Benefits of not smoking during pregnancy for non-Aboriginal women and their babies in New South Wales, Australia: a record linkage study

BackgroundSmoking rates among pregnant women in New South Wales (NSW) have plateaued at 8-9%. To inform relevant smoking reduction efforts, we aimed to quantify the benefits of not smoking during pregnancy for non-Aboriginal NSW mothers and their babies. The benefits of not smoking during pregnancy for NSW Aboriginal mothers have previously been described. These data are important inputs in modelling health and economic impacts of smoking cessation interventions. MethodsThis population-based cohort study used linked-data from routinely collected data sets. Not smoking during pregnancy was the exposure of interest among all NSW non-Aboriginal women who became mothers of singleton babies in 2012-2016. Unadjusted and adjusted relative risks (aRR) were used to examine associations between not smoking during pregnancy and adverse outcomes including severe morbidity, inter-hospital transfer, perinatal death, preterm birth and small-for-gestational age. Population attributable fractions (PAFs) were calculated to quantify adverse perinatal outcomes avoided in the population if all mothers were non-smokers. ResultsCompared with babies born to mothers who smoked during pregnancy, babies born to non-smoking mothers had a lower risk of all adverse perinatal outcomes including perinatal death (aRR}=0.68, 95%CI 0.61-0.76), preterm birth (aRR=0.58, 95%CI 0.56-0.61) and small-for-gestational age (aRR=0.48, 95%CI 0.47-0.50). PAFs(%) were 3.9% for perinatal death, 5.6% for preterm birth and 7.3% for small-for-gestational-age. Compared with women who smoked during pregnancy (n=36,518), those who did not smoke (n=413,072) had a lower risk of suffering severe maternal morbidity (aRR=0.87, 95%CI 0.81-0.93) and being transferred to another hospital (aRR=0.92, 95%CI 0.86-0.99). ConclusionsMothers who reported not smoking during pregnancy had a small reduction in their risk of morbidity and of being transferred to another hospital whilst their babies had substantially reduced risks of all adverse perinatal outcomes. Results have implications for clinician training, clinical care standards, and performance management.

Hospitalisations for pelvic inflammatory disease in young Aboriginal women living in remote Australia: the role of chlamydia and gonorrhoea

ObjectiveAboriginal women living in remote Australia experience a high burden of both chlamydia and gonorrhoea infections and disproportionately high rates of pelvic inflammatory disease (PID). We estimated for the first time the fraction of PID attributable to these infections in young Aboriginal women living in these settings.MethodsUsing published data from two large Australian studies (2002–2013; 2010–2014), we calculated the fraction of emergency department presentations and hospitalisations for PID attributable to chlamydia and/or gonorrhoea infection in Aboriginal women aged 16–29 years living in remote Australia. We used a Monte Carlo simulation to estimate the mean and 95% CIs for the assumed prevalence and population attributable fractions for PID for infection stratifications (chlamydia only, gonorrhoea only and dual infection) as well as for any infection (chlamydia and/or gonorrhoea). Additional outputs were calculated for chlamydia infection with/without gonorrhoea coinfection, and vice versa.ResultsThe prevalence of chlamydia only was 12.9% (95% CI: 11.6% to 14.2%), gonorrhoea only was 7.8% (95% CI: 6.6% to 8.9%) and dual infection was 6.5% (95% CI: 5.8% to 7.2%); rate ratios of PID were 1.9 (95% CI: 1.5 to 2.3), 5.2 (95% CI: 4.3 to 6.4) and 4.6 (95% CI: 3.8 to 5.5), respectively. The overall fraction of PID attributable to chlamydia and/or gonorrhoea was 40.2% (95% CI: 36.0% to 44.4%); any gonorrhoea was 33.4% (95% CI: 29.2% to 37.8%) and any chlamydia was 20.6% (95% CI: 16.9% to 24.6%).ConclusionOur study demonstrates the importance of calculating the fraction of PID related to chlamydia and gonorrhoea in the local context, demonstrating the major contribution gonorrhoea makes to PID hospitalisations among Australian Aboriginal women living in remote settings. To significantly and sustainably reduce the unacceptable rate of PID in this population, strategies are urgently needed to improve timely testing and treatment and recognition and management of PID in primary care.

