Infant Mortality among Indigenous and Torres Strait Islanders Communities - Case Study Example

Infant mortality among Indigenous and Torres Strait Islanders communities Student’s Name: Course: Tutor’s Name: Date: Introduction Infant mortality is still a public health issue even in developed countries such as the US, Britain and Australia. Although preventable deaths have greatly declined among infants in Australia in the past three decades, it has been argued that more lives are still being lost needlessly. Like everywhere else, infant mortality in Australia is related to lack of resources, or the uneven distribution of the same resources among communities. In essence, an African proverb describes the social, cultural and economic determinants that affect infant mortality by arguing that “Children will thrive only if their families thrive and if the whole society cares enough to provide for them” (Clinton, 1996, p.12). This paper focuses on Australia’s Indigenous communities, and argues that that concerted efforts by the government and other stakeholders can reduce infant mortality in the subject communities through improving the social, economic and cultural determinants of health that contribute to high infant mortality. In the discussion part, this paper proposes that the social and economic interventions made by government and other stakeholders must be culturally acceptable by the Indigenous communities. It has been noted that Indigenous communities in Australia have always registered poor infant outcomes (Zhang, Dempsey, Johnstone & Guthridge, 2010). In 2007 for example, the South Australian government revealed that infants birthed to Indigenous mothers were three times likely to die at the perinatal age (i.e. during their first four weeks of life) compared to infants birthed to non-Indigenous mothers (University of Adelaide, 2009, p. 4). Further statistics indicate that in the 2002-04 period, 13.4 infants out of every 1000 live births died among Indigenous communities, while 8.2 infant deaths out of every 1000 live births we recorded among non-Indigenous communities in the Northern Territory, South Australia, Queensland and Western Australia (Perinatal Mortality, 2006). The Northern Territory was identified as the state that recorded the highest infant deaths with 18.3 deaths per 1000 live births (Perinatal Mortality, 2006). Even more disturbing statistics indicate that “Indigenous babies in the Northern Territory, South Australia and Queensland died in the perinatal period at twice the rate of non-Indigenous babies in these jurisdictions” (Perinatal Mortality, 2006, p. 325). In a study conducted in 2009 by the University of Adelaide, it was discovered that the adverse infant outcomes were closely related to social, economic and cultural factors prevalent among Indigenous communities. For example, alcohol use, diabetes prevalence, and failure to breastfeed the infants were found to have some causal relations with increased infant mortality. On the other hand, lack of antenatal care, diabetes, obesity, lack of maternal education, infections, hypertension and family violence were linked to the increased risk of perinatal deaths. Social determinants affecting infant mortality among Indigenous communities According to the World Health Organisation (WHO, 2012), “the social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system” (para. 1). Notably, the social determinants of health are shaped by the allocation of resources, money and power at the global, national, regional and local levels. Putting this definition into context, it is notable that Indigenous communities have suffered neglect in terms of resource allocation and development for the longest time (Islam & Sheikh, 2010, p. 263). This in turn means that they lack basic facilities such as hospitals, schools, and are generally economically worse off than the non-Indigenous communities. Viewed from an infant mortality perspective, conditions in which Indigenous women live increase the risk of infant mortality. For example, the Indigenous women are more likely to smoke, engage in substance abuse, consume alcohol, suffer domestic violence, and have unhealthy diets among other things that risk the lives of infants (Watts, 2000). Additionally, the lack of hospitals or health facilities which can attend to the mothers and their infants all contribute to poor infant outcomes. Further, and as has been noted by Kildea, Kruske, Barclay and Tracy (2010) there is a shortage of procedural General Practitioners (GPs) i.e. in addition to shortage of specialised maternity services in remote parts of Australia where the Indigenous communities live. Additionally, Kildea et al. (2010) note that although Indigenous communities in Australia have equitable allocation of midwives, the fact that their rural locations discourage nurses and other trained healthcare professional from working in such communities means that the midwives take up the roles of nurses and other caregivers. As such, the midwives’ “focus of care fails to maximise opportunities to work with women to increase their health in pregnancy and their capacity to be socially, emotionally, and environmentally ready for parenthood” (Kildea et al., 2010, p. 7). Such lack of preparation of the mothers-to-be leads to poor mother-infant outcomes after childbirth, often culminating in infant mortality. Economic determinants of health and infant mortality According to Watts (2000, p.1), there is a proven link between income levels, how people spend their incomes, and their health outcomes. In other words, the level of income has an effect on health in that high income earners are more likely to afford health insurance, comprehensive health services, and medicine. Watts (2000, p.1) further notes that economic well-being is determined by levels of employment or other gainful economic activities such as farming. In Australia, the Indigenous communities are usually economically disempowered owing to their low-literacy levels, which translate to low employment. Additionally, historical injustices such as disenfranchising them from their ancestral lands have made their livelihoods even harder (Beck, 2000). The Indigenous conditions are further worsened by the fact that past government regimes have underinvested in Indigenous social infrastructure in sectors such as heath and education. Combined, such conditions make Indigenous women less healthy, prepared, or ready for the duties of motherhood. Consequently, their infants are at an increased risk of mortality either because the mother cannot afford to seek the necessary medical interventions, or because the physical environment exposes them to increased health risks. Watts (2000, p. 2) finds a link between low education levels and low immunisation rates hence indicating that the Indigenous communities may ignore, or fail to fully appreciate the importance of immunisations for their infants. As a result, they expose their infants to increased risks of disease, disabilities or even death. Another study (Beck, 2001) found a link between economic status and sense of self-worth, whereby, people on the lower side of the economic well-being were less likely to have a high sense of self-worth when compared to their economically well-to-do counterparts. Used in context, such low sense of self-worth among Indigenous communities would translate to situations where mothers do not value themselves or their infants and hence do not take as much care to protect them from the environmental hazards that may jeopardise their health. As implied above, employment has an effect on income levels; however, the National Advisory Committee on Health and Disability (1998) in New Zealand further found that employed people had better mental and physical health compared to their unemployed counterparts. While physical health is related to proper nutrition and the ability to seek medical intervention in good time, mental health is associated with less mental stress (at least because the monetary provisions are catered for). Unemployed mothers in Indigenous communities are likely to have unstable means of providing for their families and this may strain them emotionally and mentally. It has been observed that instances of postnatal depression (which is linked to the economic-social status of the mother) that can lead to infant neglect or even harm, and even deaths are more likely. Such incidences are especially likely to occur if the Indigenous mother lacks a support system (Kildea & Wardaguga, 2009). Beck (2001, p. 275) specifically identified socioeconomic stress as one of the key factors that contributed to postpartum depression. Other contributing factors were identified as: stress related to childcare, poor marital relationship, low-social support, and low-self esteem (Beck, 2001, p. 275). Cultural determinants of health and infant mortality in Indigenous communities The Centre for Disease Control and Prevention in the United States has defined culture as the “blended patterns of human behaviour that include language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups” (CDC, 2011, para. 3). Borrowing from this definition, it is clear that factors such as the Indigenous communities’ beliefs in traditional medicines as opposed to conventional healthcare services may not be timely or effective enough for infants. Additionally, other cultural aspects such as smoking, substance use, sexual patterns, alcohol consumption, high diabetes levels due to poor eating habits among others all contribute towards poor infant