This report presents the findings of a project which assessed Aboriginal and Torres Strait Islander women’s access to hospitals with public birthing services and 3 other types of maternal health services across Australia, then investigated possible high-level associations between access, maternal risk factors and birth outcomes.
Access to services
The study examined the geographic access of Indigenous women of child-bearing age (15–44) to 4 types of on-the-ground maternal health services: hospitals with a public birthing unit; Indigenous-specific primary health-care services (ISPHCSs); Royal Flying Doctor Service clinics; and general practitioners (GPs). Using 1 hour drive time boundaries around these locations and population counts from the 2011 Census at a range of geographic levels (SA2, remoteness, jurisdiction), the study found:
- approximately one-fifth (25,600 or 21%) of Indigenous women of child-bearing age lived outside a 1 hour drive time from the nearest hospital with a public birthing unit
- nearly all (97%) Indigenous women of child-bearing age had access to at least 1 type of maternal health service within a 1 hour drive time. The lowest levels of access were for women in Very remote and Remote areas, where 84% and 93%, respectively, had access to at least 1 type of service.
- Indigenous women of child-bearing age in Major cities, Inner regional and Outer regional areas had more types of services available to them within a 1 hour drive time than did women in more remote areas. Thus, they had more choice in which service they use.
Association with area-level maternal risk factor and birth outcomes
Examining possible associations between geographic accessibility to services, maternal risk factors and birth outcomes at the Indigenous Region level, the study found that poorer access to:
- GPs was associated with higher rates of pre-term birth and low birthweight
- ISPHCSs with maternal/antenatal services was associated with higher rates of smoking and low birthweight
- hospitals with public birthing units was associated with higher rates of smoking, pre-term birth and low birthweight
- at least 1 service was associated with higher smoking rates and higher rates of pre-term delivery and low birthweight.
An analysis at Primary Health Network (PHN) level found fewer significant associations, which is likely to be due to the PHNs’ size—particularly in jurisdictions with large Indigenous populations (such as the Northern Territory and Western Australia)—which may mask important intra-area variation.
This report was not able to take into account ISPHCSs which did not report to the Online Services Report collection, including state or territory maternal health services, outreach services, and antenatal/postnatal clinics conducted from hospitals which do not have birthing units. It also focused on spatial accessibility and did not take into account other aspects of maternal health services such as cultural competency. Future analyses could incorporate other indicators or measures of access, maternal risk factors and birth outcomes.
Preliminary material: Acknowledgments; Abbreviations
- Role of services
- Structure of the report
- Types of services
- Geographic level of analysis
- Geographic levels for spatial analyses and reporting
- Drive time analyses
- Proportions of women of child-bearing age within/outside a 1 hour drive time to a service
- Association between spatial accessibility and outcome variables
- Methods: spatial accessibility
- Examining the association between access and outcomes
- Data sources
- Service locations
- Population data
- Maternal risk factors and birth outcomes
- Summary of sources
- Data limitations
3 Service accessibility
- Birthing units
- Drive time to hospitals with public birthing units
- Spatial accessibility of antenatal and postnatal services
- Drive time analyses
4 Associations between access to services, maternal risk factors and birth outcomes
- Descriptive statistics
- Statistical analyses
- Statistically significant correlations
- Non-statistically significant correlations
- Additional analyses
- Importance of factors in addition to access affecting the use of antenatal care
- Importance of the content of antenatal care
- Future work
Appendix A: Detailed methods
Appendix B: PHN results
End matter: Glossary; References; List of tables; List of figures; Related publications