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	MOTHERS' AND CHILDREN'S HEALTH: PREGNANCY AND MATERNAL HEALTH
	This article is part of a comprehensive series released as The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples.

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KEY MESSAGES The median age of Aboriginal and Torres Strait Islander women who registered a birth in 2011 was 24.8 years, almost 6 years lower than the median age of all mothers (30.6 years). In 2008, 87% of birth-mothers of Aboriginal and Torres Strait Islander children aged 0–3 years had regular check-ups while pregnant (at least one every two months). Nearly half the mothers of Aboriginal and Torres Strait Islander children aged 0–3 years (49%) took folate before or during their pregnancy, though the proportion in remote areas was 35%. In 2008, for Aboriginal and Torres Strait Islander children aged 0–3 years, 8% of mothers had diabetes or sugar problems and 14% had high blood pressure during their pregnancy. Nationally for Aboriginal and Torres Strait Islander children aged 0–3 years for whom data were collected in 2008, one in five mothers (20% of 42,800) reported they had consumed alcohol during pregnancy and 42% had smoked tobacco, though 24% smoked less while pregnant.

The foundations for health are laid early in life and are influenced by genetic, behavioural and environmental factors. Regular visits to health professionals provide more opportunities for identifying and addressing health conditions and health risks, as well as for education on aspects of parenting such as the benefits to both mother and child of breastfeeding. Also, appropriate antenatal care and a healthy environment for the mother can improve the chances that the baby will have a healthy birthweight (Endnote 1). The World Health Organisation (WHO) recommends a minimum of four antenatal visits for low-risk pregnancy (Endnote 2).

This topic presents results from the 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) which provides the most recent data for Aboriginal and Torres Strait Islander maternal practices and outcomes. Information was collected for children aged 0–3 years in relation to their birth mother's pregnancy including antenatal care and birth of the infant. If the parent or guardian was not available, a close relative or other household member who had responsibility for the child provided information about the child.

Information presented includes:

• median age of mother
• antenatal care
• nutritional intake during pregnancy
• conditions and risk factors during pregnancy.

Other related topics:

• Aboriginal and Torres Strait Islander births and perinatal mortality, see discussion on Aboriginal and Torres Strait Islander babies and children (2008)
• maternal mortality, see discussion on Aboriginal and Torres Strait Islander mothers (2008).

MEDIAN AGE OF MOTHER

Overall, Aboriginal and Torres Strait Islander women have children at younger ages than all women. The median age of Aboriginal and Torres Strait Islander women who registered a birth in 2011 was 24.8 years, almost 6 years lower than the median age of all mothers (30.6 years). Of the states and territories, Aboriginal and Torres Strait Islander mothers living in Western Australia had the lowest median age (24.2 years), followed by those in the Northern Territory and South Australia (both 24.6 years) (Endnote 3).

Back to top ANTENATAL CARE

Nationally, 87% of birth-mothers of Aboriginal and Torres Strait Islander children aged 0–3 years in 2008, reported having regular check-ups while pregnant (at least one every two months), similar in both non-remote and remote areas.

A range of health professionals provide antenatal care for Aboriginal and Torres Strait Islander women during pregnancy including obstetricians, GPs, doctors, midwives and Aboriginal and Torres Strait Islander health workers who may work as generalist members of primary health care teams, as hospital liaison officers or as specialists in areas such as diabetes, alcohol, sexual health and mental health. Nationally, the most frequently consulted health professional for regular pregnancy checkups was a doctor, GP or obstetrician (61%), followed by a midwife or nurse (42%). In non-remote areas, birth-mothers were one and a half times more likely to have regular pregnancy checkups as part of their antenatal care with a doctor, GP or obstetrician (66% compared with 43% in remote areas). Regular checkups with Aboriginal and Torres Strait Islander health workers were more common among birth-mothers who lived in remote areas (15% compared with 5% in non-remote areas).

			Non-remote	Remote	Australia
Had regular pregnancy check-ups		%	(d)88.0	(d)84.7	87.3
Type of health professional consulted for regular pregnancy check-ups(a)
	Doctor, GP or Obstetrician	%	66.3	42.7	61.1
	Midwife or nurse	%	(d)40.1	(d)48.2	41.9
	Aboriginal and Torres Strait Islander Health Worker	%	5.5	15.0	7.6
Had check-ups but not regular(b)		%	5.1	*5.1	5.1
Did not have check-ups		%	*3.9	*2.7	3.6
Not collected		%	*2.7	7.4	3.7
Total(c)		%	100.0	100.0	100.0

* Estimate has an relative standard error of 25% to 50% and should be used with caution.
(a) Sum of components may exceed total as respondents may have indicated more than one response category. 
(b) Includes not known whether check-ups were regular.
(c) Includes not known if had check-ups while pregnant.
(d) Difference between estimates for non-remote and remote are not statistically significant.
Source: 2008 National Aboriginal and Torres Strait Islander Social Survey.These estimates are also available for download in the Mothers' and children's health datacube.

