Respectful maternity care in the Top End of the Northern Territory: a cross-sectional study

Abstract

Problem: Respectful maternity care is widely recognised as an important goal to achieve, however few validated tools are available to measure, and therefore act as a guide to improve care. Background: Disrespectful maternity care has been cited as a barrier to seeking care in pregnancy. Populations in Australia with lower rates of antenatal care attendance include Australian First Nations women, and women from a migrant or refugee background. These women also experience poorer pregnancy outcomes. Aim: To determine the extent to which Australian First Nations women, and women from a migrant or refugee background, birthing in the Top End of the NT, currently experience respectful maternity care. Methods: 65 women participated in a validation process for the Mothers On Respect index (MORi) Survey to be inclusive of First Nations women from the Top End, with 195 women living in the Top End of the Northern Territory completing the survey between February and November 2023. The survey consists of 14 questions with a 6-point Likert scale. With a maximum score of 84, a higher score indicates more respectful care, with a lower score indicating less respectful care. Findings: The mean MORi score was 75.85 (SD 8.7). Migrant women had a 14 point higher mean score than Australian First Nations women residing in remote communities, (95%Confidence Interval, 10.06-18.03, p<0.001). There were no significant differences between MORi scores across the number of antenatal visits, educational attainment, or primary caregiver. Discussion: Across the Top End of the Northern Territory, the level of respectful maternity care experienced by women is relatively high. Australian First Nations women from very remote communities report experiencing the lowest levels of respectful maternity care. Women who came to Australia as a refugee reporting feeling the most pushed into accepting what was suggested. This may be a symptom of the systemic disadvantages they continue to face rather than a reflection of the respect shown to them by individual clinicians. Several studies suggest that women who experience a greater burden of systemic disadvantage, such as Australian First Nations women and women from a refugee background, would benefit greatly from continuity models of care in pregnancy. Conclusion: More work is urgently needed to ensure that not only individual clinicians, but crucially, the systems designed to care for pregnant and birthing women are provided in a manner “to all women that maintains their dignity, privacy, and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth.