Embedding cultural competence in maternity services to improve outcomes for Aboriginal women and infants

Background: Aboriginal women experience poor maternity outcomes compared with other women in Australia. Few mechanisms and resources exist to support health services and professionals to provide culturally responsive care to Aboriginal women. The right of Aboriginal women to express their diverse cultural needs during pregnancy and birthing requires maternity services to be culturally secure as well as clinically safe. Existing policies state that Cultural Competence (CC) of hospital services and staff is ‘critical to achieve positive outcomes for both mother and baby' and a priority reform area in closing the gap in Aboriginal maternal and child health outcomes. Yet an audit of antenatal care in Western Australia (WA)in 2010 found that 75% of services fail to provide culturally competent care to Aboriginal women. Methods: The audit findings were provided to key health services personnel and Aboriginal women during an extensive consultation. Based on their feedback and a review of the literature, an individual and organisational Cultural Competence Assessment Toolkit (CCAT) was developed, trialled and evaluated with 75 staff in two hospitals. Results: All participants found the CCAT highly relevant and useful to effectively enhance organisational and workforce CC in health services and policy sectors with great potential to be effective if embedded as part of the CQI mechanism in maternity services. Conclusion: A review of the maternity services framework and indicators recommended the CCAT be implemented as part of the National Maternity Services Plan. Building on these recommendations our current study is investigating how to support Aboriginal women's diverse needs to ensure their cultural security in an urban maternity setting: and evaluating the cultural competency, workforce and education needs of midwives. This involves conducting culturally sensitive, semi-structured interviews with Aboriginal women using a personal and conversational manner yarning and deep listening practices to explore the meaning of birthing on country with Aboriginal women. The findings will be used to refine and validate the CCAT and inform CC policies and practice, midwifery education and services reform to enhance the quality of and access to maternal health services and improve health and wellbeing outcomes for Aboriginal and other marginalised populations.