Evaluation of an Australian Aboriginal model of maternity care: The Malabar Community Midwifery Link Service.

BACKGROUND: The urban-based Malabar Community Midwifery Link Service integrates multidisciplinary wrap-around services along-side continuity of midwifery care for Aboriginal and Torres Strait Islander mothers and babies. AIM: To evaluate the Malabar Service from 1 January 2007 to 31 December 2014. METHODS: A mixed method design. Outcomes for mothers of Aboriginal and/or Torres Strait Islander babies cared for at an urban Australian referral hospital by the Malabar Service were compared to mainstream. Primary outcomes are rates of low birth weight; smoking >20 weeks gestation; preterm birth; and breastfeeding at discharge. Malabar outcomes are also compared to national and state perinatal outcomes. RESULTS: The Malabar Service (n = 505) demonstrated similar rates of preterm birth (aOR 2.2, 95% CI 0.96-4.97); breastfeeding at discharge (aOR 1.1, 95% CI 0.61-1.86); and a higher rate of low birth weight babies (aOR 3.6, 95% CI 1.02-12.9) than the comparison group (n = 201). There was a 25% reduction in smoking rates from 38.9% to 29.1%. Compared to national and state populations, Malabar outcomes were better. Women experienced greater psychosocial complexity but were well supported. Malabar Mothers (n = 9) experienced: accessibility, preparedness for birth and cultural safety. Staff (n = 13) identified going 'above and beyond' and teamwork to provide culturally safe care counterbalanced with concerns around funding and cultural support. CONCLUSIONS: Dedicated integrated continuity of midwifery care with wrap-around services for Aboriginal and/or Torres Strait Islander mothers is highly valued and is culturally safe. The service is as safe as main stream services and promotes better clinical outcomes compared to national and state outcomes.

Group antenatal care for Aboriginal and Torres Strait Islander women: An acceptability study.

BACKGROUND: Good quality antenatal care is essential to improve the perinatal outcomes of Aboriginal and Torres Strait Islander women in Australia. Group antenatal care (GAC) is an innovative model which places clinical assessment, education and social support into a group setting. Previous studies have found GAC to be associated with improved perinatal outcomes, particularly for vulnerable populations, and high satisfaction levels among group members. No implementations of GAC, or evaluations of its acceptability, for an Indigenous population in Australia have been previously conducted. AIM: To explore the perceptions of a group of Indigenous health workers (n=5) in a health service in Far North Queensland, Australia, towards the prospective acceptability of GAC as an additional choice of model of care for their Indigenous women clients. METHODS: This qualitative acceptability study employed a descriptive/exploratory methodology. Data collection was by semi structured interview. Data analysis was guided by a theoretical framework of acceptability and conducted following a process of iterative categorisation. FINDINGS: No overall precluding factors were identified to render the model unacceptable for Indigenous women in this locality. Some features of the model would not suit all women. Indigenous health workers were interested in increased involvement with antenatal care and participation in a GAC model. CONCLUSION: A foundation of acceptability exists upon which the implementation of a GAC model could offer benefits to Indigenous women in this health service. The positive response of the Indigenous health workers to the concept of GAC endorsed the potential of this model to contribute to the provision of culturally appropriate and effective antenatal care within mainstream services.

Establishing teams aiming to provide culturally safe maternity care for Indigenous families.

PROBLEM: It is not well known how to prepare new multidisciplinary teams aiming to provide culturally safe maternity care for Aboriginal and Torres Strait Islander families in an urban setting. BACKGROUND: National policies recommend increasing the Aboriginal and Torres Strait Islander workforce and cultural competencies of the non-Indigenous workforce as key drivers of culturally safe care. QUESTION: What are the key learnings from staff experiences establishing multidisciplinary teams aiming to provide culturally safe maternity care that aims to privilege Indigenous ways of knowing, being and doing? METHODS: As part of a larger participatory action research project, semi-structured qualitative interviews were conducted December 2014-April 2015 with 21 Aboriginal and Torres Strait Islander and non-Indigenous healthcare staff. Thematic analysis was used to identify learnings for practice. FINDINGS: Four key learnings were identified for forming new teams aiming to provide culturally safe care: (a) having a shared understanding of what characterises cultural safety in the local program context; (b) understanding and valuing different roles and knowledges people bring to the team; (c) acknowledging the influence of race and culture on staff behaviour; and (d) acting on individual and organisational responsibilities for continuous improvement towards cultural safety. DISCUSSION: We present recommendations from our participatory action research approach to respond to these learnings in practice. CONCLUSION: A deliberate workforce investment at the early stages of team development is crucial when aiming to provide culturally safe maternity care that can respond to the unique needs of Aboriginal and Torres Strait Islander women and families.

