Reproductive Health in the Western Desert
Aboriginal Australians face well documented inequalities in health outcomes, including reproductive health. Access to acceptable, safe, and reliable contraception for women who do not want to be pregnant and preconception care for women who might become pregnant is an important reproductive health right. At the commencement of this project there was a scarcity of up to date information on remote Aboriginal women’s experiences with contraception, pregnancy planning and preconception care and a lack of guidance for services about how to improve their care in these areas.
This PhD project aimed to improve the understanding of reproductive health issues of importance to Aboriginal women and contribute to improving reproductive health related services in remote parts of the Kimberley region of Western Australia. This involved:
- exploring women’s experiences in managing their reproductive health and the formation and expression of pregnancy intentions
- describing contraception use; exploring the acceptability of different contraceptive methods; exploring women’s experiences accessing reproductive health care
- describing the preconception care currently being delivered.
How was this study done?
A process of iterative community consultation guided project planning, implementation and analysis throughout. This project utilised a range of methods to address the different aims:
- Quantitative methods involved electronic and manual extraction of information from the electronic medical record system used in participating communities to examine patterns of contraception use and the delivery of preconception care. Quantitative analysis was largely descriptive with additional survival analysis and analysis of trends over time
- Qualitative data included semi-structured one-on-one interviews with women residing in participating communities (n = 27)
- Towards the end of the project a regional pre-conception protocol was developed on behalf of the Kimberley Aboriginal Health Planning Forum.
What did we find?
A single long-acting reversible contraception (LARC) method (the etonogestrel implant (Implanon®) was by far the most common contraception used. It had high continuation rates and was understood as effective and accepted by many women in the communities involved. Overall, prevalent contraception use was lower than national figures. For some women a more ‘discreet’ method would offer greater autonomy. Injectable progesterone is one such method but had poorer continuation rates.
Most women used contraception consistent with their pregnancy intentions (70%), although a number were ambivalent about a future pregnancy. Some participants had observed or experienced pressure from partners to cease contraception to become pregnant.
Women recognised the role of the clinic in supporting their health before and during a pregnancy, and their idea of what this might include matched the most common preconception activities provided by the clinic (STI testing and micronutrient supplementation). The proportion of pregnant women receiving preconception care was suboptimal, particularly for risk factor reduction and health promotion advice, and especially for younger women. Despite this, a large proportion of women (73%) presented for antenatal care in their first trimester, especially if they had received advice about reproduction and conception from clinical staff prior to pregnancy. Additionally, the importance of understanding and respecting cultural structures was clearly and repeatedly identified by women interviewed as essential to the delivery of culturally safe care.
What happens now?
This study provides new insights into the reproductive health experiences and priorities of remote dwelling Aboriginal women. It presents novel data on the use and acceptability of contraception, the formation and expression of pregnancy intentions, and access to and delivery of preconception care.
Reproductive health care must be supported and integrated into the existing Aboriginal Community Controlled Health Service model of care, with in-built flexibility of service delivery design to allow space for a patient-centred approach and community control. A rights-based approach is necessary to ensure health services are trusted by women to provide quality care. Including Aboriginal health professionals on future research and clinical teams is important, and interventions should also aim to support health literacy.
When designing service delivery, young women, and women at risk of reproductive coercion, may require additional support and services tailored to their particular needs. It is suggested that future interventions promote care delivery that is integrated, rights-based and incorporates knowledge gained from other successful Aboriginal health programs.
Emma K Griffiths, Julia V Marley, Domenica Friello and David N Atkinson. Uptake of long-acting, reversible contraception in three remote Aboriginal communities: a population-based study. Med J Aust 2016; 205:21-25.
Emma K Griffiths, David N Atkinson, Domenica Friello and Julia V Marley. Pregnancy intentions in a group of remote-dwelling Australian Aboriginal women: a qualitative exploration of formation, expression and implications for clinical practice. BMC Public Health 2019; 19:568.
Emma K Griffiths, David N Atkinson, and Julia V Marley. Preconception Care in a Remote Aboriginal Community Context: What, When and by Whom? Int J Environ Res Public Health 2020; DOI 10.3390/ijerph17103702
We would like to thank the women who participated in this project. Without your help this research would not have been possible.