Improving and Integrating Urban Indigenous Health Services

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Reduction in Indigenous newborn removals by child protection services

Australian research published this month shows women who received care through an innovative Indigenous-led model of maternity care were three times less likely to have their Indigenous newborn removed by child protection services than women who received standard maternity care.

The research lands at the same time as the Australian Government’s Closing the Gap 2023 Annual Report which shows the rate of over-representation of Indigenous children in out-of-home care in Australia continues to increase.

Kristie Watego, Birthing in Our Community (BiOC) Service Development Manager, Institute for Urban Indigenous Health (IUIH), said the results show it is possible to significantly reduce the number of Indigenous babies removed at birth through effective holistic codesigned services.

“Existing maternity care models, and child protection systems, lack preventative measures and fail to prioritise family preservation. IUIH’s Birthing in Our Community service is a holistic, Indigenous-led and governed, multi-agency partnership between Aboriginal community-controlled health services and hospitals in parts of Southeast Queensland.

“It has already proven effective in improving health outcomes for Indigenous babies, reducing pre-term births by 38%, and significantly reducing related costs on the health system. Research now shows BiOC is also effective in improving family outcomes and reducing child protection intervention,” Ms Watego said.

In 2021-22 in the Southeast Queensland jurisdiction where this research took place, Indigenous babies accounted for 43% of infants in out-of-home care while only representing 9.7% of all infants.

The research was conducted at IUIH’s Salisbury BiOC Community Hub and their partner, Brisbane’s Mater Mothers’ Hospital, from 2013 to 2019. During the study, 1988 women pregnant with Indigenous babies were offered either standard care or the BiOC service. In that time 944 women (960 babies) received BiOC care while 1044 women (1048) babies received standard care.

Thirty-one women who received standard care had their babies removed by child protection services at birth, while only nine of the women who received BiOC care had their babies removed. The BiOC model of care also showed a significantly lower removal rate (9.5 per 1000) than the 2021-22 national rate of 57.8 per 1000.

“The BiOC model of care offers a more holistic and culturally safe and supportive wrap-around service. We see women come earlier and more often during their pregnancy because we’ve built relationships and connection with them. They feel comfortable and trust our staff, and that means they disclose challenges and then engage to strengthen themselves and their families. That’s at odds with what you often see in standard services with women concerned about child protection services,” Ms Watego said.

Renee Blackman, CEO, Aboriginal and Torres Strait Islander Community Health Service Brisbane, which partners with IUIH to run BiOC Hubs in Brisbane, said the design of the integrated service was integral to the improved outcomes.

“Pregnancy and childbirth provide an opportune time to engage women and break cycles of trauma. Unfortunately, most strategies and funding are directed towards child removal at birth which is expensive and avoidable in many cases,” Ms Blackman said.

The BiOC model is an example of what the Closing the Gap reforms were intended to deliver, significant impact through a strong community-controlled sector, transforming government organisations, shared decision-making, and shared access to better data in collaboration with Aboriginal and Torres Strait Islander people and organisations.

Adrian Carson, CEO, IUIH, said the research is timely evidence of the success of community-controlled approaches after this month’s damning Productivity Commission review of progress on the National Agreement on Closing the Gap.

“The review highlighted the lack of meaningful change in many areas, particularly that governments had failed to enable self-determination through sharing of power, and need to recognise that the community-controlled sector can achieve better results.

“We’ve demonstrated improvements in health and community outcomes, that it is possible to close the gap, and we’re contributing long-term cost savings to governments in the process. As a community-controlled health service we’ve successfully led the design and delivery of this incredibly effective service in partnership with mainstream services. It’s time for action, and funding, to follow the evidence,” Mr Carson said.

Professor Yvette Roe, Director, Charles Darwin University’s Molly Wardaguga Research Centre, said that the implications are clear for policy and practice.

“Investment in Indigenous organisations across the country to provide these evidence-based services is urgent,” Professor Roe said.

The research was published in Child Abuse & Neglect, The International Journal by the International Society for Prevention of Child Abuse and Neglect. Link to full paper:

The research was funded by the Australian National Health and Medical Research Council, and involved staff, data and researchers from the Institute for Urban Indigenous Health, Aboriginal and Torres Strait Islander Community Health Service Brisbane, Mater Mothers’ Hospital, Mater Research, and Charles Darwin University.

Additional BiOC research
  • The Lancet (2023): Birthing on country service compared to standard care for First Nations Australians: a cost-effectiveness analysis from a health system perspective Link to journal
  • The Lancet (2021): Effect of a Birthing on Country service redesign on maternal and neonatal health outcomes for First Nations Australians: a prospective, non-randomised, interventional trial Link to journal
  • The Lancet (2019): Reducing preterm birth amongst Aboriginal and Torres Strait Islander babies: A prospective cohort study, Brisbane, Australia Link to journal