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Breastfeeding

Breastfeeding has many positive effects on the survival chances, growth, development and health of infants. Many studies have shown that breastfeeding has a protective effect against conditions such as diarrhoea and respiratory infections and has benefits for children’s growth, cognitive development and immunological functioning (Zubrick et al. 2004). Other studies have shown a protective effect against sudden infant death syndrome, asthma and other allergic diseases (Hoffman 1988; Oddy et al. 1999; Merrett et al.1988).

The 2001 National Health Survey, which included an Indigenous supplement, collected information from 3,681 Aboriginal and Torres Strait Islander Australians, comprising 1,853 adults and 1,828 children. The survey estimated that in 2001, of all Indigenous women aged 18-64 years who had had children and whose breastfeeding status was known, 85% had breastfed their children. Indigenous women living in remote areas were more likely to have breastfed their children than those in non-remote areas (95% compared with 83%). A total of 75% of non-Indigenous mothers had breastfed their children.

Similar results were reported in the WAACHS, where 88% of Aboriginal children aged 0-17 years in Western Australia were reported, by carers, to have been breastfed. The proportion of Aboriginal children who had ever been breastfed increased with level of relative isolation, from 82% in the Perth metropolitan area to 96% in areas of extreme isolation (table 6.8). An estimated 35% of Aboriginal children aged 0-17 years had been breastfed for 12 months or more, and an estimated 10% of Aboriginal children aged 0-3 years were breastfed exclusively (i.e. were not given other types of milk).

6.8 Duration of breastfeeding among Indigenous children(a), by level of relative isolation, Western Australia - 2001-02
			LEVEL OF RELATIVE ISOLATION
			None	Low	Moderate	High	Extreme	Total
Children never breastfed		%	18.5	12.3	6.7	4.7	3.7	12.0
Children ever breastfed
	Less than 3 months	%	20.2	19.0	7.6	6.8	3.4	14.7
	3 months to less than 6 months	%	13.5	13.1	10.3	4.9	9.4	11.6
	6 months to less than 9 months	%	8.0	7.2	10.6	6.2	5.8	8.0
	9 months to less than 12 months	%	8.4	11.6	14.8	16.0	12.1	11.5
	12 months or more	%	26.8	30.6	39.7	51.0	48.7	34.5
	Still being breastfed	%	4.8	6.1	10.3	10.4	16.9	7.8
	Total ever breastfed	%	81.5	87.7	93.3	95.3	96.3	88.0
Children(b)		no.	8 780	6 050	4 920	2 240	1 970	24 000
(a) Data are for children aged 0-17 years whose primary carer is their birth mother.
(b) Data are weighted estimates and have been derived by weighting the survey sample to reflect the Western Australian Aboriginal population.
Zubrick et al. 2004

Diet and nutrition

Diet and nutrition are particularly important to Aboriginal and Torres Strait Islander people for a number of reasons. The change in their diet, following European settlement, from a traditional Aboriginal diet high in protein and fibre, to a diet high in carbohydrates and saturated fats, is associated with the present high levels of obesity, Type II diabetes and renal disease among Indigenous Australians (NHMRC 2000c). Aboriginal and Torres Strait Islander families living in isolated areas face particular challenges in providing their children with affordable, healthy food on a regular basis. Poor nutrition in the early years of life can affect childhood development, growth and health. Inadequate vitamin and nutrition intake, especially in the preschool years, can affect immune function and increase susceptibility to illness, disease and infection (Tomkins 2001).

The National Health and Medical Research Council Dietary Guidelines recommend consuming a wide variety of nutritious foods, including a high intake of plant food such as fruit and vegetables, while also recommending moderating total fat and saturated fat intake. The guidelines for vegetable intake recommend an average of two serves of vegetables each day for children aged 4-7 years and three serves per day for older children (NHMRC 2003). The fruit intake guidelines recommend an average of one serve of fruit each day for children aged 4-11 years and two serves per day for older children.

The WAACHS provides data on the dietary intake of Aboriginal children. Four indicators of dietary quality were used: water usually being drunk when thirsty, some form of unsweetened and unflavoured cow or soy milk being regularly consumed, fresh fruit usually being consumed on six or seven days of the week and at least half a cup of at least three vegetables, other than potato, usually being consumed on six or seven days of the week (Zubrick et al. 2004).

