Mapping and yarning women’s health

  • Circle of women's hands holding woven items

Image: Amber Galvin

By
Dr Jared Watts and Cynthia Tapiwa
Royal Australian and New Zealand College of Obstetricians and Gynaecologists
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When a rural town has a maternity service, it is a place where new families are literally started. Maintaining high-quality and safe obstetric and gynaecological (O&G) services is therefore essential for many towns’ survival; and is not without its challenges.

The Australian Government-funded Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) Mapping Maternal Health and Gynaecological Services in Rural, Regional and Remote Australia: Uptake, Barriers and Recommendations – Research Project (mapping project) aimed to address these challenges. The project brought together health service, workforce and population datasets, and research data from maternity leaders. This helped create an online platform to support future service planning. The project also engaged with rural and remote women to hear about their experiences accessing O&G services.

Fifty-nine Aboriginal and 28 non-Aboriginal women took part in yarning circles led by researchers from Flinders University in South Australia, and Murdoch University in Western Australia. This helped determine how services can be more effective as outlined below.

  • Recommendation 1: Appointment scheduling – Scheduling appointments for rural and remote women requires an appreciation of the long distances travelled. Consideration should be given to other appointments the women need while at larger centres.
  • Recommendation 2: Mobile services – A need for consistent timetabling of women’s health visiting services such as cervical screening and mammograms was recommended.
  • Recommendation 3: Health practitioner attributes – Women identified the importance of being comfortable with trusted health providers that provide continuity of care and the opportunity for an equal partnership in health.
  • Recommendation 4: Support during telehealth consultations – Aboriginal women highlighted the importance of being accompanied by an Aboriginal Health Worker or local health provider during telehealth consultations.

The RANZCOG-led ethics-approved research of rural, regional and remote health services took place from May 2022 to January 2023, with data analysis undertaken by the University of Notre Dame. Maternity leaders completed an online survey covering available services, supporting services, models of care and workforce data.

The findings below from the 80 health services that took part in the research were statistically significant:

  • As expected, obstetric service options decreased the higher the remoteness category. However, several Monash Modified Model (MM) 6 and MM 7 located health services provided advanced obstetric services such as vaginal birth after caesarean (VBAC). This finding provides an opportunity to consider if these services can be safely replicated across other remote areas.
  • Health services offered fewer gynaecological services than they offered maternity services.
  • Surgical abortions later than 12 weeks require women to travel longer distances than for other gynaecological services.
  • Health services that had shared care or public hospital maternity care models of care were around three times more likely to report increased demand for services compared to those with other models of care.
  • For every 10 per cent increase in the percentage of fly-in fly out (FIFO) consultants in the previous month, the odds of reporting increased demand for gynaecological services increased by 15 per cent.
  • Health services that offered hysterectomies were four times more likely to report increased demand for gynaecological services.
  • Health services that offered colposcopy or cystoscopy were more likely to report increased demand for gynaecological services.
  • Staffing issues as a reason for obstetric transfer started at MM3 and in general increased with remoteness level.
  • Medical staffing issues were reported less often as a reason for obstetric transfer than midwifery staffing issues.
  • The degree to which a health service relied on FIFO and/or locum staff within the previous month varied from 10 to 100 per cent of total FTE.
  • The proportion of staff employed as FIFO or locum increased with the remoteness category.

As part of the mapping project, RANZCOG developed a publicly available interactive online map to be made accessible on the RANZCOG website. The map will have locations of O&G services, key population and workforce data. The launch of the map is underway.

To find out more about the mapping project please email [email protected]

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