Abstract
Background: Strategies to reduce over-representation of Indigenous children in out-of-home care must start in pregnancy given Indigenous babies are 6 % of infants (<1 year), yet 43 % of infants in out-of-home care.
Objective: To determine if an Indigenous-led, multi-agency, partnership redesign of maternity services decreases the likelihood of babies being removed at birth. Participants and setting: Women carrying an Indigenous baby/babies who gave birth at the Mater Mothers' Public Hospital, Brisbane (2013–2019).
Methods: A prospective, non-randomised, intervention trial evaluated a multi-agency service redesign. Women pregnant with an Indigenous baby birthing at a tertiary hospital were offered standard care or Birthing in Our Community (BiOC) service. We compared likelihood of babies being removed by Child Protection Services (CPS) at birth by model of care. Inverse probability of treatment propensity score weighting controlled baseline confounders and calculated treatment effect. Standardized differences were calculated to assess balance of risk factors for each copy of multiple imputation. Australian New Zealand Clinical Trial Registry, ACTRN12618001365257.
Results: In 2013–2019, 1988 women gave birth to 2044 Indigenous babies, with 40 women having babies removed at birth (9 BiOC, 31 standard care). Adjusted odds of baby removal were significantly lower for mothers in BiOC compared to standard care (AOR 0.37, 95 % CI 0.16, 0.84). In total, 2.0 % of Indigenous babies were removed by CPS; eight times higher than non-Indigenous babies at the same hospital (0.25 %).
Conclusions: BiOC reduced removals of newborn Indigenous babies likely disrupting generational cycles of CPS contact, trauma, and maltreatment, and contributing to short and long-term health and wellbeing benefits for mothers and babies.
| Original language | English |
|---|---|
| Article number | 106664 |
| Pages (from-to) | 1-11 |
| Number of pages | 11 |
| Journal | Child Abuse and Neglect |
| Volume | 149 |
| DOIs | |
| Publication status | Published - Mar 2024 |
Bibliographical note
Funding Information:This work was supported by an Australian National Health and Medical Research Council (NHMRC) partnership grant (GNT1077036) to SKi, SKr, CN, YR, AC, JC, KW, RB.The research team received an Australian NHMRC partnership grant (GNT1077036), and the partner organisations funded delivery of the new health service, with additional funding from the Queensland Government to the Institute for Urban Indigenous Health (to AC, CN, and KWa) to expand health service delivery. During the study: SKi and YG were employed by Mater Research Institute and University Queensland, then Charles Darwin University; SH was employed by Mater Research Institute then Charles Darwin University; YR was employed by the Institute of Urban Indigenous Health, then Mater Research Institute, then Charles Darwin University. CN, AC, JCu, KWa, and SKr were employed by Institute of Urban Indigenous Health, with JCu then employed by Aboriginal and Torres Strait Islander Community Health Service Brisbane, and SKr then employed by Charles Darwin University. MR, KWi and JCo were employed by Mater Hospital, then JCo employed by the Institute of Urban Indigenous Health. Some of the NHMRC funding that supported the research contributed to salaries of YR, SH and YG. BOD received funding from the Australian Government (Research Training Program Scholarship) and the Alison Mary Jackson and Nancy Rosemary Kingsland Scholarship, through the Molly Wardaguga Research Centre as part of her PhD Candidature at Charles Darwin University. We declare no other competing interests.We acknowledge and thank the Indigenous families involved in BiOC and all the staff who contributed to development of the service. We also acknowledge members of the BiOC Steering Committee, and the Indigenous Birthing in an Urban Setting investigators and research team. The study was funded by the Australian NHMRC partnership grant, and the service was funded by the Institute for Urban Indigenous Health, the Aboriginal and Torres Strait Islander Community Health Service Brisbane, and the Mater Mothers' Hospital. Additional funding for service expansion was received from the Queensland Government, and for researchers' salaries from Charles Darwin University, Mater Research Institute, and the University of Queensland.
Funding Information:
This work was supported by an Australian National Health and Medical Research Council (NHMRC) partnership grant ( GNT1077036 ) to SKi, SKr, CN, YR, AC, JC, KW, RB.
Funding Information:
We acknowledge and thank the Indigenous families involved in BiOC and all the staff who contributed to development of the service. We also acknowledge members of the BiOC Steering Committee, and the Indigenous Birthing in an Urban Setting investigators and research team. The study was funded by the Australian NHMRC partnership grant, and the service was funded by the Institute for Urban Indigenous Health , the Aboriginal and Torres Strait Islander Community Health Service Brisbane , and the Mater Mothers' Hospital . Additional funding for service expansion was received from the Queensland Government , and for researchers' salaries from Charles Darwin University , Mater Research Institute , and the University of Queensland .
Publisher Copyright:
© 2024 The Author(s)
