Changing infant death rates: diagnostic shift, success story, or both?

EditorialRoger W. Byar

A review of the impact of antenatal care for Australian Indigenous women and attempts to strengthen these services

Objectives: To review evaluations of changes in the delivery of antenatal care for Australian Indigenous women and the impact on care utilization and quality, birth outcomes and women’s views about care. Methods: Seven databases were searched electronically for articles describing evaluations of antenatal care programs developed for Australian Indigenous women. Manual searches were performed of the publication sections of websites of Australian Government Departments responsible for health and Indigenous affairs. Results: Evaluations of 10 antenatal care programs were identified. Wide variations were present in the design, quality and reported outcomes of each evaluation. There was a lack of consistency in the findings across all care programs for many outcomes. Modest increases were reported for measures of care utilization, including the proportion of women initiating care in the first trimester and the mean number of antenatal visits overall. For birth outcomes, benefits were reported by some but not all care programs for perinatal mortality, preterm birth, mean birth weight and the proportion of low birth weight infants. Of the four care programs reporting women’s views about care, most comments were positive reflections about care, including the use of female staff and the continuity of care providers. Conclusions: The impact of the antenatal care programs evaluated and published to date remains inconclusive. Limitations arose from the diversity in the design of evaluations and the quality of reported data. This review has highlighted the need for good quality long-term data collection about the health services providing antenatal care for Australian Indigenous women.Alice R. Rumbold and Joan Cunningha