'Partnerships are crucial': an evaluation of the Aboriginal Family Birthing Program in South Australia.

OBJECTIVES: To evaluate implementation and outcomes of the Aboriginal Family Birthing Program (AFBP), which provides culturally competent antenatal, intrapartum and early postnatal care for Aboriginal families across South Australia (SA). METHODS: Analysis of births to Aboriginal women in SA 2010-2012; interviews with health professionals and AFBP clients. RESULTS: Around a third of all Aboriginal women giving birth in SA 2010-2012 (n=486) attended AFBP services. AFBP women were more likely to be more socially disadvantaged, have poorer pregnancy health and to have inadequate numbers of antenatal visits than Aboriginal women attending other services. Even with greater social disadvantage and higher clinical complexity, pregnancy outcomes were similar for AFBP and other Aboriginal women. Interviews with 107 health professionals (including 20 Aboriginal Maternal and Infant Care (AMIC) workers) indicated differing levels of commitment to the model, with some lack of clarity about AMIC workers and midwives roles. Interviews with 20 AFBP clients showed they highly valued care from another Aboriginal woman. CONCLUSIONS: Despite challenges, the AFBP reaches out to women with the greatest need, providing culturally appropriate, effective care through partnerships. Implications for Public Health: Programs like the AFBP need to be expanded and supported to improve maternal and child health outcomes for Aboriginal families.

Nursing Care of Pregnant Muslim Women During Ramadan.

There are approximately 3.3 million people of the Muslim faith living in the United States. This article explores how Muslim women observe their religious beliefs during pregnancy and discusses implications for nursing care of pregnant Muslim women during Ramadan. Although pregnant Muslim women can be exempt from fasting, many still choose to fast during Ramadan. Factors that influence a woman's decision to fast include gravity and parity, maternal education, maternal age, body mass index, comprehension of Islamic Law, and gestational trimester. Nurses can tailor their care of pregnant Muslim women to include episodes of fasting and help them make informed decisions regarding fasting during Ramadan.

Maternal health and pregnancy outcomes among women of refugee background from African countries: a retrospective, observational study in Australia.

BACKGROUND: Women of refugee background from Africa are reported to have a greater risk of adverse pregnancy outcomes compared to women born in resettlement countries. However, there is currently little insight into whether adverse pregnancy outcomes are more common among migrant women of refugee background, compared to women who have migrated for non-humanitarian reasons. To inform whether women of refugee background require additional services in pregnancy compared to non-refugee migrant women from similar world regions we aimed to describe and compare maternal health, pregnancy care attendance and pregnancy outcomes among migrant women from Africa with or without a refugee background. METHODS: Retrospective, observational study of singleton births at a single, metropolitan, maternity service in Australia 2002-2011, to women born in humanitarian source countries (HSC) and non-HSC from North Africa (n = 1361), Middle and East Africa (n = 706) and West Africa (n = 106). RESULTS: Compared to non-HSC groups, age < 20 years (0-1.4% vs 2.3-13.3%), living in relatively socio-economically disadvantaged geographic areas (26.2-37.3% vs 52.9-77.8%) and interpreter need (0-23.9% vs 9.7-51.5%) were generally more common in the HSC groups. Compared to non-HSC groups, female genital mutilation (0.3-3.3% vs 5.1-13.8%), vitamin D insufficiency (8.7-21.5% vs 23.3-32.0%), syphilis (0-0.3% vs 1.2-7.5%) and hepatitis B (0-1.1% vs 1.2-18%) were also generally more common among the HSC groups. Unplanned birth before arrival at the hospital (3.6%) was particularly high in the North African HSC group. HSC-birth was associated with gestational diabetes mellitus (odds ratio = 3.5, 95% confidence interval: 1.8-7.1) among women from Middle and East Africa, after adjusting for maternal age, parity, body mass index and relative socio-economic disadvantage of area of residence. The West African HSC group had the highest stillbirth incidence (4.4%). CONCLUSIONS: Migrant women of refugee background from different African regions appear to be at greater risk of specific adverse pregnancy outcomes compared to migrant women without a refugee background. Awareness of differing risks and health needs would assist provision of appropriate pregnancy care to improve the health of African women and their babies.

