Low birthweight is influenced by many factors, including incomes, geographic location, access to services, and intimate partner violence.
Progress towards improving maternal and infant health in these cohorts must be finely tailored to specific needs – and therefore must be informed by the lived experience of those most impacted.
A commitment to driving health equity led North Western Melbourne Primary Health Network (NWMPHN) to commission the Strong Families Strong Babies Project, which looked to address low birthweight in the Punjabi-speaking Indian and Matu-speaking Chin communities living in Melton South.
Melton South, a suburb 37km west of Melbourne’s CBD, has more people in low socioeconomic categories than most other parts of Victoria. It has one of the highest proportions of low birthweight infants, and is home to many families of migrant and refugee backgrounds.
The Strong Families Strong Babies Project looked at the barriers that exist for its two target communities in accessing culturally appropriate and safe maternal and child health care services. Funded by NWMPHN, it was undertaken by a partnership between the Intergenerational Health group Murdoch Children’s Research Institute, Western Health, Melton City Council Maternal and Child Health Service, VICSEG New Futures, and the Victorian Foundation for Survivors of Torture.
The project began in 2020 and was significantly hampered by the COVID-19 pandemic. Its final evaluation, led by MCRI, was published in May 2023.
During this period communication between health practitioners and both communities was boosted by the appointment of bi-cultural workers who were native Chin and Punjabi speakers. Community consultations and advisory groups identified serious obstacles to health care.
Perhaps not surprisingly, language emerged as a primary barrier.
“The inaccessibility of high-quality interpreter services, and the impact of this inaccessibility, was a central focus,” the evaluation report concludes.
“Community members stressed that unless women and families have access to the right interpreter at the right time, there is no way for them to access the care they need during pregnancy and the early years of their child’s life.”
Among other things, Chin women reported that interpreters present at maternity appointments sometimes spoke only Burmese rather than Chin, and that written material was available only in English. Even making it to appointments often required long journeys in both directions, necessitating additional arrangements to make sure other children were cared for during these periods.
The report laid out several issues of concern voiced by Punjabi-speaking women.
“Evaluation of the pregnancy and postnatal support group identified that Indian migrant women often experience maternity and early childhood healthcare as culturally inflexible and rigid,” the author wrote.
“As a result, women can feel that their cultural traditions and therefore whole selves do not fit or belong within these services. Support group attendees described their experiences of pregnancy and motherhood as sitting between two cultural worlds; Punjabi cultural traditions of pregnancy and mothering, and western biomedical cultural traditions dominant within Australian maternity and early childhood healthcare settings.”
Recommendations emerging from the Strong Families Strong Babies Project were numerous and detailed. However, they centred on 3 interlinked themes, all of which can be adapted to suit other communities experiencing higher than average incidences of low birthweight.
First, future projects must be funded and structured well enough to allow long-term meaningful engagement with target communities.
Second, careful planning must guide ways in which the communities and health care providers can support each other and develop a shared sense of purpose and belonging – thus creating trust and a spirit of collaboration.
Third, bicultural mentors must be embedded into maternal and child health care settings, and the needs of client families and their communities must sit above those of the health system that serves them.
The Strong Families Strong Babies Project is an example of how careful listening to the voices of specific communities can reveal a path forward that leads to improved health for their members, builds knowledge and awareness among health service providers – and takes the ideals of integration and equity closer to realisation.
For more information, email: Jess.Dally@nwmphn.org.au