When asked which drink was usually consumed when thirsty, 68% of Aboriginal children aged 4-17 years reported water, 15% cordial, 10% soft drinks, 4% fruit juice, and 3% other drinks (table 6.9). Children living in areas of high or extreme isolation were more likely to drink water than children living in metropolitan areas.

Around two-thirds of Aboriginal children aged 4-11 years (67%) and three-quarters of those aged 12-17 years (76%) were reported to usually eat fresh fruit daily. Younger children were more likely to have adequate vegetable intake (41%) than children in the 12-17 year age group (28%). Of the children who usually ate vegetables, half (50%) of 4-11 year olds ate five or more different vegetables (other than potato), and 27% of children aged 12-17 years ate five or more different vegetables.

Only one in five children met all four indicators of dietary quality. A greater proportion of children aged 4-11 years met all four indicators (21%) than did children aged 12-17 years (15%).

6.9 Dietary indicators among Indigenous children, by age group, Western Australia - 2001-02
		Age (years)
		4-11	12-17	Total
Drinks water usually when thirsty	%	67.1	69.4	68.0
Drinks unsweetened and unflavoured cow or soy milk regularly	%	94.2	90.5	92.7
Eats fresh fruit usually on six or seven days of the week	%	66.8	75.6	70.3
Eats adequate vegetables(a)	%	41.3	27.8	35.9
All four indicators are met	%	21.0	15.3	18.7
Children(b)	no.	13 800	9 100	22 900
(a) Eats at least half a cup of at least three vegetables, other than potato, usually on six or seven days of the week.
(b) Data are weighted estimates and have been derived by weighting the survey sample to reflect the Western Australian Aboriginal population.
Zubrick et al. 2004

Immunisation

The Australian Childhood Immunisation Register (ACIR), managed by the Health Insurance Commission, holds information on childhood immunisation coverage. All children under seven years of age, enrolled in Medicare, are automatically included on the ACIR. Children who are not eligible to enrol in Medicare can be added to the ACIR when details of a vaccination are received from a doctor or immunisation provider. It should be noted that coverage estimates for Aboriginal and Torres Strait Islander children include only those who are identified as Indigenous and are registered on the ACIR. Children identified as Indigenous on the ACIR may not be representative of all Aboriginal and Torres Strait Islander children, therefore coverage estimates should be interpreted with caution.

In 2003, vaccination coverage for Indigenous children aged 12 months was lower than for other children for each single vaccine (table 6.10). However, at two years of age, a greater proportion of Indigenous children were fully vaccinated against hepatitis B, diptheria, tetanus and pertussis (DTP), polio (OPV), and measles, mumps and rubella (MMR).

Aboriginal and Torres Strait Islander children had lower coverage for all vaccines at 12 months of age (82% compared with 91%), while at two years of age, they had vaccination coverage comparable with other children (91%). This suggests that there is a delay in the receipt of vaccines for Indigenous children in that significant numbers of Indigenous children are not vaccinated with the primary schedule of vaccines by 12 months of age but receive doses later (by two years of age). Schedules of vaccines may be delayed for a number of reasons including illness during infancy. The reported coverage estimates at two years of age also suggest that, while a greater proportion of Indigenous children at two years of age have been vaccinated for some diseases, they have not all been fully vaccinated.

For information on adult vaccination coverage refer to Chapter 7.

6.10 Children fully vaccinated, coverage estimates at one and two years of age(a)(b) - 31 December 2003
	One year old		Two years old
	Indigenous	Other	Indigenous	Other
	%	%	%	%
Hepatitis B	94.0	94.8	97.9	95.5
DTP (diphtheria, tetanus and pertussis vaccine)	84.8	92.7	96.7	95.7
OPV (oral polio vaccine)	84.1	92.6	95.2	94.5
Hib (Haemophilus influenzae type b)	93.0	94.4	92.9	92.9
MMR (measles, mumps and rubella vaccine)	. .	. .	94.2	93.1
All vaccines	82.2	91.2	90.9	91.3
. . not applicable
(a) Three month cohorts, age at 30 September 2003, calculated at 31 December 2003. Coverage assessment date was 12 or 24 months after the last birth date of each cohort.
(b) Includes data from New South Wales, Victoria, South Australia, Western Australia and the Northern Territory only. These jurisdictions have been assessed as having adequate completeness of data on Indigenous status by the states/territories.
Menzies et al. 2004