Food beliefs and practices during pregnancy in Ghana: implications for maternal health interventions.

Ghanaian women's food beliefs and practices during pregnancy and the scope for developing more effective maternal health interventions were explored in this study. Thirty-five multiethnic Ghanaian women between the ages of 29 and 75 were interviewed about pregnancy food beliefs and practices. I show that, based on the data analysis, their knowledge about food was drawn from lifeworlds (family and friends), educational settings, health professionals, mass media, and body-self knowledge (unique pregnancy experiences). Core lay ideas converged with expert knowledge on maternal health nutrition. Multiple external factors (e.g., economics, cultural representations of motherhood) and internal factors (e.g., the unpredictable demands of the pregnant body) influenced pregnancy food practices. I suggest and discuss a need for culturally situated multilevel interventions.

[Ethnic differences in uptake of professional maternity care assistance]. / Etnische verschillen in het gebruik van kraamzorg.

OBJECTIVE: To examine the ethnic differences in the uptake of professional maternity care assistance (MCA) in the Netherlands, and the factors that may explain these differences. Additionally the effect of MCA on health risk behaviour around infants is examined. DESIGN: Questionnaire survey. METHOD: Questionnaire data from 3967 mothers from the ABCD study (Amsterdam Born Children and their Development) included during pregnancy in 2003-2004, were used. We examined the explanatory role of ethnicity, age, socioeconomic status, mastery of the Dutch language, parity, housing situation and place of giving birth on MCA uptake, and the effect of MCA uptake on health risk behaviour around infants, such as smoking indoors, infant sleep behaviour, infant nutrition, and response to infant crying. RESULTS: Mothers of non-Western origin less often used MCA than Dutch mothers (Ghanaian: 70%; Turkish: 75%; Moroccan: 79%; Surinamese: 81%; Dutch Caribbean: 85% vs. Dutch: 95%). Higher educational level, better mastery of the Dutch language, having a paid job and home delivery were all independently associated with the uptake of MCA, and also partially explained ethnic differences in the uptake of MCA. Mothers who received MCA more often breastfed, more often gave vitamin K when not breastfeeding, and more often lived in smoke-free homes. The protective effect of MCA was stronger for non-Western mothers than for Dutch mothers. CONCLUSION: Mothers of non-Western origin make less use of professional MCA. Given that the use of MCA is associated with a less risk behaviour around infants, efforts should be made to improve the accessibility of professional MCA for mothers of non-Western origin.

Acculturation and maternal health behaviors: findings from the Massachusetts birth certificate.

BACKGROUND: Although prior studies have shown disparities in maternal health behaviors according to race/ethnicity and acculturation, whether these patterns are evident among new immigrant populations remains unclear. PURPOSE: To examine the associations among proxies of acculturation and maternal smoking during pregnancy and breastfeeding initiation within each major ethnic group in Massachusetts. METHODS: Data were from the Standard Certificate of Live Births on 1,067,375 babies by mothers from 31 ethnic groups for 1996-2009. Mothers reported whether they smoked during pregnancy and the birth facility recorded whether mothers started breastfeeding. The acculturation proxy combined mothers' country of birth and language preference: U.S.-born, foreign-born English-speaking, and foreign-born non-English speaking. For each ethnic group, adjusted logistic regression models were used to examine associations between the acculturation proxy and whether mothers smoked or initiated breastfeeding. Data were analyzed from 2012 to 2013. RESULTS: A lower proportion of foreign-born mothers had a high school degree or private insurance than U.S.-born mothers. However, foreign-born mothers who were English (range of AORs=0.07-0.93) or non-English speakers (AORs=0.01-0.36) were less likely to smoke during pregnancy than their U.S.-born counterparts. Foreign-born mothers who were English (AORs=1.22-6.52) or non-English speakers (AORs=1.35-10.12) were also more likely to initiate breastfeeding compared to U.S.-born mothers, except for some mothers with Asian ethnicities. CONCLUSIONS: The consistency of the associations of being foreign-born with less smoking and more breastfeeding suggests that for the majority of ethnic groups studied, acculturation in the U.S. results in poorer maternal health behaviors.

