AbstractGlobally, since the latter part of the 20th Century, maternal and neonatal mortality rates have continued to reduce. However, in high-income countries (HICs), rates are still higher for women living in rural and remote locations compared to those in living metropolitan areas6. Pregnant women residing in Indigenous communities in the Northern Territory of Australia must relocate from home at 36-38 weeks gestation to wait near a hospital for the birth of their baby and remain in that place until given medical clearance to return home. The situation is similar for non-Indigenous women but they do have more choices available to them regarding the place, date and time of relocation.
HICs, such as Australia, provide advanced primary and secondary health services which are available to all residents, whether free or by payment. Reports from the World Health Organization (WHO) and the World Bank show improvements in maternal and neonatal health outcomes over time and that the Millennium Development Goals (MDGs) were being largely met. Missing from these reports are data on the inequalities of health outcomes within HICs for people who live in geographically isolated areas. This study discusses current policies and practices in maternal health care around the world and particularly in the remote Northern Territory of Australia (NT). I sought to identify evidence of any effect on maternal and neonatal health from the requirement for pregnant women, with low-risk pregnancies, to relocate from home at 36-38 weeks gestation to stay near a maternity facility.
The study was undertaken as a review of literature in three different styles comprising systematic, grey, and narrative and culminated in an umbrella view of the overall results. This work contributes to the current range of literature by showing that there has been no rigorous research directly applicable to the primary research question.
This study highlights the need for further research into what women want in relation to birthing choices. In order that women can be free to choose the place of birth of their baby, research must be conducted which unequivocally demonstrates whether planned early relocation from their local community to near a major birthing centre, at 36-38 weeks gestation, has any effect on the health of the mother or baby. These choices will need to be balanced against increasing costs for the provision of health services to remote areas and the lack of midwives, nurses and doctors able (or willing) to work away from urban settings.
|Date of Award||2021|
|Supervisor||Peter Morris (Supervisor) & Elizabeth McDonald (Supervisor)|