outcomes, including deaths. For example, Kildea (2006) found that only three percent of Aboriginal mothers go to healthcare facilities during childbirth. While this may be caused by their lack of proximity to hospitals, much of it is connected to their culture whereby women used to give birth attended by family and friends from the local community (Kildea & Wardaguga, 2009). As indicated by Kildea (2006, p. 388) for example, relocating a woman before childbirth was, and probably still is considered culturally unacceptable. Giving birth at home usually means that complications that may arise during childbirth are not well addressed, and that both the infant and the mother are at an increased risk of infection. Kildea and Wardaguga (2009) further observe that smoking ceremonies are common during childbirth as the Indigenous communities believe that smoking decreases bleeding, soothes or settles the baby, prevents infections, and assists the mother in breastfeeding. Investigating why Indigenous women would still expose themselves and their infants to smoking despite the overwhelming evidence that such practices are not safe, Jordan (1997, p. 55) argues that their convictions are best explained by authoritative knowledge. According to Jordan (1997, p. 57-58), authoritative knowledge is neither knowledge-based nor necessarily correct; however, members of a particular culture have full conviction that it is right. As such, such kind of knowledge has power and influence over members of a particular culture. For example, Kildea (2006) observes that Indigenous women believe that some rituals are necessary during and immediately after childbirth for purposes of strengthening the baby’s spirit. Based on such convictions, some women ignore the risk of birthing at home in order to ensure that the rituals are conducted. By so doing, they expose their infants to increased risks of poor health especially if the baby needs medical care immediately after birth. Rawlings (1998) further observes that while the modern health facilities may meet the physical needs of Indigenous women when giving birth, the birthing experience is not wholesome when the people who meet the woman’s spiritual and cultural needs are not present. Such absence of spiritual and cultural support may affect how a mother cares for her infant in the postpartum period, and even jeopardise the child’s life. This is especially true if the cultural and social support that the woman was used to during her pregnancy ceases. Overall, cultural practices although well meaning may sometimes predispose infants to increased risks of disease, poor development or even death. Discussion: Strategies for improving the well-being of women and their infants Citing Michael Marmot, Islam and Sheikh (2010, p. 269) observes that remedies to different factors affecting healthcare need to be designed to address the specific causes. For example, it is stated that “if the major determinants of health are social, so must be the remedies” (Islam & Sheikh, 2010, p. 269). Seeing that social, economic and cultural factors have been identified as determinants in infant mortality among the Indigenous communities, it can thus be argued that the remedies need to be specific to the social, economic and cultural issues. In other words, a collective approach needs to be taken by all stakeholders in order to address issues that contribute to high infant mortality in Indigenous communities. As had been noted by Faira Aboriginal Corporation (1999, para. 3), the Indigenous communities’ concept of health encompasses “the spiritual, the intellectual, physical and emotional” dimensions of life. As such, in order to effectively design solutions, it is important for due consideration to be paid to all the identified dimensions. Due to the above considerations, a holistic approach to addressing infant mortality among the Indigenous communities is best attained through multiple dimensions. Specifically, there is no denying that the communities’ social and economic positions need to be improved (i.e. improve the social amenities – such as schools and hospitals; and enhance the opportunities to empower them economically). However, the improvements must respect the culture upheld by the communities. For example, Kildea and Wardaguga (2009, p. 280) states that Australia needs to come up with a system that provides “control over the birthing experience, culturally safe models of care, social support in labour, and continuity of care”. Through such systems, the government will arguably have found a way for hospitals to be accepted by the Indigenous communities as the place of choice to give birth. As indicated elsewhere in this paper, it is not just enough for hospitals to provide the physical facilities necessary to reduce the