Life chances are often shaped long before birth

  • Life chances are often shaped long before birth

The future of rural Australia is being created right now – one baby at a time. That future could be a very bright one, but that happy time will neither happen by accident nor by hoping for good luck.

Unfortunately, the great majority of mothers and fathers were (and are) woefully unprepared for parenthood. Roughly half of all pregnancies across Australia are still unintended, unplanned or mistimed (although not always unwanted). The use of Long Acting Reversible Contraception (LARCs) continues to be too low. Adverse pregnancy and birth outcomes – from miscarriages and stillbirths, to unhealthy/damaged babies - remain too high.

Prospective parents are too rarely encouraged and supported in meaningful ways to ask and answer such fundamental questions as:

Do I ever want to become a parent?
If not, then what am I doing to actively and effectively avoid pregnancy?

If so, then with whom, when and under what circumstances would it best for me to have a baby?
How can I get the assistance I want and need to prepare for this life-creating and life-changing event?

Australia, and specifically rural Australia, does too little too late to improve the lives and life chances of the next generation of babies, parents and families. The price of ‘que sera sera’ passivity, and a lack of proper preparation, is incredibly high in financial, societal and human terms.

This is not a peculiarly Australian weakness. Most OECD nations continue to display a pernicious professional, political and societal blind-spot about the root causes and starting points of child health and health inequalities. Just as child development does not begin at birth, so too, early intervention and primary prevention do not begin with pregnancy.

The answer is not to name, shame and blame prospective parents. Rather it is nurture and support them by building upon the good news that everyone who will become a parent shares the same three goals: a safe pregnancy, a thriving baby and a rewarding parenthood. The bad news is that these three universal goals are not achieved as often as they could and should be.

We have sufficient human, financial and institutional resources to close the gap between positive rhetoric and negative realities.

The first step is to understand why this gap exists and how to overcome the reluctance to either prevent or prepare for parenthood.

The second step is to increase dramatically preconception health, education care across the life course. At each age and stage of life, rural Australians must – individually and collectively – take full advantage of the chances that already exist to better prepare and support the next generation of mothers, fathers and families.

Preconception and interconception health – that is, truly being ready for the first baby or the next baby – can be a powerful, multifaceted, democratic strategy for:

  • Promoting social justice across generations; 
  • Preventing a ‘bad hand’ from being dealt in the first place;
  • Easing the demands upon health professionals; and 
  • Grasping the opportunity to listen to, and then support, girls and women, boys and men in ways leading to healthier families, wiser use of public resources and a more successful society.  

Neither the wellbeing of prospective mothers and fathers, nor the futures of their babies, are spectator sports. The choices we make and the actions we take (or fail to take) – individually and collectively -- will have at least as much impact on the next generation of rural Australians as either their postcodes or their genetic codes.

Dr. Jonathan Sher is an independent consultant based in Scotland. He will be a keynote speaker at the 14th National Rural Health Conference (link). To learn more about his research and recommendations, begin with: http://www.nhsggc.org.uk/media/237841/prepared-for-pregnancy-j-sher-may-2016.pdf ; contact: jonathan@deltaforce.net

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