The early bird

It’s difficult to make an argument against timely antenatal care. All the available research indicates that timely antenatal care leads to better health for mothers, fewer interventions in late pregnancy and positive child health outcomes.  In the case of pregnancy and birth, the early bird achieves greater outcomes. Accordingly, the Australian Antenatal Guidelines recommend that the first antenatal visit occur within the first ten weeks of pregnancy. Wise advice.

However, in Australia there is a group of women that miss out on care within the first 14 weeks of pregnancy. Of the women who gave birth in Australia in 2013, 43% of overseas-born women and 35% of Australian-born women did not see a doctor for their pregnancy before 14 weeks. By 20 weeks, these figures decrease to 18% and 14% respectively: better numbers but concerning nonetheless.

What is behind these numbers? What prevents women from seeing their doctors within the first 10 weeks of pregnancy? Cost is a factor. The public health system offers free care to Australian permanent residents, but there are many immigrant women on temporary visas who pay their own way if they become pregnant during the first twelve months on arrival, and therefore fall within the 12 month health insurance waiting period.

Accessibility is another factor. While the health system might be self-explanatory to those who are familiar with its idiosyncrasies, for people born overseas, the health system can be a labyrinth. It takes time to decipher the system and evaluate the right entry point, for different reasons and at particular points in time.

Language barriers also get in the way, as do time constraints. The multiple demands on women’s time and energy lead to a need to prioritise and women’s health doesn’t always make it to the top of the list. During the course of our health education work we met a newly arrived woman who was in her eight month of pregnancy and who had not yet booked in to the hospital. The woman had a range of other pressing priorities: she needed to earn an income, find a stable home, and arrange for her husband to join her in Australia. Fortunately we were able to link her with a hospital that then arranged supports for her other issues.

Every woman giving birth in Australia should have the opportunity to access timely and appropriate antenatal care. Health services can play their part by acknowledging that their service starts long before a woman approaches them for care. There are proven strategies that health services can employ to reach out more widely, including promotion in ethnic media,  and the use of interpreting services and bilingual workers. Even when written information is provided in-language, women still need the opportunity to discuss the options available to them in ways that are culturally responsive and relevant to their needs.

Partnerships with organisations like MCWH, or ethno specific and settlement services help in creating a smoother pathway from the community to the health system. There is no doubt that timely care benefits mothers and babies, and makes the job of health professionals more effective. Further sustained investment into early intervention will make it easier for all women to take action on their health at the time it matters most.