Estimating Indigenous life expectancy: pitfalls with consequences

The methods used by the Australian Bureau of Statistics (ABS) to estimate life expectancies of Aboriginal and Torres Strait Islander peoples in 2009 have been controversial and require critical and sensitive analysis. The introduction by ABS of the direct method for estimating Indigenous life expectancies, based on estimated deaths and populations, has been generally welcomed. But the way this method has been applied and, in particular, death estimates used by the ABS, warrant scrutiny. These estimates were based on a first ever linkage between Indigenous deaths and census records following the 2006 census. Census-based identification was used in place of identification in the death registrations, rather than as a supplementary data source. The various national, state and regional life expectancy estimates published may have been biased upwards by this process. Because the impact of the methodology varies across Australia, regional differentials reported appear substantial but are not soundly based. The questionable ABS results are highlighted and discussed. Analysis based on more comprehensive linkage of death records in New South Wales over 5?years suggests that the ABS methods have understated Indigenous deaths and so overstated life expectancy. The effect of an alternative ABS approach is also discussed. ABS estimates published in 2009 are not necessarily definitive and may well overestimate Aboriginal and Torres Strait Islander life expectancy and underestimate the life expectancy gap. Estimates should be based on accurate estimates of deaths and population. Consultation and a thorough review are essential before the next round of estimates following the findings of the 2011 population census. Closing the Gap commitments focus on eliminating the life expectancy gap between Aboriginal and Torres Strait Islander peoples and other Australians. Life expectancy estimates need to be based on methods and data that are well understood and broadly supported. The alternative is unproductive debate about statistics rather than the range of policies and resourcing issues needed to improve Indigenous health.     

Review of online breastfeeding information for Aboriginal and Torres Strait Islander women

BackgroundBreastfeeding provides the healthiest start to life, but breastfeeding rates amongst Aboriginal and Torres Strait Islanders is lower than non-Indigenous women.AimTo assess the accuracy, quality and appropriate presentation of online breastfeeding information for Aboriginal and Torres Strait Islander women in Australia.MethodsAn online search conducted in Google, Bing and Yahoo search engines to identify any breastfeeding websites that provided information for Aboriginal and Torres Strait Islander women. Relevant websites were evaluated against: a) National Health and Medical Research Council clinical guidelines, b) the quality of health information on the Internet by using DISCERN instrument, and c) appropriate key design features for Aboriginal and Torres Strait Islander women.ResultsThe search located 348 sites with 31 being eligible for inclusion. Websites from governmental organizations had the highest accuracy while YouTube videos had the lowest accuracy. Three quarters (74%, n = 23) of sites incorporated the national clinical guidelines adequately, and most of the sites (77.8%, n = 24) were considered high quality. Only 23% (n = 7) of sites had sufficient key design features appropriate for Aboriginal and Torres Strait Islander women. Four websites were considered exemplary for their accuracy, quality and cultural appropriateness of information for Aboriginal and Torres Strait Islander women.ConclusionSome websites are tailored to provide breastfeeding information and support to Aboriginal and Torres Strait Islander women. However, only a few contain culturally appropriate key design features. Further participatory action research is required to design online platforms for women from different cultural backgrounds that take into account cultural principles, beliefs and values.     

Community perspectives on delivering trauma-aware and culturally safe perinatal care for Aboriginal and Torres Strait Islander parents

BackgroundSince colonisation, Aboriginal and Torres Strait Islander peoples have experienced violence, loss of land, ongoing discrimination and increased exposure to traumatic events. These include adverse childhood experiences which can lead to complex trauma, and are associated with increased incidence of high-risk pregnancies, birth complications and emergence of post-traumatic symptoms during the perinatal period, potentially impacting parenting and leading to intergenerational trauma. The perinatal period offers unique opportunities for processing experiences of trauma and healing yet can also be a time when parents experience complex trauma-related distress. Therefore, it is essential that trauma-aware culturally safe perinatal care is accessible to Aboriginal and Torres Strait Islander parents.AimThis study aimed to understand community perspectives of what ‘trauma-aware culturally safe perinatal care’ would look like for Aboriginal and Torres Strait Islander parents.MethodsData were collected during a workshop held with predominantly Aboriginal and Torres Strait Islander key stakeholders to co-design strategies to foster trauma-aware culturally safe perinatal care. Data were thematically analysed.FindingsFour overarching themes represent proposed goals for trauma-aware culturally safe care: Authentic partnerships that are nurtured and invested in to provide the foundations of care; a skilled workforce educated in trauma awareness; empowering and compassionate care for building trust; and safe and accessible environments to facilitate parent engagement.ConclusionsProvision of trauma-aware culturally safe care achieving these goals is likely to enable parents experiencing complex trauma to access appropriate support and care to foster healing in the critical perinatal period.     

