Background: Australian Aboriginal and Torres Strait Islander women are between two to five times more likely to die in childbirth than non-Aboriginal women, and two to three times more likely to have a low birthweight infant.

Babies with a low birthweight are more likely to have chronic health problems in adult life.

Currently, there is limited research evidence regarding effective interventions to inform new initiatives to strengthen antenatal care for Aboriginal families.

Method/Design:

The Aboriginal Families Study is a cross sectional population-based study investigating the views and experiences of Aboriginal and non-Aboriginal women having an Aboriginal baby in the state of South Australia over a 2-year period.

The primary aims are to compare the experiences and views of women attending standard models of antenatal care with those accessing care via Aboriginal Family Birthing Program services which include Aboriginal Maternal Infant Care (AMIC) Workers as members of the clinical team; to assess factors associated with early and continuing engagement with antenatal care; and to use the information to inform strengthening of services for Aboriginal families.

Women living in urban, regional and remote areas of South Australia have been invited to take part in the study by completing a structured interview or, if preferred, a self-administered questionnaire, when their baby is between 4–12 months old.

Discussion: Having a baby is an important life event in all families and in all cultures. How supported women feel during pregnancy, how women and families are welcomed by services, how safe they feel coming in to hospitals to give birth, and what happens to families during a hospital stay and in the early months after the birth of a new baby are important social determinants of maternal, newborn and child health outcomes.

The Aboriginal Families Study builds on consultation with Aboriginal communities across South Australia. The project has been implemented with guidance from an Aboriginal Advisory Group keeping community and policy goals in mind right from the start. The results of the study will provide a unique resource to inform quality improvement and strengthening of services for Aboriginal families.

Keywords: Antenatal care, Health inequalities, Indigenous health, Maternal health, Participatory research, Perinatal health outcomes.

Introduction

Australian Aboriginal and Torres Strait Islander women are between two to five times more likely to die in childbirth than non-Indigenous women, and two to three times more likely to have a low birthweight infant [1].

Babies with a low birth weight are more likely to die in infancy [2], more likely to be admitted to neonatal intensive care [3], and may be more likely to have serious health problems (e.g. cardiovascular disease, diabetes) in adult life [4]. Recent data suggest that in some Australian states, including South Australia, the proportion of low birth weight babies born to Aboriginal mothers may be increasing [5,6].

The Australian Government has set agreed targets for closing the gap in Indigenous disadvantage outlined by the Council of Australian Governments (COAG) in the National Indigenous Reform Agenda [7].

Under the terms of this agreement, federal, state and territory governments have committed to closing the gap in life expectancy between Aboriginal and non-Aboriginal Australians within a generation, and halving the gap in mortality rates for Aboriginal children under five within a decade.

Key performance indicators for the National Indigenous Reform Agenda include: an increase in the proportion of Aboriginal and Torres Strait Islander mothers receiving antenatal care in the first trimester of pregnancy (≤13 weeks’ gestation) and in the proportion of Aboriginal and Torres Strait Islander mothers attending five or more antenatal visits; and a reduction in the proportion of Aboriginal and Torres Strait Islander infants with a low birthweight (<2,500 grams).

New funding made available under the COAG National Partnership Agreement on Indigenous Early Childhood Development has facilitated a range of new programs and initiatives to strengthen antenatal care and child and maternal health services for Aboriginal families in all Australian states and territories [8].

Currently there is a dearth of research evidence regarding effective intervention strategies to inform these initiatives [9-12].

Most of the available evidence comes from small-scale local evaluation studies, predominantly undertaken in regional and remote locations [13-20]. The roll out of COAG funding under the National Partnership Agreement has in effect created an Australia wide ‘natural experiment’ in seeking to improve maternal and perinatal outcomes for Aboriginal and Torres Strait Islander women and children. It is vital that lessons learned fromthe range of programs being developed and implemented with COAG funding are captured by concurrent evaluation at a state and territory level.

However, there is still no complete national perinatal data for Aboriginal mothers and babies. State and territory based perinatal data collections vary in their capacity to ascertain Aboriginal and Torres Strait Islander status of mothers and infants, and steps have only recently been taken to include information regarding status of the infant in the minimum data set for most state jurisdictions [21].

This paper describes the development of a statewide study in South Australia that aims to invite approximately 300 women giving birth to an Aboriginal baby to talk about their experiences of using services during pregnancy, labour and birth, and the first 4–12 months after having a baby.

The study has been developed by researchers based at the Murdoch Childrens Research Institute and the University of Adelaide, in partnership with the Aboriginal Health Council of South Australia Inc. (AHCSA). The project arose in the context of planning for a population-based postal survey of recent mothers in South Australia and Victoria.

In 2006, the researchers planning this survey approached the AHCSA about working in partnership on a project to provide avenues for Aboriginal women’s voices to be included in the research. At our initial meeting we discussed the idea of seeking funding to facilitate consultations with Aboriginal community organisations and communities in South Australia as a way to seek input into development of the research. The Aboriginal Families Study is the name given to the project that grew out of these discussions. South Australia where the project is based is one of six Australian states, and covers a geographic area four times the size of the UK.

Often when researchers approach Aboriginal community organisations and/or communities, they already havea fairly well developed research question and study protocol in mind. We did not. This paper charts the social history of the project, and outlines the steps we took to get from our initial discussions in 2006 to the stage of developing the study protocol, governance arrangements, and procedures for carrying out the study.

These include: obtaining ‘in principle’ support from the Board of Management of the AHCSA for the conduct of consultations with Aboriginal communities about the project; development of a project agreement between MCRI and the AHCSA; establishment of an Aboriginal Advisory Group to guide the consultations, and subsequently, the development of the study protocol, and conduct of the research; statewide consultations with  Aboriginal communities, policy makers and service providers preceding development of the study design and methods; a lengthy pilot study phase that tested different versions of the study questionnaire and recruitment procedures; obtaining ethics approval from a variety of institutional ethics committees; development of a Research Agreement covering governance arrangements for the research phase of the study signed by all partner organisations and study investigators; appointment and training of the fieldwork team; through to recruitment and interviewing of women in urban, regional and remote areas of South Australia.