeing literature, it became apparent that conventional statistical collections used to report on the status of populations are governed by a series of assumptions regarding three related concepts: wellbeing; demography; and economic productivity and prosperity. These assumptions have direct implications for how Indigenous peoples are represented to governments and broader society. The paper draws together the existing threads of literature regarding Indigenous wellbeing research to posit a possible broader framework for organising various kinds of Indigenous wellbeing analyses. In doing so, it identifies important shortcomings and deficits in the kinds of data that are available to Indigenous peoples in presenting themselves and their aspirations to governments with. It also opens up a critical analysis of the opportunities and obstacles for Indigenous communities in undertaking such research.     

Remote dwelling Aboriginal Australian women and birthing: A critical review of literature

Problem

Australian Aboriginal women’s aspirations for birthing on country (having our babies born on our traditional land) are increasingly being reported in Australian scholarly and policy literature. However given the paucity of publications authored by Aboriginal Australians from remote areas of Australia, how well can the current knowledge base in Australia inform the development of culturally appropriate maternity services for our communities?

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.     

Uncontained subjects: Population and household in remote aboriginal Australia

The particular abstractions represented by the terms population and house-hold are central categories in modern demographic analysis. They form the organizing principles of national censuses in Western liberal democracies such as Australia, and profoundly influence both the collection methodology and the content of the collection instrument. This paper argues that these categories are founded on a particular metaphor, the ‘bounded container’, that broadly reflects the population and household structures of sedentary societies such as mainstream Australia. Bounded discrete categories are conducive to the collection of reliable census data in such societies, since unbounded behaviours can be controlled for by statistical means. However, remote Abprogoma; populations behave in radically unbounded ways. This paper proposes that the dominant metaphor underlying Yolngu (and much remote Aboriginal) sociality is, instead, the nodal network. It then explores the consequences of attempting to capture nodal network societies in terms of models based on the bounded container.     

Indigenous demography and public policy in Australia: population or peoples?

This paper reviews the application of demographic analysis to Indigenous Affairs public policy in Australia as an exemplar case of the demography of disadvantage. Demography has found a natural and successful role using census, survey and administrative data, but for the most part this is restricted to a series of gap analyses based on a deficit model of Indigenous well-being as measured by standard social indicators. While useful for macropolicy settings, translation of these research findings into coherent policy on the ground is thwarted by a lack of ethnographically informed data that account for the intercultural world in which many Indigenous people exist and operate. This is because the categories and contexts deployed are uncritically those of the mainstream, and not those reflective of Indigenous social structures or life projects. This inadequacy is explored against the background of an emerging dialogue between demography and anthropology. Ironically, Australian demographers pioneered such a dialogue but so far it has failed to penetrate demographic research that informs Indigenous public policy.     

Canada’s forced birth travel: towards feminist indigenous reproductive mobilities

ABSTRACT

The mandatory travel for birth experienced by Indigenous women living in rural and remote areas of Canada is examined using an emergent lens of Indigenous reproductive mobilities. Current evacuation practices are contextualized within the historic and ongoing systems of oppression experienced by Indigenous people in Canada. Indigenous feminist and decolonial theoretical approaches are used to outline one way in which Indigenous women counter settler colonialism to assert sovereignty over their birth experiences – through the resurgence of culturally-based doulas or birth workers. A further contribution of these analyses is the inclusion and centering of the voices and experiences of those previously neglected within this particular body of scholarship, shifting the power relations underpinning reproductive mobilities.     

Rating Health and Social Indicators for Use with Indigenous Communities: A Tool for Balancing Cultural and Scientific Utility

This study reports on the development and evaluation of a rating tool to assess the scientific utility and cultural appropriateness of community-level indicators for application with Indigenous populations. Indicator criteria proposed by the U.S. Institute of Medicine were culturally adapted through reviewing the literature and consultations with academic and Indigenous stakeholders. Pre-testing and collaborator feedback drove the iterative development of the tool with stakeholder groups in Canada, Aotearoa/New Zealand, and Australia. Pilot testing with 17 raters across countries involved rating the same selection of six health and social indicators using a six-point ordinal scale. The final version of the rating tool includes 16 questions within three criterion domains: importance, soundness, and viability. Academic and community stakeholder review established face and content validity. The indicator rating tool demonstrated good internal consistency and excellent inter-rater reliability for two of three pilot testing groups. Use of this instrument can strengthen collaborative research planning and evaluation with Indigenous communities through selection of relevant and culturally appropriate indicators for application to public health research, prevention programmes, and health and social policy.     

Ethnographic perspectives on the enumeration of aboriginal people in remote Australia

This paper compares population counts and age distributions from the last two Australian Bureau of Statistics (ABS) enumerations of the Aboriginal population of Aurukun, Cape York Peninsula, with the results of detailed ethnographic surveys of the same population at similar points in time. This reveals substantially lower numbers for the ABS counts, particularly of young adults and children. Reasons for this discrepancy are sought in the ethnographic realities of remote indigenous communities and an alternative methodology for Aboriginal enumeration in remote regions is suggested.     

An Indigenous Knowledges Perspective on Valid Meaning Making: A Commentary on Research with the EDI and Aboriginal Communities

Offering an Indigenous perspective, this commentary discusses collaborative research, shared meaning making, and knowledge building specific to child development, and reflects on social, cultural, and historical aspects that influence these processes. Drawing upon experiences of developing a collaborative research approach with which to engage Aboriginal communities to appreciate, understand, and potentially use the Early Development Instrument (EDI; Janus and Offord in Can J Behav Sci 39:1–22, 2007), a teacher-administered rating scale on kindergarten children’s development, the commentary focuses on five key questions relevant to research processes undertaken with Indigenous Peoples, and the importance of social, ethical, and cultural aspects of validity: How do Indigenous epistemologies and knowledges inform and influence research processes that utilize the EDI as a measurement tool? How can the EDI be used as a measurement tool within a research process that fosters the thriving of children and their families in Aboriginal communities while promoting Indigenous Peoples’ self-determination? In what ways do local, Indigenous cultural and ethical considerations inform aspects of validation research pertaining to the EDI? How can (Western mainstream) universities build research capacity that is informed by Indigenous knowledges and ways of being, doing, and knowing? What are the potential consequences of using normative research tools—such as the EDI—as a method to build knowledge on children’s development with Indigenous Peoples and Aboriginal communities? This commentary suggests that from an Indigenous perspective, research on child development is valid and meaningful knowledge if it is clearly linked to the children’s and families’ wellbeing according to local cultural norms and values.