Mapping for maternal and newborn health: the distributions of women of childbearing age, pregnancies and births.

BACKGROUND: The health and survival of women and their new-born babies in low income countries has been a key priority in public health since the 1990s. However, basic planning data, such as numbers of pregnancies and births, remain difficult to obtain and information is also lacking on geographic access to key services, such as facilities with skilled health workers. For maternal and newborn health and survival, planning for safer births and healthier newborns could be improved by more accurate estimations of the distributions of women of childbearing age. Moreover, subnational estimates of projected future numbers of pregnancies are needed for more effective strategies on human resources and infrastructure, while there is a need to link information on pregnancies to better information on health facilities in districts and regions so that coverage of services can be assessed. METHODS: This paper outlines demographic mapping methods based on freely available data for the production of high resolution datasets depicting estimates of numbers of people, women of childbearing age, live births and pregnancies, and distribution of comprehensive EmONC facilities in four large high burden countries: Afghanistan, Bangladesh, Ethiopia and Tanzania. Satellite derived maps of settlements and land cover were constructed and used to redistribute areal census counts to produce detailed maps of the distributions of women of childbearing age. Household survey data, UN statistics and other sources on growth rates, age specific fertility rates, live births, stillbirths and abortions were then integrated to convert the population distribution datasets to gridded estimates of births and pregnancies. RESULTS AND CONCLUSIONS: These estimates, which can be produced for current, past or future years based on standard demographic projections, can provide the basis for strategic intelligence, planning services, and provide denominators for subnational indicators to track progress. The datasets produced are part of national midwifery workforce assessments conducted in collaboration with the respective Ministries of Health and the United Nations Population Fund (UNFPA) to identify disparities between population needs, health infrastructure and workforce supply. The datasets are available to the respective Ministries as part of the UNFPA programme to inform midwifery workforce planning and also publicly available through the WorldPop population mapping project.

The evaluation of maternal health in rural western China.

OBJECTIVE: The double burden of undernutrition and overnutrition is recognized as a global devastating problem. However, few studies have investigated the maternal nutritional status among different ethnicities and the socio-demographic characteristics in rural areas of western China. This study attempted to fill this gap. DESIGN: Data on 10,495 women with children under three years old were collected using a three-stage probability proportion to size sampling from 45 counties of 10 provinces in western China. Generalized Estimating Equation (GEE) was used to assess the maternal nutrition conditions, including chronic energy deficiency (CED) and overweight/obesity. RESULTS: According to the WHO BMI standard, the prevalences of CED and overweight/obesity were 12.3% (BMI≤18.5 kg/m2) and 12.4% (BMI≥25 kg/m2), respectively, while overweight/obesity rate was 18.5% (BMI≥24 kg/m2) based on the Chinese standard. A significant difference in malnutrition between Han and Minority was not observed. The relationship between breastfeeding and CED was inverse (OR 0.64, 95%CI: 0.48, 0.87), but higher parity were positively correlated with CED (OR 1.57, 95%CI: 1.36, 1.82). The highest odds of CED were observed in the group with 1-5 years of education (OR 1.21, 95%CI: 1.03, 1.43). Higher parity was also associated with overweight/obesity (OR 0.78, 95%CI: 0.67, 0.91), and rural women aged 30-39 years old were more likely to be overweight/obese (OR 2.21, 95%CI: 1.47, 3.32). In addition, higher socioeconomic status was positively related to overweight women (OR 1.19, 95%CI: 1.01, 1.43), and inversely associated with CED (OR 0.83, 95%CI: 0.72, 0.97). CONCLUSION: The coexistence of undernutrition and overweight among women of reproductive age are determined in rural western China. It appears that socio-demographic factors considerably influence maternal nutritional status in the study. These findings have important policy implications for recommendations on maternal health intervention in China.

