Associations between dental care approachability and dental attendance among women pregnant with an Indigenous child: a cross-sectional study

Background Oral health during pregnancy is vital for both mother and child. Indigenous Australians face many barriers in accessing dental care. Service approachability is one of the key domains in accessing health services. There is little empirical evidence of the association between service approachability and dental care attendance or oral health outcome. The aim of this study is to examine the relationship between dental service approachability on dental care attendance and self-reported gum disease among South Australian women pregnant with an Aboriginal child. Methods Four hundred and twenty-seven women pregnant with an Aboriginal child completed questionnaires in both metropolitan and regional health settings in South Australia in 2011. Four variables related to approachability of dental services: (1) perception of need; (2) service-related health literacy; (3) oral health beliefs and; (4) trust and expectation of dental service. The association between service approachability-related factors, dental utilisation and self-reported gum disease during pregnancy were assessed using Generalised Poisson regression models, after adjusting for age, remoteness, employment status and education. Estimates were presented as adjusted prevalence ratios (APR). Results Most participants (85.8%) reported a need for dental care, had positive oral health beliefs (88.3%) and had expectations towards dental care (86.2%). Dental service utilisation during pregnancy was low (35.7%). Many participants (78.0%) expressed knowing what to do if they needed dental care, while most (39.8%) doubted that dental care would be available the next day. Poor health service literacy was identified as a risk factor for non-optimal dental attendance (APR = 0.86, 95%CI 0.74–0.99). Perceived need for dental care was positively associated with self-reported gum disease (APR = 1.24, 95%CI 1.06–1.45). Conclusion Inability to navigate the dental care system was a risk factor for poor dental attendance among South Australian women pregnant with an Aboriginal child. Perceived need for dental care was associated with gum disease.

Cohort profile: South Australian Aboriginal Birth Cohort (SAABC)—a prospective longitudinal birth cohort

PurposeThe South Australian Aboriginal Birth Cohort (SAABC) is a prospective, longitudinal birth cohort established to: (1) estimate Aboriginal child dental disease compared with population estimates; (2) determine the efficacy of an early childhood caries intervention in early versus late infancy; (3) examine if efficacy was sustained over time and; (4) document factors influencing social, behavioural, cognitive, anthropometric, dietary and educational attainment over time.ParticipantsThe original SAABC comprised 449 women pregnant with an Aboriginal child recruited February 2011 to May 2012. At child age 2 years, 324 (74%) participants were retained, at age 3 years, 324 (74%) participants were retained and at age 5 years, 299 (69%) participants were retained. Fieldwork for follow-up at age 7 years is underway, with funding available for follow-up at age 9 years.Findings to dateAt baseline, 53% of mothers were aged 14–24 years and 72% had high school or less educational attainment. At age 3 years, dental disease experience was higher among children exposed to the intervention later rather than earlier in infancy. The effect was sustained at age 5 years, but rates were still higher than general child population estimates. Experiences of racism were high among mothers, with impacts on both tooth brushing and toothache. Compared with population estimates, levels of self-efficacy and self-rated oral health of mothers at baseline were low.Future plansOur data have contributed to a better understanding of the environmental, behavioural, dietary, biological and psychosocial factors contributing to Aboriginal child oral and general health, and social and emotional well-being. This is beneficial in charting the trajectory of cohort participants’ health and well-being overtime, particularly in identifying antecedents of chronic diseases which are highly prevalent among Aboriginal Australians. Funding for continued follow-up of the cohort will be sought.Trial registration numberACTRN12611000111976; Post-results.

Associations Between Dental Care Approachability and Dental Attendance Among Women Pregnant With an Indigenous Child: A Cross-Sectional Study

Background Oral health during pregnancy is vital for both mother and child. Indigenous Australians face many barriers in accessing dental care. Service approachability is one of the key domains in accessing health services. There is little empirical evidence of the association between service approachability and dental care attendance or oral health outcome. The aim of this study is to examine the relationship between dental service approachability on dental care attendance and self-reported gum disease among South Australian women pregnant with an Aboriginal child.Methods Four hundred and twenty-seven women pregnant with an Aboriginal child completed questionnaires in both metropolitan and regional health settings in South Australia in 2011. Four variables related to approachability of dental services: (1) perception of need; (2) service-related health literacy; (3) oral health beliefs and; (4) trust and expectation of dental service. The association between service approachability-related factors, dental utilisation and self-reported gum disease during pregnancy were assessed using Generalised Poisson regression models, after adjusting for age, remoteness, employment status and education. Estimates were presented as adjusted prevalence ratios (APR).Results Most participants (85.8%) reported a need for dental care, had positive oral health beliefs (88.3%) and had expectations towards dental care (86.2%). Dental service utilisation during pregnancy was low (35.7%). Many participants (78.0%) expressed knowing what to do if they needed dental care, while most (39.8%) doubted that dental care would be available the next day. Poor health service literacy was identified as a risk factor for non-optimal dental attendance (APR=0.86, 95%CI: 0.74-0.99). Perceived need for dental care was positively associated with self-reported gum disease (APR= 1.24 95%CI 1.06-1.45).Conclusion Inability to navigate the dental care system was a risk factor for poor dental attendance among South Australian women pregnant with an Aboriginal child. Perceived need for dental care was associated with gum disease.

Settler-Colonial Violence and the ‘Wounded Aboriginal Child’: Reading Alexis Wright with Irene Watson (and Giorgio Agamben)

Drawing on Alexis Wright’s novel The Swan Book and Irene Watson’s expansive critique of Australian law, this article locates within the settler–Australian imaginary the figure of the ‘wounded Aboriginal child’ as a site of contest between two rival sovereign logics: First Nations sovereignty (grounded in a spiritual connection to the land over tens of millennia) and settler sovereignty (imposed on Indigenous peoples by physical, legal and existential violence for 230 years). Through the conceptual landscape afforded by these writers, the article explores how the arenas of juvenile justice and child protection stage an occlusion of First Nations sovereignty, as a disappearing of the ‘Aboriginality’ of Aboriginal children under Australian settler law. Giorgio Agamben’s concept of potentiality is also drawn on to analyse this sovereign difference through the figures of Terra Nullius and ‘the child’.

A Commentary Against Aboriginal to non-Aboriginal Adoption

This article focuses on the author’s experience and observations respecting the appropriateness of adopting Aboriginal children into non-Aboriginal settings, and its impact on children, youth and parents receiving services from an Aboriginal child and family services agency in Toronto.

Talking about the Aboriginal Community: Child Protection Practitioners’ Views

Child protection practitioners view Aboriginal communities as victim, adversary, participant, partner, and protector of children. These representations of communities are derived from interview data with 19 Aboriginal and non-Aboriginal child protection social workers in British Columbia, Canada. The representations of the community are informed by the practitioner’s geographic relationship to the community and the length of community residency (including whether it’s the practitioner’s community of origin). Practitioners view communities as a victim or adversary when no relationship of trust exists with the community. Practitioners view communities having a participative or partnership role in child protection when trust has developed. When communities take full responsibility for children’s welfare, practitioners view the community as the protector of children. No clear association was found between the different representations of the community and the practitioner’s culture or organizational auspices. The practitioner’s own vision of practice is believed to significantly influence the relationship that develops with the community.