Barriers to seeking care during pregnancy faced by First Nations women living in a major city

This project is nested primarily within the respiratory theme of HOT NORTH, but also with relevance to skin and ear health. This project will provide novel data on enablers and
barriers faced by First Nations women when seeking care during pregnancy. If these are identified, a follow-on study will seek to determine whether these barriers extend beyond pregnancy by 12 months. Emerging data from low- and middle-income countries suggest that child health outcomes are impacted as a result of barriers faced during pregnancy. Identifying barriers and enablers to care seeking in pregnancy will inform the follow-on study, which will then aim to provide opportunities for program development and policy changes to address barriers and enablers that impact both maternal and child health in the Northern Territory.

Among low- and middle-income countries, disrespectful maternity care has been identified as a significant barrier to seeking care in pregnancy. These delays are not only attributed to up to two-thirds of maternal deaths in these settings but lead to poor clinical outcomes for both mothers and neonates. Additionally, for every maternal death, an estimated 50-100 women suffer severe maternal morbidity, which could have been prevented with timely care-seeking, and have an impact on a woman’s ability to care for her child.

Evidence is slowly emerging from low and middle-income countries about the long-term effect of poor engagement with health services during pregnancy on child mortality rates. One study found that children whose mothers attended 8 or more antenatal visits, had higher survival rates at 5 years. The reason for this is not fully appreciated, but it may be that similar barriers to seeking care experienced during pregnancy extend beyond that period into early life of the child. Furthermore, delayed care-seeking can result in poorer clinical outcomes and development of chronic lung disease, ear infections, skin conditions, and rheumatic heart disease in First Nations children.

Acute lower respiratory tract infection is the leading cause of child mortality worldwide, and in Australia accounts for 13% of hospital admissions for First Nations infants. The long-term sequelae of delayed or poorly managed recurrent bronchiolitis or pneumonia is a form of chronic, irreversible lung disease called bronchiectasis. This chronic disease results in multiple hospitalisations,
frequent courses of antibiotics, and often a shortened life.’® Gaining a better understanding of which factors contribute to delayed care-seeking for children with any illness, but respiratory conditions, in particular, can prevent progression to chronic disease. What remains currently unknown, is whether First Nations women’s experience of pregnancy care impacts health care-seeking behaviours for their children. To the best of our knowledge, no study has explored how care-seeking behaviours and clinical outcomes for Australian First Nations children relate to previous maternal experience of pregnancy care.