Factors influencing Aboriginal and Torres Strait Islander women’s breastfeeding practice: A scoping narrative review

BackgroundThe nutritional and health benefits of breastfeeding for infants and young children are well-established however rates of breastfeeding initiation and duration for Aboriginal and Torres Strait Islander children are lower than non-Indigenous children.AimTo describe factors influencing breastfeeding practice amongst Aboriginal and Torres Strait Islander women.MethodsA scoping narrative review was conducted using the Joanna Briggs Institute framework. A search was conducted in four online databases (PubMed, Scopus, ANU SuperSearch, and Science Direct). Findings were analysed using [30] narrative synthesis.FindingsThis review included 9 journal articles, a conference summary and a book. This review identified four factors influencing women’s breastfeeding practice; sources of support, culturally appropriate care, intention to breastfeed and social determinants.ConclusionMultiple social determinants resulting from colonization have interrupted traditional infant feeding practices and women’s sources of support. Although Aboriginal and Torres Strait Islander women have strong intention to breastfeed, their breastfeeding outcomes are impacted by lack of pro-breastfeeding support when encountering breastfeeding challenges as well as norms surrounding the use of infant formula milk. Culturally appropriate care is essential for identifying women’s needs and avoiding stereotyping. Further research is needed to investigate the effectiveness of breastfeeding interventions for this group of women.     

Aboriginal migration and labour market programs

Despite the potential for government employment policies both to encourage and preclude migration among the Aboriginal workforce, little is known about the impacts of such policies. This paper seeks to construct a base line for identifying these impacts by establishing the spatial structure of labour migration among the Aboriginal and Torres Strait Islander population. It makes use of 1986 Census data to describe the volume and pattern of net and gross flows of working-age Aborigines and Islanders through the national settlement system, distinguishing between movements in remote and closely settled parts of the country. Full determination of the links between policy and migration flows awaits comparison with 1991 Census results.     

Indigenous Australian population projections: problems and prospects

According to estimates from the 2006 Census, Aboriginal and Torres Strait Islander (Indigenous) Australians made up 2.5 % of the total Australian population. However, the focus of research and policy debate on Indigenous Australians far exceeds their population size for reasons of history, socio-economics, geography and demography. This has led to a need for accurate population projections of the population. In this paper, we outline a number of issues related to Indigenous population projections. These include the nature of self-identification; the impact of particular policy changes; significant differences in demographic parameters; and high rates of exogamy, especially in urban areas. We also document the relative accuracy of past and current population projections. In the final section of the paper we outline a research agenda that has the potential to lead to new and better Indigenous population projections.     

Is aboriginal fertility on the decline?

This paper examines if there has been sustained Aboriginal fertility decline since the mid-1980s, as expected in previous studies (Gray 1983, 1990; Jain 1989), by analysing fertility information obtained from the 1994 National Aboriginal and Torres Strait Islander Survey, birth registrations and midwives’ collections data by states. Although two studies (Gray and Tesfaghiorghis 1993:87–90; Dugbaza 1994) refuted this expectation, the results are questionable because of the unreliability of the data on which the estimates were based and the lack of fertility information. This study has produced more reliable age patterns of fertility at the national and state levels. The paper also examines the definition of Aboriginality and associated measurement problems, which are central to an understanding of Aboriginal demography.     

Using participatory action research to co-design perinatal support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma

