Obligation and compromise: Aboriginal maternal infant care workers successes, challenges and partnerships.

Abstract

Marked inequalities in maternal and child health exist between Australia’s Aboriginal and non-Aboriginal populations. Improving the care of Aboriginal women before and during pregnancy has been identified as a key strategy to closing the gap in health outcomes. In 2004 a new birthing model of care was introduced into Port Augusta and Whyalla with the implementation of the Anangu Bibi Regional Family Birthing Program and the Aboriginal Regional Family Birthing Program. The model includes Aboriginal Maternal Infant Care (AMIC) workers, a specialised role unique to South Australia, working in partnership with midwives and other care providers to deliver antenatal and postnatal care. This project broadly aims to increase understanding of the role of the AMIC worker and explore the ways in which they manage the interface between the biomedical model of maternity care and Aboriginal knowledge and beliefs about reproductive health. This study was preceded by consultations with Aboriginal community leaders in Port Augusta and Whyalla, the State-wide Steering Committee overseeing the programs, Pika Wiya Health Service and the Port Augusta Regional Hospital. The data that informs the research include narratives from semi-structured interviews that were undertaken with six AMIC workers, six program midwives, five ward midwives, two medical practitioners and eleven clients. Analyses were undertaken to identify the major factors influencing the role and wellbeing of AMIC workers and the program environment. Analyses revealed a number of key influences on the ways AMIC workers negotiate the space in which they work. These included the strength of their relationships with colleagues and clients, their ability to advocate for both parties, and their level of confidence and self-worth arising from the value they place on clinical and cultural knowledge. AMIC workers continue to be challenged by the recognised differences between Aboriginal and Western cultures in relation to views about health, and this is often compounded by the intensive medicalisation of pregnancy and birthing. Furthermore, the traditional Westernised work ethic in place in a highly medicalised health system creates expectations about the ‘ideal worker’, which are outdated and inappropriate to AMIC workers, who often have many cultural and family obligations. These expectations, along with other systemic factors (e.g. inflexible visitation times, experiences of institutionalised racism) and aspects of AMIC worker’s private lives (e.g. extent of caring responsibilities) contribute to experiences of emotional labour and burnout. However, a strong AMIC-midwife partnership may act as a buffer to the challenges associated with the AMIC role, as it provides opportunities for two-way learning and promotes respect for individuals that may have different worldviews. This study has identified a number of complexities facing AMIC workers that are often invisible to the systems and institutions they are working in. Strategies that support the development of positive relationships between health professionals will help to ensure the sustainability of this model of care. These include training in cultural safety, promoting awareness of systemic issues that create challenges for AMIC workers, and creating more widespread positive recognition of the role. Essential resources that will improve the working environment for AMIC workers have also been identified and include an appropriate space conducive of a culturally safe and respectful environment. My research highlights that while there are discourses recognising that AMIC workers are essential to improving Aboriginal maternal and infant health outcomes, they are rarely dominant and thus do not drive priorities or change. Until the AMIC workers are truly valued (by way of respect and autonomy to care appropriately for Aboriginal women and their infants), I argue that improvements to Aboriginal health will not be realised.