Reproductive health in indigenous Chihuahua: giving birth 'alone like the goat'.

INTRODUCTION: Indigenous peoples in the state of Chihuahua, Mexico, are known to outsiders as the Tarahumaras. The Tarahumaras are one of the few cultural groups known to have no traditional birth attendants, and Tarahumara women often give birth alone and outdoors. Currently, little is known about this group, their health status or their culture. OBJECTIVE: The objective of this study was to assess the state of reproductive health outcomes, risks, protective factors, beliefs and behaviors in the Tarahumara population. DESIGN: This paper reports on the qualitative results of a mixed methods study, comprised of focus groups, interviews, participatory exploratory methods, ethnographic observation and household surveys investigating the reproductive health status of the Tarahumara peoples and contextual factors influencing it. Qualitative data is presented, supported by preliminary quantitative findings. RESULTS: This study supports speculation that the Tarahumara population is burdened by severe maternal health problems. The sample size was too small to definitively assess risk factors for the outcome of maternal mortality, but qualitative findings point to some important contextual issues that contribute to participants' perceptions of susceptibility to and severity of the problem, their reproductive health beliefs and behaviors, and barriers to behavior change. Major issues included disparities in biomedical knowledge, trust between non-indigenous providers and indigenous patients, and structural issues including access to medical facilities and infrastructure. CONCLUSION: Qualitative data is drawn upon to make recommendations and identify lessons applicable to similar situations where cultural minorities suffer serious health inequities. This study underscores the importance of needs and assets assessment, as it reveals unique contextual factors that must be taken into account in intervention design. Also, collaborative partnership with community members and leaders proved to be invaluable in the research, warranting further collaboration by both governmental and non-governmental groups attempting to improve the health of this population. This becomes especially important when making and enforcing health policy.

Childbirth traditions and cultural perceptions of safety in Nepal: critical spaces to ensure the survival of mothers and newborns in remote mountain villages.

OBJECTIVE: to uncover local beliefs regarding pregnancy and birth in remote mountainous villages of Nepal in order to understand the factors which impact on women's experiences of pregnancy and childbirth and the related interplay of tradition, spiritual beliefs, risk and safety which impact on those experiences. DESIGN: this study used a qualitative methodological approach with in-depth interviews framework within social constructionist and feminist critical theories. SETTING: the setting comprised two remote Nepalese mountain villages where women have high rates of illiteracy, poverty, disadvantage, maternal and newborn mortality, and low life expectancy. Interviews were conducted between February and June, 2010. PARTICIPANTS: twenty five pregnant/postnatal women, five husbands, five mothers-in-law, one father-in-law, five service providers and five community stakeholders from the local communities were involved. FINDINGS: Nepalese women, their families and most of their community strongly value their childbirth traditions and associated spiritual beliefs and they profoundly shape women's views of safety and risk during pregnancy and childbirth, influencing how birth and new motherhood fit into daily life. These intense culturally-based views of childbirth safety and risk conflict starkly with the medical view of childbirth safety and risk. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: if maternity services are to improve maternal and neonatal survival rates in Nepal, maternity care providers must genuinely partner with local women inclusive of their cultural beliefs, and provide locally based primary maternity care. Women will then be more likely to attend maternity care services, and benefit from feeling culturally safe and culturally respected within their spiritual traditions of birth supported by the reduction of risk provided by informed and reverent medicalised care.

VDR gene polymorphisms, interaction with smoking and risk of periodontal disease in Japanese women: the Kyushu Okinawa maternal and child health study.