risks of infant deaths during birth; rather, there needs to be a culturally acceptable environment in order to enhance the infants’ and mothers’ experiences after leaving the hospital. One such way as proposed by Kildea and Wardaguga (2009, p. 277) is bringing “birth back to the remote communities where Aboriginal women will be in charge”. In other words, communities should be provided with culturally appropriate birthing and infant care services which should reflect their traditions, values and beliefs. By so doing, they will mostly likely choose professional care over home births. Additionally, the government and other stakeholders in the healthcare sector need to enhance the Indigenous communities’ capacity to join the workforce. This is possible if the communities’ social aspects such as literacy levels are improved. In addition to the professional qualifications, the Indigenous people’s workforce would have the cultural competence needed to improve infant outcomes in the communities. In conclusion, it is worth noting that the perceived legitimacy of an infant in most Indigenous communities depends on their birth place. In other words, just as much as the social and economic aspects affect the quality of health services an infant may receive at birth and during critical stages thereafter, their acceptance by the larger communities, and to some extent by the mother may depend on whether the environment surrounding their birth was culturally acceptable. Ultimately, this may have an effect on the quality of care the infant receives, and in some cases, it may even be a case of life or death. References Beck, C.T. (2001). Predictors of postpartum depression. Nursing Research, 50(5), 275-280. Centres for Disease Control and Prevention – CDC. (2011). Social determinants of health. Retrieved August 2, 2012, from http://www.cdc.gov/socialdeterminants/Definitions.html Clinton, H. R. (1996). It takes a village and other lessons that children reach us. New York: Simon & Schuster. Faira Aboriginal Corporation. (1999). Geneva declaration on the health and survival of Indigenous peoples. Retrieved August 2, 2012, from http://esvc000200.wic061u.server-web.com/lrq/archives/199912/stories/geneva-declaration.html Islam, R., & Sheikh, A. (2010). Cultural and socio-economic factors in health, services, and prevention for indigenous people. Antrocom Online Journal of Anthropology, 6(2): 263-273. Retrieved August 2, 2012, from http://www.antrocom.net/upload/sub/antrocom/060210/12-Antrocom.pdf Jordan, B. (1997). Authoritative knowledge and its construction. In R.E. Davis-Floyd & C. F. Sargent (Eds.), Childbirth and authoritative knowledge: Cross-cultural perspectives, Berkley, CA: University of California Press. (pp. 55-79). Kildea, S. & Wardaguga, M. (2009). Childbirth in Australia: Aboriginal and Torres Strait Islander women. In H. Selin (Ed.), Childbirth across culture: Ideas and practices of pregnancy, childbirth and the postpartum, London; New York: Springer. (pp. 275-286). Kildea, S. (2006). Risky business: Contested knowledge over safe birthing services for Aboriginal women. Health Sociology review, 15(4):387-396 Kildea, S., Kruske, S., Barclay, L., & Tracy, S. (2010). Closing the Gap’: How maternity services can contribute to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait Islander women. Rural and Remote Health, 10: 1383. Retrieved August 1, 2012 from http://www.rrh.org.au/publishedarticles/article_print_1383.pdf National Advisory Committee on Health and Disability (1998).The social, cultural and economic determinant of health in New Zealand: action to improve health. Retrieved August 1, 2012, from http://www.nhc.health.govt.nz/sites/www.nhc.health.govt.nz/files/documents/publications/det-health.pdf Perinatal Mortality (2006). Health status and outcomes (Tier 1) - Aboriginal and Torres Strait Islander health performance framework 2006 report. Retrieved August 01, 2012, from http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442458448. Rawlings, L. (1998). Traditional Aboriginal birthing issues. Birth Gazette, 14: 6-13. University of Adelaide. (2009). Preventing infant deaths among Aboriginal and teenage women in South Australia. Retrieved August 1, 2012, from http://aboriginalhealth.flinders.edu.au/Newsletters/2010/Downloads/SHRP%20FINAL%20REPORT%20PART%20ONE%20July%202009v2.pdf Watts, C. (2000). The economic determinants of health and illness. Washington Public Health, Fall. pp. 1-3. World Health Organization -WHO. (2011). Social determinants of health. Retrieved August 1, 2012, from http://www.who.int/social_determinants/en/ Zhang, X., Dempsey, K., Johnstone, K., & Guthridge, S. (2010). Trends in the heath of mothers and babies Northern Territory 1986-2005. Australian Indigenous Health Bulletin, 10(4) 1-66. Read More