Problem & backgroundSupport is important for all parents but critical for those experiencing complex trauma. The The Healing the Past by Nurturing the Future project uses participatory action research to co-design effective perinatal support for Aboriginal and Torres Strait Islander parents.AimThis research aims to identify and refine culturally appropriate support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma.DesignWe presented our synthesised eight parent support goals and 60 strategies, collated from Elder and parent focus groups, previous participatory workshops, and evidence reviews, for discussion at a stakeholder workshop. Stakeholder perspectives were captured using a three-point agreement activity and, self- and scribe-recorded comments. Aboriginal and non-Aboriginal researchers analysised the qualitative data, to identify core factors which might facilitate or help enact the parenting related goals.FindingsOverall, stakeholders (n = 37) strongly endorsed all eight goals. Workshop attendees (57% Aboriginal) represented multiple stakeholder roles including Elder, parent and service provider. Four core factors were identified as crucial for supporting parents to heal from complex trauma: Culture (cultural traditions, practices and strengths), Relationality (family, individual, community and services), Safety (frameworks, choice and control) and Timing (the right time socio-emotionally and stage of parenting).DiscussionContext-specific support tailored to the Culture, Relationality, Safety, and Timing needs of parents is essential. These four factors are important elements to help enact or facilitate parenting support strategies.ConclusionFurther work is now required to develop practical resources for parents, and to implement and evaluate these strategies in perinatal care to address cumulative and compounding cycles of intergenerational trauma.     

The Stages of Human Capital and Economic Growth: Does the Direction of Causality Matter for the Rich and the Poor?

This paper demonstrates that key models of human mobility across several disciplines can be considered as specific cases of a broader conceptualisation of mobility in terms of its contribution to wellbeing. It is argued that this wellbeing perspective offers important advantages for the formulation of policy in areas that must respond to mobility in cross-cultural contexts, and particularly in regard to policy relating to highly mobile, indigenous peoples. An applied example is provided through a discussion of how this conceptualisation of mobility offers a different understanding of the mobility of Aboriginal and Torres Strait Islander Australians, one that may have led to superior policy outcomes.     

Aboriginal population prospects

Data from the 1991 Census largely confirm earlier projections of the size and structure of the Aboriginal population, although the data for Torres Strait Islanders are markedly inconsistent with previous counts. The 1986 and 1991 Censuses mark the first intercensal period for decades for which Aboriginal population counts have been consistent. This provides an opportunity, taken in this paper, to examine closely the discrepancies between projections and the 1991 Census and to comment on ways in which determinants of Aboriginal population change are diverging from the parameters used for previous projections. We pay particular attention to mortality prospects, because of the occurrence in the 1991 Census of a higher than expected sex ratio and differences between projections and counts for certain age groups. We note the evidence for under-enumeration of the Aboriginal population in particular age groups in the 1991 Census as in previous censuses, and estimate the size of adjustments necessary to correct for some, but not all, of these deficiencies. The analysis shows that Aboriginal fertility increased in the second half of the 1980s.     

Stillbirth in Australia 3: Addressing stillbirth inequities in Australia: Steps towards a better future

Persistent disparities in stillbirth risk and care are present in Australia. Eliminating these disparities is possible with a commitment to enhancing and scaling up models of culturally safe maternity care shown to be effective for Aboriginal and Torres Strait Islander women and those of migrant and refugee backgrounds. Campaigns to improve public awareness of stillbirth also play an important role in reducing stillbirth risk and consequences. To achieve reach and impact in communities at risk, messaging needs to be framed around the social and cultural context of women’s lives. Here we describe important initiatives underway within the Stillbirth Centre of Research Excellence to develop a coordinated national approach to stillbirth prevention and care in communities that bear a disproportionate burden of stillbirth.     

Factors associated with breastfeeding initiation and maintenance for Aboriginal and Torres Strait Islander women in Australia: A systematic review and narrative analysis.

BackgroundAustralian Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) women breastfeed at lower rates than non-Aboriginal women. Little is known about factors associated with breastfeeding specific to Aboriginal women and infants.AimDetermine the protective and risk factors associated with breastfeeding for Aboriginal women in Australia.MethodsCINAHL, Medline, EMBASE, SCOPUS, PsycINFO, and the Cochrane library were searched for peer-reviewed literature published between 1995 and 2021. Quantitative studies written in English reporting protective and risk factors associated with breastfeeding for Aboriginal women or women having an Aboriginal infant were included. Ten percent of papers were co-screened, and two reviewers completed data extraction. Narrative data synthesis was used.FindingsThe initial search identified 12,091 records, with 31 full text studies retrieved, and 17 reports from 14 studies met inclusion criteria. Protective factors included living in a remote area, attending an Aboriginal-specific service, attending a regional service, higher levels of education attainment, increased maternal age, living in larger households, being partnered, and having a higher reported number of stressful events and social health issues. The identified risk factors were smoking in pregnancy, admission to SCN or NICU, and being multiparous.ConclusionThis review identified factors associated with breastfeeding for Aboriginal women. Government focus, support, and consistent funding are required to plan and implement evidence-based interventions and services for Aboriginal women and infants in urban, rural, remote, and very remote locations. Rigorous research is required to understand the Aboriginal-specific factors associated with breastfeeding to improve rates and health outcomes for Aboriginal women and infants.     