Epidemiological evidence on the relationship between vitamin D receptor (VDR) polymorphisms and periodontal disease is inconsistent. We investigated associations between four VDR single-nucleotide polymorphisms (SNPs) including rs731236 (TaqI), rs7975232 (ApaI), rs1544410 (BsmI) and rs2228570 (FokI), and the risk of periodontal disease among young Japanese women. Cases included 131 women who had at least one tooth with a probing depth of 3.5 mm or deeper. Controls included 1019 women without periodontal disease. Adjustment was made for age, region of residence, education, toothbrushing frequency and use of an interdental brush. Compared with the AA genotype of SNP rs731236, the GG genotype had a significantly increased risk of periodontal disease: the adjusted OR was 3.68 (95% confidence interval: 1.06-12.78). There were no significant relationships between SNPs rs7975232, rs1544410 or rs2228570 and periodontal disease. None of the haplotypes were significantly related to periodontal disease. Compared with subjects with the AA or AG genotype of SNP rs731236 who had never smoked, those with the GG genotype who had ever smoked had a significantly increased risk of periodontal disease; nevertheless, neither multiplicative nor additive interaction was significant. The additive interaction between SNP rs7975232 and smoking was significant, although the multiplicative interaction was not statistically significant. No multiplicative or additive interactions were observed between the other SNPs and smoking. Our results indicated that VDR SNP rs731236 might be associated with periodontal disease. In addition, we present new evidence for a biological interaction between VDR SNP rs7975232 and smoking that affects periodontal disease.

Perspectives of family physicians on the care of uninsured pregnant women.

OBJECTIVE: No official provisions are made for the medically uninsured under provincial public health programs in Canada. Studies have shown that uninsured pregnant women have inadequate access to prenatal and obstetrical services that favour healthy maternal and child outcomes. This qualitative study aimed to explore the perspectives of family physicians who provided care to uninsured pregnant women. METHODS: Eight family physicians affiliated with two Montreal-based primary-care clinics and one tertiary care hospital between 2004 and 2007 were interviewed using a semi-structured interview guide. Data were assessed using thematic analysis. RESULTS: Uninsured pregnant patients were characterized by physicians as socially vulnerable, with precarious immigration status that limited their access to health services. Uninsured patients were thought not to benefit from the same standard of perinatal care as their insured counterparts. Care of uninsured women was generally thought to be a professional obligation, regardless of the woman's ability to pay. Caring for this population was considered by family physicians to be challenging, engendering psychological stress, increased workload, and occasional tensions with other health care providers. CONCLUSION: In the present context, family physicians are left to negotiate the health care system in an attempt to provide adequate perinatal care for uninsured pregnant patients. This situation has repercussions for physicians, for patients and, ultimately, for infants. Leadership is required to ensure that all pregnant women in Canada have access to appropriate health care during the perinatal period.

Objectif : Il n'existe aucune disposition officielle en ce qui concerne les personnes qui ne sont pas couvertes par les régimes publics d'assurance-maladie provinciaux au Canada. Des études ont démontré que les femmes enceintes non assurées ne disposent pas d'un accès adéquat aux services prénataux et obstétricaux qui favorisent l'obtention de résultats maternels et infantiles sains. Cette étude qualitative avait pour but d'explorer les points de vue de médecins de famille ayant offert des soins à des femmes enceintes non assurées. Méthodes : Des entrevues semi-structurées ont été menées auprès de huit médecins de famille affiliés à deux cliniques montréalaises de soins primaires et à un hôpital de soins tertiaires de la même région entre 2004 et 2007. Les données ont été évaluées au moyen d'une analyse thématique. Résultats : Les patientes enceintes non assurées ont été caractérisées, par ces médecins, comme étant des personnes vulnérables sur le plan social dont le statut précaire en matière d'immigration limitait leur accès aux services de santé. Ces médecins estimaient que les patientes non assurées ne bénéficiaient pas du même standard de soins périnataux que leurs homologues assurées. D'ordre général, ils estimaient que l'offre de soins aux femmes non assurées constituait une obligation professionnelle, sans égard à la capacité de payer. Les médecins de famille considéraient que l'offre de soins à cette population était une activité complexe, qu'elle engendrait du stress psychologique, qu'elle entraînait une augmentation de la charge de travail et qu'elle donnait occasionnellement lieu à des tensions dans leurs relations avec d'autres fournisseurs de soins de santé. Conclusion : Dans le contexte actuel, les médecins de famille sont laissés à eux-mêmes dans leurs efforts visant à utiliser le système de santé pour tenter d'offrir des soins prénataux adéquats aux patientes enceintes non assurées. Cette situation a des répercussions pour les médecins, les patientes et, en bout de ligne, les enfants. Les décideurs doivent faire preuve de leadership pour s'assurer que, au Canada, toutes les femmes enceintes obtiennent accès à des soins de santé appropriés au cours de la période périnatale.

