Goal 1: Aboriginal children are born healthy and thrive

In 2022, 10.8 per cent of babies born of Aboriginal mothers in Victoria were born with a low birth weight. For babies of non‑Aboriginal mothers, 6.4 per cent were of low birthweight. Low birthweight is defined as births less than 2500 grams. The proportion of babies of Aboriginal mothers born with a low weight has been gradually decreasing since 2017 (13.7 per cent) and has remained consistent since 2020 (10.9 per cent). By contrast, the proportion of babies of non-Aboriginal mothers born with low weight remained stable over the long term. Birthweight is a determinant for health outcomes later in life. Major factors influencing low birthweight are extremes of maternal age (younger than 16 or older than 40), multiple pregnancy, obstetric complications, chronic maternal conditions (for example, hypertensive disorders of pregnancy), infections (such as malaria), nutritional status, exposure to indoor air pollution, tobacco, and drug use. Aboriginal culture remains a strong protective factor for the health and wellbeing of Aboriginal Victorians and must be prioritised within maternal and infant health services.

Measure 1.1.2 Rate of pre-term birth

In 2022, 12.4 per cent of babies born to Aboriginal mothers in Victoria were pre-term. This was a decrease from 2020 where 13.4 per cent were pre-term. Over the long term (since recording started in 2008) pre-term births for babies born to Aboriginal mothers has remained relatively steady since 2013. Babies born pre-term to non‑Aboriginal mothers decreased from 8.5 per cent to 7.6 per cent since 2018. Pre-term birth is influenced by maternal nutrition, cigarette smoking, substance use or abuse, work and physical activity, prenatal care, genitourinary tract infection, sexually transmitted diseases, psychological factors, and multiple gestations. While work is underway to improve the health of Aboriginal mothers and babies and their experiences in healthcare settings, mainstream healthcare services do not adequately consider the cultural needs and cultural safety of Aboriginal Victorians. This has deterred Aboriginal mothers from accessing essential services. Culturally safe services, such as Koorie Maternity Services are meeting this need and are experiencing their highest service use since the VAAF started measuring it (Measure 1.2.2).

Measure 1.1.3 Rate of perinatal mortality

Over 2020-22, the rate of perinatal mortality for babies born to Aboriginal mothers in Victoria was 10.2 per 1,000 babies. This measure has been slowly improving since 2017-19. In the long term, perinatal mortality has significantly decreased since 2008-10 (23.6 per 1,000 babies). This is a continuing trend.

The rate of perinatal mortality for babies born to Aboriginal mothers is now near parity with babies born to non-Aboriginal mothers. The rate for babies born to non-Aboriginal mothers was 8.6 per 1,000 babies in 2020-2022. In 2008-10, babies born to Aboriginal mothers were 2.3 times more likely to suffer perinatal death than their non-Aboriginal peers. In 2020-22, this has dropped to 1.2 times more likely. Rates of perinatal mortality have been linked with rates of antenatal care and pre-existing medical conditions (hypertension, diabetes etc).Racism plays a major role in both the quality of delivered care and the ability for mothers to access that care. Aboriginal health in Aboriginal hands is key to grounding perinatal services in culturally safe practices.

Measure 1.1.4 Smoking during pregnancy

In 2022, 37.7 per cent of Aboriginal women in Victoria smoked during their first 20 weeks of pregnancy. For non‑Aboriginal women, 6.4 per cent smoked during the first 20 weeks. Historically, Aboriginal women have been more likely to smoke during their first 20 weeks of pregnancy than non-Aboriginal women. Since 2009 there has been a 2.5 percentage point decrease in the proportion of Aboriginal women and a 4.7 percentage point decrease in the proportion of non-Aboriginal women smoking during pregnancy. While the number of Aboriginal women smoking during pregnancy has reduced over time, Aboriginal women remain more likely to smoke during their first 20 weeks of pregnancy than their non-Aboriginal peers. Underlying socio-economic determinants present challenges to decreasing rates further. Tobacco prevention strategies consider the unique impact of colonisation on outcomes for Aboriginal Victorians. Nationally, the First Peoples led Which Way? project aims to provide culturally safe and effective support. Research into the project has found that First Peoples health professionals are best placed to provide quit smoking plans but are often overburdened by demand within their roles.[2] Investment and resourcing to build a skilled workforce to support quitting and maintaining smokefree behaviour in a culturally safe way is necessary.