A Global Silence: A Critical Interpretive Synthesis of Aboriginal Mothering Through Domestic and Family Violence

Aboriginal women globally face extreme risk of violence and their exposure to domestic and family violence (DFV) and state sanctioned violence is increasing. Attention to the impact on Aboriginal mothering is lacking and is underpinned by issues of social justice. This study employs Critical Interpretive Synthesis to examine the evidence on Aboriginal mothering through DFV. Serrant-Green’s Silences Framework was used to structure the critique, understand its problematics and generate an argument to counter the evidential silence. From 6,117 search results, ten publications were reviewed, only four of which substantially addressed Aboriginal mothering in the context of family and domestic violence; a conspicuous absence from the literature about Aboriginal women, children, and mothering. Studies addressing Aboriginal women’s experience of DFV did not credit the issue of mothering. Equally, studies that did address mothering through violence were generally not inclusive of Aboriginal women. Silence, therefore, sits at the nexus of DFV, Aboriginal women, and mothering. While violence against Aboriginal women is acknowledged as a social ill, inattention to mothering in research represents a disregard for Aboriginal women’s mothering identities and roles. Aboriginal women’s voice and citizenship are critical to addressing this issue.

Codeveloping a multibehavioural mobile phone app to enhance social and emotional well-being and reduce health risks among Aboriginal and Torres Strait Islander women during preconception and pregnancy: a three-phased mixed-methods study

ObjectiveDescribe the development and pretest of a prototype multibehavioural change app MAMA-EMPOWER.DesignMixed-methods study reporting three phases: (1) contextual enquiry included stakeholder engagement and qualitative interviews with Aboriginal women, (2) value specification included user-workshop with an Aboriginal researcher, community members and experts, (3) codesign with Aboriginal researchers and community members, followed by a pretest of the app with Aboriginal women, and feedback from qualitative interviews and the user-Mobile Application Rating Scale (U-MARS) survey tool.SettingsAboriginal women and communities in urban and regional New South Wales, Australia.ParticipantsPhase 1: interviews, 8 Aboriginal women. Phase 2: workshop, 6 Aboriginal women. Phase 3: app trial, 16 Aboriginal women. U-MARS, 5 Aboriginal women.ResultsPhase 1 interviews revealed three themes: current app use, desired app characteristics and implementation. Phase 2 workshop provided guidance for the user experience. Phase 3 app trial assessed all content areas. The highest ratings were for information (mean score of 3.80 out of 5, SD=0.77) and aesthetics (mean score of 3.87 with SD of 0.74), while functionality, engagement and subjective quality had lower scores. Qualitative interviews revealed the acceptability of the app, however, functionality was problematic.ConclusionsDeveloping a mobile phone app, particularly in an Aboriginal community setting, requires extensive consultation, negotiation and design work. Using a strong theoretical foundation of behavioural change technique’s coupled with the consultative approach has added rigour to this process. Using phone apps to implement behavioural interventions in Aboriginal community settings remains a new area for investigation. In the next iteration of the app, we aim to find better ways to personalise the content to women’s needs, then ensure full functionality before conducting a larger trial. We predict the process of development will be of interest to other health researchers and practitioners.