Aboriginal Families Study: a population-based study keeping community and policy goals in mind right from the start.

BACKGROUND: Australian Aboriginal and Torres Strait Islander women are between two to five times more likely to die in childbirth than non-Aboriginal women, and two to three times more likely to have a low birthweight infant. Babies with a low birthweight are more likely to have chronic health problems in adult life. Currently, there is limited research evidence regarding effective interventions to inform new initiatives to strengthen antenatal care for Aboriginal families. METHOD/DESIGN: The Aboriginal Families Study is a cross sectional population-based study investigating the views and experiences of Aboriginal and non-Aboriginal women having an Aboriginal baby in the state of South Australia over a 2-year period. The primary aims are to compare the experiences and views of women attending standard models of antenatal care with those accessing care via Aboriginal Family Birthing Program services which include Aboriginal Maternal Infant Care (AMIC) Workers as members of the clinical team; to assess factors associated with early and continuing engagement with antenatal care; and to use the information to inform strengthening of services for Aboriginal families. Women living in urban, regional and remote areas of South Australia have been invited to take part in the study by completing a structured interview or, if preferred, a self-administered questionnaire, when their baby is between 4-12 months old. DISCUSSION: Having a baby is an important life event in all families and in all cultures. How supported women feel during pregnancy, how women and families are welcomed by services, how safe they feel coming in to hospitals to give birth, and what happens to families during a hospital stay and in the early months after the birth of a new baby are important social determinants of maternal, newborn and child health outcomes. The Aboriginal Families Study builds on consultation with Aboriginal communities across South Australia. The project has been implemented with guidance from an Aboriginal Advisory Group keeping community and policy goals in mind right from the start. The results of the study will provide a unique resource to inform quality improvement and strengthening of services for Aboriginal families.

Migration and maternity: insights of context, health policy, and research evidence on experiences and outcomes from a three country preliminary study across Germany, Canada, and the United kingdom.

A group from Germany, Canada, and the United Kingdom undertook country-specific scoping reviews and stakeholder consultations before joining to holistically compare migration and maternity in all three countries. We examined four interlinking dimensions to understand how international migrant/minority maternal health might be improved upon using transnational research: (a) wider sociopolitical context, (b) health policy arena, (c) constellation, outcomes, and experiences of maternity services, and (d) existing research contexts. There was clear evidence that the constellation and delivery of services may undermine good experiences and outcomes. Interventions to improve access and quality of care remain small scale, short term, and lacking in rigorous evaluation.

Case-control study of eczema in relation to IL4Rα genetic polymorphisms in Japanese women: The Kyushu Okinawa Maternal and Child Health Study.

Epidemiological research on the relationship between single nucleotide polymorphisms (SNPs) in the IL4Rα gene and eczema is sparse. We investigated the associations between IL4Rα SNPs rs1805011, rs1805015 and rs1801275 and risk of eczema in young adult Japanese women. Included were 188 women who met the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC) for eczema. Controls were 635 women without eczema according to the ISAAC criteria who also had not been diagnosed with asthma, atopic eczema and/or allergic rhinitis by a doctor. Adjustment was made for age, region of residence, number of children, smoking and education. Under the additive model, SNP rs1805011 was significantly related to eczema: the adjusted OR was 0.55 (95% CI: 0.31-0.99). SNP rs1805015 was significantly associated with eczema in the additive and dominant models: the adjusted ORs were 0.55 (95% CI: 0.30-0.98) and 0.55 (95% CI: 0.30-0.997), respectively. There was no significant association between SNP rs1801275 and eczema. None of the haplotypes were significantly related to eczema. Significant associations between SNPs rs1805011 and rs1805015 and eczema were reported in women who had never smoked, but not in those who had ever smoked; the multiplicative interactions, however, were not significant. This is the first study to demonstrate significant associations between IL4Rα SNPs rs1805011 and rs1805015 and eczema. We do not find evidence for interactions affecting eczema between IL4Rα SNPs and smoking.