Measure 1.2.1 Participation rates for Maternal and Child Health Key Ages and Stages Consultation

Aboriginal children continue to attend Key Age consultations at a high rate in 2023-24. On average 80.1 per cent of Aboriginal children attended their Key Ages and Stages consultations in 2023-24. Most age groups went to Key Age consultations at the same rate in 2023-24 as in 2022-23. Participation rates for 2 years and 3.5 years consultation increased while participation rates for 4 months, 8 months, 12 months, 18 months all slightly decreased.

When comparing to all children, Aboriginal children attended Key Ages and Stages consultations at the same proportion or higher for home visit, 2-year and 3.5-year visits in 2023-24. While the result of an estimated 100 per cent participation for Home Visit consultations is positive, this result should be treated with caution. Population projections for very young children used to calculate this rate are subject to a margin of error. The participation rates over time nevertheless indicate a positive and sustained trend. Access to health care in the early stages of life is a key factor in greater health outcomes later in life.

The increasing participation of Aboriginal children in 3.5-year Key Age consultation is a very positive step. This is generally the Key Age consultation with the lowest participation rate for both Aboriginal children and all children year on year.

Addressing the cultural safety of perinatal healthcare is necessary to improve outcomes. If Aboriginal mothers do not feel safe or listened to, consultation participation is likely to be low. To ensure the delivery of ongoing Cultural Safety professional development, the Department of Health has continued to provide access to free cultural safety training for the Maternal and Child Health workforce. Currently, Key Age consultations are free of charge for all Victorian children.

Measure 1.2.2 Attendance at Koori Maternity Services

In 2023-24, 870 women attended Koori Maternity Services (KMS), more than double the attendance for 2020-21. Despite this sharp increase in demand for the service, KMS continue to provide culturally safe, holistic and responsive care and support to women having Aboriginal babies, and their families and carers.

KMS is delivered by multidisciplinary teams including Aboriginal Health Practitioners, Aboriginal Health Workers and midwives. DH continues to work with the Victorian Aboriginal Community Controlled Organisation (VACCHO) and KMS to review the program guidelines and ensure they align with the Aboriginal Health and Wellbeing Partnership Agreement and Action Plan.

Measure 1.2.3 Immunisation rates at 12, 24, and 60 months

Over the long term, immunisation rates for all Aboriginal children are increasing. In 2024, health providers immunised Aboriginal one-, two- and five-year-olds at 91.6, 89.6, and 95.8 per cent respectively. Aboriginal children in Victoria aged five have a greater immunisation rate than non-Aboriginal children in Victoria by one percentage point. National targets for immunisations are still not being met for most key ages (for both Aboriginal and non-Aboriginal cohorts). In 2023, Aboriginal five-year‑olds were the only cohort to meet the Federal Government immunisation target rate of 95 per cent or higher.

Measure 1.2.4 Participation in facilitated playgroups (0-5 years)

[iIn 2023-24, 712 Aboriginal children (0-5 years old) were in supported playgroups, and 239 in Koorie supported playgroups. The 712 Aboriginal children in Supported Playgroups represent 7.2 per cent of all Aboriginal children. Supported playgroup participation has not been this high since 2019 with 7.7 per cent of Aboriginal children in supported playgroups. When considering all children, Aboriginal children are twice as likely to be in a supported playgroup.

Five ACCOs were newly funded for Koorie supported playgroups in 2024. This brought the total number of ACCOs providing Koorie supported playgroups to 15.

Footnotes

[2] Which Way? Indigenous-led Smoking Cessation Care: Knowledge, Attitudes and Practices of Aboriginal and Torres Strait Islander Health Workers and Practitioners - A National Cross-sectional Survey, Kennedy M, Longbottom H, Mersha A, Maddox R, Briscoe K, Hussein P, Bacon S and Bar-Zeev Y