Law, Culture and Decolonisation: The Perspectives of Aboriginal Elders on Family Violence in Australia

Family violence within Aboriginal communities continues to attract considerable scholarly, governmental and public attention in Australia. While rates of victimization are significantly higher than non-Aboriginal rates, Aboriginal women remain suspicious of the ‘carceral feminism’ remedy, arguing that family violence is a legacy of colonialism, systemic racism, and the intergenerational impacts of trauma, requiring its own distinctive suite of responses, ‘uncoupled’ from the dominant feminist narrative of gender inequality, coercive control and patriarchy. We conclude that achieving meaningful reductions in family violence hinges on a decolonizing process that shifts power from settler to Aboriginal structures. Aboriginal peoples are increasingly advocating for strengths-based and community-led solutions that are culturally safe, involve Aboriginal justice models, and recognises the salience of Aboriginal Law and Culture. This paper is based on qualitative research in six locations in northern Australia where traditional patterns of Aboriginal Law and Culture are robust Employing a decolonising methodology, we explore the views of Elders in these communities regarding the existing role of Law and Culture, their criticisms of settler law, and their ambitions for a greater degree of partnership between mainstream and Aboriginal law. The paper advances a number of ideas, based on these discussions, that might facilitate a paradigm shift in theory and practice regarding intervention in family violence.

631Benefits of not smoking during pregnancy for Aboriginal women and their babies

Background To provide evidence for targeted smoking cessation policy, the aim of this study was to compare pregnancy outcomes of Aboriginal mothers who reported not smoking during pregnancy with those who reported smoking. Methods This population-based retrospective cohort study used linked data from routinely collected datasets. Not smoking during pregnancy was the exposure of interest among all New South Wales Aboriginal women who became mothers of singleton babies in 2010–2014. Unadjusted and adjusted relative risks (aRR) and 95%CIs from modified Poisson regression were used to examine associations between not smoking during pregnancy and maternal and perinatal outcomes including severe morbidity, inter-hospital transfer, perinatal death, preterm birth and small-for-gestational age. Population attributable fractions (PAFs) were calculated using adjusted relative risks. Results Compared with babies born to mothers who smoked during pregnancy, babies born to non-smoking mothers had a lower risk of all adverse perinatal outcomes including perinatal death (aRR=0.58, 95%CI 0.44–0.76), preterm birth (aRR=0.58, 95%CI 0.53–0.64) and small-for-gestational age (aRR=0.35, 95%CI 0.32–0.39). PAFs(%) were 27% for perinatal death, 26% for preterm birth and 48% for small-for-gestational-age. Compared with women who smoked during pregnancy (n = 8,919), those who did not smoke (n = 9,235) had a lower risk of being transferred to another hospital (aRR=0.76, 95%CI 0.66–0.89). Conclusions Babies born to women who did not smoke had much lower risks of all adverse perinatal outcomes. Key messages Between a quarter and a half of adverse perinatal outcomes in this population could potentially be prevented by an effective smoking cessation program.

ka pamihiwehk mino pimatisiwin: kichi ininiw ahkosowinow kakiskaocik ahkosowinow HIV (Promoting mino pimatisiwin: Urban Aboriginal Women Living with HIV)

This research projects examine the impact of HIV among urban Aboriginal women living with HIV in Winnipeg, Manitoba. Despite the antiretroviral tereatment and HIV prevention strategies, new HIV positive cases for urban Abvoriginal women are increasing. Previous studies have failed to address the disparities of urban Aboriginal women living with HIV. Attempting to understand the lived experiences of urban Aboriginal women living with HIV, Indigenous methodologies, storytelling and talking circles were used for data collection. Incorporating the natural law of respect, the women in this project are acknowledged as the experts or knowledge keepers of HIV. This project is a way of reclaiming traditional knowledge. To reclaim our tradition, we need to decolonize ourselves, our thoughts of where we came from, who we are and where we are going. Stating our identity, as women, mothers and grandmothers, we can pick up our medicine bundles. In doing this, we establish our traditional resposibilities as iskewewak (women) in caring for our people through the achimo (story) of the seven sacred teachings. This research project is like digging up ancestral roots of knowledge or reclaiming our achimowak (stories), ka is kisiskenitamen (ways of knowing), ka is totaman (ways of doing),ekwa ka is itastasiwin (ways of being). We are the agents of change, the shapeshifters creating a paradigm shift in research. This is my medicine story.