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.     

Breastfeeding rates of Aboriginal and Torres Strait Islander women in Australia: a systematic review and narrative analysis

BackgroundAustralian Aboriginal and Torres Strait Islander (referred to hereafter as Aboriginal) women breastfeed at lower rates than non-Aboriginal women, and rates vary across and within Aboriginal populations.AimTo determine rates of breastfeeding initiation and maintenance and compare individually collected survey data with existing routinely collected state and national breastfeeding data for Aboriginal women.MethodsCINAHL, Medline, EMBASE, SCOPUS, PsycINFO, and the Cochrane library were searched for peer-reviewed literature published between 1995 and 2021. Quantitative studies written in English and reporting breastfeeding for Aboriginal women or women having an Aboriginal infant were included. Screening and quality assessment included co-screening 10% of papers. Two reviewers completed data extraction. A proportional meta-analysis was undertaken for breastfeeding initiation and narrative data synthesis used to summarise breastfeeding maintenance.FindingsThe initial search identified 12,091 records, with 31 full text studies retrieved, and 27 reports from 22 studies met inclusion criteria. Breastfeeding initiation was 78% (95% CI 0.71, 0.84), however, rates were lower than non-Aboriginal women. Maintenance ranged between one week and five years. Rates and definitions varied significantly between studies, with inconsistencies in government collection and reporting of breastfeeding.ConclusionSignificant variation in definitions and reporting make comparisons difficult. Breastfeeding rates were below recommended targets. Future pattern and trend analyses require standardised measures and definitions. Current collection and reporting of breastfeeding data, particularly routinely collected state-based data, is inadequate to present an accurate picture of current breastfeeding in Australia for Aboriginal women and infants, and to effectively inform interventions and policies.     

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.     

Midwifery: "at the edge of history"

The paper focuses on possible future pathways in maternity care for midwives and nations to consider. The paper blends personal and professional experiences to outline priority areas facing midwives in the future. It begins by examining maternal mortality and morbidity in the developing world and considering the potential of the ten high priority action messages (1997) in helping to improve the plight of women and children in the future. The paper then examines major issues facing midwives in the developed world including: the way birth is viewed; the medical-midwifery divide; marketing midwifery; and finally the challenge of dealing with fear around birth. The third part of the paper examines a part of society where the two worlds meet and there are issues from both the developed and developing world to consider. The paper focuses on women from culturally and linguistically diverse communities, Aboriginal and Torres Strait Islander women and women birthing in remote and rural areas. By looking at these three worlds separately the paper examines different concerns facing midwives in the future but also draws on common issues that face us all as citizens of this planet and particularly as predominantly women. The paper challenges midwives to be politically active and dare to change the world.     

Remote access and care: A comparison of Queensland women's maternity care experience according to area of residence

BackgroundThis study fills a gap in the literature with a quantitative comparison of the maternity care experiences of women in different geographic locations in Queensland, Australia.MethodData from a large-scale survey were used to compare women's care experiences according to Australian Standard Geographical Classification (major city, inner regional, outer regional, remote and very remote).ResultsCompared to the other groups, women from remote or very remote areas were more likely to be younger, live in an area with poorer economic resources, identify as Aboriginal and/or Torres Strait Islander and give birth in a public facility. They were more likely to travel to another city, town or community for birth. In adjusted analyses women from remote areas were less likely to have interventions such as electronic fetal monitoring, but were more likely to give birth in an upright position and be able to move around during labour. Women from remote areas did not differ significantly from women from major cities in their satisfaction with interpersonal care. Antenatal and postpartum care was lacking for rural women. In adjusted analyses they were much less likely to have booked for maternity care by 18 weeks gestation, to be telephoned or visited by a care provider in the first 10 days after birth. Despite these differences, women from remote areas were more likely to be breastfeeding at 13 weeks and confident in caring for their baby at home.ConclusionsFindings support qualitative assertions that remote and rural women are disadvantaged in their access to antenatal and postnatal care by the need to travel for birth, however, other factors such as age were more likely to be significant barriers to high quality interpersonal care. Improvements to maternity services are needed in order to address inequalities in maternity care particularly in the postnatal period.