Antenatal care may be provided across a number of different settings and on occasion women are hospitalised during pregnancy due to pregnancy complications. These may range from pregnancy conditions such as gestational diabetes, and hypertension to threatened labour and other complications. In both remote and non-remote areas around one in five birth-mothers of Aboriginal and Torres Strait Islander children aged 0–3 years (22%) in 2008, spent time in hospital because of her pregnancy. One in ten mothers (10%) spent three nights or less in hospital (8% in remote), and one in eight (12%), spent four nights or more in hospital because of pregnancy.

Most children (94%) aged 0–3 years were born in a hospital, with 68% of children's birth-mothers reporting having given birth in the closest hospital. For those living in remote areas, 90% reported giving birth in a hospital and 51% in the closest hospital. Nationally, nearly half (45%) of all birth-mothers travelled less than ten kilometres to give birth, while in remote areas a similar proportion (41%) travelled 250 kilometres or more to have their baby.

Nationally, 90% of birth-mothers spent one night or more in hospital following birth, with (55%) spending up to three nights in hospital (including those who stayed but not for a night), and 32% spending from four to seven nights. The length of postnatal stay varied with remoteness and distance to hospital, with those who lived in remote areas more likely to stay in hospital for longer (11% stayed more than one week compared with 5% of the childrens' mothers who lived in non-remote areas). Over one-quarter (26%) of mothers whose postnatal stay was one week or more, lived 250km or more from the place of birth.


NUTRITIONAL INTAKE DURING PREGNANCY

Adequate nutrition during pregnancy is vital for the health of both mother and developing child. As well as having a balanced diet, women are advised to take a folate supplement before and during the first trimester of pregnancy as a preventative measure against the risk of neural tube defects such as spina bifida. Nationally, nearly half of birth-mothers (49%) of Aboriginal and Torres Strait Islander children aged 0–3 years in 2008, reported taking folate supplements before or during their pregnancy, though the proportion in remote areas was lower (35%). Other medications or supplements such as heart tablets, iron, or cold and flu tablets were taken by 42% of the birth-mothers during pregnancy (49% in remote areas).

Birth-mothers who reported seeking advice or information about aspects of pregnancy or childbirth (37% of mothers in non-remote areas and 29% in remote areas) were more likely to take folate than those who did not. Among birth-mothers who sought advice and information about pregnancy and childbirth, well over half (63%) reported taking folate before or during pregnancy. Seeking advice, however, had no apparent relationship with whether they took other other medications or supplements during pregnancy.


CONDITIONS AND RISK FACTORS DURING PREGNANCY

Two adverse conditions that can arise in pregnancy are gestational diabetes and high blood pressure. Gestational diabetes is diagnosed when higher than normal blood glucose levels first appear during pregnancy. If diagnosed with gestational diabetes, both mother and child have a higher risk of developing type 2 diabetes later in life (Endnote 4). Nationally, one in twelve birth-mothers (8%) of Aboriginal and Torres Strait Islander children aged 0–3 years in 2008, had diabetes or sugar problems during pregnancy.

High blood pressure (hypertension) in pregnancy can cause strokes, seizures, renal damage and cardiovascular disease (Endnote 5). Nationally, 14% of birth-mothers of Aboriginal and Torres Strait Islander children aged 0–3 years in 2008 reported high blood pressure during their pregnancy. There were no significant differences in the prevalence rates of both gestational diabetes and high blood pressure for those living in non-remote and remote areas in 2008.

Pregnancy behavioural risk factors

Several pregnancy risk factors that influence poor infant and child health have been identified and include alcohol consumption, smoking and illicit substance use during pregnancy (Endnote 6).

Nationally for Aboriginal and Torres Strait Islander children aged 0–3 years in 2008, one in five birth-mothers (20%) reported they had consumed alcohol during pregnancy and 42% had smoked tobacco, though 24% smoked less while pregnant (Endnote 7). The vast majority of children aged 0–3 years (95%) had birth-mothers who did not use illicit drugs during their pregnancy in 2008 (Endnote 7).

Aboriginal and Torres Strait Islander children aged 0–3 years whose mothers sought advice during pregnancy were less likely to smoke during pregnancy than those who did not seek advice (64% compared with 53%). However, seeking advice had no apparent relationship with abstaining from drinking alcohol while pregnant.

ENDNOTES

1. Australian Health Ministers' Advisory Council 2008, 'Aboriginal and Torres Strait Islander Health Performance framework Report 2008', AHMAC, Canberra.

2. World Health Organisation 2009, 'Antenatal care coverage', < www.who.int>

3. Australian Bureau of Statistics 2012, 'Births, Australia, 2011', cat. no. 3301.0, ABS, Canberra, <www.abs.gov.au>.

4. Diabetes Australia 2009, 'Gestational Diabetes', <www.diabetesaustralia.com.au>

5. Heart Foundation 2007, 'Research@ Heart', Issue 9, p2, <www.heartfoundation.org.au>.

6. American Congress of Obstetricians and Gynaecologists, 'Tobacco, Alcohol, Drugs, and Pregnancy' June 2008.

7. Questions about alcohol consumption, smoking and substance use during pregnancy were asked of the child's birth-mother only, hence information on these risk factors during the birth-mother's pregnancy was collected for 79% of 53,900 children aged 0–3 years.

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